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Title: Evaluation of anorectal manometry in children with chronic functional constipation

Agnieszka Krzywicka, Jarosław Kwiecień, Jolanta Porębska, Krystyna Karczewska
Contemporary Pediatrics, Gastroenterology, Hepatology and Child Feeding
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chronic constipation, dolichosigma, anorectal manometry

Introduction: Chronic constipation constitute a marked problem in pediatrics. Constipated children contribute about 10-25% of patients referred to pediatric gastrological clinics. Pathogenesis of chronic constipation is complex, and only 5-10% of cases has organic background. Among possible organic causes a dolichosigma remains the most controversial. Many authors consider dolichosigma a variant of normal anatomy, and negates it as a cause of the disease. Aim of study: Evaluation of anorectal manometry in children with chronic functional constipation dependingon resultsof bariumenema X-ray. Material and methods: Files of 134 children hospitalized between 2002 and 2006 in Silesian Center of Pediatrics, Zabrze because of chronic constipation were analyzed retrospectively. 94 patients fulfilling the criteria of functional constipation according to Rome III consensus, and who according to their age, could cooperate during anorectal manometry, were enrolled to the study. The study group consisted of 62 boys and 32 girls aged 4-18 years (mean 10,43±3,74 years). The study group was divided upon the basis of X-ray result into two subgroups: 45 patients with normal radiology and 49 patients with dolichosigma. Results: Significant differences between both subgroups were observed during anorectal manometry. In patients with dolichosigma the disorders of perception of rectal filling in the form of elevation of I and II treshold values were recorded. The most often defecation's disorder was a tendency to paradoxal anal spasm during simulated defecation in both groups; a positive correlation was revealed betwe­en rectal pressure and mean anal canal pressure during simulated defecation in both groups (Pearson's correlation, p<0,05). During simulated cough test no significant differences were observed between patients with correct and incorrect cough test results in both groups (t2 test, p>0,05). No significant relation was observed between incorrect results of cough test and other functional parameters of anal defecation pattern (test t2, p>0,05). Moreover a positive correlation between rectal pressure and mean anal canal pressure during simulated cough in both groups was detected. That being so, the anal function in scope of stools control, was find correct (Pearson's correlation, p<0,05). Conclusions: Anorectal manometry may be a useful tool (together with patients history and physical examination) in diagnosing func­tional constipation. Moreover upon the basis of obtained results it may be concluded that dolichosigma as a variant of normal anatomy may contribute to chronic constipation in children.