Don’t Let the Chief of Staff Review This Constipation Study

A useful study from Cincinnati (D Klaus et al. J Pediatr 2016; 171: 183-8) provides data on the high prevalence of constipation in Duchenne Muscular Dystrophy. (DMD)  Though, the authors acknowledge that rectal examination was “deferred unless clinically indicated.” I’m fairly certain that the former chief of staff, if asked for input, would have stated that the only two reasons for not doing this part of the exam was “either no rectum or no finger.”

In this prospective cross-sectional study, the authors relied on the Questionnaire on Pediatric Gastrointestinal Symptoms based on Rome-III criteria (QPGS-RIII) to identify constipation.  Based on this questionnaire, 46.7% (56 of 120) of patients with DMD were diagnosed with functional constipation.

  • Traditional features of constipation like bowel movement infrequency of <3/week and hard stools were present in only 16% and 17% respectively.
  • Other features that identified constipation included straining with defecation in 35.1%, painful defecation (27.8%), and clogging toilet (22.6%)
  • The Bristol Stool scale had a low sensitivity for detecting constipation (only 18%) but had a high specificity of 95% if type 1 or 2.
  • Constipation did not increase with age or functional status which makes the concern that this is primarily related to an ineffective bear-down (Valsalva) less likely

My take: Constipation in children with DMD is underreported and often overlooked.  It needs to be considered more carefully at routine visits.

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When you look closely at the horse's nose, you can see that this art was completed with toy soldiers

When you look closely at the horse’s nose, you can see that this art was completed with toy soldiers

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