Electromanometría anorectosigmoídea en el diagnóstico diferencial de la constipación en el niño

W, Claus Krebs; Floras, Guillermo; R, Iván Bravo; F, María Antonieta Cruz; M, Rodolfo Sepúlveda; F, Susana Rojas

doi:10.4067/s0370-41061988000100001

Cited by 3 publications

(8 citation statements)

References 3 publications

(2 reference statements)

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“…We have already reported elsewhere on our experience in electromanometric and histochemical differential diagnosis of chronic constipation (6,7,8,9,10,11).…”

Section: Discussionmentioning

confidence: 94%

“…Eleetromanometry of the anoreetum is, in eomparison, absolutely free of risk (4, 3, 10) and in our experienee allows, in the majority of ehronie constipated patients, a diagnostically safe method without the need of another examination (6,7,8,9,10,11).…”

Section: Discussionmentioning

confidence: 94%

“…Modern examination methods make it possible to define precisely the organic and functional cause of chronic constipation, thus enabling a specific therapy (1,3,4,10,14).…”

Section: Discussionmentioning

confidence: 99%

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Anorectal Electromanometry in the Diagnosis of Neuronal Intestinal Dysplasia in Childhood

Krebs

Mc²,

Ma³

1991

Eur J Pediatr Surg

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The diagnosis of neuronal intestinal dysplasia (NID) is currently established by histochemical procedures. From October 1, 1981, until July 31, 1990, we submitted a total number of 737 patients under 15 years of age with several distinct colonic and anorectal disorders, to clinical, radiological, electromanometrical, histochemical and histological evaluation. 573 had a clinical diagnosis of chronic constipation, and in 38 of these NID could be demonstrated by histochemical examination. Motivated by our own findings with the anorectal electromanometry in these patients we performed a double-blind prospective study to find out if there are any particular and pathognomonic manometric parameters of NID in childhood. 80% of our patients with NID diagnosed prospectively since April 1st, 1986, had a relaxation of the internal anal sphincter which was not proportional to the volume of rectal distention. Anorectal hyperexcitability was also present in these patients, whereas a statistically highly significant (p less than 0.01) increase of the amplitude of anorectal fluctuations (7.27 +/- 1.12 mmHg) as compared to the values measured in our own patients with functional chronic constipation (2.87 +/- 0.33 mmHg) could be demonstrated. Considering only those patients who simultaneously presented all of the above mentioned electromanometric criteria (e.g. non-proportional relaxation of the internal anal sphincter, anorectal hyperexcitability, increased amplitude of anorectal fluctuations) without an increase of the anorectal pressure profile, we could demonstrate that the correlation between the electromanometric diagnosis of NID and the final histochemical diagnosis was 100%. Nevertheless, under these conditions, 30% (9 out of 30) of patients with NID were not recognized electromanometrically because they had been excluded as false negative cases.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…We have already reported elsewhere on our experience in electromanometric and histochemical differential diagnosis of chronic constipation (6,7,8,9,10,11).…”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

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Anorectal Electromanometry in the Diagnosis of Neuronal Intestinal Dysplasia in Childhood

Krebs

Mc²,

Ma³

1991

Eur J Pediatr Surg

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“…El porcentaje importante de lactantes (57%) no tratados antes de ingresar al protocolo relleja la poca relevancia que aparentemente se otorga al problema. Las deposiciones duras persistentes pueden causar inflamacion cr6nica -en algunos casos intensa-, fibrosis del esfmter interno y perpetuar la constipacion 10 . Su oportuna detecci6n y tratamiento permitirian tambie'n evitar los problemas sico!6-gicos que se asocian con la afeccidn a edades posteriores 11 .…”

Section: Comentariounclassified

Tratamiento de la constipación crónica del lactante con avena machacada y harina de avena

D¹,

S²,

M³

et al. 1995

Rev. chil. pediatr.

