Medical Professional Publications

New Guidelines for Anorectal and Colonic Manometry in Children

Columbus, OH — January 2017

Anorectal manometry is the most frequently performed motility test in children. Colonic manometry, once confined to only few pediatric hospitals, is now becoming more widespread at major pediatric referral institutions. The development of novel technologies and the greater accessibility of these tests have prompted two major American gastroenterology organizations to jointly publish guidelines on their indications and interpretations in children.  

The recent statement from the American Neurogastroenterology and Motility Society (ANMS), endorsed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), helps to define best practices for these diagnostic tests. It was published in Neurogastroenterology and Motility.

“It is important to define the indications of motility studies as sometimes there is confusion about what to expect and when to order these tests,” says Miguel Saps, MD, senior author of the statement and attending gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital. “We need to educate the medical community on how to interpret the results of these tests, and how to use them to help their patients. Our intent was to provide specialists and primary care physicians with an up-to-date guide to be used in daily practice.”

Dr. Saps is the director of research at Nationwide Children’s Motility Center and the national pediatric representative on the board of ANMS. Carlo Di Lorenzo, MD, Chief of Gastroenterology at Nationwide Children’s, is a coauthor of the statement and past president of NASPGHAN.

The statement offers a thumbnail sketch of all aspects of the two manometric studies, from preparations for testing (i.e. anorectal manometry requires few special arrangements, while colorectal manometry requires cessation of medication for at least 48 hours and a colonic clean-out) to normative values including recto-anal inhibitory reflex and high amplitude propagated contraction.

”The indications of these tests differ in adults and children,” says Dr. Saps, who is also a professor of Pediatrics at The Ohio State University College of Medicine. “The most important reason to perform anorectal manometry in children is the exclusion of Hirschsprung’s disease. Anorectal and colonic manometry are used in specialized motility centers to assess patients with intractable constipation and fecal incontinence, to diagnose colonic dysmotility and to plan surgical interventions in patients who have failed medical treatment. These tests are also used in major colorectal centers to evaluate children who had surgery for malformations associated with constipation and fecal incontinence.”

But as important as learning the benefit of using these tests is understanding their limitations, and how to interpret their results in the context of each patient.

“The role of the pediatric motility expert in complex cases cannot be ignored. It is important to understand that these are some of the tools in the armamentarium of the motility specialists,” says Dr. Saps. “But, as advanced as the tests are, there is still a need for real motility expertise to combine the results of the tests with the history and clinical findings of the patient in order to establish the best plan of care for each patient.  We are very excited about the progress in the field. There have been many new technological advances over the last few years that allow us to see in 3D, and to better understand the mechanisms of constipation, but we still need more research to understand how useful each of these findings is in helping care for our patients. Our institution is in the forefront of the most advanced investigations to help find answers for the most complex problems.”

Dr. Saps and his colleagues are continuing to work on similar guidelines for two other motility tests, antroduodenal and esophageal manometries.

Reference:

Rodriguez L, Sood M, Di Lorenzo C, Saps M. An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterology and Motility.  2016 Oct 9. [Epub ahead of print]

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