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Interrater reliability in pediatric high-resolution anorectal manometry recordings

Julia M J van der Zande1,2, Marc A Benninga2, Bruno P Chumpitazi3

  • 1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.

Journal of Pediatric Gastroenterology and Nutrition
|February 2, 2026
PubMed

Insights

High-resolution anorectal manometry (HR-ARM) shows excellent interrater reliability for measuring anal pressures in children. However, interpretation of the rectoanal inhibitory reflex and bear down maneuver requires standardization for consistent pediatric HR-ARM analysis.

Area of Science:

  • Pediatric Gastroenterology
  • Neurogastroenterology
  • Motility Disorders

Background:

  • High-resolution anorectal manometry (HR-ARM) is crucial for evaluating anorectal neuromuscular function in pediatric patients with constipation or fecal incontinence.
  • Previous studies have not assessed the interrater reliability of HR-ARM in pediatric populations.

Purpose of the Study:

  • To evaluate the interrater reliability of pediatric high-resolution anorectal manometry (HR-ARM) assessments.
  • To identify areas of agreement and disagreement among pediatric specialists in HR-ARM interpretation.

Main Methods:

  • Ten pediatric gastroenterologists analyzed ten deidentified pediatric HR-ARM studies.
  • Evaluated parameters included resting pressure, squeeze pressure and duration, rectoanal inhibitory reflex (RAIR), bear down maneuver, and overall interpretation.
  • Statistical analysis utilized Fleiss' Kappa (κ) for categorical data and intraclass correlation coefficient (ICC) for continuous data.

Main Results:

  • Excellent interrater reliability was observed for anal canal resting pressure (ICC 0.97), squeeze pressure (ICC 0.97), and squeeze duration (ICC 0.93).
  • Fair agreement was found for RAIR detection (κ=0.35).
  • Moderate agreement was noted for the bear down maneuver (κ=0.50) and final study interpretation (κ=0.43).

Conclusions:

  • Pediatric HR-ARM demonstrates excellent reliability for quantitative pressure measurements.
  • Suboptimal interrater reliability exists for the qualitative assessment of RAIR and the bear down maneuver.
  • Standardization of HR-ARM protocols and interpretation criteria is essential for pediatric practice.
Abstract

Keywords:
Hirschsprung diseasechildrendiagnostic test

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