Paediatric constipation for adult surgeons--article 1: targeting the cause
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Published on: August 18, 2023
Jonathan R Sutcliffe1, Sebastian K King, Bridget R Southwell
1Department of General Surgery, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Constipation, often resistant to treatment, affects all ages. Advances in diagnosing childhood constipation, including slow transit constipation and intestinal neuronal dysplasia, offer insights for adult care.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Constipation is a prevalent condition across all age groups, often leading to chronic morbidity and resistance to standard therapies.
- Childhood-onset constipation frequently results in persistent symptoms extending into adulthood.
- Recent diagnostic and therapeutic advancements in pediatric constipation may hold relevance for adult patient management.
Purpose of the Study:
- To review diagnostic methods for differentiating colonic motility disorders from anorectal hold-up in constipation.
- To describe the diagnosis and management of slow transit constipation in children, including a novel manometric catheter placement technique.
- To explain intestinal neuronal dysplasia and discuss the controversy surrounding its diagnostic criteria.
Main Methods:
- Review of diagnostic techniques for colonic motility disorders.
- Discussion of colonic manometry and scintigraphy findings in slow transit constipation.
- Explanation of diagnostic criteria for intestinal neuronal dysplasia.
Main Results:
- Delineation of methods to distinguish colonic motility disorders from anorectal dysfunction.
- Identification of slow transit constipation as a distinct entity in children, characterized by specific manometric and scintigraphic features.
- Proposal for extending traditional histological criteria for intestinal neuronal dysplasia to encompass broader forms of enteric nervous system dysplasia.
Conclusions:
- Advances in pediatric constipation diagnosis, particularly for slow transit constipation and intestinal neuronal dysplasia, offer valuable insights for adult practice.
- The differentiation between colonic motility disorders and anorectal hold-up is crucial for effective constipation management.
- Revising diagnostic criteria for intestinal neuronal dysplasia may improve the identification of clinically significant enteric nervous system abnormalities.
Abstract:
Constipation is very common in all age groups and can be resistant to standard therapies, producing chronic morbidity. Childhood onset constipation frequently produces symptoms that persist into adulthood. Recent advances have been made in the diagnosis and treatment of childhood constipation that could have application in adult practice. In the first part of the present review, the methods of differentiation of patients with a disorder of colonic motility from those with an anorectal hold-up are discussed. Slow transit constipation, with distinct features on colonic manometry and scintigraphy, has only recently been recognized in children. This diagnosis, together with a novel method of placement of a manometric catheter, is described. While the cause of slow transit constipation remains unclear, clinical features that differ between children and adults may provide an insight into the aetiology. The diagnosis of intestinal neuronal dysplasia is explained and the controversy surrounding the diagnosis outlined. We propose that the traditional histological criteria exclude many other clinically significant forms of dysplasia of the enteric nervous system and should be extended.
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