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PubMed2005

Role of anal dilatation in treatment of idiopathic constipation in children: long-term follow-up of a double-blind randomized controlled study.

Constipation in childhood is a common symptom, with an estimated incidence between 0.3% and 8%. Most of the evidence for the current management of constipation and fecal soiling in children is based on reports of nonrandomized retrospective trials. Anal dilatation has had an established role in the management of idiopathic constipation but has never been evaluated by a randomized study. A double-blind randomized controlled trial was done of children who failed to respond to medical treatment and were admitted for investigation and treatment of idiopathic constipation to Guy's Hospital, London, between April 2001 and April 2003. All children had intestinal transit study on admission. They were randomized, using a computer-generated allocation in sealed envelopes, to receive no anal dilatation (control group) or anal dilatation (anal dilatation group). Anorectal manometry and endosonography were done under ketamine anesthesia followed by anal dilatation if necessary under the same anesthesia. Disimpaction of feces from the rectum was done at the end of the procedure under general anesthesia using propofol muscle relaxant to minimize stretching of anal sphincter muscles in the control group. All children had intensification of medical treatment, toilet training, and monitoring of their response to treatment during their hospital stay, which ranged from 3 to 5 days. Outcome was measured using a parent's questionnaire of symptom severity at 3 and 12 months of follow-up by one of the authors, who was blinded to randomization. The symptom severity score ranged between 0 and 65 and consisted of scores for the following: delay in defecation (score range 0-10), difficulty and pain with passing stool (0-5), soiling problem (0-10), intensity of laxative treatment (0-10), child's general health (0-5), behavior related to the bowel problem (0-5), overall improvement of symptoms (0-12,) and assessment of megarectum on abdominal examination (0-8). Of 60 neurologically normal children, 31 (19 males) were randomized in the control group and 29 (18 males) in the anal dilatation group. All children had findings consistent with idiopathic constipation and positive anorectal reflex on manometry, no anal sphincter damage on endosonography, and no anal fissure on examination under anesthesia. The median age for control and anal dilatation groups was 7.97 (range 4.1-14.25) years and 7.78 (4-13.25) years, respectively. Both groups were also comparable with regard to median of duration of laxative treatment (32 months vs. 31.5 months), internal anal sphincter thickness on endosonography (0.90 mm vs. 0.80 mm), resting anal sphincter pressure on manometry (51 mmHg vs. 51 mmHg), total rectal capacity on manometry (260 mmHg vs. 260 mmHg), and total symptom severity score before admission (33 vs. 29), respectively. At 12-month follow-up, the median pre-admission symptom severity score had improved significantly, from 33 (range 12-49) in the control group and 29 (16-51) in the dilatation group to 15 (0-51, p < 0.0001) and 19 (1-46, p < 0.0001), respectively. There was no significant difference between the two groups with regard to symptom severity score improvement at 12-month follow-up (p < 0.92). We found a significant correlation between total rectal capacity measured on manometry and symptom severity score before admission and at 12-month follow-up (r = 0.30, p < 0.01 and r = 0.25, p < 0.05, respectively). Our results indicate that anal dilatation does not contribute to the management of school-aged children with idiopathic constipation. Admission to hospital for clarification of diagnosis and intensification of medical treatment with disimpaction of stool from the rectum is beneficial.

Adolescent↗

PubMed2004

Postoperative objective outcomes for upright, supine, and bipositional reflux disease following laparoscopic nissen fundoplication.

