Physiologic investigation of primary chronic constipation in children: comparison with the barium enema study

Area of Science:

• Pediatric Gastroenterology
• Colorectal Physiology

Background:

• Constipation is a common pediatric issue.
• Understanding the underlying physiological mechanisms is crucial for effective treatment.

Purpose of the Study:

• To evaluate rectoanal manometry and rectometrographic parameters in constipated children.
• To identify objective physiological abnormalities associated with pediatric constipation.

Main Methods:

• Rectoanal manometry and rectometrographic studies were performed on 63 constipated children and 31 controls.
• Barium enema was conducted on constipated children and a subset of controls.
• Key parameters measured included reflex thresholds, rectal sensitivity, anal closure pressure, and rectal compliance.

Main Results:

• Barium enema was not found to be a meaningful diagnostic tool.
• While some anal closure pressures were elevated, reflex thresholds were not specific for constipation.
• Significantly higher rectal sensitivity thresholds and increased rectal compliance were observed in constipated children.
• Organic abnormalities were identified in 97% of constipated children without Hirschsprung's disease.

Conclusions:

• Rectoanal manometry and rectometrographic studies reveal significant physiological abnormalities in most constipated children.
• Increased rectal compliance and altered rectal sensitivity are key indicators of functional constipation.
• These findings support the use of advanced physiological testing for diagnosing pediatric constipation.