Slow-transit constipation in childhood

Background/Purpose: Intestinal neuronal dysplasia (IND) as a cause for seve re chronic constipation remains controversial. The authors have identified a deficiency of substance P (SP) immunoreactivity in the colonic nerve fibr es of some children with severe constipation, and aim to correlate this Wit h clinical features and transit studies. Methods: Over 100 children with intractable constipation with or without so iling have been assessed by clinical questionnaire, nuclear transit study, and laparoscopic seromuscular biopsy of the colon labelled with antibodies to SP and vasoactive intestinal peptide (VIP) using immunofluorescence. Results: More than 30% of children had delayed passage of meconium, and sym ptoms of constipation appeared by the age of 1 year in 63%. More than 80% h ad significant delay in colonic transit, and of these, about 80% had reduce d SP immunoreactivity in the axons of the colonic circular muscle. A furthe r 6% had heterotopic ganglion cells or hypoplastic ganglia on routine histo logy. Conclusions: In children with intractable constipation, features of early o nset and delayed colonic transit correlated with deficiency of SP in myente ric axons. The authors propose that deficient SP immunoreactivity may be us ed as a histological marker for severe constipation. Defective excitatory n euromuscular transmission may be the cause of slow colonic transit. Copyrig ht (C) 1999 by W.B. Saunders Company.