Lefteris Stathopoulos1, Sebastian K King1,2,3, Bridget R Southwell1,2, John M Hutson4,5,6. 1. Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. 2. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 3. Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia. 4. Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. john.hutson@rch.org.au. 5. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. john.hutson@rch.org.au. 6. Department of Urology, The Royal Children's Hospital, Melbourne, VIC, Australia. john.hutson@rch.org.au.
Abstract
BACKGROUND/ PURPOSE: Long-term problems with faecal incontinence occur in up to 50 % of patients after pull-through for Hirschsprung disease (HSCR). The cause often remains unknown, leading to empirical treatments. Using nuclear transit study, we found some patients surprisingly had rapid proximal colonic transit, suspicious of occult diarrhoea. We aimed to assess whether these patients had unrecognized adverse reactions to food. METHODS: Patients (n = 10, all males, 9.6 year; 4.25-15.5 years) with persistent faecal incontinence following pull-through for HSCR referred to the senior author and after exclusion of anatomical defects, underwent nuclear transit studies. Most (8) subsequently underwent breath hydrogen tests for sugar malabsorption and were tested for adverse reactions to food. Exclusion diets for protein allergens, lactose or fructose were then trialed. RESULTS: Of the 10 patients with rapid intestinal transit proven on nuclear transit study, breath hydrogen tests for fructose and/or lactose malabsorption were done in 8, and were positive in 7/8 patients. Exclusion diets contributed to either resolution or improvement in faecal incontinence in 9/10 patients. CONCLUSIONS: Rapid transit in the proximal, ganglionated colon may be present in children with faecal incontinence following pull-through for HSCR, possibly secondary to adverse reactions to food. This study suggests that children with post-operative soiling may benefit from a transit study and hydrogen breath tests to diagnose adverse reactions to food caused by sugar malabsorption.
BACKGROUND/ PURPOSE: Long-term problems with faecal incontinence occur in up to 50 % of patients after pull-through for Hirschsprung disease (HSCR). The cause often remains unknown, leading to empirical treatments. Using nuclear transit study, we found some patients surprisingly had rapid proximal colonic transit, suspicious of occult diarrhoea. We aimed to assess whether these patients had unrecognized adverse reactions to food. METHODS:Patients (n = 10, all males, 9.6 year; 4.25-15.5 years) with persistent faecal incontinence following pull-through for HSCR referred to the senior author and after exclusion of anatomical defects, underwent nuclear transit studies. Most (8) subsequently underwent breath hydrogen tests for sugarmalabsorption and were tested for adverse reactions to food. Exclusion diets for protein allergens, lactose or fructose were then trialed. RESULTS: Of the 10 patients with rapid intestinal transit proven on nuclear transit study, breath hydrogen tests for fructose and/or lactose malabsorption were done in 8, and were positive in 7/8 patients. Exclusion diets contributed to either resolution or improvement in faecal incontinence in 9/10 patients. CONCLUSIONS: Rapid transit in the proximal, ganglionated colon may be present in children with faecal incontinence following pull-through for HSCR, possibly secondary to adverse reactions to food. This study suggests that children with post-operative soiling may benefit from a transit study and hydrogen breath tests to diagnose adverse reactions to food caused by sugarmalabsorption.
Authors: Jonathan R Sutcliffe; Sebastian K King; John M Hutson; David J Cook; Bridget R Southwell Journal: Pediatr Surg Int Date: 2009-05-06 Impact factor: 1.827