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OBJECTIVE: The aim was to evaluate the outcomes of conventional anorectal manometry (ARMM) testing and biofeedback therapy in adolescents with functional constipation. METHODS: A retrospective analysis of ARMM findings in patients aged 10-18 years with intractable constipation over a 4-year period was conducted. RESULTS: Of the 41 patients (mean age, 13.5±2.44 years) included, 20 (48.7%) were male. Rectoanal inhibitory reflex (RAIR) was positive in all patients. Group 1 had 31 patients with dyssynergic defecation (DD) and Group 2 had 10 patients without DD. Anal canal resting pressure, squeeze test pressure, rectal defecation pressure, and first and urge sensation volumes were similar between the groups. Maximum tolerated volume and the relaxation percentage of RAIR were higher in Group 1 than in Group 2 (p<0.05). Among 31 patients referred for biofeedback therapy, 8 (25.6%) completed the program with complete resolution of their symptoms. The mean follow-up period for these patients was 21±14.7 months. CONCLUSION: DD is relatively common in patients with psychosocial adjustment disorders, and it can be diagnosed via ARMM. Despite the low rate of adherence to the therapy in the presented series, biofeedback therapy was highly effective in resolving the symptoms including soiling. [ABSTRACT FROM AUTHOR]

Introduction: For several reasons, a patient may be taken to a colostomy for closure as soon as possible. However, their treatment may vary, and predicting adequate continence after colostomy closure can be difficult. The objective is to characterize preoperative manometry because, in Colombia, few cases describe its usefulness. Methods: A descriptive cross-sectional study of adult patients treated in two gastroenterology centers in Colombia between 2018 and 2020. Results: Of 316 patients, 13 were indicated manometry before colostomy closure, predominantly women (69%), with an average age of 51.69 years (standard deviation: 24.18). When evaluating the basal pressures of the anal sphincter, we noted 68% hypotonia, 16% hypertonia, and 16% normal pressures. The voluntary contraction test was abnormal in 25%, and a pattern of dyssynergic defecation was observed in 30%, all with type III patterns. The inhibitory rectoanal reflex was present in 92%, with an abnormal balloon expulsion test in 100% of patients. More than 70% of patients persisted with the colostomy in situ after the first year of construction and 30% beyond 36 months. Conclusions: The present study posits questions about the cost-effectiveness of anorectal manometry before colostomy closure, which requires corroboration by studies with more patients and more robust methodological designs. [ABSTRACT FROM AUTHOR]

Introduction: There is no clarity about manometric findings in patients with proctalgia fugax; evidence shows different results. This study aims to evaluate dyssynergic defecation through anorectal manometry in Colombian patients in two gastroenterology centers in Bogotá, Colombia. Materials and methods: A cross-sectional descriptive observational study in adult patients with proctalgia fugax undergoing anorectal manometry and treated in two gastroenterology centers in Bogotá between 2018 and 2020. Results: 316 patients were included, predominantly women (65%), with a median age of 45.2 (range: 18-78; standard deviation [SD]: 28.3). Four percent of patients had hypertonicity, 50% were normotonic, and 46% were hypotonic. Regarding manometric parameters, 50% had normal pressure, and 46% had anal sphincter hypotonia; 76% had a normal voluntary contraction test. Dyssynergic defecation was documented in 5% of patients, and the most frequent was type I, followed by type III. A rectoanal inhibitory reflex was identified in all patients, 42% with altered sensory threshold and 70% with abnormal balloon expulsion. There was an agreement between the results of the anorectal manometry and the subjective report of the digital rectal exam by the head nurse who performed the procedure. Conclusions: The data obtained in the present study suggest that proctalgia is not related to the elevated and sustained basal contracture of the sphincter but neither to the alteration in voluntary contraction since most patients have typical values. [ABSTRACT FROM AUTHOR]

High resolution anorectal manometry is a diagnostic test, used for anorectal motor and sensory disorders. It consists of measurement of basal tone, anal contraction and squeeze, the rectoanal inhibitory reflex (RAIR), and rectal sensory parameters. The conventional interpretation of anorectal manometry focuses on describing the dysfunctional anatomical region in isolation. However, the London classification seeks to standardize the report of these results, grouping them into major, minor and inconclusive findings in a manner similar to the Chicago classification for esophageal motor disorders. [ABSTRACT FROM AUTHOR]

