Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School.
Pediatric Gastroentrology Division, Department of Pediatrics, Boston Medical Center, Boston University, Boston, MA.
J Pediatr Gastroenterol Nutr. 2021 Mar 1;72(3):361-365. doi: 10.1097/MPG.0000000000002978.
The aim of the study is to evaluate the utility of motility studies in pediatric functional constipation with/without fecal incontinence.
Patients with functional constipation and failure to conventional therapy undergoing colonic manometry (CM) and/or anorectal manometry (ARM) manometry were classified as functional constipation without fecal incontinence (FC) or with fecal incontinence (FCI). Clinical data, motility parameters, and treatment outcomes were compared.
A total of 280 were included, and all patients underwent CM (229 FC and 51 FCI) and 219 ARM. We found no difference in CM interpretation and presence of normal high amplitude propagating contractions (HAPCs) between groups; however, patients with FCI had higher frequency and presence of HAPCs and normal gastrocolonic meal response (GC). No CM parameter predicted outcomes. In FC, more patients with an abnormal CM responded to therapy compared to those with a normal study (79% vs 65% respectively, P = 0.04). FCI patients had lower median anal resting pressure compared to FC (49 vs 66 mmHg, respectively, P = 0.03); no other ARM parameter differentiated FC from FCI. We found no association between therapy response and ARM interpretation (P = 0.847) or any ARM parameter. A multivariate analysis found only male gender was associated with FCI (P < 0.001).
FCI patients have higher frequency of normal CM parameters compared to FC, but overall interpretation was no different. CM helped predict response to therapy in FC but not in FCI. ARM demonstrated no added benefit in the evaluation of functional constipation with/without soiling. Patients with both normal ARM and CM had a lower response to therapy than those with abnormal studies.
本研究旨在评估动力研究在伴有/不伴有粪便失禁的小儿功能性便秘中的应用价值。
功能性便秘且经常规治疗失败的患者行结肠测压（CM）和/或肛门直肠测压（ARM）检查，根据是否伴有粪便失禁将其分为功能性便秘无粪便失禁（FC）或伴有粪便失禁（FCI）。比较临床资料、动力参数和治疗结果。
共纳入 280 例患者，所有患者均行 CM（229 例 FC 和 51 例 FCI）和 219 例 ARM 检查。我们发现两组 CM 结果解读和正常高频传播收缩（HAPCs）的存在无差异；然而，FCI 患者的 HAPCs 频率更高且更常见，胃结肠餐反应（GC）正常。CM 参数均无法预测治疗结局。在 FC 中，异常 CM 患者的治疗反应率高于正常 CM 患者（分别为 79%和 65%，P=0.04）。FCI 患者的肛门静息压中位数低于 FC（分别为 49mmHg 和 66mmHg，P=0.03）；其他 ARM 参数无法区分 FC 和 FCI。我们未发现治疗反应与 ARM 解读（P=0.847）或任何 ARM 参数之间存在关联。多变量分析发现仅男性与 FCI 相关（P＜0.001）。
与 FC 相比，FCI 患者的 CM 正常参数频率更高，但总体解读结果无差异。CM 有助于预测 FC 患者的治疗反应，但对 FCI 患者无预测价值。ARM 在评估伴或不伴污粪的功能性便秘方面无额外获益。ARM 和 CM 均正常的患者的治疗反应率低于异常检查患者。
