The Study Of Anorectal Manometry Chnages In Children With Functional Constipation Before And After Tretment

Background and ObjectiveFunctional constipation (FC) is a common cause of child defecation.Clinical observations at home and abroad show that about 95% constipationchildren have are functional constipation. The latest Romeâ…¢criteria ofchildren's functional gastrointestinal disorders in 2006 shows that the incidencerate of constipation of children was from 0.3% to 8.0%. Children with thissymptom seeking for treatment accounts for 3% to 5% of comprehensive outpatientpediatric and more than 25% of patients of pediatric digestive outpatient.The incidence of this disease in children is high, when short-termconventional treatment doesn't work; thus resulting in clinical problemsaffecting children's physical and mental health. Therefore, it is necessary toexplore new diagnosis, treatment.Anorectal manometry technique and colonic transit tests (CTT) are thecommon method of diagnosis and assessment of children with functionalconstipation of treatment. Through baroreceptor, anorectal manometry, a safe, simple, non-invasive, objective test technology, measures the changes oftransrectal pressure, which can help to quantify , understandand and assess thefunctions of anal canal and rectum self defecation and provide pathophysiologybasis for study of the diseases of anal canal, rectum, as abnormal bowelmovement, etc. and guide clinical treatment as well. We enrolled children withFC accepting treatment at Fourth Military Medical University, Tang DuHospital pediatric from January 2008 to December 2009 for anorectal study, forthe first time in the country discussing differences in dynamics and anorectalanomalies between healthy children and all types of children with FC beforeand after Fosson treatment, providing experimental evidence for diagnosis andtreatment of the clinical classification.MethodsThirty-five children with FC were enrolled at the Fourth MilitaryMedical University, TangDu Hospital pediatric from January 2008 toDecember 2009 as FC group. At the same period, 10 children withoutgastrointestinal symptoms and daily normal defecation were enrolled as healthycontrol group.Using colonic transit index (TI) determined by X ray opaque markers(ROM) to classify the FC type, the FC children were divided into outletobstruction type (OOC),slow transit (STC) type and mixed type.With the adoption of the Dutch MMS company's Solar GIgastrointestinal dynamic inspection system to measure indicators of anorectalmanometry, FC group was treated with Polyethylene Glycol 4000 powder toobserve the efficacy and to test anorectal manometry before and after treatment.Results35 cases of FC according to TI values were divided into outlet obstruction (OOC) 19 cases and slow transit (STC) 16 cases . TI values of thetwo sub-groups were significant (t = 14.33, P<0.01). The study did not findMIX children. Two weeks after Polyethylene Glycol 4000 powder treatment,20 cases were reviewed colonic transit test, discharge quantity of the markerwere over; 80%, that is, the numbers of residual colon and rectum ROM areless than 4.There was no significant difference between FC group and healthy controlgroup as well as the groups of two types of FC in the anal sphincter restingpressure (P>0.05). OOC group's anal sphincter maximum systolic blood pressurewas higher than that of the healthy control group and higher than STC group,which has a significant difference (P<0.05). The lowest rectal volume andmaximum tolerated dose-sensitive of FC group were higher than those of healthycontrol group and there was significant difference between them (P <0.05). Thetwo subgroups rectal minimum sensitivity and the maximum tolerated dose wasno significant difference (P>0.05).There was no significant difference before andafter treatment between STC group and OOC group in anal sphincter restingpressure and anal sphincter maximum systolic blood pressure (P>0.05),however,the minimum rectal volume and rectal sensitivity decreased the maximumtolerated dose, the difference was significant (P<0.05).FC group after treatment,compared with the healthy control group, had no significant differences in theanal sphincter resting pressure, anal sphincter maximum systolic blood pressureand rectal maximum tolerated dose (P>0.05). There existed significantdifferences in rectal sensitive to the amount of the minimum between OOC groupafter treatment and the healthy control group (P <0.05).ConclusionsThere were obvious anorectal dynamic disorder and obnormal feeling in children with functional constipation, and dysfunction of colonic transit.Polyethylene Glycol 4000 powder treatment can improve this abnormalityandcan restore normal bowel function.