Guidelines and Standard-of-Care
|Clinical Guidelines and Expert Opinions|
|…//… ”Your child needs a colonic transit study to show if there are any problems with their digestive system” …//…1|
…//…”There are no risks to your child linked to taking the pellets needed for this test, and they will pass out of your child in their faeces. They can be flushed away safely”…//…1
|…//… “Our experience is that supplementary investigation of these patients with colon transit time, anorectal manometry, defecography with several examinations, may be of value to better characterize the underlying mechanisms of constipation and thereby improve the possibilities for targeted, albeit experimental treatment”…//…2|
|…//… “(9) Based on expert opinion, a colonic transit study may be useful to discriminate between functional constipation and functional nonretentive fecal incontinence and in situations in which the diagnosis is not clear”…//…3|
|…//… “investigations of anorectal manometry, endosonography and colonic transit studies provide noninvasive objective assessment of diagnosis and severity of chronic IC and fecal incontinence in children. This information is valuable for the clinician to plan the treatment strategy and for parents and children to understand the underlying pathophysiology”…//…4|
|…//… “When Treatment Isn’t Working. “Intractable” constipation means that the symptom does not respond to the treatments described above. Persons with intractable constipation may see a specialist for diagnostic tests. These may include: Transit time or colonic marker studies: A simple test that measures movement of material through the colon over time”…//…5|
|…//… ”Transit time studies may be indicated in patients with rapid transit diarrhoea”…//…6|
|…//… “Colonic transit studies this test is generally reserved for patients who have failed medical therapy, as it may guide further management including consideration of potential surgical interventions”…//…|
…//… “Slight differences in performing the test exist between laboratories, with one validated method being the ingestion of 10 radiopaque markers per day for six consecutive days, followed by fluoroscopy imaging on the morning of day 7 to count the remaining markers”…//…7
|…//… “Colonic transit tests are required to distinguish normal from slow-transit constipation, colonic scintigraphy and ROM can provide initial information to differentiate between diffuse and localized colonic dysmotility and/or evacuation disorders and that the recommended diagnostic approaches are ROM studies and colonic scintigraphy, which are considered the best suited for measurement of CTT”…//…8|
|…//… “12. Statement: Colon transit time is useful for differentiating between the subtypes of defecatory disorders and slow transit constipation in patients with chronic constipation. Grade of recommendation: 1. Level of evidence: B. Experts’ opinions: completely agree (20%), mostly agree (68%), partially agree (8%), mostly disagree (4%), completely disagree (0%), and not sure (0%)”…//…9|
|…//… “Assessments of colonic transit and anorectal function allow patients to be categorized into 3 subgroups (i.e., defecatory disorders, normal transit constipation [NTC], and slow transit constipation [STC]), which facilitates management in refractory patients”…//…10|
|…//… “Physiologic tests for chronic constipation”…//… “Colonic transit study with radiopaque markers is useful for classifying patients according to pathophysiological subtypes”…//…11|
|…//… “Application: Measurement of total GITT and segmental colonic transit by repeated marker ingestion followed by a single X-ray is applicable both in clinical practice and in scientific studies of colonic transit”…//…12|
- The National Health Service (NHS), The Gastroenterology Investigation Suite in collaboration with the Child and Family Information Group (2020). Colon transit (pellet) study. https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/colonic-transit-pellet-study/. Accessed on January 24, 2023.
- Grimheden, P., Mårtensson, T., Klevebro, S., et al (2019). Funktionell obstipation hos barn och ungdomar. https://gastro.barnlakarforeningen.se/vardprogram-2/. Accessed on January 24, 2023.
- Tabbers, M.M., DiLorenzo, C., Berger, M.Y., et al. (2014). Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN. JPGN. Vol. 58, No. 2, 258-274.
- Keshtgar, A.S., Ward, H.C., Clayed, G.S. (2013). Pathophysiology of chronic childhood constipation_ Functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study. Journal of Pediatric Surgery. Vol. 48, 806-812.
- The International Foundation for Gastrointestinal Disorders (IFFGD). Overview of Constipation Treatments. https://aboutconstipation.org/treatment/treatment-overview/. Accessed on January 24, 2023.
- Savarino, E., Zingone, F., Barberio, B., et al. (2022). Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. Vol. 10, 556-584. https://doi.org/10.1002/ueg2.12259
- Aziz, I., Whitehead, W.E., Palsson, O., Törnblom, H. & Simrén, M. (2020). Expert Review of Gastroenterology & Hepatology. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation [electronic version]. Taylor & Francis Group, Vol. no. 14, 1-8.
- Keller, J., Bassotti, G., Clarke, J., et al. (2018). EXPERT CONSENCUS DOCUMENT. Advances in the diagnosis and classification of gastric and intestinal motility disorders [electronic version]. Nat Rev Gastroenterol Hepatol., Vol. 15(5), 291-308.
- Shin, J.E., Jung, H-K., Lee, T.H., et al. (2016). Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition. J Neurogastroenterol Motil., Vol. 22, 383-411.
- Bharucha, A.E., Dorn, S.D., Lembo, A., et al. American Gastroenterological Association [AGA]. (2013). GUIDELINE. Evaluation and management of constipation. https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/. Accessed on January 24, 2023.
- Lindberg, G., Hamid, S., Malfertheiner, P., et al. (2010). World Gastroenterology Organisation Global Guidelines. Constipation: A Global Perspective. https://www.worldgastroenterology.org/guidelines/constipation/constipation-english. Accessed on January 24, 2023.
- Scandinavian Association for Gastrointestinal Motility. (1991). Methods for studying gastrointestinal motility: consensus reports from working teams organized by Scandinavian Association for Gastrointestinal Motility (SAGIM). Almqvist & Wiksell, Stockholm.