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Interobserver Variability in the Interpretation of Colon Manometry Studies in Children

Sood, Manu R.*; Mousa, Hayat; Tipnis, Neel*; Di Lorenzo, Carlo; Werlin, Steven*; Fernandez, Sergio; Liem, Olivia; Simpson, Pippa; Rudolph, Colin*

Journal of Pediatric Gastroenterology and Nutrition: November 2012 - Volume 55 - Issue 5 - p 548–551
doi: 10.1097/MPG.0b013e3182569c8b
Original Articles: Gastroenterology

Objectives: The aim of the present study was to evaluate the variability in interpretation of colon manometry (CM) in children.

Methods: Fifty-seven colon motility studies were independently reviewed by 5 observers. Each observer was required to report on the colonic motility during fasting, after administration of a meal, and after bisacodyl stimulation. They were also asked to comment whether CM study was normal or abnormal and whether in their opinion the postprandial recording provided clinically useful information.

Results: The median (range) agreement regarding the presence of high-amplitude propagating contractions (HAPC) was 83% (80%–92%). The interpretation of gastrocolonic response produced the most inconsistent results with median (range) agreemnet of 64% (53%–95%). The postprandial period was reported to be useful in only 3% to 24% of the studies. The median (range) agreement regarding the overall interpretation of the study being either normal or abnormal was 87% (83%–90%).

Conclusions: The most easily recognizable contraction pattern during CM is the high-amplitude propagating contractions. Visual interpretation of the gastrocolonic response produces the most inconsistent results and maximum variability. Abbreviated CM studies without the postprandial period or routine calculation of the motility index to evaluate gastrocolonic response can help make colon manometries more objective and reliable.

*Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI

Department of Pediatrics, Division of Gastroenterology, Nationwide Children Hospital, Ohio State University, Columbus, OH

Department of Quantitative Health Science, Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI.

Address correspondence and reprint requests to Manu R. Sood, Associate Professor, Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI 53045 (e-mail:

Received 19 November, 2010

Accepted 16 May, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN