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Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and

Duc Long Tran^1,2, Phu Nguyen Trong Tran^1,2, Paweena Susantitaphong^3,4

¹Clinical Sciences Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Clinical and Experimental Pediatrics

|November 13, 2024

Insights

Transabdominal ultrasonography can effectively diagnose pediatric functional constipation (FC) in children. A rectal diameter (RD) over 31 mm shows good accuracy, making ultrasound a valuable tool for FC detection.

Area of Science:

Pediatric Gastroenterology
Diagnostic Imaging
Medical Ultrasound

Background:

Functional constipation (FC) is a common pediatric condition.
Transabdominal ultrasonography is emerging as a non-invasive diagnostic tool for FC.
Accurate diagnostic parameters for FC using ultrasonography require further evaluation.

Purpose of the Study:

To systematically review and meta-analyze the diagnostic accuracy of transabdominal ultrasonography for pediatric functional constipation.
To assess key parameters such as rectal diameter (RD) and anterior rectal wall thickness.
To determine an optimal cutoff value for RD in diagnosing FC.

Main Methods:

Systematic search of major medical databases (Ovid MEDLINE, Embase, Scopus, PubMed) up to September 29, 2023.
Inclusion of 14 studies with 1,255 children comparing ultrasonographic parameters in children with and without FC.
Meta-analysis using random-effects models to calculate weighted mean differences and diagnostic performance metrics (sensitivity, specificity, AUC).

Main Results:

Children with FC had a significantly larger mean rectal diameter (RD) compared to controls (MD: 10.35 mm, P<0.001).
An optimal RD cutoff of 31 mm demonstrated good diagnostic accuracy (AUC: 0.86, sensitivity: 0.75, specificity: 0.84).
No statistically significant difference was found in anterior rectal wall thickness between constipated and non-constipated children.

Conclusions:

Transabdominal ultrasonography, specifically measuring rectal diameter (RD), is a valuable tool for diagnosing pediatric functional constipation.
An RD cutoff of 31 mm provides good diagnostic accuracy for FC in children.
Further research may explore the role of anterior rectal wall thickness, though it was not significant in this meta-analysis.

Read full analysis

Abstract:

Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD and anterior wall thickness using transabdominal ultrasonography in children with versus without FC. Metaanalyses were performed using random-effects models to calculate the weighted mean differences (MDs) in RD and anterior wall thickness. Comprehensive Meta-Analysis ver. 3, R, and Review Manager ver. 5.4.1 software were used to assess the optimal cutoff, sensitivity, specificity, and area under the curve (AUC). Fourteen studies involving 1,255 children (mean age, 6.21±2.3 years) were included. The mean RD was significantly larger in constipated children versus controls (MD, 10.35 mm; 95% confidence interval [CI], 6.97-13.74; P<0.001; I2=94%). A meta-regression showed no significant effects of age, weight, or height on RD. An optimal RD cutoff point of 31 mm was suggested by a pooled analysis with an AUC of 0.86 (95% CI, 0.8-0.91; P<0.001), sensitivity of 0.75 (95% CI, 0.59-0.86), and specificity of 0.84 (95% CI, 0.68-0.93). The mean anterior rectal wall thickness was greater among constipated children than among controls (MD, 0.44; 95% CI, -0.26 to 1.13; P=0.22), but this difference was not statistically significant. RD measured using transabdominal ultrasonography with a cutoff point of 31 mm exhibited good diagnostic accuracy for diagnosing FC in children.

Keywords:

Child Functional constipation Meta-analysis Rectal diameter Ultrasonography

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