Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5199-5207. doi: 10.26355/eurrev_202108_26533.
Dyssynergic defecation (DD) may be one of the most important causes of constipation, but its diagnostic criteria have not been formally validated in children. This study aims to evaluate constipated children with 3DHRAM (three-dimensional high-resolution anorectal manometry) and determine a new pediatric cut-off for DD variables.
205 patients diagnosed with functional constipation (FC) based on Rome III criteria were prospectively enrolled. Data were compared to a historical control group (C). Initially, the diagnosis of DD was based on adult criteria and divided into 4 types. A new cut-off value for percent anal relaxation was determined based on ROC curve analysis.
The FC group presented significantly lower values of percent anal relaxation during straining compared to the C group (9.5% vs. 20%, respectively, p=0.03). Based on adult criteria, DD was found in 53% of the FC group and 46% of the C group (p=0.3), with type II occurring most frequently (35.8%). New cut-off value of 31% for percent anal relaxation in children was derived based on the ROC curve analysis. Based on this new cut-off value, DD was diagnosed in 69.3% of constipated children, with type IV occurring most frequently (28.9%). The analysis of segmental pressure showed significant influence of segments at the locations of the puborectalis muscle and external anal sphincter.
We found that during bear down maneuver the percent anal relaxation variable significantly differed between patients and controls. The higher cut-off value should be used when 3DHRAM and the standard four-type classification are used to diagnose DD in children.
协同失调性排便（DD）可能是便秘的最重要原因之一，但尚未在儿童中正式验证其诊断标准。本研究旨在通过三维高分辨率肛门直肠测压法（3DHRAM）评估便秘儿童，并确定用于 DD 变量的新儿科截断值。
前瞻性纳入 205 例根据罗马 III 标准诊断为功能性便秘（FC）的患者。将数据与历史对照（C）组进行比较。最初，DD 的诊断基于成人标准，并分为 4 种类型。基于 ROC 曲线分析，确定新的肛门松弛百分比截断值。
与 C 组相比，FC 组在用力排便时的肛门松弛百分比明显较低（分别为 9.5%和 20%，p=0.03）。根据成人标准，FC 组中有 53%存在 DD，C 组中有 46%存在 DD（p=0.3），其中 II 型最常见（35.8%）。根据 ROC 曲线分析，得出儿童肛门松弛百分比的新截断值为 31%。基于此新截断值，69.3%的便秘儿童被诊断为 DD，其中最常见的是 IV 型（28.9%）。分段压力分析显示，耻骨直肠肌和肛门外括约肌位置的节段存在显著影响。
我们发现，在用力排便过程中，患者和对照组之间的肛门松弛百分比变量存在显著差异。在使用 3DHRAM 和标准的四分型分类诊断儿童 DD 时，应使用较高的截断值。
