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24-Hour colonic manometry in pediatric slow transit constipation shows significant reductions in antegrade
Sebastian K King1, Anthony G Catto-Smith, Michael P Stanton
1Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Insights
Children with slow transit constipation (STC) exhibit impaired colonic motor activity and a lack of response to normal stimuli. These findings highlight key differences in pediatric STC compared to adults.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Research
Background:
- The physiological underpinnings of slow transit constipation (STC) in children are not well understood.
- Severe chronic constipation in children often necessitates further investigation beyond conservative therapies.
Purpose of the Study:
- To investigate pan-colonic motility patterns in children diagnosed with STC.
- To compare colonic motility in STC children with healthy controls and non-STC constipated children.
Main Methods:
- Conducted 24-hour pan-colonic manometry in 18 children with scintigraphically proven STC.
- Utilized a water-perfused catheter via appendicostomy for motility assessment.
- Compared data with healthy adult controls and pediatric non-STC patients.
Main Results:
- STC subjects showed significantly reduced antegrade propagating sequences (PS) compared to controls.
- High amplitude propagating sequences (HAPS) frequency was normal in STC children.
- STC patients failed to exhibit the normal increase in motility index with waking and meals.
Conclusions:
- Children with STC demonstrate impaired antegrade colonic motor activity and blunted responses to physiological stimuli.
- The frequency of HAPS remains normal in pediatric STC, unlike some adult presentations.
- These results indicate distinct clinical and physiological characteristics of STC in children versus adults.
Background:
The physiological basis of slow transit constipation (STC) in children remains poorly understood. We wished to examine pan-colonic motility in a group of children with severe chronic constipation refractory to conservative therapy.
Methods:
We performed 24 h pan-colonic manometry in 18 children (13 boys, 11.6 +/- 0.9 yr, range 6.6-18.7 yr) with scintigraphically proven STC. A water-perfused, balloon tipped, 8-channel, silicone catheter with a 7.5 cm intersidehole distance was introduced through a previously formed appendicostomy. Comparison data were obtained from nasocolonic motility studies in 16 healthy young adult controls and per-appendicostomy motility studies in eight constipated children with anorectal retention and/or normal transit on scintigraphy (non-STC).
Results:
Antegrade propagating sequences (PS) were significantly less frequent (P < 0.01) in subjects with STC (29 +/- 4 per 24 h) compared to adult (53 +/- 4 per 24 h) and non-STC (70 +/- 14 per 24 h) subjects. High amplitude propagating sequences (HAPS) were of a normal frequency in STC subjects. Retrograde propagating sequences were significantly more frequent (P < 0.05) in non-STC subjects compared to STC and adult subjects. High amplitude retrograde propagating sequences were only identified in the STC and non-STC pediatric groups. The normal increase in motility index associated with waking and ingestion of a meal was absent in STC subjects.
Conclusions:
Prolonged pancolonic manometry in children with STC showed significant impairment in antegrade propagating motor activity and failure to respond to normal physiological stimuli. Despite this, HAPS occurred with normal frequency. These findings suggest significant clinical differences between STC in children and adults.
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