Segmental colonic dilation is associated with premature termination of high‐amplitude propagating contractions in children with intractable functional constipation

Koppen, Ilan J.N.; Thompson, Benjamin P.; Ambeba, Erica J.; Lane, Victoria A.; Bates, D. Gregory; Minneci, Peter C.; Deans, Katherine J.; Levitt, Marc A.; Wood, Richard J.; Benninga, Marc A.; Lorenzo, Carlo Di; Yacob, Desale

doi:10.1111/nmo.13110

Cited by 18 publications

(18 citation statements)

References 34 publications

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“…CM studies were performed per the respective institutions’ protocols and previously published guidelines (11,12). Both water-perfused and solid state catheters were used, with sensors spaced 2–10 cm apart.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder

Coe¹,

Ciricillo

Mansi

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility. Methods: A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility. Results: Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P = 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P < 0.0001). Conclusions: Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.

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Section: Methodsmentioning

confidence: 99%

Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder

Coe¹,

Ciricillo

Mansi

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…It has been suggested that, in children, partial propagation of HAPCs is associated with slow colonic transit 49 and segmental colonic dilation. 37 However, synchronous pressurizations at the termination of HAPCs are also hypothesized to function as a means to maintain colonic wall tone to facilitate transit in health. 45,50 Corsetti et al 45 identified pressurizations at the termination of 74% of propagating contractions in the prandial period in healthy adults.…”

Section: Our Data Included a High Prevalence Of Partially Propagatingmentioning

confidence: 99%

“…For example, if HAPCs do not propagate to the distal colon, and if the distal colon is dilated, these children could benefit from colonic resection in combination with a cecostomy. 37,54 In addition, surgical intervention may result in improved colonic motility. Following antegrade continence enemas or colonic diversion, some children with no HAPCs observed on their initial study later demonstrate HAPCs on subsequent colonic manometry studies.…”

Section: Clinical Decision-making Regarding Surgical Intervention In mentioning

confidence: 99%

“…35,36 The "completeness" of the HAPCs is also described, with previous studies demonstrating that HAPCs terminating >15 cm from the anal verge may be pathological. 37 The colonic bisacodyl response is comparable when bisacodyl is infused into the left 38,39 or right 5 hemicolon, and is dose-dependent with higher doses of bisacodyl being associated with an increase in length of HAPC propagation and total HAPC count. 40 In this study, we have collated colonic manometry data from five tertiary/quaternary pediatric hospitals in the United States of America (USA), the United Kingdom (UK), and the Netherlands (NL), with the aim of characterizing the colonic response to intraluminal infusion of bisacodyl in children with treatment-refractory constipation.…”

Section: Introductionmentioning

confidence: 96%

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Characterization of the colonic response to bisacodyl in children with treatment‐refractory constipation

Heitmann

Wiklendt

Thapar

et al. 2020

Neurogastroenterology Motil

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Background Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment‐refractory constipation. If bisacodyl does not induce high‐amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies. Methods Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion. Results One hundred and sixty‐five children were included (median age 10, range 1‐17 years; n = 96 girls). One thousand eight hundred and ninety‐three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre‐ vs post‐bisacodyl (Z = −0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ2(1)=7.04, P < .01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response. Conclusions and Inferences Intraluminal bisacodyl induced HAPCs in 93% of children with treatment‐refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined.

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“…There is no consensus yet on the precise definition of refractory constipation but failure to respond to conventional bowel management is a generally acceptable definition 2 . In patients with refractory constipation, colonic manometry (CM) testing is indicated to evaluate for colonic dysmotility from both functional and organic etiology 2–4 . CM provides information on the neuromuscular integrity of the colon by evaluating colonic muscle contractions and motility by measuring intraluminal colonic pressures throughout the cleansed colon using a manometry catheter placed endoscopically or under fluoroscopy with sensors covering the entire length of the colon from cecum to sigmoid colon 5 .…”

Section: Introductionmentioning

confidence: 99%

High amplitude propagated contractions with Glycerin versus Bisacodyl: A within‐subject comparison in children undergoing colonic manometry

Mansi

Bahia

Patel

et al. 2023

Neurogastroenterology Motil

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Background:The presence of high amplitude propagated contractions (HAPCs) measured by colonic manometry (CM) reflect an intact neuromuscular function of the colon. Bisacodyl and Glycerin are colonic stimulants that induce HAPCs and are used for the treatment of constipation. HAPCs characteristics with each drug have not been compared before. We aimed to compare the HAPC characteristics with Bisacodyl and Glycerin in children undergoing CM for constipation.Methods: This is a prospective single-center cross-over study of children aged 2-18 years undergoing CM. All patients received both Glycerin and Bisacodyl during CM.They were randomized to group A with Bisacodyl first (n = 22) and group B with Glycerin first (n = 23), with 1.5 hours in between each dose. Differences in patient and HAPC characteristics between groups were summarized using descriptive statistics and compared using Chi-square test or Wilcoxon rank sum test as appropriate.Key Results: A total of 45 patients were included. HAPCs post Bisacodyl had a longer duration of action (median of 40 vs 21.5 min, p < 0.0001), longer propagation (median of 70 vs 60 cm, p = 0.02), and more HAPCs (median of 10 vs 5, p < 0.0001) compared Glycerin. No differences were found in the HAPC amplitude and onset of action between both medications.

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Segmental colonic dilation is associated with premature termination of high‐amplitude propagating contractions in children with intractable functional constipation

Abstract: Segmental colonic dilation was associated with prematurely terminating HAPCs and may be a useful indicator of colonic dysmotility.

Cited by 18 publications

References 34 publications

Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder

Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder

Characterization of the colonic response to bisacodyl in children with treatment‐refractory constipation

High amplitude propagated contractions with Glycerin versus Bisacodyl: A within‐subject comparison in children undergoing colonic manometry

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