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Rodriguez, L; Sabharwal, S; Flores, AF
Pediatric Neurodigestive Center. *Department of Pediatrics. Floating Hospital for Children. Tufts University School of Medicine
Antegrade colonic enemas via cecostomy (ACEC) have been used in a select group of patients with chronic constipation No data is available in relation to its effects on colonic manometry in patients with constipation from colonic neuropathy or Hirschsprung's disease (HD) s/p pull through.
Describe the manometric changes of colonic manometry after ACEC use and its correlation with successful regimennn discontinuation. Methods: 8 patients (2 w/HD) with severe constipation underwent colonic manometry consistent with colonic neuropathy. All 8 patients underwent a cecostomy tube placement and manometry was repeated after a mean of 24 months of ACEC. Parameters evaluated in the colonic manometry: presence of peristaltic contractions during the fasting period, gastrocolonic reflex and bysacodil induced high amplitude peristaltic contractions (HAPC).
No patient had gastrocolonic reflex before ACEC, 5 had contractions during the fasting period and 2 had normal HAPC's and 2 other had partially propagated HAPC's. After ACEC 3 patients showed gastrocolonic reflex, all 8 had contractions during fasting period and 4 had normal HAPC's and 4 had partially propagated HAPC's, one patient had normal HAPC's initially that became partially propagated after cecostomy. At a mean follow up of 45 months all patient report significant improvement of their constipation symptoms but all 8 are still depending on the ACEC and multiple attempts to wean its use have failed.
Colonic manometry improves after antegrade enemas but it does not correlate with the ability to successfully discontinue their use. This improvement could be attributable to a mechanical effect or an improvement in the contractility of the colon that does seem to have a relationship with the clinical response to ACEC but not with the ability to become independent from them. The parameter that improved the most is the presence of bysacodil induced HAPC's.
© 2005 Lippincott Williams & Wilkins, Inc.
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