Yik Yee Ian, Clarke Melanie C C, Catto-Smith Anthony G, Robertson Val J, Sutcliffe Jonathan R, Chase Janet W, Gibb Susan, Cain Timothy M, Cook David J, Tudball Coral F, Hutson John M, Southwell Bridget R
F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, VIC, 3052, Australia.
Pediatr Surg Int. 2011 Jul;27(7):705-11. doi: 10.1007/s00383-011-2872-x. Epub 2011 Mar 4.
Transcutaneous electrical stimulation (TES) speeds up colonic transit in children with slow-transit constipation (STC). This study examined if concurrent upper gastrointestinal dysmotility (UGD) affected response to TES.
Radio-nuclear transit studies (NTS) were performed before and after TES treatment of STC as part of a larger randomised controlled trial. UGD was defined as delayed gastric emptying and/or slow small bowel transit. Improvement was defined as increase of ≥1 Geometric Centre (median radiotracer position at each time [small bowel = 1, toilet = 6]).
Forty-six subjects completed the trial, 34 had NTS after stimulation (21 M, 8-17 years, mean 11.3 years; symptoms >9 years). Active stimulation increased transit in >50% versus only 25% with sham (p = 0.04). Seventeen children also had UGD. In children with STC and either normal upper GI motility (NUGM) and UGD, NTS improved slightly after 1 month (57 vs. 60%; p = 0.9) and more after 2 months (88 vs. 40%; p = 0.07). However, mean transit rate significantly increased with NUGM, but not UGD (5.0 ± 0.2: 3.6 ± 0.6, p < 0.01).
Transcutaneous electrical stimulation was beneficial for STC, with response weakly associated with UGD. As measured by NTS, STC children with NUGM responded slightly more, but with significantly greater increased transit compared to those with UGD. Higher numbers are needed to determine if the difference is important.
经皮电刺激（TES）可加快慢传输型便秘（STC）患儿的结肠传输。本研究旨在探讨同时存在的上消化道动力障碍（UGD）是否会影响对TES的反应。
作为一项更大规模随机对照试验的一部分，在对STC患儿进行TES治疗前后进行了放射性核素传输研究（NTS）。UGD定义为胃排空延迟和/或小肠传输缓慢。改善定义为几何中心增加≥1（每次的放射性示踪剂中位位置[小肠=1，排便=6]）。
46名受试者完成了试验，34名在刺激后进行了NTS（21名男性，8 - 17岁，平均11.3岁；症状出现>9年）。主动刺激使超过50%的患儿传输加快，而假刺激组仅为25%（p = 0.04）。17名儿童也存在UGD。在患有STC且上消化道动力正常（NUGM）和UGD的儿童中，NTS在1个月后略有改善（57%对60%；p = 0.9），2个月后改善更明显（88%对40%；p = 0.07）。然而，NUGM组的平均传输速率显著增加，而UGD组未增加（5.0±0.2：3.6±0.6，p < 0.01）。
经皮电刺激对STC有益，其反应与UGD的相关性较弱。通过NTS测量，NUGM的STC患儿反应稍多，但与UGD患儿相比，传输增加更为显著。需要更多病例数来确定这种差异是否具有重要意义。
