G3 Dyssynergia and chronic constipation. (12th September 2022)

• Record Type: Journal Article
• Authors: Bingham, Carly; Papadopoulos, Michalis; Mutalib, Mohamed
• Is Part Of: Frontline gastroenterology. Volume 13(2022)Supplement 1
• Page Start: A17
• Page End: A17
• Publication Date: 2022-09-12
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1136/flgastro-2022-bspghan.22
• Languages: English
• ISSNs: 2041-4137

Abstract

Abstract : Introduction/Background: Chronic constipation is a frequent cause of referrals to tertiary gastroenterology centres. In children where medication and lifestyle modifications have failed to alleviate the issue, anorectal manometry can be used to examine the functional mechanisms surrounding defecation, including the relaxation of the anal sphincters, the rectal pressure increase and the co-ordination of these two manoeuvres when trying to defecate. Dyssynergia is defined as an increase in pressure or failure to relax of the anal sphincters when attempting defecation, with or without an increase in rectal pressure. There are four types of dyssynergia based on which combination of issues are present. Aim: The aim of this study was to examine the rate of dyssynergia diagnoses in paediatric patients with chronic constipation and investigate whether there is any demographic differences in the patients presenting with different types of dyssynergia. Subjects and Methods: A retrospective review was carried out of all patients who attended Evelina London Children's Hospital for awake high resolution anorectal manometry with constipation as a referral reason in the period March 2019 – November 2021. 62 patients were identified, of which 45 (29 male, average age: 10.1 years) had complete data for the push manoeuvre recorded. The data for each of these patients were reviewed to identify whether dyssynergia was present and the type of dyssynergia, as well as their age at time of investigation and gender. Results: Dyssynergic defecation was found in 26 of the 45 children (58%), with 20 identified as Type I and 6 identified as Type II. A chi squared test showed no significant difference (p > 0.05) between the gender split across all children with constipation, children with Type I dyssynergia and Type II dyssynergia A two-tailed t-test also showed no significant difference (p > 0.05) between the ages of the Type I and Type II groups. Summary and Conclusion: Dyssynergia is a likely contributor to chronic constipation, with 58% of the patients presenting for anorectal manometry at our centre being diagnosed with either Type I or Type II dyssynergia. Age and gender did not affect the likelihood of presenting with dyssynergia and were not predictive of the type of dyssynergia diagnosed.