[tri-med] FYI - Slow transit constipation in children

I am forwarding this article or URL for your information (FYI) as I believe
it may be of interest and is from a reliable source. As always, check the
information with your own doctor or health care professional before starting
or changing any treatments.

http://www.blackwell-synergy.com/Journals/content/abstracts/jpc/2001/37/5/abstract_jpc692.asp?journal=jpc&issueid=7517&artid=137316&;
cid=jpc.2001.5&ftype=abstracts

Journal of Paediatrics and Child Health 37 (5), 426-430
© Royal Australasian College of Physicians

Slow transit constipation in children
JM Hutson, J McNamara, S Gibb and Y-M Shin

Departments of General Surgery and General Paediatrics, Royal Children's 
Hospital and, Murdoch Children's Research Institute,
Parkville, Victoria, Australia

Abstract: Patients with chronic constipation that fails to respond to treatment 
remain a challenge for paediatricians and surgeons.
Ongoing work in our institution suggests that a number of children with 
intractable symptoms have slow transit constipation, which
has only been described recently in paediatrics. Common features of slow 
transit are: delayed passage of the first meconium stool
beyond 24 h of age, symptoms of severe constipation within a year, or 
treatment-resistant 'encopresis' at 2-3 years, soft stools
despite infrequent bowel actions, and delay in colonic transit on a transit 
study. A proportion of children with slow transit
constipation have an abnormality of intestinal innervation associated with the 
dysfunctional colonic motility, recognized as
intestinal neuronal dysplasia (IND). Intestinal neuronal dysplasia type B, the 
most common variant of IND, is defined on rectal
biopsy by hyperplasia of the submucosal plexus. On laparoscopic colon muscle 
biopsy, many specimens show reduced numbers of
excitatory substance P-immunoreactive nerve fibres in the circular muscle. 
Functional markers of the nerves allow new diagnostic
criteria to be developed which may also allow a more rational approach to 
treatment. The aetiology remains obscure and the optimal
management poorly defined, although subtotal colectomy, proximal colostomy or 
appendicostomy (for antegrade enemas) have been tried.
Once the anatomy and physiology of the colon in children with slow colonic 
transit is better understood, we will have defined not
only a new form of constipation, but also will be able to consider new 
therapies.

Keywords: constipation; encopresis; intestinal neuronal dysplasia; substance P.


--------------------------------------------------------------------------------

Correspondence: Professor JM Hutson Department of General Surgery, Royal 
Children's Hospital, Flemington Road, Parkville 3052,
Victoria, Australia. Fax: +61 3 9345 6668; email: 
hutsonj@xxxxxxxxxxxxxxxxxxxxxxxxxx

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