| Idiopathic chronic constipation is a frequent and distressing com-plaint in childhood. The morbidity is 3 -5%. But its pathophysiologi-cal grounds remain poorly understood. In particular, there is little knowledge about the correlation between distal ( anorectal area) and proximal ( colonic area) motor abnormalities in this condition, espe-cially the proximal colonic motility. For this purpose, we studied chronically constipated patients with simplified method of radio opaque markers and anorectal vector manometry, partly with X defecography to explore the colonic motility of idiopathic chronic constipation.Materials and MethodsAll the subjects involved in this study were divided into 2 groups. One group was control, 33 healthy volunteers (21 males and 12 fe-males) aged 2-13 years (mean 5 years) were involved in this group. The other was constipation group, in which 25 patients (15 males and 10 females) aged 3-14 years ( mean 7 years) referred to constipation on BenningaS standard according to the informed written consent from the parents were involved. In this study we used the simplified method of radio opaque markers to determine the total gastrointestinal transit time(TGITT) and segmental colonic transit time (right colonic transittime, RCTT; left colonic transit time, LCTT; and rectosigmoid colonic transit time, RSTT) of the normal and constipated children, combined with anorectal vector manometry and X ray defecography to assess the colonic motor function.ResultsBy the simplified method of radio opaque markers we found the total gastrointestinal transit time (TGITT) and segmental colonic tran-sit time ( right colonic transit time, RCTT; left colonic transit time, LCTT; and rectosigmoid colonic transit time, RSTT) of the normal children were 28.7 ?.7hJ.5 ?.2hN6.5 ?.8h and 13.4?.6h respectively. There was no significant difference between males and females in TGITT(26. 1 ?. 9h vs 27. 8 ?. 7h,P >0. 05). All the normal children were divided into two groups by age of 5, and there was also no significant difference between these two groups in TGITT (28.3 ?.5h vs 25. 1 ?.9h, P > 0. 05). In the constipated chil-dren , the TGITT, LCTT and RSTT were significantly longer than those in controls (92.2 ?5. 5h vs 28. 7 ?. 7h,P <0. 001; 16. 9 ?12. 6h vs6.5?.8h,P<0.01;61.5?9.0hvsl3.4?.6h,P< 0. 001 ) , while the RCTT had no difference. The anal pressure and vector volume in squeezing condition were significantly higher than those in resting condition. Compared with controls, the squeezing anal maximum pressure of the constipated children was higher ( 236 ?44mmHg vs 190 ?38mmHg , P < 0. 05 ) , vector symmetric index ( VSI) was lower(0. 71 ?. 06 vs 0. 84 ?. 08, P <0.05) while vec-tor volume had no difference. X defecography demonstrated one recto-cele, one permeal descent syndrome and one puborectal muscle syn-drome respectively.DiscussionColonic transit test is an important objective test for evaluating the colonic motor function; moreover, it is the only noninvasive meth-od that can diagnose slow - transit constipation. At present it is widely used in studying colonic motor function. But previous study mainly fo-cused on one marker daily ?films technique, and seldom used the sin-gle - film estimate. Up to now there is still no report on colonic transit time of normal oriental children. In the current study, it is the first time that we used the simplified method of radio opaque markers, also named as the single - film technique , to determinate the TGITT( 28. 7 ?7.7) in normal children, which is not significantly influenced by sex and age.The etiology of chronic constipation is diversified. But the tradi-tional therapy only focused on relieving the symptoms of constipation by generally using laxatives. So it is necessary to find the etiology of constipation to guide its treatment. Colonic transit time is very impor-tant for us to differentiate the types of constipation. According to the segmental colonic transit time the constipated children can be divided into four... |
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