It is often seen that children with chronic idiopathic constipation (CIC) visit a surgeon when medical therapies have failed. With regard to this, rapid transit constipation, a pattern of CIC has garnered significant attention. It was first identified in 2011 as part of surgical workup. The identification was done by a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to find out the site of slowing within the bowel and to inform surgical treatment. The researchers found that rapid transit constipation occurred in 29% of 1,000 transit studies in a retrospective audit. Irritable bowel syndrome occur in 7-21% of the population, affecting children the most, and with constipation-type being the commonest one. Of these, nearly 60% patients improve with time while 40% continue with symptoms.

First-line treatment for irritable bowel syndrome in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols. It helps in decreasing the symptoms in more than 70% of patients. Fructose intolerance is reported in approximately 35-55% of children with functional gastrointestinal disorders. Thus, reducing fructose produced remarkable improvement in 77-82% of intolerant patients. Exclusion of fructose significantly improved abdominal pain, constipation, stool consistency and reduced laxative usein children with rapid transit constipation and a positive breath test upon fructose challenge. Thus, the researchers have hypothesized that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in rapid transition constipation suggest irritable bowel syndrome-constipation. These findings enhance the chances that a large proportion of children with CIC could benefit if fructose is reduced early in their diet and this may also help in preventing the development of irritable bowel syndrome in later life.

Source: PediatrSurg Int. 2020 Jan;36(1):11-19.