Utility of gastrointestinal transit scintigraphy in chronic constipation evaluation

Introduction: Chronic constipation is a common pathology in clinical practice, representing a significant health burden, with a prevalence in the pediatric age group of 12% and in adults of 16%. In the absence of response to treatment, assessment of gastrointestinal function is recommended.

Gastrointestinal transit scintigraphy is currently considered the most sensitive non-invasive method to evaluate alterations of colon motility, although its use is not widespread in our health care system.

The aim of this study was to evaluate the utility of gastrointestinal transit scintigraphy in both´pediatric and adult patients with chronic constipation.

Methods: A retrospective study was designed including 37 patients referred to our department from April 2014 to November 2022 for evaluation chronic constipation refractory to treatment, syringomyelia, study prior to rectocele surgery or suspicion of abdominal migraine. The study group consisted of 19 pediatric patients (age range 5 to 16) and 18 adults (age range 17 to 74).

All of them had previously undergone clinical evaluation, analytical studies, and in some cases rectal biopsy. The radiological studies performed varied in each subject, including intestinal transit, anorectal manometry, balloon expulsion test and/or defecography.

A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. A dose of [111 In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calcúlate the geometric center.

Results: 26 patients were referred for constipation refractory to treatment (2 with disease associated with eosinophilic gastritis and Schaaf-Yang syndrome) 9 for rectocele, 1 for abdominal migraine and 1 for syringomyelia.

In pediatric group, scintigraphy study showed 4 with normal colon transit pattern, 3 with generalized slow pattern, 3 with functional outlet obstruction, 5 with colonic inertia, 3 with rapid proximal colonic transit and anorectal holdup and 1 with global delay (stomach and small and large intestine).

In adults group, 4 patients showed normal colon transit pattern, 4 with generalized slow pattern, 3 with functional outlet obstruction, 4 with colonic inertia and 3 with small-bowel transit delay.

Considering the group as a whole, scintigraphy results modified the therapeutic management in 28 patients.

Conclusions: Scintigraphic studies provided useful information in chronic constipation in both pediatric and adult patients, having an impact on diagnosis and therapeutic management.

Scintigraphy study is a reproducible and accurate method. Physiological and quantitative information provides both global and regional evaluation of gastrointestinal transit.