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1Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Diagnostic studies for pediatric constipation are reviewed. Colon transit studies, colon scintigraphy, MRI, and anorectal manometry help identify causes in children unresponsive to conventional therapy.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Functional Bowel Disorders
Background:
- Constipation is a frequent reason for pediatric gastroenterology consultations.
- Most children improve with lifestyle changes and conventional treatments.
- Some cases necessitate further diagnostic evaluation.
Purpose of the Study:
- To review diagnostic studies for evaluating functional constipation in children.
- To guide the appropriate use of investigations in pediatric constipation.
Main Methods:
- Review of diagnostic modalities including colon transit studies (radiopaque markers or scintigraphy), MRI, and manometry.
- Discussion of indications for each diagnostic tool.
- Exclusion of routine abdominal X-rays.
Main Results:
- Colon transit studies are useful when clinical history is inconsistent or to guide manometry.
- Anorectal manometry assesses rectal function and recto-anal inhibitory reflex.
- MRI is indicated for suspected spinal abnormalities.
Conclusions:
- Diagnostic studies aim to uncover treatable causes of constipation.
- These investigations evaluate colonic/rectal anatomy, transit, and motility.
- Indications are primarily for patients refractory to standard treatments.
Background:
Constipation is among the most common symptoms prompting a consultation with a paediatric gastroenterologist. While most patients will respond to lifestyle and dietary changes and conventional therapy, some may require diagnostic studies.
Aim:
To review the diagnostics studies used to evaluate children with functional constipation.
Materials And Methods:
There is no evidence to support the routine use of abdominal X-rays in the evaluation of paediatric constipation. Colon transit by radiopaque markers (ROM) should be indicated when medical history does not match clinical findings, to guide colon manometry (CM) performance and to discriminate between faecal incontinence from functional constipation and non-retentive faecal incontinence. Colon scintigraphy may be useful as an alternative to ROM. Lumbar spine MRI may be indicated to evaluate for spinal abnormalities. The role of defecography has not been properly evaluated in children. Anorectal manometry in children is indicated primarily to evaluate anal resting pressure, presence and quality of the recto-anal inhibitory reflex and simulated defecation manoeuvres. The CM is indicated to guide surgical interventions after failing medical therapy.
Conclusions:
The goal of these studies is to identify treatable causes of constipation. Most of these studies are designed to evaluate anatomy, transit and/or colon/rectum motility function and are primarily indicated in those who fail to respond to conventional therapy.
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