Abstract
Aim: Compare fecal loading (FL) using Leech and Starreveld methods in children and adolescents with functional constipation (FC) or irritable bowel syndrome (IBS-C).
Methods: Single-center, observational, retrospective, cross-sectional study of consecutive cases referred with unresponsive constipation. Inclusion criteria: FC and IBS-C, according to the Rome IV Criteria, age between 4 and 15 years old. Exclusion criteria: underlying chronic disorders, no medication during the two weeks preceding the radiography. Data collection is executed from electronic medical records. Before the analysis, two pediatric gastroenterologists discussed the methods to ensure an accurate evaluation. The scores were applied to the entire colon.
Results: 114 children/adolescents were divided into the FC group (59 patients) and the IBS-C group (55 patients). Baseline characteristics highlight the more prevalent duration of symptoms and painful defecation in FC and female sex, defecation frequency, and abdominal pain in IBS-C. There is a high level of agreement between the two pediatric gastroenterologists in their assessment of FL for both FC and IBS-C, indicating the reliability of the methods. The FL scores in FC were higher than IBS-C, Leech (p<0.001), and Starreveld (p<0.002). The Leech proportion of positive score was FC (93%) and IBS-C (78%), and Starreveld, FC (95%) and IBS-C (89%). Results underscore the effectiveness of the methods in identifying FL. However, in the comparison of the proportion of positive results, FC was higher than IBS-C using only Leech (p<0.02) with Sensitivity (0.93) and Specificity (0.21), and the Starreveld method does not differentiate FC and IBS-C (p=0.30).
Conclusions: FC and IBS-C effectively identify groups with differences in FL. Notably, IBS-C had a significantly lower FL score than FC. Thus, the simplicity, low cost, and applicability of the Leech and the Starreveld for observing the FL and gas distribution in the colonic segments may permit better therapeutic planning.
Keywords
Functional constipation, Irritable bowel syndrome, Abdominal radiography, Children, Leech method, Starreveld method, Fecalloading