Anorectal Manometry on Children: A Moroccan Series and Literature Review

HANANE DELSA; Ilham Serraj; Mohamed Khalis; Nawal Kabbaj

doi:10.3889/oamjms.2021.6058

Authors

HANANE DELSA EFD-Hepatogastroenterology Unit, Ibn Sina Hospital, Rabat, Morocco; Department of Gastroenterology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco https://orcid.org/0000-0001-7008-8552
Ilham Serraj EFD-Hepatogastroenterology Unit, Ibn Sina Hospital, Rabat, Morocco
Mohamed Khalis Department of Epidemiology, International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco https://orcid.org/0000-0003-4639-049X
Nawal Kabbaj EFD-Hepatogastroenterology Unit, Ibn Sina Hospital, Rabat, Morocco

DOI:

https://doi.org/10.3889/oamjms.2021.6058

Keywords:

Manometry, Child, Fecal incontinence, Constipation, Hirschsprung disease

Abstract

Introduction and objectives: Anorectal manometry is a test that evaluates the function of the rectum,but also the anus. It is useful for the diagnosis of several conditions like fecal incontinence and constipation.In children these tests are being increasingly used for all ages.The aim of this study was to determine the benefit of anorectal manometry in children and to report our experience.

Material and Methods:Over a period of four years, 273children that underwent anorectal manometry were included in the study,their data and tests results were analyzed.

Results:Out of 273 patients included,68,5% were boys and 31,5% were girls.The mean age was 9 years.154patients(51,6%) had Fecal incontinence(Group1),75children(27,5%) had chronic constipation(Group2),and both of them(Group3) were reported in 37children(13,6%).An awake manometry was performed in 248children(91%) however this test under sedation allowed us the exclusion of Hirschsprung’s disease in 21children(84%).In group1, 25%patients had bad anal contraction.In groupe3, 21,6%children had bad anal contraction.The statistical analysis showed a significant difference in age(p=0.022) and resting pressure(p=0.050) between the three groups.Children with fecal incontinence had a higher rate of dyssynergy,80.2% and 83.8% in groups 1 and 3 respectively compared to 60.4% in patients with chronic constipation(p=0,852)

Conclusion:The gold standard for the exploration of children’s terminal constipation and encopresis is the anorectal manometry.It is an important tool to establish diagnosis.In our study, this test allow the exclusion of Hirschsprung’s disease in infants with constipation, in other hand we found a higher rate of dyssynergy in children with fecal incontinence(80%) which had allow us to propose a biofeedback therapy.

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References

Athanasakos E, Cleeve S, Thapar N, Lindley K, Perring S, Cronin H, et al. Anorectal manometry in children with defecation disorders BSPGHAN motility working group consensus statement. Neurogastroenterol Motil. 2020;32(6):1-11. https://doi.org/10.1111/nmo.13797 DOI: https://doi.org/10.1111/nmo.13797

Athanasakos E, Dalton S, McDowell S, Shea T, Blakeley K, Rawat D, et al. Scientific solution to a complex problem: Physiology and multidisciplinary team improve understanding and outcome in chronic constipation and faecal incontinence. Pediatr Surg Int. 2020;36(3):295-303. https://doi.org/10.1007/s00383-019-04605-y PMid:31844977 DOI: https://doi.org/10.1007/s00383-019-04605-y

Remes-Troche JM, Rao SS. Diagnostic testing in patients with chronic constipation. Curr Gastroenterol Rep. 2006;8(5):416- 24. https://doi.org/10.1007/s11894-006-0028-2 PMid:16968610 DOI: https://doi.org/10.1007/s11894-006-0028-2

Rao SS, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: A systematic review. Am J Gastroenterol. 2005;100(7):1605-15. https://doi.org/10.1111/j.1572-0241.2005.41845.x PMid:15984989 DOI: https://doi.org/10.1111/j.1572-0241.2005.41845.x

Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016;22(3):423-35. https://doi.org/10.5056/jnm16060 PMid:27270989 DOI: https://doi.org/10.5056/jnm16060

Banasiuk M, Banaszkiewicz A, Dziekiewicz M, Załęski A, Albrecht P. Values from three-dimensional high-resolution anorectal manometry analysis of children without lower gastrointestinal symptoms. Clin Gastroenterol Hepatol. 2016;14(7):993-1000.e3. https://doi.org/10.1016/j.cgh.2016.01.008 PMid:26820403 DOI: https://doi.org/10.1016/j.cgh.2016.01.008

Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: Review of collective experience. Am J Gastroenterol. 2002;97(2):232-40. https://doi.org/10.1111/j.1572-0241.2002.05450.x PMid:11866256 DOI: https://doi.org/10.1111/j.1572-0241.2002.05450.x

Gowers WR 4th. The automatic action of the sphincter ani. Proc R Soc London. 1878;26(179-184):77-84. https://doi.org/10.1098/rspl.1877.0013 DOI: https://doi.org/10.1098/rspl.1877.0013

Denny-Brown D, Robertson EG. An investigation of the nebvous conteol of defecation. Brain. 1935;58(2):256-310. DOI: https://doi.org/10.1093/brain/58.2.256

Tambucci R, Quitadamo P, Thapar N, Zenzeri L, Caldaro T, Staiano A, et al. Diagnostic tests in pediatric constipation. J Pediatr Gastroenterol Nutr. 2018;66(4):e89-98. https://doi.org/10.1097/mpg.0000000000001874 PMid:29287015 DOI: https://doi.org/10.1097/MPG.0000000000001874

