Ilan J N Koppen1, Sophie Kuizenga-Wessel2, Peter L Lu3, Marc A Benninga2, Carlo Di Lorenzo4, Victoria A Lane5, Marc A Levitt5, Richard J Wood5, Desale Yacob4. 1. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands. Electronic address: i.j.koppen@amc.nl. 2. Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands. 3. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA. 4. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. 5. Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: Children with intractable functional constipation (FC) may eventually require surgery, often guided by motility testing. However, there are no evidence-based guidelines for the surgical management of intractable FC in children. AIM: To assess the diagnostic and surgical approach of pediatric surgeons and pediatric gastroenterologists towards children with intractable FC. METHODS: A survey was administered to physicians attending an international conference held simultaneously in Columbus (Ohio, USA) and Nijmegen (the Netherlands). The survey included 4 questions based on cases with anorectal and colonic manometry results. RESULTS: 74 physicians completed the questionnaire. Anorectal manometry was used by 70%; 52% of them would consider anal sphincter botulinum toxin injections for anal achalasia and 21% would use this to treat dyssynergia. Colonic manometry was used by 38%; 57% of them reported to use this to guide surgical decision-making. The surgical approach varied considerably among responders answering the case questions based on motility test results; the most commonly chosen treatments were antegrade continence enemas and anal botulinum injections. CONCLUSION: Surgical decision-making for children with intractable FC differs among physicians. There is a need for clinical guidelines regarding the role of anorectal and colonic manometry in surgical decision-making in children with intractable FC.
BACKGROUND:Children with intractable functional constipation (FC) may eventually require surgery, often guided by motility testing. However, there are no evidence-based guidelines for the surgical management of intractable FC in children. AIM: To assess the diagnostic and surgical approach of pediatric surgeons and pediatric gastroenterologists towards children with intractable FC. METHODS: A survey was administered to physicians attending an international conference held simultaneously in Columbus (Ohio, USA) and Nijmegen (the Netherlands). The survey included 4 questions based on cases with anorectal and colonic manometry results. RESULTS: 74 physicians completed the questionnaire. Anorectal manometry was used by 70%; 52% of them would consider anal sphincter botulinum toxin injections for anal achalasia and 21% would use this to treat dyssynergia. Colonic manometry was used by 38%; 57% of them reported to use this to guide surgical decision-making. The surgical approach varied considerably among responders answering the case questions based on motility test results; the most commonly chosen treatments were antegrade continence enemas and anal botulinum injections. CONCLUSION: Surgical decision-making for children with intractable FC differs among physicians. There is a need for clinical guidelines regarding the role of anorectal and colonic manometry in surgical decision-making in children with intractable FC.
Authors: Mana H Vriesman; Ilan J N Koppen; Michael Camilleri; Carlo Di Lorenzo; Marc A Benninga Journal: Nat Rev Gastroenterol Hepatol Date: 2019-11-05 Impact factor: 46.802
Authors: Mana H Vriesman; Lyon Wang; Candice Park; Karen A Diefenbach; Marc A Levitt; Richard J Wood; Seth A Alpert; Marc A Benninga; Karla Vaz; Desale Yacob; Carlo Di Lorenzo; Peter L Lu Journal: Neurogastroenterol Motil Date: 2020-02-03 Impact factor: 3.598