Carmine was used as a marker to estimate the transit time through the gut of 306 children with recurrent abdominal pain (RAP) of whom 96 had migraine as well. They were compared with a further 160 children with migraine alone.
Clinical examination revealed that having rectal constipation was present in 66 (22%) of children with RAP and transit was delayed in 91% of them. They presented distinctive features which suggest that rectal constipation alone may be a cause of RAP. In the remaining 240 children (78%) colonic spasm was thought to be responsible for attacks of abdominal pain. Transit time was prolonged in 44% and the colon was tender in 45% of cases. Colonic tenderness was associated more often with migraine and with a greater incidence and severity of intestinal delay than when colonic tenderness was absent. However in neither subgroup did the coexistence of migraine further delay intestinal transit. Children with migraine alone showed a delay in transit in 27% of cases, possibly accounted for mostly by colonic constipation, but delay is almost doubled in incidence and severity if abdominal pain supervenes with colonic tenderness.
It is suggested that when rectal constipation has been excluded, children with RAP should be classified as cases of colonic spasm in view of the strong similarity with spastic colon of adults.