Dorfman Lev, El-Chammas Khalil, Khanna Sahana, Fei Lin, Kaul Ajay
Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Neurogastroenterol Motil. 2025 Apr;37(4):e14998. doi: 10.1111/nmo.14998. Epub 2025 Jan 9.
Colonic manometry (CM) is a diagnostic procedure used to evaluate pediatric patients with refractory constipation, fecal incontinence, Hirschsprung disease, and pediatric intestinal pseudo-obstruction. Pan-colonic high-amplitude propagated contractions (HAPCs), measured by CM, reflect an intact neuromuscular function of the colon. Current guidelines recommend starting CM with fasting recording for 1-2 h, but no prior evaluation has determined the diagnostic yield of the fasting phase. We aimed to determine the utility of the fasting phase during CM studies.
We evaluated CM studies conducted at a tertiary pediatric center (2018-2022). Fasting phases of normal CM studies were evaluated.
In 433 included studies 241 (55.7%) females, median age (9.7 years), the average fasting recording lasted 126 min. A total of 193 (44.6%) studies exhibited fasting HAPCs, with 123 (28.4%) being pan-colonic. The presence of pan-colonic HAPCs was based solely on the fasting phase in 11 (2.5%) studies. Patients with fasting pan-colonic HAPCs were younger (median age of 6.9 vs. 9.8 years, p = 0.0001) and had a higher rate of postprandial HAPCs (69.1% vs. 25.2%, p < 0.0001). Most fasting pan-colonic HAPCs presented during the first 60 min (94/123, 76.4%). All studies demonstrated HAPCs after stimulation with bisacodyl. In analyzing just the initial 30 min of fasting on CM, only 2 (0.5%) studies would have been misclassified as abnormal, with no bisacodyl administration in these studies.
CONCLUSIONS & INFERENCES: Shortening the fasting phase minimally affects next-day CM results and could reduce patient inconvenience, hospital-related costs, and potential side effects.
结肠测压法（CM）是一种诊断程序，用于评估患有难治性便秘、大便失禁、先天性巨结肠和小儿肠假性梗阻的儿科患者。通过CM测量的全结肠高振幅传播收缩（HAPC）反映了结肠完整的神经肌肉功能。当前指南建议CM从禁食记录1-2小时开始，但之前没有评估确定禁食期的诊断率。我们旨在确定CM研究中禁食期的效用。
我们评估了在一家三级儿科中心进行的CM研究（2018-2022年）。对正常CM研究的禁食期进行了评估。
在433项纳入研究中，有241名（55.7%）女性，中位年龄（9.7岁），平均禁食记录持续126分钟。共有193项（44.6%）研究显示有禁食HAPC，其中123项（28.4%）为全结肠性。在11项（2.5%）研究中，全结肠HAPC的存在仅基于禁食期。有禁食全结肠HAPC的患者更年轻（中位年龄6.9岁对9.8岁，p = 0.0001），餐后HAPC的发生率更高（69.1%对25.2%，p < 0.0001）。大多数禁食全结肠HAPC出现在最初60分钟内（94/123，76.4%）。所有研究在用比沙可啶刺激后均显示有HAPC。在仅分析CM禁食的最初30分钟时，只有2项（0.5%）研究可能会被错误分类为异常，这些研究中未使用比沙可啶。
缩短禁食期对次日CM结果的影响最小，并可减少患者的不便、医院相关成本和潜在副作用。