Ratuapli SK, Bharucha AE, Noelting J, Harvey DM, Zinsmeister AR. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology. 2013;144(2):314-22.e2. https://doi.org/10.1053/j.gastro.2012.10.049 PMid:23142135 DOI: https://doi.org/10.1053/j.gastro.2012.10.049

Carrington E V., Brokjær A, Craven H, Zarate N, Horrocks EJ, Palit S, et al. Traditional measures of normal anal sphincter function using high-resolution anorectal manometry (HRAM) in 115 healthy volunteers. Neurogastroenterol Motil. 2014;26(5):625-35. https://doi.org/10.1111/nmo.12307 PMid:24628873 DOI: https://doi.org/10.1111/nmo.12307

Tang YF, Chen JG, An HJ, Jin P, Yang L, Dai ZF, et al. High-resolution anorectal manometry in newborns: Normative values and diagnostic utility in Hirschsprung disease. Neurogastroenterol Motil. 2014;26(11):1565-72. https://doi.org/10.1111/nmo.12423 PMid:25263969 DOI: https://doi.org/10.1111/nmo.12423

Wu JF, Lu CH, Yang CH, Tsai IJ. Diagnostic role of anal sphincter relaxation integral in high-resolution anorectal manometry for hirschsprung disease in infants. J Pediatr. 2018;194:136-41.e2. https://doi.org/10.1016/j.jpeds.2017.10.017 PMid:29212617 DOI: https://doi.org/10.1016/j.jpeds.2017.10.017

Benninga MA, Voskuijl WP, Akkerhuis GW, Taminiau JA, Büller HA. Colonic transit times and behaviour profiles in children with defecation disorders. Arch Dis Child. 2004;89(1):13-6. PMid:14709493

Keshtgar AS, Athanasakos E, Clayden GS, Ward HC. Evaluation of outcome of anorectal anomaly in childhood: The role of anorectal manometry and endosonography. Pediatr Surg Int. 2008;24(8):885-92. https://doi.org/10.1007/s00383-008-2181-1 PMid:18512062 DOI: https://doi.org/10.1007/s00383-008-2181-1

Keshtgar AS, Choudhry MS, Kufeji D, Ward HC, Clayden GS. Anorectal manometry with and without ketamine for evaluation of defecation disorders in children. J Pediatr Surg. 2015;50(3):438- 43. https://doi.org/10.1016/j.jpedsurg.2014.08.016 PMid:25746704 DOI: https://doi.org/10.1016/j.jpedsurg.2014.08.016

Rodriguez L, Sood M, Di Lorenzo C, Saps M. An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterol Motil. 2017;29(1):1- 8. https://doi.org/10.1111/nmo.12944 PMid:27723185 DOI: https://doi.org/10.1111/nmo.12944

Tran K, Kuo B, Zibaitis A, Bhattacharya S, Cote C, Belkind-Gerson J. Effect of propofol on anal sphincter pressure during anorectal manometry. J Pediatr Gastroenterol Nutr. 2014;58(4):495-7. https://doi.org/10.1097/mpg.0000000000000190 PMid:24121151 DOI: https://doi.org/10.1097/MPG.0000000000000190

Keshtgar AS, Ward HC, Clayden GS. Pathophysiology of chronic childhood constipation: Functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study. J Pediatr Surg. 2013;48(4):806-12. https://doi.org/10.1016/j.jpedsurg.2012.08.037 PMid:23583138 DOI: https://doi.org/10.1016/j.jpedsurg.2012.08.037

Ambartsumyan L, Rodriguez L, Morera C, Nurko S. Longitudinal and radial characteristics of intra-anal pressures in children using 3D high-definition anorectal manometry: New observations. Am J Gastroenterol. 2013;108(12):1918-28. https://doi.org/10.1038/ajg.2013.361 PMid:24169274 DOI: https://doi.org/10.1038/ajg.2013.361

Meinds RJ, Trzpis M, Broens PM. Anorectal manometry may reduce the number of rectal suction biopsy procedures needed to diagnose hirschsprung disease. J Pediatr Gastroenterol Nutr. 2018;67(3):322-7. https://doi.org/10.1097/mpg.0000000000002000 PMid:29652729 DOI: https://doi.org/10.1097/MPG.0000000000002000

Voskuijl WP, Van Ginkel R, Benninga MA, Hart GA, Taminiau JA, Boeckxstaens GE. New insight into rectal function in pediatric defecation disorders: Disturbed rectal compliance is an essential mechanism in pediatric constipation. J Pediatr. 2006;148(1):62- 7. https://doi.org/10.1016/j.jpeds.2005.08.061 PMid:16423599 DOI: https://doi.org/10.1016/j.jpeds.2005.08.061

Toro-Monjaraz EM, Peña-Vélez R, Ignorosa-Arellano KR, Zaráte-Mondragón F, Cervantes-Bustamante R, Ramírez- Mayans JA. Anorectal manometry in children with retentive fecal incontinence: What parameters should we evaluate? Rev Gastroenterol Méx. 2019;84(3):419-22. https://doi.org/10.1016/j.rgmxen.2019.02.012 PMid:31151864 DOI: https://doi.org/10.1016/j.rgmxen.2019.02.012

Koivusalo AI, Pakarinen MP, Rintala RJ. Botox injection treatment for anal outlet obstruction in patients with internal anal sphincter achalasia and Hirschsprung’s disease. Pediatr Surg Int. 2009;25(10):873-6. https://doi.org/10.1007/s00383-009-2438-3 PMid:19662428 DOI: https://doi.org/10.1007/s00383-009-2438-3