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'Rapid transit' constipation in children: a possible genesis for irritable bowel syndrome
J M Hutson1,2,3, M C Hynes4, I Kearsey4
1Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. john.hutson@rch.org.au.
Insights
Rapid transit constipation (RTC), a pattern in children, may be linked to fructose intolerance. Reducing fructose improved symptoms in many children, suggesting a potential early dietary intervention for constipation and irritable bowel syndrome (IBS).
Area of Science:
- Pediatric Gastroenterology
- Dietary Science
- Functional Gastrointestinal Disorders
Background:
- Chronic idiopathic constipation (CIC) in children often necessitates surgical intervention after medical treatments fail.
- Rapid transit constipation (RTC) is a pattern identified in CIC, previously linked to surgical workup.
- Irritable bowel syndrome (IBS), particularly the constipation-predominant subtype (IBS-C), affects a significant portion of children.
Purpose of the Study:
- To discuss the pattern of Rapid Transit Constipation (RTC) in children with Chronic Idiopathic Constipation (CIC).
- To explore the potential link between RTC, fructose intolerance, and Irritable Bowel Syndrome (IBS) in pediatric patients.
- To investigate the efficacy of dietary fructose restriction in managing RTC symptoms.
Main Methods:
- Retrospective audit of 1000 nuclear medicine gastrointestinal transit studies (NMGIT) to identify RTC prevalence.
- Assessment of fructose intolerance using breath tests in children with RTC.
- Evaluation of symptom improvement (constipation, pain, stool consistency) and laxative use following fructose exclusion diets.
Main Results:
- RTC was identified in 29% of pediatric NMGIT studies.
- Children with RTC and positive fructose breath tests showed significant improvement in constipation, abdominal pain, and stool consistency after fructose exclusion.
- Fructose restriction led to a decrease in laxative use among these patients.
Conclusions:
- RTC may be associated with fructose intolerance and potentially IBS-C in children.
- Dietary fructose restriction shows promise as an early treatment for children with RTC, potentially preventing long-term IBS development.
- These findings suggest a paradigm shift towards early dietary management for pediatric constipation.
Abstract:
Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called 'Rapid transit constipation (RTC)' first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7-21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35-55%. Reducing fructose produced significant improvement in 77-82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.
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