Colonic Hyperactivity Results in Frequent Fecal Soiling in a Subset of Children After Surgery for Hirschsprung Disease

Kaul, Ajay; Garza, Jose M.; Connor, Frances; Cocjin, Jose; Flores, Alejandro; Hyman, Paul E.; Lorenzo, Carlo Di

doi:10.1097/mpg.0b013e3181efe551

Cited by 49 publications

(59 citation statements)

References 15 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We believe that this approach can be temporary in otherwise healthy patients, as it may allow recovery of the colonic dysfunction and eventually discontinue its use, although this has not been studied. The colon manometry has been reported as useful in clinical practice to typify the colonic physiology in defecations disorders in patients with colorectal disorders like Hirschsprung's disease 8,9 and imperforate anus, 10 to predict ACE outcome 11 and to guide surgical therapy in refractory constipation. 12,13 However, the diagnostic value of the CM to predict outcomes has not been properly evaluated.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Rodriguez¹,

Nurko²,

Flores³

2012

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Antegrade continence enemas (ACE) have been used in the treatment of defecation disorders in children; little is known on their effect on colon motility and the utility of the colon manometry (CM) predicting long term ACE outcomes. Methods Retrospective review of children with constipation undergoing CM before and after ACE to evaluate CM changes and their utility on predicting ACE outcome. Results 40 patients (mean age 8.8 SD 3y and 53% female) were included; 39/40 responded to the ACE. Of these 39, 14 (36%) were dependent and 25 (64%) had decreased it (11 of those or 28% discontinued it). On repeat CM we found a significant increase in the fasting (p<0.01) and post-prandial (p=0.03) motility index, number of bisacodyl-induced high amplitude propagating contractions (HAPC’s) (p=0.03) and total HAPC’s (p=0.02). Gastrocolonic response to a meal, propagation and normalization of HAPC’s improved in 28%, 58% and 33%, respectively with CM normalizing in 33% of patients. The baseline CM did not predict ACE outcome. The presence of normal HAPC’s on the repeat CM was associated with ACE decrease. Progression and normalization of HAPC’s (p=0.01 and 0.02 respectively) and CM normalization (p=0.01) on repeat CM were individually associated with ACE decrease. No CM change was associated with ACE discontinuation. Multivariate analysis showed that older age and HAPC normalization on CM predict ACE decrease and older age is the only predictor for ACE discontinuation. Conclusions Colon motility improves after ACE and the changes on the repeat CM may assist in predicting ACE outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Rodriguez¹,

Nurko²,

Flores³

2012

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…Previous studies established that patients with Hirschsprung’s Disease have increased frequency of HAPCs after surgery compared to children without surgery 34 . The mechanism for this increase is unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of Colon Transection on Spontaneous and Meal‐Induced High‐Amplitude–Propagating Contractions in Children

Jacobs¹,

Wolfson²,

Lorenzo³

et al. 2015

J. pediatr. gastroenterol. nutr.

Self Cite

View full text Add to dashboard Cite

Background After Hirschsprung’s disease (HD) surgery, many children suffer fecal incontinence caused by increased number of high amplitude propagating contractions (HAPCs) propagating through the neorectum to the anal verge. The aim of this study was to determine whether children with HD have more HAPCs than children with colon transections for reasons other than HD. Methods We reviewed 500 colon manometries. Children (7.6±5.1 yrs; 275 male) with functional constipation (n=237; 7.4±5.0yrs; 126 male) and chronic abdominal pain (n=48; 9.8±5.8yrs; 25 male) served as controls compared to subjects with HD (n=56; 6.9±4.1yrs; 44 male) and colon transection for other reasons (n=24; 6.1±5.8yrs; 12 male). We excluded 139 subjects without HAPCs. We documented HAPCs during 1 h fasting and 1 h postprandial. Results are mean ± SD. Results During fasting, HD subjects had more HAPCs (2.2±3.4/h) vs. functional constipation (0.8±2.2/h, p=0.0004) and chronic pain (0.5±1.1/h, p=0.001), but not more than colon transection (1.9±3.2/h, p=1.0). HD showed more postprandial HAPCs (4.0±5.4/h) than functional constipation (1.5±2.5/h, p<0.0001) and chronic pain (0.9±1.6/h, p<0.0001), but not more than colon transection (2.4±3.0/h, p=0.6). There were more HAPCs fasting and post-prandial after colon transection (1.9 ± 3.2/h and 2.4±3.0/h) than functional constipation (0.8±2.2/h, p=0.3 and 1.5±2.5/h, p=1.0) and chronic pain (0.5±1.1/h, p=1.0 and 0.9±1.6, p=1.0). HD subjects were divided by chief complaint: fecal incontinence or constipation. HD subjects with incontinence (n=23) only had more HAPCs fasting (p=0.01) and post-prandial (p=0.01) than HD subjects with constipation (n=28) only. Conclusions Increased HAPCs followed colon transection, regardless of cause. HD subjects with incontinence had more HAPCs than subjects with colon transection for other reasons.

show abstract

“…Colonic manometry in combination with ARM has emerged as an important tool in understanding the pathophysiology and guiding the management of persistent postoperative symptoms of patients with Hirschsprung's disease and anorectal malformations, such as imperforate anus. Treatment guided by the CM (laxatives when HAPCs were weak or absent and medications to increase stool consistency in the presence of HAPCs migrating to rectum with normal or low tone anal sphincter) resulted in a significant improvement in quality of life and frequency and consistency of bowel movements . It has been reported that 80% of patients with imperforate anus and fecal incontinence have HAPCs propagating into the neorectum and 60% have low internal anal sphincter resting pressure.…”

Section: Indicationsmentioning

confidence: 99%

“…To evaluate persistent symptoms following surgery, specifically for HAPCs were weak or absent and medications to increase stool consistency in the presence of HAPCs migrating to rectum with normal or low tone anal sphincter) resulted in a significant improvement in quality of life and frequency and consistency of bowel movements. 53,54 It has been reported that 80% of patients with imperforate anus and fecal incontinence have HAPCs propagating into the neorectum and 60% have low internal anal sphincter resting pressure. Treatment based on those findings resulted on improvement of fecal incontinence in 45% of patients.…”

mentioning

confidence: 99%

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

Rodriguez

Sood

Lorenzo

et al. 2016

Neurogastroenterology Motil

120

220

View full text Add to dashboard Cite

show abstract

Colonic Hyperactivity Results in Frequent Fecal Soiling in a Subset of Children After Surgery for Hirschsprung Disease

Abstract: Daily, frequent fecal soiling after pull-through surgery for HSCR may be due to colonic hyperactivity in some children. It is imperative that this unique subset be identified because the management strategy would include avoidance of laxatives, contrary to standard current practice.

Cited by 49 publications

References 15 publications

Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Effect of Colon Transection on Spontaneous and Meal‐Induced High‐Amplitude–Propagating Contractions in Children

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

Contact Info

Product

Resources

About