Recently the cost of Sitzmarks® increased to $175 (for 12)–it’s worth the cost. According to one study, the use of a transit study helps determine which patients will benefit from colonic manometry (JPGN 2012; 54: 258-62). A retrospective review of 24 children showed that all five children with normal oral-anal transit (OTT) studies had normal colonic manometry. In contrast, 9/19 (47%) with abnormal (slow OTT) had abnormal colonic manometry.
The authors define their approach to OTT which is helpful.
- In patients with a fecal impaction, this was cleared prior to starting study
- If patients had difficulty with capsule ingestion, markers were administered by embedding in part of a banana or mixed with applesauce
- Stimulant laxatives withheld for 72hrs prior to study
- AXR obtained on days 3 and 5
- Slow OTT (abnormal) defined as >6 markers proximal to rectum on day 5
Of those with abnormal colonic manometry, two-thirds (6) were referred for surgical intervention; one patient with normal OTT had surgery. Surgeries: 3 cecostomy, 4 subtotal colectomy.
- -JPGN 2004; 38: 75. Colostomy in 10 children with intractable constipation.
- -Arch Dis Child. 2004 Jan;89(1):13-6. Benninga MA, Voskuijl WP, Akkerhuis GW, Taminiau JA, Buller HA. Related Articles, Colonic transit times and behaviour profiles in children with defecation disorders.
- -J Pediatr Surg. 2004 Jan;39(1):73-7. Youssef NN, Pensabene L, Barksdale E Jr, Di Lorenzo C. Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?
- -Am J Gastroenterol. 2003 May;98(5):1052-7. Pensabene L, Youssef NN, Griffiths JM, Di Lorenzo C. Related Articles, Colonic manometry in children with defecatory disorders. role in diagnosis and management.
- -JPGN 2002 Jul;35(1):31-8. Gutierrez C, Marco A, Nogales A, Tebar R. Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation.
- -JPGN 2001 Nov;33(5):588-91. Villarreal J, Sood M, Zangen T, Flores A, Michel R, Reddy N, Di Lorenzo C, Hyman PE. Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions.