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Updated: Mar 30, 2026
Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
Need for Rectal Biopsy for Childhood Constipation Predicts Severity of Illness and Need for Laxatives
Khoa Tran1, Kyle Staller, Eric Macklin
1*Division of Pediatric Gastroenterology, Floating Hospital for Children at Tufts Medical Center and Tufts Medical School †Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School ‡Biostatistics Unit, Massachusetts General Hospital §Division of Pediatric Surgery, Massachusetts General Hospital for Children and Harvard Medical School ||Division of Pediatric GI and Harvard Medical School, Massachusetts General Hospital for Children ¶Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.
Insights
Severe constipation in children, often requiring rectal biopsy (RB), has poor long-term outcomes. Early diagnosis and treatment are crucial, as younger age and shorter symptom duration predict better results.
Area of Science:
- Pediatric Gastroenterology
- Clinical Outcomes Research
Background:
- Severe constipation in children poses significant clinical challenges.
- Rectal biopsy (RB) is sometimes necessary for diagnosing conditions like Hirschsprung disease in severe pediatric constipation cases.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of children with severe constipation requiring RB.
- To identify baseline predictors of successful treatment outcomes in this cohort.
Main Methods:
- A retrospective chart review compared children with severe constipation who underwent RB to a matched control group without RB.
- Clinical outcomes were assessed over 24 months based on bowel movement frequency and fecal incontinence episodes.
- Multivariate analysis identified predictors of successful outcomes.
Main Results:
- Children requiring RB had significantly longer constipation duration before evaluation compared to controls.
- Only 24% of children with severe constipation requiring RB achieved successful outcomes by 24 months, versus 73% in the control group.
- Younger age at evaluation (OR 0.87) and shorter constipation duration before RB (OR 0.45) were significant predictors of success.
Conclusions:
- Long-term clinical outcomes for children with severe constipation requiring RB are poor, with only a quarter achieving success within two years.
- Early diagnosis and prompt treatment initiation are critical for improving outcomes in pediatric severe constipation.
- Younger age and shorter duration of symptoms at the time of biopsy are key indicators for successful management.
Objectives:
This study aimed to examine the long-term clinical outcomes of children with severe constipation, as defined by need for rectal biopsy (RB), and to determine which baseline characteristics were predictors of successful outcome.
Methods:
Children with severe constipation who underwent RB for evaluation of Hirschsprung disease at a tertiary medical center were eligible. A cohort of children with constipation without a history of RB served as controls (matched 2:1 by sex and age). Retrospective chart review of clinic visits was performed at baseline, 3, 6, 12, 18, and 24 months. Successful clinical outcomes were defined as ≥3 bowel movements weekly for ≥4 weeks, with ≤2 fecal incontinence episodes monthly, irrespective of laxative use.
Results:
A total of 175 RB children (90 boys, mean age: 6.7 years) were matched to 350 controls. Mean duration of constipation symptoms before intake in the RB group was significantly longer compared with controls (3.7 vs 0.4 years, P < 0.001). By 24 months, the cumulative percentage of children achieving at least 1 period of successful outcome was significantly higher in the control group compared with RB population (73% vs 24%, P < 0.001). Multivariate analysis revealed that younger age (P = 0.001, odds ratio 0.87) and shorter duration of constipation before RB (P = 0.03, odds ratio 0.45) were significant predictors of successful outcome.
Conclusions:
Only one-quarter of patients with severe constipation achieved successful outcome during 2-year follow-up. Younger age and shorter duration of constipation at time of biopsy were predictors of successful outcomes, emphasizing the importance of early diagnosis and initiation of treatment in this population.
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