Accuracy of anorectal manometry in the diagnosis of Hirschsprung's disease
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P S Low1, S H Quak, K Prabhakaran
1Department of Paediatrics, National University of Singapore.
Insights
Anorectal manometry accurately diagnoses Hirschsprung's disease (HD) in children with chronic constipation. This diagnostic tool showed 90% overall accuracy, aiding in distinguishing HD from other conditions.
Area of Science:
- Pediatric Gastroenterology
- Surgical Diagnostics
- Colorectal Surgery
Background:
- Hirschsprung's disease (HD) is a congenital disorder affecting the large intestine.
- Chronic constipation in children often necessitates accurate diagnosis of HD.
- Anorectal manometry is a potential diagnostic modality for HD.
Purpose of the Study:
- To evaluate the diagnostic value of anorectal manometry for Hirschsprung's disease in pediatric patients.
- To compare anorectal manometry results with rectal biopsy findings for HD diagnosis.
Main Methods:
- Fifty children with chronic constipation underwent anorectal manometry and rectal biopsy.
- Rectal biopsy specimens were histologically examined for the presence of ganglion cells.
- Diagnostic accuracy, sensitivity, specificity, and predictive values of manometry were calculated.
Main Results:
- Anorectal manometry demonstrated 90.0% overall accuracy in diagnosing HD when compared to histology.
- The test achieved a sensitivity of 0.79, specificity of 0.97, positive predictive value of 0.94, and negative predictive value of 0.88.
- Concordant results between manometry and histology were observed in 45 out of 50 children.
Conclusions:
- Anorectal manometry is a highly accurate and valuable non-invasive tool for diagnosing Hirschsprung's disease in children.
- The study supports the use of anorectal manometry as a reliable diagnostic method, reducing the need for invasive procedures.
Abstract:
The value of anorectal manometry as a diagnostic tool for Hirschsprung's disease (HD) was assessed in 50 children presenting with chronic constipation. Anorectal manometric studies and rectal biopsy were performed on all children. Biopsy specimens were stained with hematoxylin and eosin and serial sections were examined for ganglion cells. Forty-five children had concordant manometric and histologic results, 15 of whom were positive for HD and 30 negative. In five children, the results were discordant. Using histologic aganglionosis as the reference point for the final diagnosis of HD, the overall accuracy of anorectal manometry as a discriminative test was 90.0%. The sensitivity, specificity, and positive and negative predictive values of manometric studies for the diagnosis of HD were 0.79, 0.97, 0.94, and 0.88, respectively. Factors responsible for the inaccuracies of manometric studies are discussed.