Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Dyssynergic Defecation in Chronically Constipated Children in Korea

  • Sun Hwan Bae (Department of Pediatrics, Konkuk University Medical Center)
  • Received : 2022.06.23
  • Accepted : 2023.02.08
  • Published : 2023.03.15
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Abstract

Purpose: Dyssynergic defecation (DSD) is one of the important causes of chronic constipation in children. We aimed to analyze the clinical features, diagnostic test results, and treatments for DSD in children. Methods: Children diagnosed with DSD using fluoroscopic defecography were enrolled in this study. Clinical data, including the results of colon transit time (CTT) test and biofeedback (BF) therapy, were collected from medical records retrospectively. Results: Nineteen children were enrolled. The median age was 9 years (6-18 years), the median frequency of bowel movement was 1/7 days (1-10 days), the median duration of constipation was 7.0 years (2-18 years), the median age of onset of constipation was 2.5 years (1-11 years). In the CTT test, outlet obstruction type was noted in 10/18 (55.6%), slow transit type in 5/18 (27.8%), and normal transit in 1/18 (5.6%). The median CTT was 52 hours (40-142 hours). Initial medical therapy was performed with the polyethylene glycol 4000, and the response was good in 9/19 (47.4%), fair in 9/19 (47.4%), and poor in 1/19 (5.0%). BF was performed in 8/19, with good results in 6/8 (75.0%) children and failure in 2/8 (25.0%) children. After long-term medical therapy (11/19), 3/5 showed good response with medication alone, 6/8 showed good response with BF and medication combined. Conclusion: DSD should be considered as a cause of chronic constipation in children, especially in those with abnormal CTT test results. BF combined with medical therapy is effective even with age-limited cooperation.

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References

  1. Bae SH, Kim MR. Subtype classification of functional constipation in children: polyethylene glycol versus lactulose. Pediatr Int 2020;62:816-9. https://doi.org/10.1111/ped.14235
  2. Yoo HY, Kim MR, Park HW, Son JS, Bae SH. Colon transit time test in Korean children with chronic functional constipation. Pediatr Gastroenterol Hepatol Nutr 2016;19:38-43. https://doi.org/10.5223/pghn.2016.19.1.38
  3. Kim MR, Park HW, Son JS, Lee R, Bae SH. Correlation between colon transit time test value and initial maintenance dose of laxative in children with chronic functional constipation. Pediatr Gastroenterol Hepatol Nutr 2016;19:186-92. https://doi.org/10.5223/pghn.2016.19.3.186
  4. Lee G, Son JS, Bae SH. Clinical features of severely constipated children: comparison of infrequent bowel movement and fecal soiling groups. Pediatr Gastroenterol Hepatol Nutr 2020;23:26-34. https://doi.org/10.5223/pghn.2020.23.1.26
  5. Mugie SM, Bates DG, Punati JB, Benninga MA, Di Lorenzo C, Mousa HM. The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children. Pediatr Radiol 2015;45:173-80.  https://doi.org/10.1007/s00247-014-3137-3
  6. Makosiej R, Makosiej A, Bossowski A, Kolejwa M, Wawrusiewicz-Kurylonek N, Legowik A, et al. Dyssynergic defecation and anal sphincter disorders in children in high-resolution anorectal manometry investigation. J Pediatr Gastroenterol Nutr 2020;71:484-90. https://doi.org/10.1097/MPG.0000000000002819
  7. Kim K, Jeon HJ, Bae SH. Value of fluoroscopic defecography in constipated children with abnormal colon transit time test results. J Neurogastroenterol Motil 2020;26:128-32. https://doi.org/10.5056/jnm18201
  8. Dranove J, Fleishman N, Reddy S, Teich S. Does the oral-anal transit test correlate with colonic manometry findings in children with refractory constipation? Pediatr Gastroenterol Hepatol Nutr 2020;23:137-45. https://doi.org/10.5223/pghn.2020.23.2.137
  9. Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology 1987;92:40-7. https://doi.org/10.1016/0016-5085(87)90837-7
  10. Rao SS, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004;16:589-96. https://doi.org/10.1111/j.1365-2982.2004.00526.x
  11. Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil 2016;22:423-35. https://doi.org/10.5056/jnm16060
  12. Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005;129:86-97. https://doi.org/10.1053/j.gastro.2005.05.015
  13. Rao SS, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil 2015;27:594-609. https://doi.org/10.1111/nmo.12520
  14. Nolan T, Catto-Smith T, Coffey C, Wells J. Randomised controlled trial of biofeedback training in persistent encopresis with anismus. Arch Dis Child 1998;79:131-5. https://doi.org/10.1136/adc.79.2.131
  15. Ratuapli SK, Bharucha AE, Noelting J, Harvey DM, Zinsmeister AR. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology 2013;144:314-322.e2. https://doi.org/10.1053/j.gastro.2012.10.049
  16. Mellgren A, Bremmer S, Johansson C, Dolk A, Uden R, Ahlback SO, et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 1994;37:1133-41. https://doi.org/10.1007/BF02049817
  17. Harvey CJ, Halligan S, Bartram CI, Hollings N, Sahdev A, Kingston K. Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology 1999;211:223-7. https://doi.org/10.1148/radiology.211.1.r99mr16223
  18. Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Furst A. Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 2001;44:999-1007. https://doi.org/10.1007/BF02235489
  19. Koivusalo AI, Pakarinen MP, Rintala RI, Seuri R. Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int 2012;28:815-20. https://doi.org/10.1007/s00383-012-3125-3
  20. Loening-Baucke V. Biofeedback treatment for chronic constipation and encopresis in childhood: longterm outcome. Pediatrics 1995.96(1 Pt 1):105-10.
  21. van der Plas RN, Benninga MA, Buller HA, Bossuyt PM, Akkermans LM, Redekop WK, et al. Biofeedback training in treatment of childhood constipation: a randomised controlled study. Lancet 1996;348:776-80. https://doi.org/10.1016/S0140-6736(96)03206-0