Colonic transit in children and adolescents with chronic constipation / Trânsito intestinal em crianças e adolescentes com constipação crônica

OBJECTIVE: The aim of this study was to assess clinical features and colonic transit patterns in Brazilian children with refractory constipation.METHODS: From 2010 to 2013, 79 constipated patients received follow-up care in a tertiary hospital. Of these patients, 28 (aged 8-14 years) were refractory to conventional therapy and underwent a simplified visual method of nuclear colonic transit study, by ingestion of a liquid meal containing 9.25 MBq/kg of 99mTc-phytate. Abdominal static images were taken immediately and at two, six, 24, 30, and 48 h after ingestion for qualitative analysis of the radio marker progression through the colon.RESULTS: Two patterns of colonic transit were found: slow colonic transit (SCT,n = 14), when images at 48 h showed a larger part of the tracer remained in proximal and transverse colon, and distal retention (DR, n = 14), when after 30 h, the radio isotope passed the transverse colon and was retained in the rectosigmoid up to 48 h. The SCT and DR group included, respectively, nine and ten males; median ages in the nuclear study of 11 and 10 years, p = 0.207; median duration of constipation of seven and six years, p = 0.599. Constipation appearing during first year age (p = 0.04) and report of soft stools (p = 0.02) were more common in SCT patients. Palpable abdominal fecal impaction was found only in DR group. Appendicostomy for antegrade continence enema was successful in 4/12 (30%) of SCT patients (median follow-up: 2.4 years).CONCLUSION: Nuclear transit study distinguished two colonic dysmotility patterns and was useful for guiding refractory patients to specific therapies.

OBJETIVO: Avaliar as características clínicas e os padrões de trânsito intestinal em crianças brasileiras com constipação refratária.MÉTODOS: De 2010 a 2013, 79 pacientes constipados receberam acompanhamento em um hospital terciário. Desses pacientes, 28 (entre 8-14 anos) foram identificados como terapia refratária a convencional e passaram por um método visual simplificado de estudo nuclear do trânsito intestinal, com ingestão de uma refeição líquida contendo 9,25 MBq/Kg de fitato-99mTc. Imagens estáticas abdominais foram tiradas imediatamente e em duas, seis, 24, 30 e 48 horas após a ingestão para uma análise qualitativa da progressão do marcador radioativo pelo cólon.RESULTADOS: Foram encontrados dois padrões de trânsito intestinal: trânsito intestinal lento (STC, n = 14), quando as imagens de 48 horas mostraram que grande parte do marcador permaneceu no cólon proximal e transversal; e retenção distal (DR, n = 14), quando, após 30 horas, o radioisótopo havia passado o cólon transverso e estava retido no retossigmoide até 48 horas. O grupo STC e o grupo DR incluíram, respectivamente, nove e 10 meninos; idade média no momento do NTS: 11 e 10 anos, p = 0,207; duração média de constipação: sete e seis anos, p = 0,599. Sintomas de constipação durante o primeiro ano de idade (p = 0,04) e relatos de fezes moles (p = 0,02) foram mais comuns em pacientes com STC. Observou-se impactação fecal abdominal palpável apenas no grupo DR. A apendicostomia para enema anterógrado para continência foi bem-sucedida em 4/12 (305) pacientes com STC (acompanhamento médio: 2,4 anos).CONCLUSÃO: O estudo nuclear do trânsito diferenciou dois padrões de dismotilidade intestinal e foi útil para orientar pacientes refratários a terapias específicas.

Colonic transit in children and adolescents with chronic constipation.

OBJECTIVE: The aim of this study was to assess clinical features and colonic transit patterns in Brazilian children with refractory constipation. METHODS: From 2010 to 2013, 79 constipated patients received follow-up care in a tertiary hospital. Of these patients, 28 (aged 8-14 years) were refractory to conventional therapy and underwent a simplified visual method of nuclear colonic transit study, by ingestion of a liquid meal containing 9.25 MBq/kg of (99m)Tc-phytate. Abdominal static images were taken immediately and at two, six, 24, 30, and 48h after ingestion for qualitative analysis of the radio marker progression through the colon. RESULTS: Two patterns of colonic transit were found: slow colonic transit (SCT, n=14), when images at 48h showed a larger part of the tracer remained in proximal and transverse colon, and distal retention (DR, n=14), when after 30h, the radio isotope passed the transverse colon and was retained in the rectosigmoid up to 48h. The SCT and DR group included, respectively, nine and ten males; median ages in the nuclear study of 11 and 10 years, p=0.207; median duration of constipation of seven and six years, p=0.599. Constipation appearing during first year age (p=0.04) and report of soft stools (p=0.02) were more common in SCT patients. Palpable abdominal fecal impaction was found only in DR group. Appendicostomy for antegrade continence enema was successful in 4/12 (30%) of SCT patients (median follow-up: 2.4 years). CONCLUSION: Nuclear transit study distinguished two colonic dysmotility patterns and was useful for guiding refractory patients to specific therapies.