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Quantitative analysis of anorectal pressures in Hirschsprung's disease
Insights
Anorectal manometry is valuable for diagnosing Hirschsprung
Area of Science:
- Pediatric Gastroenterology
- Physiology
- Surgical Research
Background:
- Hirschsprung's disease is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
- Accurate diagnosis is crucial for timely surgical intervention and management.
- Anorectal manometry is a diagnostic tool used to assess rectal and anal canal pressures and reflexes.
Purpose of the Study:
- To investigate anorectal motility patterns in children with Hirschsprung's disease.
- To evaluate the diagnostic utility of anorectal manometry in this patient population.
- To identify specific manometric abnormalities associated with Hirschsprung's disease.
Main Methods:
- Anorectal manometry was performed on 146 children diagnosed with Hirschsprung's disease.
- A control group of 89 healthy children was included for comparison.
- Rectal and anal canal pressures were recorded at rest and during rectal distention.
Main Results:
- The rectoanal inhibitory reflex was absent in most patients with Hirschsprung's disease.
- Patients exhibited higher intraluminal rectal pressure and more frequent pressure waves than controls.
- Abnormalities in anal canal pressure variations, including lower frequency and greater amplitude, were observed.
Conclusions:
- Anorectal manometry is a valuable tool for diagnosing Hirschsprung's disease in children.
- Specific manometric findings, such as absent rectoanal inhibitory reflex and altered anal canal pressures, support the diagnosis.
- Manometric data can be useful in cases where histologic findings are inconclusive or conflicting.
Abstract:
Anorectal motility was investigated in 146 children with Hirschsprung's disease and 89 normal control subjects. Pressures were recorded in the rectum and anal canal at rest and during rectal distention. The rectoanal inhibitory reflex was absent in all but four patients. Intraluminal rectal pressure was higher than normal (16.5 vs. 14.6 cm H2O, P less than 0.03), with more frequent (41 per cent vs. 18 per cent, P less than 0.01) pressure waves. In the upper anal canal, there were more frequent (62 per cent vs. 18 per cent, P less than 0.001) spontaneous variations of pressure of lower frequency (9.5 vs. 12.8 cycles/min P less than 0.001) and greater amplitude (5.2 vs. 3.6 cm H2O, P less than 0.001) than normal. The rectoanal contractile reflex occurred in 47 per cent of the patients but in only 21 per cent of the control subjects (P less than 0.001). Aganglionosis was associated with the presence of a rectoanal inhibitory reflex in three patients. This study confirms the value of anorectal manometry in diagnosing Hirschsprung's disease in a large group of patients, and demonstrates other abnormalities that may be useful in cases in which histologic and manometric data are in conflict.