Introduction: Hirschsprung's disease (HD) is characterized by absence of ganglion cells (GC) in a variable length of the colon. The gold standard diagnosis of EH is the full thickness rectal biopsy, although some authors consider the suction biopsy as the gold standard (consensus 2005). Anorectal manometry (MAN) is a noninvasive procedure that demonstrates the absence of rectoanal inhibitory reflex (IIRR) in the cases of HD. In recent publications are regarded MAN no diagnostic value in HD. Material and Methods: A retrospective, observational, included all pediatric patients with suspected HD and counted with MAN and the diagnostic gold standard for our hospital (total thickness colorectal biopsies) from 1984-2008. 2x2 tables are made between the result of man vs. the result of the biopsy (gold standard) to determine the real value of the MAN as a diagnostic test (sensitivity, specificity, positive predictive value and negative, false positive and negative). Results: Of a total of 455 MAN performed in our hospital from 1984 to 2008, 267 were in patients in our hospital and the rest were external consults. Of these 267 MAN, 79 counted gold standard diagnosis (intestinal biopsy), 55 and 24 did not show whether IIRR IIRR showed, the first in 52 found the absence of ganglion cells confirming the diagnosis of EH, was observed in 3 ruling out the presence of ganglion cells of HD. Of the second 24 (presence of IIRR), 100% showed presence of ganglion cells in the histological study discarding EH. In no patient of the latter group showed absence of ganglion cells in the histological study. The MAN as a diagnostic test comprehensively demonstrates a sensitivity of 100%, specificity 88%, positive predictive value of 94% and negative predictive value 100%, and 5.4% false positive and false negative 0% compared with the standard gold. By grouping patients under and over two years are: children under 2 years showed that the MAN has a sensitivity of 100%, specificity 81%, 91% positive predictive value, negative predictive value 100%, 3 false positives and no false negatives, and over 2 years showed a sensitivity of 100%, specificity 100%, 100% positive predictive value, negative predictive value 100%, and no false positive nor negative. Discussion: MAN in our experience is a key diagnostic pillar to help confirm EH with high sensitivity and specificity but also because of its ability to rule by EH negative predictive value 100%, the above is particularly noticeable in older patients 2 years. Although the diagnostic gold standard in our hospital continues to be the full thickness intestinal biopsy because of the advantages offered by the MAN (less invasiveness, ease of implementation, and extensive experience in our department), the latter maintains a dominant role in the diagnosis EH, it is worth mentioning that the man in our hospital has been conducted in a standardized manner since 1984 and in 95% of the cases is done by the same staff, which gives a margin of safety to the test very high since technical standpoint. In our study is very important to note that compared to the MAN in 100% of the cases against the diagnostic gold standard and our 2x2 table is perfectly reproducible, which is considered vital in the meta-analysis impartancia giving an important validity to our study. [ABSTRACT FROM AUTHOR]

Introduction: Hirschsprung's disease (HD) is characterized by absence of ganglion cells (GC) in a variable length of the colon. The gold standard diagnosis of EH is the full thickness rectal biopsy, although some authors consider the suction biopsy as the gold standard (consensus 2005). Anorectal manometry (MAN) is a noninvasive procedure that demonstrates the absence of rectoanal inhibitory reflex (IIRR) in the cases of HD. In recent publications are regarded MAN no diagnostic value in HD. Material and Methods: A retrospective, observational, included all pediatric patients with suspected HD and counted with MAN and the diagnostic gold standard for our hospital (total thickness colorectal biopsies) from 1984-2008. 2x2 tables are made between the result of man vs. the result of the biopsy (gold standard) to determine the real value of the MAN as a diagnostic test (sensitivity, specificity, positive predictive value and negative, false positive and negative). Results: Of a total of 455 MAN performed in our hospital from 1984 to 2008, 267 were in patients in our hospital and the rest were external consults. Of these 267 MAN, 79 counted gold standard diagnosis (intestinal biopsy), 55 and 24 did not show whether IIRR IIRR showed, the first in 52 found the absence of ganglion cells confirming the diagnosis of EH, was observed in 3 ruling out the presence of ganglion cells of HD. Of the second 24 (presence of IIRR), 100% showed presence of ganglion cells in the histological study discarding EH. In no patient of the latter group showed absence of ganglion cells in the histological study. The MAN as a diagnostic test comprehensively demonstrates a sensitivity of 100%, specificity 88%, positive predictive value of 94% and negative predictive value 100%, and 5.4% false positive and false negative 0% compared with the standard gold. By grouping patients under and over two years are: children under 2 years showed that the MAN has a sensitivity of 100%, specificity 81%, 91% positive predictive value, negative predictive value 100%, 3 false positives and no false negatives, and over 2 years showed a sensitivity of 100%, specificity 100%, 100% positive predictive value, negative predictive value 100%, and no false positive nor negative. Discussion: MAN in our experience is a key diagnostic pillar to help confirm EH with high sensitivity and specificity but also because of its ability to rule by EH negative predictive value 100%, the above is particularly noticeable in older patients 2 years. Although the diagnostic gold standard in our hospital continues to be the full thickness intestinal biopsy because of the advantages offered by the MAN (less invasiveness, ease of implementation, and extensive experience in our department), the latter maintains a dominant role in the diagnosis EH, it is worth mentioning that the man in our hospital has been conducted in a standardized manner since 1984 and in 95% of the cases is done by the same staff, which gives a margin of safety to the test very high since technical standpoint. In our study is very important to note that compared to the MAN in 100% of the cases against the diagnostic gold standard and our 2x2 table is perfectly reproducible, which is considered vital in the meta-analysis impartancia giving an important validity to our study. [ABSTRACT FROM AUTHOR]