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Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

Authors

  • L. Rodriguez,

    1. Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
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  • S. Nurko,

    1. Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
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    • Dr Nurko and Dr Flores contributed equally to the present manuscript.

  • A. Flores

    1. Division of Gastroenterology, Department of Pediatrics, Floating Hospital for Children, Tufts University School of Medicine, Boston, MA, USA
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    • Dr Nurko and Dr Flores contributed equally to the present manuscript.


Address for Correspondence
Leonel Rodriguez, Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
Tel: +617 355 6055; fax: +617 730 0043;
e-mail: leonel.rodriguez@childrens.harvard.edu

Abstract

Background  Antegrade continence enemas (ACE) have been used in the treatment of defecation disorders in children; little is known on their effect on colon motility and the utility of the colon manometry (CM) predicting long-term ACE outcomes.

Methods  Retrospective review of children with constipation undergoing CM before and after ACE to evaluate CM changes and their utility on predicting ACE outcome.

Key Results  A total of 40 patients (mean age 8.8 SD 3 years and 53% female patients) were included; 39 of 40 responded to the ACE. Of these 39, 14 (36%) were dependent and 25 (64%) had decreased it (11 of those or 28% discontinued it). On repeat CM we found a significant increase in the fasting (< 0.01) and postprandial (= 0.03) motility index, number of bisacodyl-induced high amplitude propagating contractions (HAPCs) (= 0.03), and total HAPCs (= 0.02). Gastrocolonic response to a meal, propagation and normalization of HAPCs improved in 28%, 58%, and 33%, respectively, with CM normalizing in 33% of patients. The baseline CM did not predict ACE outcome. The presence of normal HAPCs on the repeat CM was associated with ACE decrease. Progression and normalization of HAPCs (= 0.01 and 0.02, respectively) and CM normalization (= 0.01) on repeat CM were individually associated with ACE decrease. No CM change was associated with ACE discontinuation. Multivariate analysis showed that older age and HAPC normalization on CM predict ACE decrease and older age is the only predictor for ACE discontinuation.

Conclusions & Inferences  Colon motility improves after ACE and the changes on the repeat CM may assist in predicting ACE outcome.

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