Abstract General Information

Title

MORPHOLOGICAL AND CONNECTOMIC BRAIN CORRELATES OF CONSTIPATION IN 9- TO 10-YEAR-OLDS IN THE US.

Introduction and objective

Constipation is common in children with urinary incontinence. Previous studies on adults reported altered cortical morphometry as well as functional connectivity (FC) associated with constipation. The aim of this study was to identify structural and functional changes in pediatric patients with constipation.

Method

Using the population-based Adolescent Brain Cognitive Development (ABCD) Study that recruited over 11,000 9- to 10-year-olds across the US, we compared structural and resting-state functional MRI parameters of children with constipation to healthy controls. Constipation was assessed according to the child behavioral checklist. Our control group had no history of constipation, urinary incontinence, encopresis and mental health diagnoses as well as no parental drug use and mental health comorbidities. MRI variables of interest included thickness, volume, and sulcus depth of 26 cortical regions, volume of 19 subcortical regions, FC within and between 6 cortical networks (cingulo-opercular, salience, dorsal and ventral attention, default and fronto-parietal networks) as well as FC from 6 cortical networks to 19 subcortical regions. Univariate logistic regression determined differences in MRI parameters between groups. Similarly, we compared the following covariates between groups: gender, age, race/ethnicity and diagnosis of ADHD, depression, oppositional defiant behavior and anxiety. Covariates with p<0.05 in the univariate regression were included in multivariate models.

Results

The final cohort consisted of 712 children with constipation (411 (57.7%) females and 301 (42.3%) males) and 488 controls (257 (52.7%) females and 231 (47.3%) males) with a mean age of 10.0 (±0.6) years. Race/ethnicity were included in the multivariate model. After covariate adjustment, children with constipation had higher cortical thickness of bilateral pars triangularis (p≤0.014), left isthmus of the cingulate cortex (p=0.044), insula (p=0.015) and lateral orbitofrontal (p=0.009) as well as right pars orbitalis (p=0.005), precuneus (p=0.004), rostral middle frontal (p=0.017) and superior frontal (p=0.021) regions. Additionally, the constipated group showed lower volume of the cerebellar cortex (p≤0.021) and increased FC of the dorsal attention network to the left amygdala (p=0.016).

Conclusion

Our analysis provides multimodal neuroimaging evidence on brain morphology and FC alterations, especially in the prefrontal cortex and supplementary motor area, in association with pediatric constipation, which portrays important clues for new treatment strategies.