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Diagnosis of Hirschsprung's disease by anorectal manometry
A Nagasaki1, K Sumitomo, T Shono
1Department of Surgery, Fukuoka Municipal Children's Hospital, Japan.
Insights
Anorectal manometry in children reveals that while anal canal contraction frequency is lower in Hirschsprung
Area of Science:
- Pediatric Gastroenterology
- Physiology
- Diagnostic Medicine
Background:
- Hirschsprung's disease diagnosis in children often relies on anorectal manometry.
- Conventional manometry may yield ambiguous results, necessitating improved diagnostic accuracy.
Purpose of the Study:
- To evaluate the effectiveness of conventional anorectal manometry in diagnosing Hirschsprung's disease in children.
- To assess the utility of novel stimulation methods in improving diagnostic reliability.
Main Methods:
- Anorectal manometry performed on 48 Japanese children with Hirschsprung's disease and 61 controls.
- Investigated resting pressure, anal canal contraction frequency, and rectoanal relaxation reflex.
- Utilized prostaglandin F2 alpha, electrical stimulation, and cold water stimulation to assess reflex distinctness.
Main Results:
- No significant difference in resting rectal and anal canal pressure between groups.
- Lower anal canal contraction frequency in Hirschsprung's disease patients, but with considerable overlap.
- Prostaglandin F2 alpha, electrical, and cold water stimulation enhanced the reliability of the rectoanal relaxation reflex assessment.
Conclusions:
- Conventional manometry's anal canal contraction frequency is inadequate for definitive Hirschsprung's disease diagnosis.
- Enhanced stimulation techniques significantly improve the accuracy and reliability of anorectal manometry.
- Clearer definitions of normal rectoanal relaxation reflexes are crucial for excluding atypical findings.
Abstract:
Anorectal manometry was performed in 48 Japanese children with Hirschsprung's disease and 61 normal children. The resting pressure of the rectum and anal canal was not significantly different between these groups of subjects. The frequency of rhythmical contractions of the anal canal of patients was significantly lower than for the normal subjects, but the frequencies overlapped considerably. Therefore, the frequency is an inadequate indicator for identifying these patients. Conventional manometry elicited a distinct rectoanal relaxation reflex from 90% of the normal children, and the rate increased to 98% when indistinct reflexes were regarded as positive. Indistinct reflexes often occur in neonates, possibly because the constriction of the anal canal is weak. However, when prostaglandin F2 alpha was intravenously administered during the examination, all ambiguous reflexes became distinct. Of patients with Hirschsprung's disease, 4% had a distinct reflex and 19% an atypical one. Most of the atypical reflexes were regarded as being artifacts and were mostly attributed to distension by a balloon. In these patients, the reflex was abolished in case of examination with electric stimulation or stimulation with cold water, procedures which do not dilate the rectum. Moreover these atypical reflexes did not fit the criteria for the normal rectoanal relaxation reflex prepared by the Japan Study Group of Pediatric Intestinal Manometry. The use of electric stimulation, cold water, or intravenously administered prostaglandin F2 alpha improves reliability of the conventional anorectal manometry. A clear and accurate definition of the normal reflex should aid in excluding the atypical reflex.