The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period

Reid, Janet R.; Buonomo, Carlo; Moreira, C.; Kozakevich, Harold; Nurko, Samuel

doi:10.1007/s002470000298

Cited by 46 publications

(37 citation statements)

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“…It may, however, not even be reliable in short-segment HD; therefore, laparoscopic full-thickness or seromuscular biopsies are required to reliably map the aganglionic segment in longsegment HD (39,40). If a BE is performed, this should be done without previous bowel preparation or recent digital rectal examination (41). In comparison with ARM and RSB, BE has a low sensitivity and specificity for the diagnosis of HD.…”

Section: Bementioning

confidence: 99%

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Schäppi

Staiano

Milla

et al. 2013

J. pediatr. gastroenterol. nutr.

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Objective: Primary gastrointestinal neuropathies are a heterogeneous group of enteric nervous system (ENS) disorders that continue to cause difficulties in diagnosis and histological interpretation. Recently, an international working group published guidelines for histological techniques and reporting, along with a classification of gastrointestinal neuromuscular pathology. The aim of this article was to review and summarize the key issues for pediatric gastroenterologists on the diagnostic workup of congenital ENS disorders. In addition, we provide further commentary on the continuing controversies in the field. Results: Although the diagnostic criteria for Hirschsprung disease are well established, those for other forms of dysganglionosis remain ill-defined. Appropriate tissue sampling, handling, and expert interpretation are crucial to maximize diagnostic accuracy and reduce interobserver variability. The absence of validated age-related normal values for neuronal density, along with the lack of correlation between clinical and histological findings, result in significant diagnostic uncertainties while diagnosing quantitative aberrations such as hypoganglionosis or ultrashort Hirschsprung disease. Intestinal neuronal dysplasia remains a histological description of unclear significance. Conclusions:The evaluation of cellular quantitative or qualitative abnormalities of the ENS for clinical diagnosis remains complex. Such analysis should be carried out in laboratories that have the necessary expertise and access to their own validated reference values.

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Section: Bementioning

confidence: 99%

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Schäppi

Staiano

Milla

et al. 2013

J. pediatr. gastroenterol. nutr.

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“…An important initial step in managing these children is the exclusion of Hirschsprung's disease starting by water-soluble contrast enema [1].…”

Section: Introductionmentioning

confidence: 99%

Contrast enema as a guide for senna-based laxatives in managing overflow retentive stool incontinence in pediatrics

2015

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“…These children are usually examined with a contrast enema. The contrast enema has up to now been used in many centres mainly for evaluating the level of 11(20) aganglionosis, but can be of value as an initial diagnostic test at centres that lack facilities for biopsy or anorectal manometry [13]; and a normal enema in this setting allows the continuation of medical therapy with further evaluation only if there is a lack of response [15]. When the radiological investigation raises suspicion of aganglionosis or is inconclusive further examination with anorectal manometry may be performed.…”

Section: Discussionmentioning

confidence: 99%

Visualisation of the rectoanal inhibitory reflex with a modified contrast enema in children with suspected Hirschsprung disease

et al. 2013

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General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Objective: To see if the rectoanal inhibitory reflex could be visualized with a modified contrast enema, thereby increasing the diagnostic accuracy of the contrast enema and reducing the number of rectal biopsies.Materials and method: 59 boys and 42 girls (median age 12 months) with suspected Hirschsprung disease were examined with a modified contrast enema, supplemented with two injections of cold, water-soluble contrast medium, in order to induce the reflex. Two paediatric radiologists evaluated the anonymised examinations in consensus. The contrast enema findings were correlated with the results of rectal biopsy or clinical follow-up.Results: Five boys and one girl (median age 7.5 days) were diagnosed with Hirschsprung disease. The negative predictive value of the rectoanal inhibitory reflex was 100%. A contrast enema with signs of Hirschsprung disease in combination with an absent rectoanal inhibitory reflex had the specificity of 98% and sensitivity of 100% for Hirschsprung disease. Conclusion:The modified contrast enema improves the x-ray diagnosis of Hirschsprung disease. By demonstrating the rectoanal inhibitory reflex in children without Hirschsprung disease the proportion of unnecessary rectal biopsies can be reduced. 3(20)

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The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period

Cited by 46 publications

References 0 publications

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Contrast enema as a guide for senna-based laxatives in managing overflow retentive stool incontinence in pediatrics

Visualisation of the rectoanal inhibitory reflex with a modified contrast enema in children with suspected Hirschsprung disease

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