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How to use a plain abdominal radiograph in children with functional defecation disorders
M A Benninga1, M M Tabbers1, R R van Rijn2
1Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
Insights
Diagnosing childhood defecation disorders like functional constipation requires adhering to Rome IV criteria. Radiography and colonic transit studies lack sufficient evidence for routine diagnosis but may aid in complex cases.
Area of Science:
- Pediatrics
- Gastroenterology
- Diagnostic Imaging
Background:
- Defecation-related functional gastrointestinal disorders (FGIDs) are common in children, with symptoms ranging from mild to severe.
- Rome IV criteria define conditions such as infant dyschezia, functional constipation, and functional non-retentive fecal incontinence.
- Conventional radiography is accessible and non-invasive but involves radiation exposure.
Purpose of the Study:
- To review and evaluate scoring methods for assessing fecal loading on abdominal radiographs.
- To assess the utility of radio-opaque markers and colonic transit time measurements in diagnosing defecation-related FGIDs.
- To determine the diagnostic value of imaging and transit studies in pediatric FGIDs.
Main Methods:
- Review of existing scoring methods for fecal loading on abdominal radiographs.
- Evaluation of the use of radio-opaque markers for assessing colonic transit time.
- Analysis of evidence supporting the diagnostic use of radiography and transit studies in FGIDs.
Main Results:
- Insufficient evidence links clinical symptoms of functional constipation or incontinence to fecal loading on radiographs.
- Routine use of colonic transit studies is not supported for diagnosing functional constipation.
- Colonic transit time may help differentiate functional constipation from functional non-retentive fecal incontinence in unclear cases.
Conclusions:
- Diagnosis of defecation-related FGIDs in children should primarily rely on Rome IV criteria.
- Radiographic assessment of fecal loading lacks sufficient diagnostic association with clinical symptoms.
- Colonic transit studies have a limited role, potentially useful for differential diagnosis in complex pediatric FGID cases.
Abstract:
Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology varies from relatively mild, such as crying before passage of soft stools or infrequent defecation to severe problems with faecal impaction and the daily involuntary loss of faeces in the underwear. Conventional radiography is widely available, relatively cheap and is non-invasive. The drawback however, is radiation exposure. This review describes and evaluates the value of different existing scoring methods to assess faecal loading on an abdominal radiograph with or without the use of radio-opaque markers, to measure colonic transit time, in the diagnosis of these defecation-related FGIDs. Insufficient evidence exists for a diagnostic association between clinical symptoms of functional constipation or functional nonretentive faecal incontinence and faecal loading on an abdominal radiograph. Furthermore, evidence does not support the routine use of colonic transit studies to diagnose functional constipation. Colonic transit time measurement may be considered in discriminating between functional constipation and functional non-retentive faecal incontinence and in patients in which the diagnosis is not clear such as having an unreliable medical history. In children with the suspicion of defecation-related FGIDs, the diagnosis should be made based on the Rome IV criteria.
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