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Am J Gastroenterol. 1997 Mar;92(3):469-75.
How useful are manometric tests of anorectal function in the management of defecation disorders?

Rao SS, Patel RS.

Division of Gastroenterology, University of Iowa, College of Medicine, Iowa City, USA.

OBJECTIVES: The clinical usefulness of assessing anorectal physiology has not been systematically examined. Our aims were to evaluate whether manometric tests of anorectal function influence the management and outcome of patients with defecation disorders, and to identify the patients who may most benefit from this assessment. METHODS: Using a standard protocol of anorectal manometry rectal sensation, saline continence, simulated defecation, and pudendal nerve terminal latency tests, we studied 143 consecutive patients (m/f = 27/116) and followed their progress over 18 months. RESULTS: Tests of anorectal function in 126 (88%) patients revealed new information that led to a change in the management of 108 (76%) patients. Among 69 patients referred with constipation, 33 (48%) had obstructive defecation, and 40 (58%) had impaired rectal sensation; 30 (43%) improved after biofeedback therapy. Among 56 patients referred with fecal incontinence, 55 (98%) had manometric abnormalities: 30 (53%) had a low squeeze sphincter pressure, 20 (36%) had impaired rectal sensation, and 28 (50%) had pudendal neuropathy. Thiry-four (60%) patients were referred for biofeedback therapy and 11 (20%) for surgery. Of these 15 completed biofeedback therapy with improvement, and six had successful surgery. Seven of 10 (70%) patients referred for preoperative evaluation had abnormalities that contraindicated surgery. CONCLUSIONS: Manometric tests of anorectal function provide not only an objective diagnosis but, also, a better understanding of the underlying pathophysiology. In addition, it provides new information that could influence the management and outcome of patients with disorders of defecation.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9068472&dopt=Abstract constipation laxative colon cleansing

Am J Gastroenterol. 1997 Mar;92(3):476-80.
Experience with gastrojejunal feeding tubes in children.

Peters JM, Simpson P, Tolia V.

Children's Hospital of Michigan, Department of Pediatrics, Wayne State University, Detroit, USA.

OBJECTIVE: Assessment of untoward symptomatic outcomes and major/minor complications occurring in children with percutaneous gastrojejunal tubes (GJT) in place. METHODS: A retrospective chart review of 28 patients with GJTs was performed. The diagnoses for these patients were: neurological diseases, 23; respiratory diseases, two; and gastrointestinal tract disorders, three. Twenty-three tubes were placed radiologically, four endoscopically, and one surgically. Patients' age range was between 1.5 and 180 months (mean 47.2 months), and weight at the time of tube insertion was between 2.28 and 42.7 kg. (mean 11.7 kg.). Duration of follow-up was from 1 to 49 months (mean 17.3 months). The patients were evaluated for the persistence or new development of the following symptoms: vomiting, hematemesis, abdominal pain, constipation, diarrhea, pain at the site of gastrostomy tube insertion, stridor with feeds, and dumping. Minor complications (including breakage, partial/total displacement, or dislodgement of GJT, tube occlusion, tube leakage, transient infection and/or granuloma at the gastrostomy site, and continued gastroesophageal reflux post-GJT conversion), as well as major complications (requiring surgical intervention) and mortality, were assessed. RESULTS: One or more symptoms either persisted or developed de novo in 20 children after tube insertion. Vomiting was the most common symptom, being present in 16 patients. One or more minor complication occurred in 21 patients; the most common was the accidental dislodgement of the jejunal feeding catheter. Major complications occurred in 11 patients (e.g., fundoplication in seven patients). Five patients died. Six patients had no complications; at the time of GJT placement, their mean age (93.3 months) was significantly olde

Gut. 1997 Feb;40(2):188-91.
Oesophageal manometry in the evaluation of megacolon with onset in adult life.

Basilisco G, Velio P, Bianchi PA.

Cattedra di Gastroenterologia, Universita degli Studi di Milano, IRCCS-Ospedale Maggiore di Milano, Italy.

BACKGROUND: Oesophageal motility is often impaired in patients with megaduodenum and other forms of intestinal pseudo-obstruction in which a visceral myopathy or neuropathy may be present. Idiopathic longstanding megacolon with onset in adult life is still a poorly defined entity, which may also be part of a more widespread motility disorder but in which oesophageal motility has not been yet systematically studied. AIMS: To assess oesophageal motility in patients with longstanding idiopathic megacolon with onset in adult life. PATIENTS: 14 consecutive subjects with idiopathic megacolon whose symptoms began after the age of 10 and a clinical history of 2-22 years. METHODS: Standard barium enema, water perfused oesophageal manometry, and also anorectal manometry. RESULTS: Oesophageal motility was impaired in five patients (36%; 95% confidence intervals 16 to 61%). Normal peristalsis was substituted by low amplitude multiple peaked simultaneous contractions in four subjects and by undetectable contractions in one. In three of them the lower oesophageal sphincter did not relax after swallows; in the same patients anal relaxation after rectal distension was also undetectable. All five patients with impaired oesophageal motility had a colonic dilatation sparing the rectum. Three of them reported constipation and a history of pesudo-obstruction and the other two only abdominal distension. CONCLUSIONS: Oesophageal manometry should be performed in patients with longstanding idiopathic megacolon with onset in adult life, in particular if the rectum is not dilated and even in absence of pseudo-obstruction. This simple test may disclose a more widespread visceral neuropathy or myopathy. Such a diagnosis helps to better understand the cause of the

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