HYPOTHESIS: Traditionally, patients with gastroesophageal reflux disease fall into 3 categories based on 24-hour pH testing and the clinical occurrence of their acid exposure. Patients with upright reflux are believed to do worse following surgery compared with supine or bipositional reflux patients. We assessed objective postoperative outcomes for patients with upright, supine, and bipositional reflux following laparoscopic Nissen fundoplication to determine if there is a category of refluxing patient who should be counseled against antireflux surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Esophageal physiology laboratory at a tertiary care teaching hospital. PATIENTS: A total of 225 patients (supine, 45; upright, 92; bipositional, 88) with preoperative and postoperative 24-hour pH measurements, manometry results, and standardized symptom assessment forms were included in the study. INTERVENTIONS: A Nissen fundoplication was performed based on 24-hour pH and manometry result. Esophageal manometry was performed with a water-perfused system, and 24-hour pH was measured with a digital capture device. MAIN OUTCOME MEASURES: Preoperative and postoperative symptom correlation, 24-hour pH, and manometric variables. RESULTS: There was a significant difference in preoperative symptom correlation between groups. Patients with bipositional reflux disease have significantly worst reflux disease (percentage of time with a pH <4, total number of reflux episodes, longest reflux episode, and Johnson-DeMeester score) and the weakest preoperative lower esophageal sphincter pressure. Postoperative symptom correlation was low among all 3 groups. There was no significant difference in postoperative 24-hour pH or manometry among groups. Success following surgery was achieved in 73.3% with supine reflux, 80.4% with upright reflux, and 75.0% with bipositional reflux. CONCLUSIONS: Patients with bipositional reflux have the most severe disease. Supine, upright, and bipositional reflux patients perform equally well following laparoscopic fundoplication as defined by objective outcome criteria.

Adult↗

PubMed1997

Esophageal dysfunction in scleroderma: relationship with disease subsets.

OBJECTIVE: To investigate the relationship between esophageal function and the extent of disease in a nonselected group of scleroderma patients, and to study gastric and small bowel motility in a group of scleroderma patients with more severe clinical manifestations. METHODS: Esophageal function in 125 scleroderma patients was investigated by radiologic, endoscopic, manometric, and pH-metric techniques. Ten patients also underwent gastrointestinal (GI) manometric recording, both during fasting and after a standard meal. RESULTS: Radiologic abnormalities of the esophagus were found in 55 of 81 patients (68%) and esophagitis in 45 of 125 (36%). No significant relationship was disclosed between GI symptoms, radiologic abnormalities, esophagitis grade, and the various disease subsets. However, the overall incidence of endoscopic esophagitis (irrespective of the degree) was significantly (P < 0.05) correlated with the patient subgroups, with 100% incidence of esophagitis in those having the more severe cutaneous involvement (type III). Manometric abnormalities were documented in 80% of patients, and pathologic reflux in 78%. The severity of esophageal abnormalities on manometry significantly correlated with the severity of the disease, whereas no correlations were found with pH-metric data. Ninety percent of the 10 female patients undergoing antroduodenal manometry displayed abnormal findings; of these, 60% showed neuropathic, and 30% myopathic, patterns. The latter were recorded in patients with a more severe stage of the disease (type III). CONCLUSION: A direct relationship was observed between scleroderma subsets and the severity of esophageal (and, probably, more distal gut) motor involvement. Since no correlation was found between esophageal symptoms and the severity of manometric abnormalities, manometry should be considered the single most important GI test to document the severity of the "esophageal" disease. Gastric and small bowel manometry may also offer evidence of widespread gut involvement, and provide a rationale for a more targeted therapeutic approach.

Adult↗

PubMed1988

Investigation of anorectal function.

Anorectal function tests were performed in 280 consecutive patients, who were referred for evaluation of different anorectal disorders. The relationship between the estimated anal sphincter pressure on digital palpation and the measured pressure on anal manometry was investigated and the interrelationship between anal manometry, rectal capacity and the saline infusion test was defined. A significant correlation (P less than 0.001) was found between digitally and manometrically measured anal sphincter pressure. Considering the relationship between the three specific anorectal function tests, only manometry and the saline infusion test correlated to some extent (P less than 0.01). This study shows that digital palpation is helpful in anorectal function investigation, but to establish the exact anal pressures, anal manometry is mandatory. Furthermore, the poor correlation observed indicates that single tests represent different aspects of anorectal function and therefore they need to be performed together.

Adolescent↗

PubMed1989

Comparison of digital and manometric assessment of anal sphincter function.

