COLONIC MANOMETRY IN CHILDREN WITH CHRONIC INTESTINAL PSEUDOOBSTRUCTION

Pressure changes were evaluated in the transverse, descending, and rec tosigmoid colon of 30 children with chronic intestinal pseudo-obstruct ion. Twenty two had severe lifelong constipation and eight had symptom s suggesting a motility disorder exclusively of the upper gastrointest inal tract. Based on prior antroduodenal manometry, 24 children were d iagnosed as having a neuropathic and six a myopathic form of intestina l pseudo-obstruction. On the day of study, endoscopy was used to place a manometry catheter into the transverse colon and intraluminal press ure was recorded for more than four hours. After a baseline recording, we gave a meal to assess the gastrocolonic response. Colonic contract ions were noted in 24 children. The six children with no colonic contr actions had a hollow visceral myopathy and constipation. In the childr en with colonic contractions, fasting motility did not differentiate c hildren with and without constipation. After the meal, in all eight ch ildren without constipation there was (1) an increase in motility inde x (3.2 (SEM 0.3) mm Hg/min basal upsilon 8.4 (SEM 1.1) mm Hg/min postp randial; p<0.001), and (2) at least one high amplitude propagated cont raction (HAPC). In the 16 constipated children with colonic contractio ns the motility index did not significantly increase after the meal (2 .1 (SEM 0.3) mm Hg/min basal upsilon 3.1 (SEM 0.4) mm Hg/min postprand ial) and 12 of them had no HAPCs (p<0.01 upsilon group without constip ation). In summary, in children with a clinical diagnosis of chronic i ntestinal pseudo-obstruction, constipation is associated with absence of HAPCs, and the gastrocolonic response or with total absence of colo nic contractions. It is concluded that studies of colonic manometry ar e feasible in children and may document discrete abnormalities in thos e with intestinal pseudo-obstruction with colonic involvement.