Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2017 Oct;29(10):1-9. doi: 10.1111/nmo.13110. Epub 2017 May 19.
Colonic dilation is common in children with intractable functional constipation (FC). Our aim was to describe the association between segmental colonic dilation and colonic dysmotility in children with FC.
We performed a retrospective study on 30 children with intractable FC (according to the Rome III criteria) who had undergone colonic manometry and contrast enema within a 12-month time period. Colonic diameter was measured at 5 cm intervals from the anal verge up to the splenic flexure. Moreover, the distance between the lateral margins of the pedicles of vertebra L2 was measured to provide a ratio (colonic diameter or length/distance between the lateral margins; "standardized colon size" [SCS]). All manometry recordings were visually inspected for the presence of high-amplitude propagating contractions (HAPCs); a parameter for colonic motility integrity. The intracolonic location of the manometry catheter sensors was assessed using an abdominal X-ray.
Colonic segments with HAPCs had a significantly smaller median diameter than colonic segments without HAPCs (4.08 cm vs 5.48 cm, P<.001; SCS 1.14 vs 1.66, P=.001). Children with prematurely terminating HAPCs had significantly larger SCS ratios for colonic diameter than children with fully propagating HAPCs (P=.008). SCS ratios for the length of the rectosigmoid and the descending colon and the SCS ratio for sigmoid colon diameter were significantly larger in children with FC compared to a previously described normative population (P<.0001, P<.0001 and P=.0007 respectively).
CONCLUSIONS & INFERENCES: Segmental colonic dilation was associated with prematurely terminating HAPCs and may be a useful indicator of colonic dysmotility.
在难治性功能性便秘（FC）患儿中，结肠扩张很常见。我们的目的是描述难治性 FC 患儿中结肠扩张与结肠动力障碍之间的关系。
我们对在 12 个月内接受结肠测压和对比灌肠的 30 例难治性 FC 患儿（根据罗马 III 标准）进行了回顾性研究。从肛缘向上至脾曲，每隔 5cm 测量结肠直径。此外，还测量了第 2 腰椎椎弓根外侧缘之间的距离，以提供一个比值（结肠直径或长度/外侧缘之间的距离；“标准化结肠大小”[SCS]）。所有测压记录均进行目测检查，以评估是否存在高振幅传播收缩（HAPC）；这是结肠运动完整性的一个参数。通过腹部 X 射线评估测压导管传感器在肠内的位置。
存在 HAPC 的结肠节段的直径中位数明显小于不存在 HAPC 的结肠节段（4.08cm 比 5.48cm，P<.001；SCS 为 1.14 比 1.66，P=.001）。HAPC 提前终止的患儿的结肠直径 SCS 比值明显大于完全传播的 HAPC 患儿（P=.008）。与之前描述的正常人群相比，FC 患儿的直肠乙状结肠和降结肠长度的 SCS 比值以及乙状结肠直径的 SCS 比值明显更大（P<.0001、P<.0001 和 P=.0007）。
节段性结肠扩张与 HAPC 提前终止有关，可能是结肠动力障碍的一个有用指标。