Anal sphincter function was assessed by digital examination and anal canal manometry in 66 patients and controls. Digital scores were allotted by using visual analogue scales for basal and squeeze sphincter function and were compared with the corresponding pressures. There were good correlations between digital basal score and maximum basal pressure (Spearman rank correlation coefficient rs = 0.56, P less than 0.001), and digital squeeze score and maximum squeeze pressure (rs = 0.72, P less than 0.001). There were wide ranges of sphincter function on digital and manometric assessment with considerable overlap between patient groups. Digital scores detected differences in sphincter function between patient groups as accurately as manometry. The sensitivities and specificities of digital scores and anal canal manometry in segregating continent and incontinent patients were similar. It was concluded that digital estimation was equally as good as assessment of anal sphincter function as anal canal manometry.

Adult↗

PubMed1994

Anal endosonography for identifying external sphincter defects confirmed histologically.

Defects of the external anal sphincter have traditionally been diagnosed by palpation, anal manometry and electromyography (EMG), but anal endosonography enables clear imaging of both the internal and external sphincter muscles. A study was performed to validate the interpretation of ultrasonographic images of external sphincter defects using histology as a 'gold standard'. In addition the accuracy of clinical examination, manometry, EMG mapping and anal endosonography in the diagnosis of sphincter defects were compared prospectively. Twelve consecutive patients with faecal incontinence (11 women, one man; mean age 46 (range 30-64) years) who required sphincter repair underwent clinical assessment, anal manometry, concentric-needle EMG mapping and anal endosonography before surgery. The endosonographer was unaware of the history or results of physiological tests and the surgeon performing the repair was blind to the ultrasonographic findings. At operation most or all of the suspected defect was excised and examined histologically. The pathologist was unaware of the endosonographic or operative findings at the time of reporting. Combined operative and histological examination identified an external sphincter defect in nine of the 12 patients. Anal endosonography correctly identified all nine defects and the three normal sphincters. The accuracy of clinical examination was 50 per cent and that of both EMG and anal manometry 75 per cent. In addition, anal endosonography identified a defect of the internal anal sphincter in eight patients. External sphincter defects identified by endosonography have not been previously verified histologically. Precise sphincter assessment is mandatory for the correct management of faecal incontinence. Anal endosonography is more accurate than clinical and conventional physiological methods and also provides information on the internal sphincter.

Adult↗

PubMed1989

Cycling, a manometric phenomenon due to repetitive episodes of gastroesophageal reflux and clearance.

We studied intraesophageal pressure changes in patients with symptoms of gastroesophageal reflux and an abnormal 24-hr pH monitoring record (N = 52). Our method was simultaneous esophageal manometry and pH monitoring. We observed a three-component esophageal manometric sequence (EMS). When this sequence recurred over and over, we termed this phenomenon "cycling." We found cycling in 35% of the patients (18/52). Those with cycling had lower basal LES pressures, more acid exposure, and an increased incidence of endoscopic esophagitis. That cycling resulted from repeated reflux events and their esophageal clearance was documented by scintigraphy during simultaneous manometry and pH monitoring (N = 7 patients). Cycling was found on the routine esophageal manometry record of 25% of symptomatic patients (N = 112) with an abnormal 24-hr pH score. In conclusion, cycling represents an esophageal manometric phenomenon due to repetitive reflux events. Its recognition during esophageal manometry may denote a severe reflux diathesis.

Adult↗

PubMed1993

How accurate is clinical examination in diagnosing and quantifying pelvirectal disorders? A prospective study in a group of 50 patients complaining of defecatory difficulties.

We prospectively evaluated 50 patients (38 females and 12 males; mean age, 44.7 +/- 15 years) who complained of defecatory difficulties to determine the accuracy of the clinical examination in diagnosing and quantifying pelvirectal abnormalities. Each parameter was then compared with the features of anorectal manometry and evacuation proctography performed by two independent observers. Global agreement between clinical diagnosis and the reference method (radiology for rectoceles, rectal intussusceptions, and abnormal perineal descent; manometry for anismus) was observed in 80 percent of cases. In rectoceles, anismus, and rectal intussusceptions especially, excellent negative predictive values were obtained (96, 96, and 80 percent, respectively). Clinical examination always diagnosed high-grade intussusceptions. Nevertheless, abnormal perineal descent was poorly evaluated in 20 patients. When compared with anal manometry, digital assessment was able to quantify resting and squeeze pressures and length of the anal canal with excellent correlation and good global agreement as well as predicting a short or hypotonic anal canal. Clinical assessment is usually sufficient and accurate in most pelvirectal disorders encountered in patients complaining of defecatory difficulties. Both anorectal manometry and evacuation proctography retain a definite but limited place in investigating pelvirectal disorders.

