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Colonic manometry in children with defecatory disorders. role in diagnosis and management
Licia Pensabene1, Nader N Youssef, Janet M Griffiths
1Department of Pediatrics, Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Insights
Colonic manometry helps understand childhood defecatory disorders. This diagnostic tool guided treatment changes in 93% of patients, leading to symptom improvement in 78%.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Diagnostic Imaging
Background:
- Childhood defecatory disorders present complex diagnostic challenges.
- Accurate pathophysiology identification is crucial for effective management.
Purpose of the Study:
- To assess the utility of colonic manometry in diagnosing the underlying causes of defecatory disorders in children.
- To determine the impact of colonic manometry findings on clinical management decisions.
Main Methods:
- Retrospective review of medical records for 146 children who underwent colonic manometry between 1996 and 2001.
- Follow-up of families median 20 months post-evaluation to assess outcomes.
Main Results:
- Colonic manometry was performed in 150 children, requested for various indications including lower GI symptoms (68%) and post-surgical Hirschsprung's disease (14%).
- Abnormal colonic motility was identified in 45% of children. Treatment recommendations were made in 93% of cases.
- Following recommendations, 78% of patients experienced symptom improvement, with 88% of parents finding the guidance helpful.
Conclusions:
- Colonic manometry is a valuable tool for clarifying the pathophysiology of defecatory disorders in children.
- The procedure significantly influences treatment strategies and improves patient outcomes.
Objective:
The aim of this study was to evaluate the role of colonic manometry in clarifying pathophysiology of childhood defecatory disorders and to evaluate its impact on management.
Methods:
We conducted a retrospective review of medical records of children referred to undergo colonic manometry to a tertiary care Motility Center from 1996 to 2001. Families were followed up a median of 20 months after evaluation (range 3-60 months).
Results:
A total of 150 colonic manometries were performed in 146 children (74 male, median age 79 months, range 4-225 months). Colonic manometry had been requested to clarify the pathophysiology of lower GI symptoms in 68%; as part of diagnostic workup for chronic intestinal pseudo-obstruction in 11%; to decide about reanastomosis of a diverted colon in 7%; and to clarify the pathophysiology of persisting symptoms after surgery for Hirschsprung's disease in 14%. Normal motility was found in the entire colon in 38% of children. In 17%, there was normal motility in the proximal colon with abnormality limited to the dilated distal colon. Abnormal motility was found in 45% of children. After colonic manometry, treatment changes were recommended in 93% of patients. We were able to follow up 65% of the families. When recommendations were followed (96% of the contacted patients), the symptoms improved in 78%, were unchanged in 18%, and were worse in 4% of patients. Among the parents, 88% believed that the suggestions given after colonic manometry had been helpful in improving their children's health.
Conclusions:
Colonic manometry may provide information useful in guiding therapy in a subgroup of patients with defecatory disorders.