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Use of colonic manometry to differentiate causes of intractable constipation in children
C Di Lorenzo1, A F Flores, S N Reddy
1Department of Pediatrics, Harbor-University of California, Los Angeles Medical Center, Torrance 90502.
Insights
Colon manometry effectively distinguishes functional fecal retention from colonic neuropathy or myopathy in children with chronic constipation. This diagnostic tool aids in identifying the underlying cause of severe, intractable constipation.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Medicine
- Physiology
Background:
- Intractable constipation in children often requires advanced diagnostic methods.
- Differentiating functional fecal retention from organic causes like neuropathy or myopathy is crucial for effective treatment.
Purpose of the Study:
- To evaluate the utility of colon manometry in differentiating the causes of intractable constipation in pediatric patients.
- To assess pressure changes and contractile patterns in the colon to identify specific etiologies.
Main Methods:
- Colon manometry was performed on 23 children with chronic constipation, measuring intraluminal pressure in the transverse, descending, and rectosigmoid colons.
- A 4-hour baseline recording was followed by a meal to assess the gastrocolonic response.
- Analysis included motility index and high-amplitude propagated contractions (HAPCs) postprandially.
Main Results:
- Colon manometry identified distinct patterns differentiating functional fecal retention from neuropathy.
- Children with functional fecal retention showed increased motility index and HAPCs after meals.
- Patients with neuropathy lacked HAPCs, and their motility index did not significantly change postprandially. Two patients with myopathy exhibited no contractions.
Conclusions:
- Colon manometry is a valuable tool for differentiating functional fecal retention from colonic neuropathy or myopathy in children with severe chronic constipation.
- The postprandial response, specifically the presence of HAPCs, is a key differentiator.
Abstract:
We evaluated colon manometry as a means of differentiating causes of intractable constipation in children. We studied pressure changes in the transverse, descending, and rectosigmoid colons of 23 children with intractable constipation. All patients had a history of less than one bowel movement per week for longer than 2 years without resolution after conventional medical management. The possibility of Hirschsprung disease was excluded in all. On the basis of pathologic and manometric studies of the upper gastrointestinal tract, 10 patients had a diagnosis of gastrointestinal neuropathy and two had a diagnosis of myopathy. The other 11 patients had functional fecal retention; this diagnosis was based on history and outcome of therapy. On the day of study we used endoscopy to place a manometry catheter into the transverse colon and recorded intraluminal pressure for longer than 4 hours. After obtaining a baseline recording, we gave the patient a meal to assess gastrocolonic response. Colonic contractions were recorded in 21 of 23 children. Children with functional fecal retention could be differentiated from those with neuropathy by examination of the postprandial record. After a meal children with functional fecal retention had (1) an increase in motility index (3.4 +/- 0.5 while fasting vs 9.1 +/- 1.3 postprandially; p less than 0.001), and (2) at least one high-amplitude propagated contraction (in 10 of 11 children). The patients with neuropathy had no high-amplitude propagated contractions (p less than 0.001 vs group with functional fecal retention) and motility index in these children did not increase significantly after a meal (2.7 +/- 1.0 while fasting vs 2.9 +/- 1.3 postprandially). The two children with hollow visceral myopathy had no contractions. We conclude that in children with severe chronic constipation the colonic results of manometry differentiate patients with functional fecal retention from those with neuropathy or myopathy of the colon.