Predictors of slow colonic transit in children

PURPOSE: Slow transit constipation (STC) and functional fecal retention (FFR) are two forms of severe intractable constipation in childhood diagnosed by nuclear transit studies (NTS). This retrospective study aims to identify the predicting factors for STC and FFR by looking at the association with neuropsychiatric disorders (NPD), obesity, family history of constipation and atopic disease. PATIENTS AND METHODS: A retrospective chart review was conducted on children with intractable constipation referred for NTS between 1st April 2003 and 1st April 2014. Comparisons were made between STC, FFR and normal transit patients with regards to NPD, obesity (BMI z score >95th percentile), family history of constipation in first and second-degree relatives and atopic disease which included food allergy, asthma and eczema. RESULTS: Between 2003 and 2014, 97 patients were referred for a NTS. Out of 36 patients with NPD, 21 (58.3 %) had STC and 13 (36.1 %) had FFR (p < 0.05). 15.8 % of patients with constipation were obese, compared to 6.4 % in the general Australian paediatric population (p < 0.05). There was no significant association between constipation and atopic disease or family history. CONCLUSION: Neuropsychiatric disorders, in particular autism, are useful predictors of STC and FFR in children. Obesity may be associated with a higher risk of developing chronic constipation

Clinical and Molecular Biological Studies in Hirschsprung's Disease

HSCR has been felt to be a polygeneic disease on the basis of an incompletely penetrant sex modified transmission, which may be either autosomal dominant or recessive in different kindred. During the 1990's several of the genes involved in this transmission have come to light. Other genes remain to be discovered

Constipation in children with autism and autistic spectrum disorder

Background: Children with autistic spectrum disorders (ASDs) have long been known to suffer from GIT symptoms. We planned to quantify the contribution of this group to our constipation clinic workload, and to discover defining group characteristics. Methods: The characteristics of the bowel habit of children with autism ± neuro-developmental psychiatric (NDP) diagnoses were compared with ‘normal’ children by retrospective chart review. Data were entered into an Excel spreadsheet (Microsoft Office 2007), and compared between groups. Results: One hundred and eighteen patients presented to the Paediatric Surgical Constipation clinic between April 2003 and May 2008. 90 patients were otherwise normal; 18 patients had NDP; 6 patients had ASD alone and 4 had ASD with other neurodevelopmental features. The median [interquartile range] age at onset in the ASD + NDP and normal groups was 2.5 (1–6) and 14 (4–36) months, respectively (p = 0.03) and the median duration of history in the ASD ± NDP and normal groups was 61 (47–89) and 27 (13–53) months, respectively (p = 0.007). Conclusions: Autism spectrum disorders are an order of magnitude more common in the constipation clinic than in the general population. 8.5% of patients who attended our Paediatric Surgical Constipation clinic had autism with or without NDP deficits. Children with autism ± NDP deficits have an earlier onset of symptoms, longer history, and some possess signs similar to those of slow transit constipation. These features may be inborn. A common genetic origin of gut and behavioural abnormalities suggests that specific targeted investigation and treatment for the constipation of ASD may in time be developed.</p