Anorectal manometry provides no additional benefit for constipated children

הסקירה באדיבות אתר מדיקונטקסט:WESTPORT, CT (Reuters Health) – A combination of anorectal manometry and conventional treatment does not result in higher success rates in chronically constipated children compared with conventional treatment alone, according to a report in the July electronic issue of Pediatrics.

Researchers conclude that "anorectal manometry has no additional demystifying or educational effect on clinical outcome in chronically constipated children."

Dr. Rijk van Ginkel, of the Academic Medical Center, Amsterdam, the Netherlands, and colleagues enrolled 212 constipated children in a prospective, controlled, randomized study to compare the effects of conventional treatment plus two anorectal manometry sessions with conventional treatment alone.

Conventional treatment included dietary advice, a daily diary, toilet training and treatment with oral laxatives following disimpaction with enemas on 3 consecutive days. "During both manometries, the child and the parent could watch the tracing on the computer screen," they explain. While no explanation was given during the procedure, the tracings were clarified after the procedure.

They defined successful treatment as defecation at least 3 times a week , no episodes of soiling or encopresis for 2 weeks, and no laxative use.

One hundred fifteen children were assigned to the convention treatment group and 97 to the combination group. Only four children in the conventional treatment group and two in the combination group had no soiling or encopresis at baseline, the authors report.

The success rate of conventional treatment after 6, 52, and 104 weeks was 4%, 32% and 43%, respectively. The corresponding success rate of combination treatment was 7%, 30%, and 35%. "No significant difference in success percentage was observed between the two groups at any time of follow-up," the investigators report.

Results from this study suggest that there is "no diagnostic or therapeutic role for anorectal manometry in chronically constipated children, except [as] a diagnostic test to exclude Hirschsprung's disease."

Conventional treatment, "including education of constipation, intensive patient contact, enhancing motivation by small gifts, toilet training, daily diary cards, and oral laxatives preceded by the cleaning of the rectosigmoid by the use of enemas, forms the cornerstone in the treatment of these patients," Dr. van Ginkel and colleagues conclude.

Pediatrics 2001;108:e9.

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