Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement

Abstract

Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) and high‐resolution anorectal manometry (HRAM) are relatively novel tools for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. Although it is the gold standard tool in adults, it has yet to be formally accepted as a standardized diagnostic tool in the pediatric age, with limited knowledge regarding indications, protocol, and normal values. ARM/HRAM is slowly becoming recognized among pediatricians, but given that there are currently no agreed guidelines there is a risk that will lead to diversity in practice. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)—Motility Working Group (MWG) therefore has taken the opportunity to provide guidance on the use of ARM/HRAM in children with CC and/or FI.

Anorectal manometry in pediatric settings: A systematic review of 227 studies

“…Based on the recent national consensus, 28 normal values used have been provided in the appendix (Tables S2 and S3).…”

“…Based on the recent national consensus, 28 a terminology table (Table S1) and protocol (Figure S1) have been provided including the quantitative assessment of different parameters (resting pressure, squeeze pressure, cough reflex, RAIR) and a qualitative assessment of the other parameters.…”

“…To address these problems, a recent national consensus was recently published and reached to utilize its use in the United Kingdom. 28 The use of ARM in the awake state or under general anesthesia/sedation is an area of great controversy. Primarily in the UK, ARM testing in children has historically been performed under sedation, 29,30 because of the child's age, the likelihood that they will be uncooperative, or simply because ARM has been perceived as an invasive procedure.…”

“…The delayed and to some extent neglected implementation within pediatrics is due to the lack of standardization for its use, indications (e.g., age, which patients with CCFSFI, diagnostic/prognostic), protocol (awake or under general anesthesia [GA]/sedation), and type of equipment (traditional vs HR‐ARM, water/solid state) (Figure 1). To address these problems, a recent national consensus was recently published and reached to utilize its use in the United Kingdom 28 …”

“…These studies included neurological abnormalities such as cerebral palsy, spinal cord tumor, spinal trauma, and sacral agenesis, as well as genetic conditions, such as Waardenburg syndrome and multiple endocrine neoplasia type 2B. They also included problems commonly encountered in neonatal services, such as ileus, necrotizing enterocolitis, and food intolerance.Based on the recent national consensus,28 normal values used have been provided in the appendix(Tables S2 and S3).…”