DEFECATION DISORDERS IN CHILDREN, COLONIC TRANSIT-TIME VERSUS THE BARR-SCORE

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate th e presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipa ted children. On clinical grounds, patients (median age 8 years (5-14 years)) could be divided into three groups; constipation, isolated enc opresis/soiling and recurrent abdominal pain. Barr-scores, a method fo r assessment of stool retention using plain abdominal radiographs, wer e obtained in the first 101 patients, for comparison with CTT measurem ents as to the clinical outcome. Of the children with constipation, 48 % showed significantly prolonged total and segmental CTT. Surprisingly 91% and 91%, respectively, of the encopresis/soiling and recurrent ab dominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segm ents, known as colonic inertia, was found in the constipation group on ly. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/ soiling children formed a separ ate entity among children with defaecation disorders, compared to chil dren with constipation. Recurrent abdominal pain in children was in th e great majority, not related to-constipation. Barr-scores were poorly reproducible, with low inter-and intra-observer reliability. This is the first study which shows that clinical differences in constipated c hildren are associated with different colonic transit patterns. The us efulness of CTT measurements lies in the objectivation of complaints a nd the discrimination of certain transit patterns. Conclusion Abdomina l radiographs, even when assessed with the Barr-score proved unreliabl e in diagnosing constipation. Marker studies should be performed in th e second stage of evaluation after failure of initial therapy.