Bacterial overgrowth and methane production in children with encopresis.

OBJECTIVES: To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis. STUDY DESIGN: Radiographic fecal impaction (FI) scores were assessed in children with secondary, retentive encopresis and compared with the breath test results. Breath tests with hypoosmotic lactulose solution were performed in both the study patients (n = 50) and gastrointestinal control subjects (n = 39) groups. RESULTS: The FI scores were significantly higher in the patients with encopresis who were methane producers (P < .01). SIBO was diagnosed in 21 of 50 (42%) patients with encopresis and 9 of 39 (23%) of control subjects (P = .06). Methane was produced in 56% of the patients with encopresis versus 23.1% of the control subjects in the gastrointestinal group (P < .01). Fasting methane level was elevated in 48% versus 10.3 %, respectively (P < .01). CONCLUSIONS: Children with FI and encopresis had a higher prevalence of SIBO, elevated basal methane levels, and higher methane production. Methane production was associated with more severe colonic impaction. Further study is needed to determine whether methane production is a primary or secondary factor in the pathogenesis of SIBO and encopresis.

[Comparative study between dynamic MRI and pelvic organography in diagnosis of pelvic floor disorders].

OBJECTIVE: To evaluate the clinical value of simultaneously combined pelvic floor dynamic MRI and pelvic organography in diagnosing female pelvic floor disorders and search for the best imaging model for diagnosing pelvic floor disorders. METHODS: Thirty women with pelvic floor disorders received pelvic floor dynamic MRI and simultaneously combined pelvic organography including cystourethrography, peritoneography, vaginography and defecography. Clinical diagnostic value was compared between this two methods. RESULTS: The diagnostic accuracy of pelvic floor dynamic MRI and simultaneously combined pelvic organograph for cystocele,anorectal junction abnormal descent, pelvic floor hernia,uterocervical prolapse was 100%, 95.2 %, 86.7%, 85.7% respectively. Rectocele and prolapse of rectal were diagnosed by pelvic organograph in 12 and 28 cases respectively, while only 6 and 0 cases were diagnosed by pelvic floor dynamic MRI respectively. The mean examining time of pelvic floor dynamic MRI and simultaneously combined pelvic organography was (16 +/- 3)min, (34 +/- 9)min respectively (P< 0.01). CONCLUSION: Pelvic floor dynamic MRI combined with defecography is the best imaging model for diagnosing pelvic floor disorders.

The plain abdominal roentgenogram in the management of encopresis.

OBJECTIVE: To determine whether fecal retention in encopretic children can be assessed objectively using the plain abdominal roentgenogram and whether roentgenographic evidence of fecal retention is associated with clinical findings on presentation in encopretic children. DESIGN: Retrospective case studies. SETTING: Two pediatric incontinence clinics. PARTICIPANTS: Sixty children (72% male), aged 4 to 18 years (mean, 8 years), who met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for the diagnosis of encopresis. All had a plain abdominal roentgenogram obtained on presentation. INTERVENTIONS: None. RESULTS: Using a systematic assessment tool with good interrater reliability (kappa = 0.65), 78% (47) of the children had fecal retention by roentgenographic criteria on presentation, while 22% (13) did not. Retentive encopretic children were less likely to have a history of difficult toilet training (P = .018) than nonretentive encopretic children. There was no association between fecal retention and several clinical factors, including historical features commonly attributed to fecal retention. Retentive encopretic children were no more likely to have a palpable abdominal mass than nonretentive encopretic children, but they were more likely to have excessive stool on rectal examination (P = .015). Using the plain abdominal roentgenogram as the gold standard, the rectal examination showed a positive predictive value of 84.8% and a negative predictive value of 50% in assessing fecal retention. CONCLUSIONS: Fecal retention in encopretic children can be assessed objectively from a plain abdominal roentgenogram. Most, but not all, encopretic children present with fecal retention. A positive rectal examination is strongly predictive of fecal retention, in which case a roentgenogram is not necessary to make that diagnosis. A negative rectal examination may not rule out fecal retention, in which case an abdominal roentgenogram may be useful to make that diagnosis.

Defaecation disorders in children, colonic transit time versus the Barr-score.

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5-14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter- and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns. Conclusion. Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation.(ABSTRACT TRUNCATED AT 250 WORDS)