Abstract
Background: Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation.
Aim: To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome.
Methods: Between 1995 and 2000, 169 consecutive patients (median age 8.4 years, 65% boys) fulfilling the criteria for constipation were enrolled. During the intervention and follow up period, all kept a diary to record symptoms. CTT was measured at entry to the study.
Results: At entry, defecation frequency was lower in girls than in boys, while the frequency of encopresis episodes was higher in boys. CTT values were significantly higher in those with a low defecation frequency (⩽1/week) and a high frequency of encopresis (⩾2/day). However, 50% had CTT values within the normal range. Successful outcome occurred more often in those with a rectal impaction. CTT results <100 hours were not predictive of outcome. However, those with CTT >100 hours were less likely to have had a successful outcome.
Conclusion: The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT >100 hours is associated with a poor outcome at one year.
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Selected References
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- Aggarwal A., Cutts T. F., Abell T. L., Cardoso S., Familoni B., Bremer J., Karas J. Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology. 1994 Apr;106(4):945–950. doi: 10.1016/0016-5085(94)90753-6. [DOI] [PubMed] [Google Scholar]
- Arhan P., Devroede G., Jehannin B., Lanza M., Faverdin C., Dornic C., Persoz B., Tétreault L., Perey B., Pellerin D. Segmental colonic transit time. Dis Colon Rectum. 1981 Nov-Dec;24(8):625–629. doi: 10.1007/BF02605761. [DOI] [PubMed] [Google Scholar]
- Barr R. G., Levine M. D., Wilkinson R. H., Mulvihill D. Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr (Phila) 1979 Nov;18(11):674, 676, 677-9, passim. doi: 10.1177/000992287901801103. [DOI] [PubMed] [Google Scholar]
- Benninga M. A., Büller H. A., Heymans H. S., Tytgat G. N., Taminiau J. A. Is encopresis always the result of constipation? Arch Dis Child. 1994 Sep;71(3):186–193. doi: 10.1136/adc.71.3.186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Benninga M. A., Büller H. A., Staalman C. R., Gubler F. M., Bossuyt P. M., van der Plas R. N., Taminiau J. A. Defaecation disorders in children, colonic transit time versus the Barr-score. Eur J Pediatr. 1995 Apr;154(4):277–284. doi: 10.1007/BF01957362. [DOI] [PubMed] [Google Scholar]
- Benninga M. A., Büller H. A., Tytgat G. N., Akkermans L. M., Bossuyt P. M., Taminiau J. A. Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr. 1996 Oct;23(3):241–251. doi: 10.1097/00005176-199610000-00007. [DOI] [PubMed] [Google Scholar]
- Benninga M. A., Voskuijl W. P., Akkerhuis G. W., Taminiau J. A., Büller H. A. Colonic transit times and behaviour profiles in children with defecation disorders. Arch Dis Child. 2004 Jan;89(1):13–16. [PMC free article] [PubMed] [Google Scholar]
- Bouchoucha M., Devroede G., Arhan P., Strom B., Weber J., Cugnenc P. H., Denis P., Barbier J. P. What is the meaning of colorectal transit time measurement? Dis Colon Rectum. 1992 Aug;35(8):773–782. doi: 10.1007/BF02050328. [DOI] [PubMed] [Google Scholar]
- Chaussade S., Khyari A., Roche H., Garret M., Gaudric M., Couturier D., Guerre J. Determination of total and segmental colonic transit time in constipated patients. Results in 91 patients with a new simplified method. Dig Dis Sci. 1989 Aug;34(8):1168–1172. doi: 10.1007/BF01537263. [DOI] [PubMed] [Google Scholar]
- Glia A., Lindberg G., Nilsson L. H., Mihocsa L., Akerlund J. E. Clinical value of symptom assessment in patients with constipation. Dis Colon Rectum. 1999 Nov;42(11):1401–1410. doi: 10.1007/BF02235036. [DOI] [PubMed] [Google Scholar]
- Gutiérrez Carolina, Marco Alfredo, Nogales Angel, Tebar Roque. Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation. J Pediatr Gastroenterol Nutr. 2002 Jul;35(1):31–38. doi: 10.1097/00005176-200207000-00008. [DOI] [PubMed] [Google Scholar]
- Hinton J. M., Lennard-Jones J. E. Constipation: definition and classification. Postgrad Med J. 1968 Sep;44(515):720–723. doi: 10.1136/pgmj.44.515.720. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hinton J. M., Lennard-Jones J. E., Young A. C. A ne method for studying gut transit times using radioopaque markers. Gut. 1969 Oct;10(10):842–847. doi: 10.1136/gut.10.10.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keuzenkamp-Jansen C. W., Fijnvandraat C. J., Kneepkens C. M., Douwes A. C. Diagnostic dilemmas and results of treatment for chronic constipation. Arch Dis Child. 1996 Jul;75(1):36–41. doi: 10.1136/adc.75.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levine M. D. Children with encopresis: A descriptive analysis. Pediatrics. 1975 Sep;56(3):412–416. [PubMed] [Google Scholar]
- Loening-Baucke V. Chronic constipation in children. Gastroenterology. 1993 Nov;105(5):1557–1564. doi: 10.1016/0016-5085(93)90166-a. [DOI] [PubMed] [Google Scholar]
- Loening-Baucke V. Constipation in early childhood: patient characteristics, treatment, and longterm follow up. Gut. 1993 Oct;34(10):1400–1404. doi: 10.1136/gut.34.10.1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Louvel D., Delvaux M., Felez A., Fioramonti J., Bueno L., Lazorthes Y., Frexinos J. Oxytocin increases thresholds of colonic visceral perception in patients with irritable bowel syndrome. Gut. 1996 Nov;39(5):741–747. doi: 10.1136/gut.39.5.741. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Metcalf A. M., Phillips S. F., Zinsmeister A. R., MacCarty R. L., Beart R. W., Wolff B. G. Simplified assessment of segmental colonic transit. Gastroenterology. 1987 Jan;92(1):40–47. doi: 10.1016/0016-5085(87)90837-7. [DOI] [PubMed] [Google Scholar]
- Mollen R. M., Claassen A. T., Kuijpers J. H. Meting van colonpassagetijd nuttig bij de evaluatie van functionele obstipatie. Ned Tijdschr Geneeskd. 1998 Feb 14;142(7):357–361. [PubMed] [Google Scholar]
- Nam Y. S., Pikarsky A. J., Wexner S. D., Singh J. J., Weiss E. G., Nogueras J. J., Choi J. S., Hwang Y. H. Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum. 2001 Jan;44(1):86–92. doi: 10.1007/BF02234827. [DOI] [PubMed] [Google Scholar]
- Papadopoulou A., Clayden G. S., Booth I. W. The clinical value of solid marker transit studies in childhood constipation and soiling. Eur J Pediatr. 1994 Aug;153(8):560–564. doi: 10.1007/BF02190658. [DOI] [PubMed] [Google Scholar]
- Preston D. M., Lennard-Jones J. E. Severe chronic constipation of young women: 'idiopathic slow transit constipation'. Gut. 1986 Jan;27(1):41–48. doi: 10.1136/gut.27.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rockney R. M., McQuade W. H., Days A. L. The plain abdominal roentgenogram in the management of encopresis. Arch Pediatr Adolesc Med. 1995 Jun;149(6):623–627. doi: 10.1001/archpedi.1995.02170190033006. [DOI] [PubMed] [Google Scholar]
- Schouten W. R., ten Kate F. J., de Graaf E. J., Gilberts E. C., Simons J. L., Klück P. Visceral neuropathy in slow transit constipation: an immunohistochemical investigation with monoclonal antibodies against neurofilament. Dis Colon Rectum. 1993 Dec;36(12):1112–1117. doi: 10.1007/BF02052258. [DOI] [PubMed] [Google Scholar]
- Sloots C. E. J., Felt-Bersma R. J. F. Effect of bowel cleansing on colonic transit in constipation due to slow transit or evacuation disorder. Neurogastroenterol Motil. 2002 Feb;14(1):55–61. doi: 10.1046/j.1365-2982.2002.00304.x. [DOI] [PubMed] [Google Scholar]
- Sutphen J. L., Borowitz S. M., Hutchison R. L., Cox D. J. Long-term follow-up of medically treated childhood constipation. Clin Pediatr (Phila) 1995 Nov;34(11):576–580. doi: 10.1177/000992289503401102. [DOI] [PubMed] [Google Scholar]
- Taitz L. S., Wales J. K., Urwin O. M., Molnar D. Factors associated with outcome in management of defecation disorders. Arch Dis Child. 1986 May;61(5):472–477. doi: 10.1136/adc.61.5.472. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Verduron A., Devroede G., Bouchoucha M., Arhan P., Schang J. C., Poisson J., Hémond M., Hébert M. Megarectum. Dig Dis Sci. 1988 Sep;33(9):1164–1174. doi: 10.1007/BF01535795. [DOI] [PubMed] [Google Scholar]
- Wald A. Colonic transit and anorectal manometry in chronic idiopathic constipation. Arch Intern Med. 1986 Sep;146(9):1713–1716. [PubMed] [Google Scholar]
- Wald A., Hinds J. P., Caruana B. J. Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology. 1989 Oct;97(4):932–937. doi: 10.1016/0016-5085(89)91500-x. [DOI] [PubMed] [Google Scholar]
- Wedel Thilo, Spiegler Juliane, Soellner Stefan, Roblick Uwe J., Schiedeck Thomas H. K., Bruch Hans-Peter, Krammer Heinz-Juergen. Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon. Gastroenterology. 2002 Nov;123(5):1459–1467. doi: 10.1053/gast.2002.36600. [DOI] [PubMed] [Google Scholar]
- van Ginkel R., Benninga M. A., Blommaart P. J., van der Plas R. N., Boeckxstaens G. E., Büller H. A., Taminiau J. A. Lack of benefit of laxatives as adjunctive therapy for functional nonretentive fecal soiling in children. J Pediatr. 2000 Dec;137(6):808–813. doi: 10.1067/mpd.2000.109153. [DOI] [PubMed] [Google Scholar]
- van Ginkel Rijk, Reitsma Johannes B., Büller Hans A., van Wijk Michiel P., Taminiau Jan A. J. M., Benninga Marc A. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology. 2003 Aug;125(2):357–363. doi: 10.1016/s0016-5085(03)00888-6. [DOI] [PubMed] [Google Scholar]
- van der Plas R. N., Benninga M. A., Büller H. A., Bossuyt P. M., Akkermans L. M., Redekop W. K., Taminiau J. A. Biofeedback training in treatment of childhood constipation: a randomised controlled study. Lancet. 1996 Sep 21;348(9030):776–780. doi: 10.1016/s0140-6736(96)03206-0. [DOI] [PubMed] [Google Scholar]
- van der Plas R. N., Benninga M. A., Redekop W. K., Taminiau J. A., Büller H. A. How accurate is the recall of bowel habits in children with defaecation disorders? Eur J Pediatr. 1997 Mar;156(3):178–181. doi: 10.1007/s004310050577. [DOI] [PubMed] [Google Scholar]