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‘Rapid transit’ constipation in children: a possible genesis for irritable bowel syndrome

  • J. M. HutsonEmail author
  • M. C. Hynes
  • I. Kearsey
  • Y. I. Yik
  • D. M. Veysey
  • C. F. Tudball
  • T. M. Cain
  • S. K. King
  • B. R. Southwell
Review Article
  • 56 Downloads

Abstract

Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called ‘Rapid transit constipation (RTC)’ first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7–21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35–55%. Reducing fructose produced significant improvement in 77–82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.

Keywords

Fructose intolerance FODMAPs Hydrogen/methane breath test Nuclear medicine Gastrointestinal transit study Nuclear transit study 

Notes

Funding

This review was not funded.

Compliance with ethical standards

Conflict of interest

There are no known conflicts of interest for any of the authors involved in this paper.

Ethical approval

This is a review and opinion piece. No studies were performed. This article does not contain any studies with human participants performed by any of the authors.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Surgical Research GroupMurdoch Children’s Research InstituteMelbourneAustralia
  2. 2.Department of UrologyThe Royal Children’s HospitalParkvilleAustralia
  3. 3.Department of PaediatricsUniversity of MelbourneMelbourneAustralia
  4. 4.Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  5. 5.Department of Nuclear MedicineThe Royal Children’s HospitalMelbourneAustralia
  6. 6.Department of Paediatric SurgeryThe Royal Children’s HospitalMelbourneAustralia
  7. 7.Department of Gastroenterology and Clinical NutritionThe Royal Children’s HospitalMelbourneAustralia

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