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Rodriguez L. Testing in functional constipation-What's new and what works. Aliment Pharmacol Ther 2024; 60 Suppl 1:S30-S41. [PMID: 38940015 DOI: 10.1111/apt.17857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
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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Affiliation(s)
- Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
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Mathias RM, Chu MKW, Edwards S, Day AS, Ma C, Jairath V, Bryant RV. Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation. Aliment Pharmacol Ther 2024; 60:6-16. [PMID: 38745540 DOI: 10.1111/apt.18029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Constipation can be diagnosed clinically using the Rome criteria. Ultrasound (US), which lacks the radiation exposure of conventional X-ray, holds promise as a non-invasive tool to evaluate colonic contents and constipation. AIM To examine the role of US in the assessment of constipation. METHODS We performed a systematic search of Embase (OVID, 1984), Medline (Ovid, 1946), Cochrane Central, ClinicalTrials.gov and Australia New Zealand Clinical Trials Registry from database inception to 26 January 2024 according to PRISMA guidelines and prospectively registered with PROSPERO. All studies using US to assess constipation or colonic contents in either adults or children were included. Rectal diameter measurements were pooled in meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scales and Joanna Briggs Institute checklists. RESULTS Of 12,232 studies screened, 51 articles (6084 patients; 3422 children) describing US to assess symptoms in patients with constipation were included. Most studies used Rome criteria to diagnose constipation. Rectal diameter was associated with clinical constipation in 29 paediatric studies (3331 patients). Meta-analysis showed the mean rectal diameter of constipated patients was significantly higher than controls (mean difference 12 mm, 95% confidence intervals (CI): 6.48, 17.93, p < 0.0001, n = 16 studies). Other features of constipation on US included posterior acoustic shadowing and echogenicity of luminal contents. CONCLUSION US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.
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Affiliation(s)
- R M Mathias
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - M K W Chu
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A S Day
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - C Ma
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alimentiv Inc., London, Ontario, Canada
| | - V Jairath
- Alimentiv Inc., London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - R V Bryant
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Riera A, Phatak UP. Qualitative Point-of-Care Ultrasound Enema Management for Constipation. Pediatr Emerg Care 2024; 40:239-242. [PMID: 37890187 DOI: 10.1097/pec.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
ABSTRACT We discuss 10 cases where the qualitative evaluation of hard stool in the rectum with point-of-care ultrasound helped guide enema administration in a pediatric emergency department. Point-of-care ultrasound findings were especially valuable in cases where the presenting symptoms were undifferentiated, a language barrier was present, or the guardian and child denied that constipation was an active problem. When sodium phosphate enema administration was done in the pediatric emergency department, evacuation of the rectal stool burden was observed in most cases before final disposition.
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Affiliation(s)
- Antonio Riera
- From the Yale University School of Medicine, Pediatric Emergency Medicine
| | - Uma P Phatak
- Yale University School of Medicine; Pediatric Gastroenterology
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Hamdy AM, Sakr HM, Boules IS, Awad YMM. The role of rectal ultrasound in children with functional constipation. J Paediatr Child Health 2023; 59:533-536. [PMID: 36718568 DOI: 10.1111/jpc.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
AIM The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. METHODS A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age- and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3 months of laxative therapy and behavioural modification. RESULTS Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3 cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3 cm for the former and >2.5 cm for the latter. After 3 months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. CONCLUSIONS Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.
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Affiliation(s)
- Ahmed M Hamdy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam M Sakr
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ireny S Boules
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yosra M M Awad
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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