Hutson JM^1,2,3, Hynes MC⁴, Kearsey I⁴, Yik YI^5,4,6, Veysey DM⁷, Tudball CF⁷, Cain TM⁷, King SK^5,4,8,9, Southwell BR^5,4. Pediatr Surg Int. 2019 Oct 31. doi: 10.1007/s00383-019-04587-x. [Epub ahead of print]

Author information

1 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. john.hutson@rch.org.au.

2 Department of Urology, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, Australia. john.hutson@rch.org.au.

3 Department of Paediatrics, University of Melbourne, Melbourne, Australia. john.hutson@rch.org.au.

4 Department of Paediatrics, University of Melbourne, Melbourne, Australia.

5 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.

6 Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

7 Department of Nuclear Medicine, The Royal Children's Hospital, Melbourne, Australia.

8 Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia.

9 Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.

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.