Devanarayana NM, Rajindrajith S, de Silva DGH, de Silva HJ. Delayed orocecal transit in pediatric gut-brain interaction disorders: A comparative study using the lactulose breath test. World J Gastrointest Pathophysiol 2025; 16(4): 110421 [DOI: 10.4291/wjgp.v16.i4.110421]
Corresponding Author of This Article
Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
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Gastroenterology & Hepatology
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Case Control Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 22, 2025 (publication date) through Dec 22, 2025
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World Journal of Gastrointestinal Pathophysiology
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2150-5330
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Devanarayana NM, Rajindrajith S, de Silva DGH, de Silva HJ. Delayed orocecal transit in pediatric gut-brain interaction disorders: A comparative study using the lactulose breath test. World J Gastrointest Pathophysiol 2025; 16(4): 110421 [DOI: 10.4291/wjgp.v16.i4.110421]
World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 110421 Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.110421
Delayed orocecal transit in pediatric gut-brain interaction disorders: A comparative study using the lactulose breath test
Niranga Manjuri Devanarayana, Shaman Rajindrajith, Delpechitracharige Gajabahu Harendra de Silva, Hithanadura Janaka de Silva
Niranga Manjuri Devanarayana, Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
Shaman Rajindrajith, Delpechitracharige Gajabahu Harendra de Silva, Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Western Province, Sri Lanka
Hithanadura Janaka de Silva, Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
Author contributions: Devanarayana NM conceptualized and designed the study, collected and analyzed the data, and wrote the initial manuscript; Rajindrajith S and de Silva DGH revised the manuscript; de Silva HJ contributed to the study concept and design and revised the manuscript.
Supported by The University of Kelaniya, No. RP/03/04/13/01/01.
Institutional review board statement: Ethical approval for the study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka.
Informed consent statement: Written informed consent was obtained from a parent or a guardian of each participant.
Conflict-of-interest statement: The authors report having no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE statement checklist of items, and the manuscript was prepared and revised according to the STROBE statement checklist of items.
Data sharing statement: The dataset used in the current study is available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Received: June 7, 2025 Revised: July 4, 2025 Accepted: November 4, 2025 Published online: December 22, 2025 Processing time: 199 Days and 16.7 Hours
Abstract
BACKGROUND
Functional abdominal pain disorders (FAPDs) are common gut–brain interaction disorders with unclear pathophysiology. While impaired gastrointestinal motility is thought to play a key role, small intestinal dysmotility remains largely unexplored. Orocecal transit time (OCTT), an indirect indicator of small intestinal transit, offers an insight into its potential contribution to FAPD's pathophysiology.
AIM
To assess OCTT in children with FAPDs compared with healthy children using the lactulose breath hydrogen test.
METHODS
Thirty-four children (44.1% males, age 5–12 years, mean 7.2 ± 2.4 years) with FAPDs attending North Colombo Teaching Hospital, Ragama, Sri Lanka, were included in the analysis. FAPDs were diagnosed using the Rome IV criteria. None had clinical or laboratory evidence of organic diseases. They were compared with 19 healthy controls (47.1% males, age 5-12 years, mean 7.8 ± 2.7 years) from the same geographical area. OCTT was calculated after an 8-hour fast using a previously validated technique. Breath hydrogen levels were measured at baseline and 15-minute intervals for 180 minutes post-lactulose ingestion (10 g in 10% solution). At each time point, 3 breath samples were collected and analyzed. OCTT was quantified as the time taken to achieve a sustained breath hydrogen increase > 10 parts per million above baseline. Symptoms were recorded using the Rome IV questionnaire, and symptom severity was graded on a 0-4 Likert scale.
RESULTS
Patients with FAPDs had increased OCTT (median, 90 minutes; interquartile range, 75-120 minutes) compared to controls (median, 75 minutes; interquartile range, 60-75 minutes) (P = 0.0045, Mann-Whitney U-test). Children with functional dyspepsia had the longest mean OCTT (110.8 ± 26.7 minutes). There was no significant correlation between abdominal pain severity and OCTT (r = 0.18, P = 0.35, Spearman correlation coefficient). OCTT did not differ between those exposed to stressful events and those not exposed to such events (P > 0.05).
CONCLUSION
Children with FAPDs have longer OCTT than healthy controls. However, the lack of a significant correlation between OCTT and symptom severity suggests that delayed small intestinal transit alone is not a substantial contributor to FAPD pathophysiology.
Core Tip: This study evaluated orocecal transit time (OCTT) in children with functional abdominal pain disorders (FAPDs) using the breath hydrogen test. Results showed significantly longer OCTT in patients compared to healthy controls, suggesting that impaired small intestinal transit may be a feature of FAPDs. However, the lack of correlation between OCTT and symptom severity indicates that delayed transit is unlikely to be a major contributor to symptom generation. These findings highlight the complexity of FAPD pathophysiology and suggest that while small intestinal motility disturbances are present, other mechanisms likely play a key role in symptom expression.
