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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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Quitadamo P, Tambucci R, Mancini V, Campanozzi A, Caldaro T, Giorgio V, Pensabene L, Isoldi S, Mallardo S, Fusaro F, Staiano A, Salvatore S, Borrelli O. Diagnostic and therapeutic approach to children with chronic refractory constipation: Consensus report by the SIGENP motility working group. Dig Liver Dis 2024; 56:406-420. [PMID: 38104028 DOI: 10.1016/j.dld.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.
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Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Hospital, Milan, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Giorgio
- UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Fabio Fusaro
- Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Digestive and Endoscopic Surgery, Gastroenterology and Nutrition, Intestinal Failure Rehabilitation Research Group, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
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Mansi S, Bahia G, Patel D, Dorfman L, El-Chammas K, Fei L, Liu C, Santucci NR, Graham K, Kaul A. High amplitude propagated contractions with Glycerin versus Bisacodyl: A within-subject comparison in children undergoing colonic manometry. Neurogastroenterol Motil 2023; 35:e14544. [PMID: 37096635 PMCID: PMC10701597 DOI: 10.1111/nmo.14544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/24/2022] [Accepted: 01/24/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The presence of high amplitude propagated contractions (HAPCs) measured by colonic manometry (CM) reflect an intact neuromuscular function of the colon. Bisacodyl and Glycerin are colonic stimulants that induce HAPCs and are used for the treatment of constipation. HAPCs characteristics with each drug have not been compared before. We aimed to compare the HAPC characteristics with Bisacodyl and Glycerin in children undergoing CM for constipation. METHODS This is a prospective single-center cross-over study of children aged 2-18 years undergoing CM. All patients received both Glycerin and Bisacodyl during CM. They were randomized to group A with Bisacodyl first (n = 22) and group B with Glycerin first (n = 23), with 1.5 hours in between each dose. Differences in patient and HAPC characteristics between groups were summarized using descriptive statistics and compared using Chi-square test or Wilcoxon rank sum test as appropriate. KEY RESULTS A total of 45 patients were included. HAPCs post Bisacodyl had a longer duration of action (median of 40 vs 21.5 min, p < 0.0001), longer propagation (median of 70 vs 60 cm, p = 0.02), and more HAPCs (median of 10 vs 5, p < 0.0001) compared Glycerin. No differences were found in the HAPC amplitude and onset of action between both medications.
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Affiliation(s)
- Sherief Mansi
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Gracielle Bahia
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Dhiren Patel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cardinal Glennon Children’s Medical Center, Saint Louis University School of Medicine, St Louis, Missour, USA
| | - Lev Dorfman
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
| | - Khalil El-Chammas
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Lin Fei
- Department of Biostatistics and Epidemiology, CCHMC, Cincinnati, Ohio, USA
| | - Chunyan Liu
- Department of Biostatistics and Epidemiology, CCHMC, Cincinnati, Ohio, USA
| | - Neha R. Santucci
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Kahleb Graham
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Ajay Kaul
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
- University of Cincinnati, Cincinnati, Ohio, USA
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Coe A, Ciricillo J, Mansi S, El-Chammas K, Santucci N, Bali N, Lu PL, Damrongmanee A, Fei L, Liu C, Kaul A, Williams KC. Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder. J Pediatr Gastroenterol Nutr 2023; 76:154-159. [PMID: 36705696 DOI: 10.1097/mpg.0000000000003662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility. METHODS A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility. RESULTS Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P = 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P < 0.0001). CONCLUSIONS Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.
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Affiliation(s)
- Alexander Coe
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sherief Mansi
- the Department of Gastroenterology and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Khalil El-Chammas
- the Department of Gastroenterology and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Neha Santucci
- the Department of Gastroenterology and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Neetu Bali
- the Department of Gastroenterology and Hepatology, Nationwide Children's Hospital, Columbus, OH
| | - Peter L Lu
- the Department of Gastroenterology and Hepatology, Nationwide Children's Hospital, Columbus, OH
| | - Alisara Damrongmanee
- the Department of Gastroenterology and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lin Fei
- the Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chunyan Liu
- the Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ajay Kaul
- the Department of Gastroenterology and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kent C Williams
- the Department of Gastroenterology and Hepatology, Nationwide Children's Hospital, Columbus, OH
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Jacobs SE, Tiusaba L, Bokova E, Russell TL, Al-Shamaileh T, Feng C, Badillo AT, Darbari A, Levitt MA. Functional constipation refractory to medical management: The colon is the problem. J Pediatr Surg 2023; 58:246-250. [PMID: 36411110 DOI: 10.1016/j.jpedsurg.2022.10.022] [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: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Management of refractory constipation in children has not been standardized. We propose a protocolized approach which includes a contrast enema, anorectal manometry and exclusion of Hirschsprung disease (HD). For those without HD or with normal sphincters, an assessment of the colonic motility may be needed. The subgroups of dysmotility include (1) slow motility with contractions throughout, (2) segmental dysmotility (usually the sigmoid), or (3) a diffusely inert colon. We offered a Malone appendicostomy in all groups with the hope that this would avoid colonic resection in most cases. METHODS Patients with medically refractory constipation were reviewed at a single institution (2020 to 2021). For patients without HD or an anal sphincter problem, assessment of colonic motility using colonic manometry was performed followed by a Malone appendicostomy for antegrade flushes. RESULTS Of 196 patients evaluated for constipation refractory to medical management, 22 were felt to have a colonic motility cause. These patients underwent colonic manometry and Malone appendicostomy. 13 patients (59%) had a slow colon but with HAPCs throughout, 5 (23%) had segmental dysmotility, and 4 (18%) had a diffuse colonic dysmotility. 19 (86%) responded well to antegrade flushes with 17 reporting no soiling and 2 having occasional accidents. 3 patients (14%) failed flushes and underwent a colon resection within 6-month following Malone procedure. CONCLUSION We propose a protocol for medically refractory constipation which provides a collaborative framework to standardize evaluation and management of these patients with antegrade flushes, which aids in avoidance of colonic resection in most cases. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Shimon E Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Teresa L Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | | | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Andrea T Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Anil Darbari
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States.