Adult↗

PubMed1997

Anorectal function in systemic sclerosis: correlation with esophageal dysfunction?

PURPOSE: This study was designed to compare esophageal and anorectal function parameters in patients with systemic sclerosis and to define the role of anorectal manometry in the diagnosis of gastrointestinal involvement of systemic sclerosis. PATIENTS AND METHODS: Twenty-six consecutive patients (22 females) with systemic sclerosis originally referred for assessment of esophageal function were evaluated by esophageal and anorectal manometry. Anorectal function parameters were compared between patients with normal and those with disturbed esophageal function. RESULTS: A total of 17 of 26 patients (65 percent) had severe esophageal dysfunction with aperistalsis of the lower two-thirds of the esophagus, whereas 9 patients (35 percent) had normal esophageal manometry. Only three patients (11.5 percent) suffered from occasional fecal incontinence. Anorectal function parameters (resting pressure, maximum squeeze pressure, perception threshold) were not significantly different between patients with normal and those with disturbed esophageal motility. Rectoanal inhibitory reflex was excitable in nearly 90 percent of patients. CONCLUSION: In an unselected group of patients with systemic sclerosis, fecal incontinence and abnormal anorectal function are rather rare findings. Anorectal manometry cannot differentiate between patients with and without gastrointestinal involvement of systemic sclerosis.

Adolescent↗

PubMed1996

Anal sphincter repair improves anorectal function and endosonographic image. A prospective clinical study.

PURPOSE: This study investigated the effect of anal sphincter repair on fecal continence in relation to anal endosonography and anal manometry. METHODS: Eighteen patients (7 male, 11 female) with anal sphincter defects and complaints of fecal incontinence (5), soiling ( = liquid discharge; 3), or both (10) were studied before and after sphincter repair with endosonography and anal manometry. Complaints were the result of obstetric trauma (7), surgical trauma (7), both (3), and other trauma (1). Five patients had previous surgery. Preoperative endosonography showed a defect of both sphincters in nine patients, a defect of the external anal sphincter in five patients, and a defect of the internal anal sphincter in four patients. An overlapping sphincter repair was performed. RESULTS: Postoperatively and subjectively (S; patient's view), 13 (72 percent) patients became continent or improved; in 5 (28 percent) patients the complaints were unaltered. Objectively (O) (incontinence or soiling frequency), these figures were 12 (67 percent) and 6 (33 percent). Postoperative endosonographic images improved in 14 (78 percent) patients; defects of the sphincters (almost) disappeared (4) or were smaller (10). In the other four patients, images were unchanged. In two patients, overlapping of the muscle was clearly visible with anal endosonography. Clinical result (subjective (S) and objective (O)) of sphincter repair correlated with changes in anal endosonography (S, r = 0.64, P < 0.004; O, r = 0.51, P = 0.03) and anal manometry (S, r = 0.54, P = 0.038; O, r = 0.44, P = 0.09 (not significant)) and not with pudendal nerve latency. CONCLUSIONS: In 78 percent of our patients, endosonographic sphincter defect had diminished or disappeared after sphincter repair. There was a good correlation between clinical effect of sphincter repair and changes with anal endosonography and anal manometry. Postoperative persistent incontinence is attributable to remaining sphincter defects. Anal endosonography should be performed as a routine procedure in patients with fecal incontinence or soiling, also after failed surgery.

Anal Canal↗

PubMed1996

Ambulatory esophageal pH testing. Referral patterns, indication, and treatment in a Canadian teaching hospital.

