Gutiérrez Carolina, Marco Alfredo, Nogales Angel, Tebar Roque
Service of Pediatrics and Section of Pediatric Surgery, Hospital General Albacete, Albacete; and Department of Pediatrics, Hospital Universitario Doce de Octubre, Madrid, Spain.
J Pediatr Gastroenterol Nutr. 2002 Jul;35(1):31-8. doi: 10.1097/00005176-200207000-00008.
Constipation is a frequent symptom in pediatric clinical practice, although the underlying pathogenesis is not fully understood. Estimating the colonic transit time may help identify subgroups of patients with different physiopathologic mechanisms.
Thirty children with normal bowel habits and 38 children with chronic idiopathic constipation, aged 2 to 14 years, were studied. The total and segmental colonic transit times were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe.
The observed upper reference values were 19.02 hours for the right colon, 19 hours for the left colon, 32 hours for the rectosigmoid colon, and 45.7 hours for the total colon. Fifty percent of the children with chronic idiopathic constipation had colonic transit times within reference values, whereas 37% had left colonic and rectosigmoid delays and 13% had global delay in all colonic segments (colonic inertia). Paradoxic anal contraction was observed in 64% of the constipated children with distal delay but in none of the subjects with colonic inertia.
Estimating colonic transit time is a simple and noninvasive technique for classifying patients with constipation. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.
便秘是儿科临床实践中常见的症状，但其潜在发病机制尚未完全明确。估计结肠运输时间可能有助于识别具有不同生理病理机制的患者亚组。
对30名排便习惯正常的儿童和38名年龄在2至14岁的慢性特发性便秘儿童进行研究。通过连续6天服用多个不透X线标志物，并在第7天进行一次腹部X线摄影来估计总结肠运输时间和节段性结肠运输时间。使用Arhan探头通过测压法评估肛门直肠功能。
观察到的右半结肠、左半结肠、直肠乙状结肠和全结肠的参考上限值分别为19.02小时、19小时、32小时和45.7小时。50%的慢性特发性便秘儿童的结肠运输时间在参考值范围内，而37%的儿童存在左半结肠和直肠乙状结肠运输延迟，13%的儿童所有结肠段均存在整体延迟（结肠惰性）。在64%的存在远端延迟的便秘儿童中观察到反常性肛门收缩，但在结肠惰性患儿中未观察到。
估计结肠运输时间是一种用于便秘患者分类的简单且无创的技术。结肠惰性可能是整体运动功能障碍的一种表现。远端结肠运输延迟的儿童更有可能出现异常排便动力学。
