Characterizing colonic motility in children with chronic intractable constipation: a look beyond high-amplitude propagating sequences

S Wessel, I Koppen, Lukasz Wiklendt, Marcello Costa, Marc Benninga, Philip Dinning

    Research output: Contribution to journalArticlepeer-review

    23 Citations (Scopus)

    Abstract

    Background: Children with chronic intractable constipation experience severe and long-lasting symptoms, which respond poorly to conventional therapeutic strategies. Detailed characterization of colonic motor patterns in such children has not yet been obtained. Methods: In 18 children with chronic intractable constipation, a high-resolution water-perfused manometry catheter (36 sensors at 1.5-cm intervals) was colonoscopically placed with the tip at the distal transverse colon. Colonic motor patterns were recorded for 2 h prior to and after a meal and then after colonic infusion of bisacodyl. These data were compared with previously published colonic manometry data from 12 healthy adult controls and 14 adults with slow-transit constipation. Key Results: The postprandial number of the retrograde cyclic propagating motor pattern was significantly reduced in these children compared with healthy adults (children, 3.1 ± 4.7/h vs healthy adults, 34.7 ± 45.8/h; p < 0.0001) but not constipated adults (4.5 ± 5.6/h; p = 0.9). The number of preprandial long-single motor patterns was significantly higher (p = 0.003) in children (8.0 ± 13.2/h) than in healthy adults (0.4 ± 0.9/h) and in constipated adults (0.4 ± 0.7/h). Postprandial high-amplitude propagating sequences (HAPSs) were rarely observed in children (2/18), but HAPS could be induced by bisacodyl in 16 of 18 children. Conclusions & Inferences: Children with chronic intractable constipation show a similar impaired postprandial colonic response to that seen in adults with slow-transit constipation. Children may have attenuated extrinsic parasympathetic inputs to the colon associated with an increased incidence of spontaneous long-single motor patterns.

    Original languageEnglish
    Pages (from-to)743-757
    Number of pages15
    JournalNeurogastroenterology and Motility
    Volume28
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2016

    Keywords

    • Colon
    • Constipated children
    • High-resolution manometry
    • Motor patterns
    • Neural pathways

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