Over a 30-month period, 867 esophageal pH studies were conducted in a Canadian teaching hospital; of these, 315 tests were recorded in patients who were first-time referrals having no chest or upper gastrointestinal surgery and taking no medication that would affect the results. Patients were referred by gastroenterologists, general surgeons, ENT surgeons, thoracic surgeons, and a miscellaneous group. Patients were classified based on: pH results [abnormal = % total time pH < 4.0 (ie, > 6.0%)], manometry (abnormal = LES resting pressure < 5 mm Hg and/or abnormal peristalsis), and gender. Fifty-one percent (162/315) of the patient records demonstrated abnormal reflux. Intergroup comparisons of severity of reflux using two-way analysis of variance demonstrated no significant differences (P = 0.13). In the 162 patients who refluxed, 70% (N = 108) had normal motility studies; however, when the severity of reflux was compared, patients with abnormal motility (N = 54) demonstrated significantly more severe reflux (19.8 +/- 12.8 vs 16.2 +/- 11.3) P = 0.02. In those patients with abnormal manometry, no significant differences (P = 0.44) in the severity of reflux were found among those with abnormal peristalsis (N = 27), low resting pressure (N = 17), or a combination of aperistalsis and low LES pressure (N = 10). Symptomatic patients with reflux (N = 107) demonstrated a significantly greater percent time pH < 4.0 than those with asymptomatic reflux (N = 55); 18.1 +/- 11.5% vs 16.2 +/- 12.7%, P = 0.04. When the severity of reflux by gender was compared, no significant differences were found [18.3 +/- 11.9 (male) N = 91 vs 16.2 +/- 11.9 (female) N = 71, P = 0.11]. The results from this study show that: (1) esophageal pH testing is important in subspecialties other than gastroenterology and that the clinical yield is high in all referring groups, (2) esophageal pH testing and manometry are complimentary tests, but that reflux occurs commonly in association with normal manometry, (3) asymptomatic reflux was found in 34% of the patients with abnormal reflux scores, and (4) the severity of reflux in male and female patients is similar.

Adolescent↗

PubMed2002

Advances in research and clinical practice in motor disorders of the sphincter of Oddi.

Perfusion manometry of the sphincter of Oddi (SO) using a pneumohydraulic capillary infusion system records phasic wave activity superimposed on basal pressure. A triple-lumen catheter allows the recording of propagation of the phasic waves. Microtransducer manometry is an alternative that permits prolonged recording of biliary pressure without the need for infusion. A cyclic change is recognized in SO motility in coordination with the migrating motor complex (MMC) of the duodenum during fasting. SO contractions occur at maximal frequency and amplitude during phase 3 of the duodenal MMC. Using two microtransducer catheters placed by duodenoscopy, a cyclic elevation of biliary pressure can be recorded in concert with phase 3. These findings indicate that human SO contractions impede bile flow. SO dysfunction causing biliary-type pain can be diagnosed by manometry. The pressure elevation during phase 3 may contribute to the development of pain in patients with biliary dyskinesia. Gastrectomy and proximal duodenal transection were proven to affect sphincter motility, as evidenced by the paradoxical response to cholecystokinin. Choledocholithiasis and hepatolithiasis are associated with low basal pressure, presumably due to repeated injury to the sphincter by passing stones. SO and biliary manometry leads to better understanding of biliary dynamics and the pathophysiology of biliary diseases.

Biliary Dyskinesia↗

PubMed2005

Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable.

