Hamdy Ahmed M, Sakr Hossam M, Boules Ireny S, Awad Yosra M M
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Paediatr Child Health. 2023 Mar;59(3):533-536. doi: 10.1111/jpc.16344. Epub 2023 Jan 30.
The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter.
A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age- and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3 months of laxative therapy and behavioural modification.
Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3 cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3 cm for the former and >2.5 cm for the latter. After 3 months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter.
Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.
本研究主要旨在比较不同年龄组功能性便秘（FC）儿童与无便秘儿童的直肠横径，以及便秘患儿基线时与治疗后的直肠横径。次要目的是确定可能影响直肠横径的因素。
一项对照前瞻性研究，共纳入100名2至11岁儿童，根据罗马IV标准将其分为50例便秘患儿和50例年龄及性别匹配的对照组。在就诊时、泻药治疗和行为矫正3个月后测量直肠横径。
病例组（3.55厘米（四分位间距，IQR），3.2 - 4）与对照组（2.3厘米（IQR，1.8 - 2.5））的初始直肠直径有显著差异，P值<0.001，且4岁以上和4岁以下儿童之间也有显著差异，因此建议便秘诊断的不同切点分别为前者>3厘米，后者>2.5厘米。随访3个月后，直肠直径显著减小至2.6（IQR，2 - 2.8），P值<0.001。症状持续时间与直肠直径呈正相关。
超声测量直肠直径是诊断和随访儿童功能性便秘的重要工具。4岁以上和4岁以下儿童的直肠直径值不同。
