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Three-dimensional high-resolution anorectal manometry: cut-off values for diagnosis of dyssynergic defecation in
M Banasiuk1, M Dobrowolska, B Skowronska
1Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland. m.e.dobrowolska@gmail.com.
Insights
A new diagnostic threshold for dyssynergic defecation (DD) in children using three-dimensional high-resolution anorectal manometry (3DHRAM) has been established. This study found a higher cut-off value is needed for accurate diagnosis in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Dyssynergic defecation (DD) is a significant cause of childhood constipation.
- Current diagnostic criteria for DD are primarily based on adult data and lack formal validation in children.
- Three-dimensional high-resolution anorectal manometry (3DHRAM) offers advanced insights into anorectal function.
Purpose of the Study:
- To evaluate constipated children using 3DHRAM.
- To establish a new, validated pediatric cut-off value for DD diagnostic variables.
- To compare diagnostic outcomes using adult versus proposed pediatric criteria.
Main Methods:
- Prospective enrollment of 205 children with functional constipation (FC) based on Rome III criteria.
- Comparison of 3DHRAM data against a historical control group.
- Determination of a new percent anal relaxation cut-off using Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- Constipated children exhibited significantly lower percent anal relaxation during straining (9.5%) compared to controls (20%).
- Using adult criteria, DD prevalence was 53% in FC patients; however, a new pediatric cut-off of 31% identified DD in 69.3% of constipated children.
- Type IV DD was most frequent (28.9%) using the new pediatric cut-off, differing from adult criteria where Type II was most common.
Conclusions:
- Percent anal relaxation during the defecation maneuver significantly differentiates constipated children from controls.
- A higher cut-off value for percent anal relaxation is recommended for diagnosing DD in children using 3DHRAM and the standard four-type classification.
Objective:
Dyssynergic defecation (DD) may be one of the most important causes of constipation, but its diagnostic criteria have not been formally validated in children. This study aims to evaluate constipated children with 3DHRAM (three-dimensional high-resolution anorectal manometry) and determine a new pediatric cut-off for DD variables.
Patients And Methods:
205 patients diagnosed with functional constipation (FC) based on Rome III criteria were prospectively enrolled. Data were compared to a historical control group (C). Initially, the diagnosis of DD was based on adult criteria and divided into 4 types. A new cut-off value for percent anal relaxation was determined based on ROC curve analysis.
Results:
The FC group presented significantly lower values of percent anal relaxation during straining compared to the C group (9.5% vs. 20%, respectively, p=0.03). Based on adult criteria, DD was found in 53% of the FC group and 46% of the C group (p=0.3), with type II occurring most frequently (35.8%). New cut-off value of 31% for percent anal relaxation in children was derived based on the ROC curve analysis. Based on this new cut-off value, DD was diagnosed in 69.3% of constipated children, with type IV occurring most frequently (28.9%). The analysis of segmental pressure showed significant influence of segments at the locations of the puborectalis muscle and external anal sphincter.
Conclusions:
We found that during bear down maneuver the percent anal relaxation variable significantly differed between patients and controls. The higher cut-off value should be used when 3DHRAM and the standard four-type classification are used to diagnose DD in children.
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