PURPOSE: Chronic anal fissure is said to be associated with internal sphincter hypertonia. However, an unknown proportion of fissures may be associated with normal or even low resting pressures and may subsequently be resistant to pharmacological treatments or at risk from surgical treatments, both of which aim to reduce sphincter hypertonia. This study investigated the ability of surgeons to detect low or normal pressure fissures by digital rectal examination. METHODS: Patients with chronic anal fissure were assessed prospectively. The results of anal manometry performed on these patients were compared with digital rectal assessment of sphincter tone undertaken by a surgeon blinded to the manometry results. RESULTS: Forty consecutive patients (21 male) with chronic anal fissure were studied. Twenty-two (55 percent) had normal maximum resting pressure and a further 3 (8 percent) had low pressures on anal manometry. On clinical assessment, only five (13 percent) patients were evaluated as having no anal hypertonia. Clinical assessment of anal tone correctly identified 14 of 15 patients with high manometric maximum resting pressure (sensitivity, 93 percent), yet detected only 4 of 25 patients with normal or low pressures (specificity, 16 percent). The positive predictive value of clinical assessment of anal tone was 40 percent and the negative predictive value, 80 percent. CONCLUSIONS: The incidence of patients with chronic anal fissure without high manometric maximum resting pressure is higher than previously reported. The ability of surgeons to identify this group clinically was poor. It is reasonable to treat all patients primarily medically, and then selectively investigate by manometry those patients who fail medical therapy before considering lateral sphincterotomy.

Anal Canal↗

PubMed2005

Telephone vs. face-to-face biofeedback for fecal incontinence: comparison of two techniques in 239 patients.

PURPOSE: Biofeedback is an effective treatment for patients with fecal incontinence, yet little is known about how it works or the minimum regime necessary to provide clinical benefit. This study compares the effectiveness of a novel protocol of telephone-assisted biofeedback treatment for patients living in rural and remote areas with the standard face-to-face protocol for patients with fecal incontinence. METHODS: A new treatment program comprising an initial face-to-face assessment and treatment with transanal manometry and ultrasound biofeedback, followed by three treatments conducted via telephone and a final face-to-face assessment, was developed. Standard treatment involved five face-to-face treatment sessions with manometry and ultrasound. Patients from rural areas were offered the telephone-assisted treatment protocol. Data gathered prospectively included incontinence scores, a quality of life index, anal manometry, and external sphincter isometric and isotonic fatigue times. RESULTS: A total of 239 consecutive patients treated between July 2001 and July 2004 were enrolled. There were no significant differences in demographic details, past history, or pretreatment measures of the two groups. Forty-six of 55 patients (84 percent) treated with the telephone protocol and 129 of 184 (70 percent) treated by the standard technique completed treatment. There were substantial, significant improvements after treatment, including 54 percent mean improvement in patient's own rating of their incontinence in both groups; a mean decrease of 3.1 and 3.2 on the St. Mark's incontinence score (from 7.9 to 4.7 and 7.4 to 4.2 of 13) and relative improvements of 128 and 130 percent in the quality of life index (from 0.29 to 0.65 and 0.3 to 0.69 of 1) for the telephone-assisted and standard groups respectively. Importantly, there were no significant differences between the telephone-assisted or standard groups in any outcome. Of patients who completed treatment, 78 percent were better or much better. CONCLUSIONS: A less intensive regime of biofeedback seems to be equally effective as the standard intensive protocol. This finding adds weight to the evolving concept that the physical aspects of biofeedback treatment, such as manometry or ultrasound, may not be necessary in the treatment of most patients with fecal incontinence. This needs to be further tested in a randomized, controlled trial.

Adult↗

PubMed2003

Clinical significance of sphincter of Oddi dyskinesia.

Sphincter of Oddi dyskinesia (SOD) is a functional disorder of the papilla region that can lead to clinical symptoms and functional obstruction of biliary and pancreatic outflow. Based on the severity of the clinical symptoms, the disorder is classified as one of three types (biliary or pancreatic type I-III). Diagnosis of SOD is hampered by the relative risk of endoscopic sphincter manometry to cause pancreatitis. Manometrically, SOD is characterized by increased pressure in the biliary or pancreatic sphincter segment and can be treated with endoscopic papillotomy. This review is an attempt to balance the arguments for invasive diagnosis with a pragmatic clinical approach in which papillotomy is performed if clinical suspicion and patient presentation support a dysfunction of the papilla. For patients with biliary or pancreatic type I, endoscopic papillotomy is the treatment of choice. In biliary type II, SO manometry may be helpful for clinical decision making; however, the ratio of risks to benefits is difficult to assess based on the present data. In type III SOD, patient selection and the low predictive value of manometry for treatment success raise questions about the clinical usefulness of SO manometry.

