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Colonic motility after surgery for Hirschsprung's disease.
Am J Gastroenterol. 2000 Jul; 95(7):1759-64.AJ

Abstract

OBJECTIVE

Years after surgery for Hirschsprung's disease, many children continue to suffer from fecal incontinence or constipation. The purpose of the present investigation was to define the physiology underlying the persistent symptoms in children after surgery for Hirschsprung's disease, and to determine the outcome of interventions based on the results of the motility testing.

METHODS

We studied 46 symptomatic patients (5.5+/-3.3 yr old, 35 male) >10 months after surgery for Hirschsprung's disease. We performed a colonic manometry with a catheter placed with the tip in the proximal colon. We used a structured questionnaire and phone interview to follow up the patients an average of 34 months after the manometry.

RESULTS

We identified four motility patterns: 1) high-amplitude propagating contractions (HAPCs) migrating through the neorectum to the anal sphincter, associated with fecal soiling (n = 18); 2) normal colonic manometry associated with fear of defecation and retentive posturing (n = 9); 3) absence of HAPCs or persistent simultaneous contractions over two or more recording sites (n = 15), associated with constipation (n = 13); and 4) normal colonic motility and a hypertensive internal anal sphincter (>80 mm Hg) (n = 4). We based treatment on results of the motility studies. There was improvement in global health (mean score, 3.9+/-1.1 vs 2.8+/-1.3 at the time of initial evaluation, p < 0.001) and emotional health (3.8+/-1.1 vs 2.6+/-1.1, p < 0.0001). Improvement in the number of bowel movements occurred in 72% of children. Resolution or decreased abdominal pain was reported in 80%.

CONCLUSIONS

Colonic manometry clarifies the pathophysiology and directs treatment in symptomatic children after surgery for Hirschsprung's disease.

Authors+Show Affiliations

Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10925981

Citation

Di Lorenzo, C, et al. "Colonic Motility After Surgery for Hirschsprung's Disease." The American Journal of Gastroenterology, vol. 95, no. 7, 2000, pp. 1759-64.
Di Lorenzo C, Solzi GF, Flores AF, et al. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol. 2000;95(7):1759-64.
Di Lorenzo, C., Solzi, G. F., Flores, A. F., Schwankovsky, L., & Hyman, P. E. (2000). Colonic motility after surgery for Hirschsprung's disease. The American Journal of Gastroenterology, 95(7), 1759-64.
Di Lorenzo C, et al. Colonic Motility After Surgery for Hirschsprung's Disease. Am J Gastroenterol. 2000;95(7):1759-64. PubMed PMID: 10925981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonic motility after surgery for Hirschsprung's disease. AU - Di Lorenzo,C, AU - Solzi,G F, AU - Flores,A F, AU - Schwankovsky,L, AU - Hyman,P E, PY - 2000/8/5/pubmed PY - 2000/8/29/medline PY - 2000/8/5/entrez SP - 1759 EP - 64 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 95 IS - 7 N2 - OBJECTIVE: Years after surgery for Hirschsprung's disease, many children continue to suffer from fecal incontinence or constipation. The purpose of the present investigation was to define the physiology underlying the persistent symptoms in children after surgery for Hirschsprung's disease, and to determine the outcome of interventions based on the results of the motility testing. METHODS: We studied 46 symptomatic patients (5.5+/-3.3 yr old, 35 male) >10 months after surgery for Hirschsprung's disease. We performed a colonic manometry with a catheter placed with the tip in the proximal colon. We used a structured questionnaire and phone interview to follow up the patients an average of 34 months after the manometry. RESULTS: We identified four motility patterns: 1) high-amplitude propagating contractions (HAPCs) migrating through the neorectum to the anal sphincter, associated with fecal soiling (n = 18); 2) normal colonic manometry associated with fear of defecation and retentive posturing (n = 9); 3) absence of HAPCs or persistent simultaneous contractions over two or more recording sites (n = 15), associated with constipation (n = 13); and 4) normal colonic motility and a hypertensive internal anal sphincter (>80 mm Hg) (n = 4). We based treatment on results of the motility studies. There was improvement in global health (mean score, 3.9+/-1.1 vs 2.8+/-1.3 at the time of initial evaluation, p < 0.001) and emotional health (3.8+/-1.1 vs 2.6+/-1.1, p < 0.0001). Improvement in the number of bowel movements occurred in 72% of children. Resolution or decreased abdominal pain was reported in 80%. CONCLUSIONS: Colonic manometry clarifies the pathophysiology and directs treatment in symptomatic children after surgery for Hirschsprung's disease. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10925981/Colonic_motility_after_surgery_for_Hirschsprung's_disease_ L2 - https://Insights.ovid.com/pubmed?pmid=10925981 DB - PRIME DP - Unbound Medicine ER -