Colonic Transit Time in Children with Recurrent Abdominal Pain

ABSTRACT

PURPOSE: Recurrent abdominal pain is defined as the presence of at least three discrete episodes of pain occurring over a period of 3 or more months. The reported prevalence is high up to 15% of school aged children. Mostly the pain results from functional dysmotility of the intestine but not much studies has been done. Thus we studied segmental colonic transit time (CTT) to determine the frequency and the type of colonic transit abnormalities in children with recurrent abdominal pain. METHODS: Two hundred and five patients who visited our clinic with recurrent abdominal pain were included in the study group. Patients who had abnormalities in liver function test, blood chemistry, urinalysis, and upper gastrointestinal endoscopy were excluded. Total colonic transit study was done with the method of Arhan and segmental colonic transit studies were done by the method of Metcalf. Control group met the criteria of normal defecation, normal colonic transit time with normal adult value in Korea. Patients were divided into three groups according to the frequency of defecation: Group A (with less than 3 bowel movements per week), group B (3 to 21 defecations per week), and group C (over 21 stools per week). RESULTS: 1) Mean age of the study groups and the control group was 9.0+/-3.2 years. There was no statistically significant difference in mean age and sex ratio among study groups and control group (P>0.05). 2) In the control group there was a statistically significant difference among colonic segments (P0.05). The mean colonic transit time of control group was 15.6+/-9.4 hour and segmental colonic transit time was 3.1+/-4.2 hour for the right colon, 5.1+/-4.9 hour for the left, and 7.4+/-4.9 hour for the rectosigmoid. Upper limit of normal value of colonic segments (mean+2SD) were 12 hour for the right colon, 15 hour for the left, and 17 hour for the rectosigmoid. 3) In the study groups there was no statistically significant differences in total and segment colonic transit time in accordance with age and gender.4) In the study groups colonic transit study defined five patterns: pelvic outlet obstruction (93 cases, 45%), hindgut dysfunction (49 cases, 24%), normal CTT (29 cases, 14%), colonic inertia (26 cases, 13%), and slow transit (8 cases, 4%). The patients who had complained constipation (group A, N=19), colonic inertia (10 cases, 53%) was most commonly found, and next was hindgut dysfunction in 6 cases, and pelvic outlet obstructionin in 2 cases. In patients with normal stool frequency (group B, N=166), pelvic outlet obstruction was most common in 87 cases (52%), and next was hindgut dysfunction in 37 cases (22%), normal CTT in 19 cases and colonic inertia in 16 cases. In patients with loose stools or frequent defecation (group C, N=20), normal CTT was most common in 9 cases (45%), and next was hindgut dysfunction in 6 cases (30%), pelvic outlet obstruction in 4 cases (20%), and colonic inertia in 1 case (5%). 5) Defecation frequency was lowest in colonic inertia with 6.6+/-6.5 per week, and highest in normal CTT up to 21.1+/-16.2, and slow transit 13.5+/-8.5. Defecation pain was mainly noted in the slow transit group up to 63%, and next was colonic inertia in 35%, and hindgut dysfunction in 18%. Stool mass was palpated in 9 cases (4%). CONCLUSIONS: Measurement of colonic transit time in children with recurrent abdominal pain is helpful in evaluating the causes of recurrent abdominal pain.