Patel Dhiren, Decker Courtney, Rodriguez Leonel
Division of Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
Children (Basel). 2025 Apr 16;12(4):512. doi: 10.3390/children12040512.
: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. : This study aims to evaluate the effectiveness of ARM in predicting therapeutic responses among children with functional constipation. : A retrospective chart review was conducted at two tertiary centers examining pediatric patients who underwent ARM between January 2018 and July 2022. Key ARM parameters were analyzed, including anal resting pressure, recto-anal inhibitory reflex (RAIR), first rectal sensation, and bear-down maneuver (BDM). Therapeutic responses were assessed post-ARM, with success defined as an increase in bowel movement frequency and/or a decrease in fecal incontinence. In addition, we also intended to evaluate the eventual need for surgical intervention as another outcome. : The study included 327 patients, with a median age of 8.2 years. The overall therapeutic response rate was 40.7%, with stimulant laxatives showing a 48% response. Notably, lower anal resting pressures and delayed rectal sensations were associated with better therapeutic outcomes. Abnormal BDM correlated with a lack of response to therapies, while the presence of abnormal RAIR was linked to a higher eventual need for surgical intervention. : ARM is instrumental in predicting therapeutic responses in pediatric patients with functional constipation. In addition to diagnosing HD, ARM could be an instrumental tool in identifying patients with dyssynergic defecation for early intervention with targeted therapy in age-appropriate patients.
肛门直肠测压（ARM）在小儿胃肠病学中对诊断肛门直肠潜在的动力障碍起着关键作用。尽管其应用普遍，但ARM在指导治疗反应方面的预测效用仍未得到充分描述。本研究旨在评估ARM在预测功能性便秘儿童治疗反应中的有效性。在两个三级中心进行了一项回顾性病历审查，研究对象为2018年1月至2022年7月期间接受ARM检查的儿科患者。分析了关键的ARM参数，包括肛门静息压、直肠-肛门抑制反射（RAIR）、首次直肠感觉和用力排便动作（BDM）。在ARM检查后评估治疗反应，成功定义为排便频率增加和/或大便失禁减少。此外，我们还打算评估最终需要手术干预的情况作为另一项结果。该研究纳入了327例患者，中位年龄为8.2岁。总体治疗反应率为40.7%，刺激性泻药的反应率为48%。值得注意的是，较低的肛门静息压和延迟的直肠感觉与更好的治疗结果相关。异常的BDM与对治疗无反应相关，而异常RAIR的存在与最终更高的手术干预需求相关。ARM有助于预测功能性便秘儿科患者的治疗反应。除了诊断先天性巨结肠外，ARM还可能是识别排便协同失调患者的有用工具，以便在合适年龄的患者中进行有针对性治疗的早期干预。
