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Predictive value of colonic transit time indices for differentiating nonnormal from normal sensation in children with
Maryam Riahinezhad1, Fatemeh Taleb1, Hosein Saneian2
1Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Colonic transit time (CTT) effectively differentiates children with normal versus abnormal sensation during defecation, offering a simpler alternative to anorectal manometry (ARM) for diagnosing chronic constipation.
Area of Science:
- Pediatric Gastroenterology
- Digestive Physiology
- Diagnostic Imaging
Background:
- Pediatric constipation is common, but its causes are not fully understood.
- Anorectal manometry (ARM) is used to identify abnormal sensation in children with chronic functional constipation.
- Evaluating colonic transit time (CTT) indices may help differentiate normal from abnormal sensation.
Purpose of the Study:
- To assess the efficacy of various colonic transit time (CTT) indices in distinguishing normal from non-normal sensation in children with chronic functional constipation.
- To compare the diagnostic value of CTT with anorectal manometry (ARM).
Main Methods:
- A cross-sectional study involving 47 children (aged 5-15) with chronic idiopathic constipation.
- Colonic transit times (total and segmental) were measured using radiopaque markers over 6 days, with a radiograph on day 7.
- Anorectal function was assessed using manometry; CTT indices' predictive value was analyzed using ROC curves.
Main Results:
- Children with non-normal sensation had significantly longer CTT indices (P < 0.001) and higher manometry parameters (P < 0.01) compared to the normal group.
- Rectosigmoid CTT demonstrated high predictive value (AUC=0.999, sensitivity=100%, specificity=94.7%) for differentiating sensation types.
- Total CTT also showed strong predictive value (AUC=0.972, sensitivity=82.3%, specificity=100%).
Conclusions:
- Colonic transit time (CTT) is a simple, noninvasive method for classifying constipation patients.
- CTT can reliably identify children with chronic constipation and abnormal sensation, serving as an alternative to ARM.
- Delayed distal colonic transit in children suggests potential global motility dysfunction and abnormal defecation dynamics.
Background:
Constipation is a common disorder in pediatrics, although the underlying pathogenesis is not fully understood. The current study aimed at evaluating the efficacy of different colonic transit time (CTT) indices for differentiating normal from nonnormal sensation in children with chronic functional constipation identified by anorectal manometry (ARM).
Materials And Methods:
In this cross-sectional study, 47 children with chronic idiopathic constipation, aged 5-15 years, were studied. The total and segmental CTTs were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. The predictive value of CTT indices was evaluated by receiver operating characteristic curve analysis. Area under the curve (AUC) along with 95% confidence interval (CI) as well as sensitivity and specificity was calculated.
Results:
The mean age of the participants was 8.30 ± 2.99 years, with a mean constipation duration of 2.90 ± 0.46; 28 children were identified with nonnormal sensation. The mean values of CTT indices were statistically significantly longer in the nonnormal sensation patients than that in the normal group (P < 0.001). In addition, the mean values of manometry parameters were statistically significantly higher in nonnormal sensation patients than that in normal group (P < 0.01). Among CTT indices, rectosigmoid CTT (AUC [95% CI] =0.999 [0.99-1]; P < 0.001) with sensitivity = 100% and specificity = 94.7% and total CTT (AUC [95% CI] =0.972 [0.93-1] P < 0.001) with sensitivity = 82.3% and specificity = 100% had the highest predictive values for differentiating nonnormal from normal sensation patients.
Conclusion:
CTT is a simple and noninvasive technique for classifying patients with constipation. It can be used for identifying children suffering from chronic constipation with nonnormal sensation reliably, instead of ARM. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.
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