Animals↗

PubMed1992

Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and extreme weight loss as a result of severe malabsorption syndrome. The abdominal roentgenogram showed a typical hypotonic intestine with an enlarged stomach and distended intestinal loops with the radiological signs of an ileus. In addition to former episodes, there was also a transient aerobilia. The patient had not undergone biliary surgery or endoscopic sphincterotomy. To investigate the cause of the findings, endoscopic retrograde cholangiopancreatography and endoscopic manometry of the sphincter of Oddi were performed. The endoscopy showed the stomach and duodenum with a wide and dilated lumen and no spontaneous motility. Endoscopic manometry of the biliary tract and the sphincter of Oddi showed several abnormalities compared with a group of normal volunteers or patients who were examined via biliary manometry for other reasons. There was a low basal pressure (3.5 mm Hg) in the sphincter of Oddi together with low-amplitude phasic contractions (25-30 mm Hg), but the contraction frequency was in the normal range. Further investigations of the motility of the gastrointestinal tract in this patient showed diffuse esophageal spasms and a markedly delayed gastric emptying. The findings of biliary manometry in this patient suggest involvement of the sphincter of Oddi and the biliary system in chronic idiopathic pseudo-obstruction.

Air↗

PubMed1995

Intestinal motility and jejunal feeding in children with chronic intestinal pseudo-obstruction.

BACKGROUND/AIMS: Total parenteral nutrition is responsible for most of the morbidity and mortality of childhood chronic intestinal pseudo-obstruction (CIP). The aim of this study was to determine if there are manometric patterns associated with the success of jejunal feedings in children with CIP. METHODS: Eighteen children with CIP (age range, 1-9 years; mean, 4 years; 11 boys and 7 girls) were studied. All patients required parenteral nutrition or failed to thrive while receiving gastrostomy feedings. All underwent an antroduodenal manometry before surgical placement of a jejunostomy. Continuous drip jejunal feeding with an elemental formula was subsequently initiated. Follow-up after jejunal feeding was 1.6 years (range, 6 months to 4 years). Jejunal manometry was performed 2 months to 1 year after jejunostomy. RESULTS: Jejunal feeding eliminated the need for parenteral nutrition in all 9 patients with migrating motor complex (MMC) and in 3 of 9 patients without MMC (P < 0.01). The MMC was present or absent in both antroduodenal and jejunal manometry in 14 of 18 children (77.7%). In 10 of 18 children (55%), duodenal and jejunal manometry showed similar qualitative abnormalities. CONCLUSIONS: In selected children with CIP who fail gastrostomy feeding, jejunal tube feeding is an alternative to parenteral nutrition. The presence of MMCs is associated with a successful adaptation to jejunal feeding.

Child↗

PubMed2004

Gastrointestinal manometric findings in a patient with total intestinal aganglionosis.

BACKGROUND/PURPOSE: The authors studied gastrointestinal motility in a patient with total intestinal aganglionosis (TIA) and the effect of octreotide (OCT) on ileal motility in this patient. METHODS: The 3200-g girl received ileostomy at 50 cm proximal to the ileocecal site and jejunostomy at 15 cm distal to the ligament of Treitz because of severe ileus owing to TIA. Histology of the intestines, including jejunostomy, showed no ganglion cells. Gastro-duodeno-jejunal and distal ileal manometries were done 8 months after birth. RESULTS: In upper gastrointestinal manometry, sporadic contractions and clusters consisting of 3 to 5 contractions were observed in the duodenum and jejunum, but no typical phase 3 was observed during the 3-hour recording period. In ileal manometry, long-lasting repetitive contractions were recorded at 2 distal sites. In the most proximal ileum, the frequency of contractions was less than in the 2 distal sites. OCT administration induced a decrease in the amplitude of contractions during the first 20 minutes. The amplitude increased thereafter and reached a level higher than that before OCT administration. CONCLUSIONS: In this patient, the predominant manometry finding was the remarkable hypermotility of the ileum. OCT induced a transient decrease in ileal motility and an increase in motility thereafter.

Digestive System Abnormalities↗