Auditando trastornos manométricos anorrectales en niños con estreñimiento en un hospital de Colombia

Introduction and Objectives: Anorectal disorders can be an underlying cause of chronic refractory constipation in pediatric patients. This study aims to identify such disorders using high-resolution anorectal manometry (HRAM) in children with chronic refractory constipation. Materials and Methods: A retrospective, observatio-nal, descriptive cross-sectional data analysis was conducted based on HRAM performed in patients under 18 years old with chronic refractory constipation at a hospital in Colombia between 2014 and 2018. An explora-tory descriptive analysis of demographic variables and manometric parameters was performed. Conventional manometric diagnoses were compared and aligned with the London classification. Results: A total of 89 patients were evaluated. According to the conventional classification, 60% of the patients had abnormalities on manometry, and 8% lacked a rectoanal inhibitory reflex (RAIR). HRAM without sedation was performed in 57 patients, of whom 80% showed an abnormal balloon expulsion test (BET); 53% had alterations in sensory thresholds, and 40% exhibited dyssynergic defecation. When extrapolated to the London classification, 93% were found to have rectal sensory disorders; 84% had rectoanal coordination disorders; 39% presented tone and contractility disorders, and 11% had rectoanal areflexia. Conclusions: Anorectal disorders are common in children with chronic refractory constipation and are diagnosed using HRAM to guide prognosis and targe-ted treatments, such as for dyssynergias. A classification similar to the London system, with manometric values tailored to pediatric populations by age groups, would provide a systematic and complementary approach to traditional methods and enhance diagnostic sensitivity.