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The effect of crushed oat and oat flour added to milk feedings was evaluated on management of infant's constipation. Ninety two infants with persistent constipation were selected (mean age 6-6 ± 1.8 month] ana divided in three groups whose milk feedings were respectively given supplements of crushed oat, oar flour or no supplement (controls! in addition to the ususal dietary indications for constipation treatment. The effect was evaluated by means of c recall of mother's opinion at 7 and 14 days after beginning of treatment and daily written records on number and hardness of infanls stools. Increased frequency of evacuation and decreased hardness of the stools was observed with both products. These trends were statistically significant, particularly at the second week of treatment. Tolerance and acceptance were good for both products. Cnenical composition and energy content of crushed oa! and oat flour were similar fa those of other cereals used in infants feeding. Administration of tnese products for longer time periods could probably result in improved effect.(Key words cons:ipation, cereals, oat, diet fiber, food, formulated.)Aunque no hay datos precisos sobre la prevalencia de la constipaci6n en el lactante, se estima que en EE.UU. afecta a 3% de los nifios que asisten a control de salud y causa 25% de sus consultas gastroenteroldgicas 1 . Las caracteristicas de las deposiciones de los lactantes vanan ampliamentc en frecuencia y consistencia, por lo que no existe consenso para definir la constipaci6n. En general, se acepta que es una evacuacion incompleta, dificil, que causa molestia o dolor. Sus manifestaciones clinicas mas frecuentes son meteorismo, colicos, dolor al evacuar, rectorragia, malestar general y anorexia 2 . La evolucitfn de la constipacion puede ser aguda o crdnica, esto ultimo cuando los sintomas duran mas de tres meses y no responden a los tratamientos habituales. Segun su patogenia puede ser funcional u organica, secundaria a amplia gama de trastornos. La mayor parte de los casos de constipacion cronica en lactantes se debe a causas funcionales, donde los factores dieteticos pueden jugar un papel importante. Entre ellos se puede mencionar la utilizacion de leche de vaca, por su alto contenido de calcio y caseina, y el escaso consumo de fibra diete'tica 3 " 5 . El tratamiento de estos pacientes tiene como proposito conseguir y mantener el vaciamiento rectal completo. Para ello se recomienda, entre otras medidas, aumentar la ingestion de fibra, aunque las posibilidades de incorporarla en la alimentacidn de los lactantes son limitadas. Generalmente se sugiere, ademas, el consumo de jugos de frutas (cuyo contenido de fibra es muy bajo) y aumentar el aporte de veduras y frutas.Dado su contenido de fibra, la avena se ha usado tradicionalmente en el manejo de la constipaci6n, incorpora"ndola a formulas l£cteas o comidas, siendo bien aceptada por la madre y por los nifios. A pesar de su empleo frecuente en el tratamiento de la constipacidn del lactante, no existen antecedentes bibliogra"ficos sobre...

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“…Additionally actual investigations have shown that the etiology of constipation is not Iimited to some sphincler dysfunction but is associated in most cases with coloreclal disorders that are primary and not secondary to the sphincter hypertonicity, which explains the persistence of symptoms in spite of some kind of operation atthe sphincter level (1,2,4,7,8,9,10).…”

Section: Molsmentioning

confidence: 99%

Transanal Internal Sphincter Myomectomy: Indications, Operative Procedure and Results

Krebs¹,

Acuña²

1994

Eur J Pediatr Surg

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From October 1, 1981, until December 31, 1991, we performed clinical, radiological, electromanometrical, histochemical and histological diagnostic procedures in 906 patients under 15 years of age, because of several distinct colonic and anorectal disorders. 739 were clinically constipated and in 272 of them hypertonicity of the internal anal sphincter with or without achalasia could be demonstrated by manometry. 121 of these patients were submitted to a posterior, transanal, partially resective internal sphincteromyomectomy, according to a slightly modified classical procedure. Follow-up of our operated patients ranged from 1 month to 9 years, with a mean of 3 years and 2 months and overall satisfactory results in 87.6% based on clinical evaluation. Additionally, 55.4% of the operated patients had early postoperative manometric controls (n = 67) and 77.6% of these (n = 52) accepted a third manometry, in order to evaluate late results of our procedure. We could demonstrate that early postoperative anorectal electromanometry shows a highly significant decrease of the internal anal sphincter pressure correlating with a clinical improvement in 98.5% of these patients (n = 67). Most late postoperative examinations showed recurrent elevation of the manometric internal sphincter pressure parameters, exceeding the mean values of our own normal controls. Nevertheless, clinically 98.1% of these patients had a persistent satisfactory remission of their symptoms, thus not correlating with the manometric findings in these cases. We conclude, that transanal internal sphincter myomectomy is a safe surgical procedure, which leads to satisfactory results in approximately 90% of chronically constipated children with anal sphincter hypertonicity, if very precise indications for operation are considered.

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Electromanometría anorectosigmoídea en el diagnóstico diferencial de la constipación en el niño

Cited by 3 publications

References 3 publications

Anorectal Electromanometry in the Diagnosis of Neuronal Intestinal Dysplasia in Childhood

Anorectal Electromanometry in the Diagnosis of Neuronal Intestinal Dysplasia in Childhood

Tratamiento de la constipación crónica del lactante con avena machacada y harina de avena

Transanal Internal Sphincter Myomectomy: Indications, Operative Procedure and Results

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