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Bowel transit studies in children: evidence base, role and practicalities
Mara Popescu1, Mohamed Mutalib1,2
1Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
Constipation in children often requires specialized tests to assess colon function and transit. This review evaluates diagnostic tools like radiopaque marker studies and scintigraphy to guide appropriate testing for difficult cases.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Constipation is a prevalent condition in children, with a significant subset developing treatment-resistant cases.
- Functional constipation is common, but difficult-to-treat constipation necessitates further investigation into colon function.
- Current diagnostic tools for colon function have limitations and often require combination for comprehensive assessment.
Purpose of the Study:
- To review and assess the strengths and limitations of common diagnostic investigations for colon transit in children.
- To provide guidance on selecting the most appropriate colon function test for specific clinical scenarios.
- To evaluate radiopaque marker studies, scintigraphy, wireless motility capsule, and colonic manometry.
Main Methods:
- Systematic review of diagnostic tests for pediatric colon transit.
- Analysis of test practicality, invasiveness, availability, and cost-effectiveness.
- Comparison of radiopaque marker studies, scintigraphy, wireless motility capsule, and colonic manometry.
Main Results:
- No single diagnostic tool offers a comprehensive assessment of colon function.
- Clinicians frequently combine multiple tests to address different clinical questions.
- Each test (radiopaque marker studies, scintigraphy, etc.) has unique strengths and limitations for evaluating colon transit.
Conclusions:
- Selecting the optimal colon function test for pediatric constipation depends on the clinical question.
- A combination of diagnostic approaches may be necessary for thorough evaluation.
- Further research may be needed to develop more comprehensive and practical colon function assessment tools.
Abstract:
Constipation is common in children and adults with varied worldwide prevalence. The majority of children have functional constipation as defined by Rome clinical criteria and respond favourably to standard medical therapy; up to one-third can develop difficult-to-treat constipation requiring investigation and specialist treatment. Colon function tests aim to assess the neuromuscular integrity, the movement of faeces across the colon and evaluate/predict response to the therapy. The 'ideal' test should be practical, non-invasive, widely available and cost-effective. None of the available diagnostic tools is designed to provide a comprehensive assessment of colon function and clinicians often have to combine more than one test to answer different questions. In this review, we aim to assess the strengths and limitations of the commonly available diagnostic investigations (radiopaque marker studies, scintigraphy, wireless motility capsule and colonic manometry) used to assess colon transit in children and to provide guidance on the most appropriate test for particular clinical settings.
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