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 20 November 2017

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News

Anorectal manometry does not improve treatment of severe childhood constipation

Anorectal manometry does not improve the outcome of treatment in chronically constipated children, claims a team from the Netherlands.

News image

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The researchers evaluated the effect of anorectal manometry on the outcome of treatment in severe childhood constipation.

They reported their findings in the July issue of Pediatrics.

212 constipated children (143 boys), who were visiting a referral pediatric gastroenterologic practice, were enrolled in the study.

Each child was prospectively randomized to conventional treatment alone (CT, 115 patients) or to conventional treatment combined with 2 manometry sessions (CTM, 97 patients). Conventional treatment comprised of dietary advice, a daily diary, toilet training, oral laxatives, and enemas.

Successful treatment was defined as a defecation frequency of 3 or more per week, and less than 1 soiling/encopresis episode per 2 weeks, and no use of laxatives.

Success rates at 6, 26, 52 and 104 weeks' follow-up:
CT: 4%, 24%, 32%, and 43%
CTM: 7%, 22%, 30%, and 35%
Pediatrics

Only 4 children from the CT group and 2 from the CTM group showed no soiling and/or encopresis. However, 76% and 65%, respectively, reported the periodic passage of large stools.

In 26% and 30% of the patients, a rectal scybalum was found on physical examination.

The success rates at 6, 26, 52, and 104 weeks' follow-up were 4%, 24%, 32%, and 43% in the CT group. These were 7%, 22%, 30%, and 35% in the CTM group, respectively.

No significant difference in success percentage was observed between the 2 groups at any time of follow-up. The relative risks (CT/CTM) at 6, 26, 52, and 104 weeks' follow-up, were 0.55, 1.13, 1.07, and 1.23, respectively.

A significant increase in defecation frequency was observed between the first and second visits. This was sustained at all subsequent visits and stages of follow-up in both groups, but was not significant.

The researchers found that there was also a significant decrease in encopresis episodes after the first visit. There was a further slow but significant decrease at 52 weeks of follow-up, in both groups.

The manometric data obtained from the CTM group showed a low percentage (28%) of children with normal defecation dynamics. This increased to 38% at the last manometry.

Anorectal manometry combined with CT, compared with CT alone, did not result in higher success rates in chronically constipated children, the authors concluded.

Rijk van Ginkel, of Emma Children's Hospital, Amsterdam, said on behalf of the group, "Anorectal manometry has no additional demystifying or educational effect on clinical outcome in chronically constipated children.

"This observation leaves no diagnostic or therapeutic role for anorectal manometry in chronically constipated children, except its use as a diagnostic test to exclude Hirschsprung's disease."

"A simple CT is successful in 30% of severely constipated children who are referred to a tertiary hospital, underscoring the importance of long-lasting and adequate laxative treatment," it was concluded.

Pediatrics 2001; 108 (1): e9
17 July 2001

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