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Heitmann PT, Wiklendt L, Thapar N, Borrelli O, Di Lorenzo C, Yacob DT, Baaleman DF, Vriesman MH, Nurko S, El-Chammas K, Kaul A, Benninga MA, Koppen IJN, Wattchow DA, Brookes SJH, Dinning PG. Characterization of the colonic response to bisacodyl in children with treatment-refractory constipation. Neurogastroenterol Motil 2020; 32:e13851. [PMID: 32281199 DOI: 10.1111/nmo.13851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment-refractory constipation. If bisacodyl does not induce high-amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies. METHODS Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion. RESULTS One hundred and sixty-five children were included (median age 10, range 1-17 years; n = 96 girls). One thousand eight hundred and ninety-three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre- vs post-bisacodyl (Z = -0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ2 (1)=7.04, P < .01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response. CONCLUSIONS AND INFERENCES Intraluminal bisacodyl induced HAPCs in 93% of children with treatment-refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined.
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Affiliation(s)
- Paul T Heitmann
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
| | - Lukasz Wiklendt
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
| | - Nikhil Thapar
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, and Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| | - Osvaldo Borrelli
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, and Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| | | | | | | | - Mana H Vriesman
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
| | - Khalil El-Chammas
- Neurogastroenterology and Motility Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ajay Kaul
- Neurogastroenterology and Motility Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - David A Wattchow
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
| | - Simon J H Brookes
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
| | - Phil G Dinning
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
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A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations. J Pediatr Surg 2019; 54:479-485. [PMID: 29778545 DOI: 10.1016/j.jpedsurg.2018.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/30/2018] [Accepted: 04/15/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Patients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex patients. METHODS We developed a model of a devoted center for these conditions that includes physicians, psychologists, social workers, nurses, and advanced practice nurses. Our weekly planning strategy includes a meeting with representatives of all specialties to review all patients prior to evaluation in our multidisciplinary clinic, followed by combined exams under anesthesia or surgical intervention as needed. RESULTS There are 31 people working directly in the Center at present. From the Center's start in 2014 until 2017, 1258 patients were cared for from all 50 United States and 62 countries. 360 patients had an ARM (110 had a cloacal malformation, 11 had cloacal exstrophy), 223 presented with HD, 71 had a spinal malformation or injury causing neurogenic bowel, 321 had severe functional constipation or colonic dysmotility, and 162 had other diagnoses including familial polyposis, Crohn's disease, or ulcerative colitis. We have had 170 multidisciplinary meetings, 170 multispecialty outpatient, and 52 nurse practitioner clinics. In our bowel management program we have seen a total of 514 patients in 36 sessions. CONCLUSION This is the first report describing the design of a multidisciplinary team approach for patients with colorectal and complex pelvic malformations. We found that approaching these patients in a collaborative way allows for combined medical and surgical decisions with many providers simultaneously, facilitates therapy, and can potentially improve patient outcomes. We hope that this model will help establish new-devoted centers in other locations to encourage centralized care for these rare malformations. LEVEL OF EVIDENCE IV.
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Levin MD. Functional constipation in children: Is there a place for surgical treatment. J Pediatr Surg 2019; 54:616-617. [PMID: 30301605 DOI: 10.1016/j.jpedsurg.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Michael D Levin
- Department of Pediatric Radiology of 1-st Hospital, Minsk, Belarus; State Geriatric Center, Netanya, Israel.
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Dinning PG. A new understanding of the physiology and pathophysiology of colonic motility? Neurogastroenterol Motil 2018; 30:e13395. [PMID: 29971850 DOI: 10.1111/nmo.13395] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In recent years, high-resolution manometry has been used in an attempt to gain a greater insight into the physiology/pathophysiology of colonic contractile activity in healthy adults and patients with colonic motility disorders. New colonic motor patterns have been identified and characterized, however, the clinical significance of these findings remains undetermined. PURPOSE This review will assess the current literature on colonic high-resolution manometry and determine if this procedure has advanced our understanding of colonic motility. The limitations, future directions, and the potential of this technique to assess the effects of treatment upon colonic motor patterns will also be discussed.
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Affiliation(s)
- P G Dinning
- The Department of Gastroenterology & Surgery, Flinders Medical Centre & the College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
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10
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Concerning our publication 'Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years': reply to M. D. Levin. Pediatr Radiol 2018; 48:1678-1680. [PMID: 29961090 DOI: 10.1007/s00247-018-4183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
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Levin MD. Reaction to Koppen et al., 'Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years'. Pediatr Radiol 2018; 48:1674-1677. [PMID: 29961089 DOI: 10.1007/s00247-018-4181-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/10/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Michael D Levin
- State Geriatric Center (Dorot), Amnon VeTamar, 1/2, 42202, Netanya, Israel. .,Pediatric Surgical Center, Minsk, Belarus.
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12
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Letter to the editor. J Pediatr Surg 2018; 53:2082-2083. [PMID: 30017068 DOI: 10.1016/j.jpedsurg.2018.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/15/2018] [Indexed: 11/22/2022]
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Abstract
Constipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review.
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