Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study

Abstract

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children’s Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189–11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67–365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27–15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.

Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal pain: A case-control study in Tehran‑Iran

“…In and the study, nearly 20% of participants had blood lead levels more than 5 µg/dL (9). according to Zamani et al In lead-poisoned children, abdominal pain is among the most frequent symptom accompanying constipation (23).…”

“…As there are different sources of lead pollution in the air, water, soil, and food, lead poisoning is of great concern in children who live in Tehran, that may lead to deleterious complications. Air pollution is a major cause of lead poisoning, according to earlier research conducted in Iran (23). Children who live in industrial areas and in areas with high air pollution records are at a signi cant risk of lead poisoning since the respiratory system is the main route through which lead is absorbed.…”

The Effect of the Flint Water Crisis Secondary to Increased Lead Levels in Drinking Water on Constipation in Children in the City of Flint, Michigan, USA

“…From a gastrointestinal point of view, lead poisoning can cause abdominal pain and constipation. Around 20% of the patients who had constipation were found to have elevated lead blood levels in Tehran [ 12 ]. Gastrointestinal manifestations due to lead poisoning can be explained by lead’s inhibitory effect on the intestine's neural plexus and intestinal smooth muscle contraction [ 13 ].…”