title: Comorbidities associated with constipation in children referred for colon manometry may mask functional diagnoses.
abstract: BACKGROUND
  In children with prolonged constipation of unclear pathogenesis or unresponsive to treatment, colon manometry can discriminate between functional fecal retention (FFR) and colon neuromuscular diseases.
  
  
  OBJECTIVE
  To identify the clinical features precipitating referral for colon manometry in children with functional constipation.
  
  
  METHODS
  Retrospective medical record review of 173 constipated children (116 male, mean age 6.9 years, range 1-17 years) referred for colon manometry.
  
  
  RESULTS
  Manometry was normal in 121 (70%). In those with normal manometry, FFR was identified in 96, irritable bowel syndrome (IBS) in 10, and functional constipation in 15. Of the 96 children FFR, 72 (76%) had comorbid conditions that might have interfered with the clinician's ability to diagnose FFR. Of 52 children with colon neuromuscular disease, only 12 (23%) had comorbid conditions (P < 0.001 compared with FFR). Of children more than 4 years, those with FFR were more likely to have fecal incontinence (44 of 62; 71%) than those with other functional disorders (2 of 19; 10%; P < 0.001) or neuromuscular disease (6 of 23; 26%; P < 0.001).
  
  
  CONCLUSIONS
  Two thirds of children referred for colon manometry had normal studies and met criteria for a functional diagnosis. Three quarters of those with functional constipation had a comorbid condition that might alter the history sufficiently to obscure the diagnosis.
authors.affiliation: Department of Pediatrics, University of Kansas, Kansas City, Kansas 66160, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Gertken
authors.forename: Jose
authors.initials: J
authors.lastname: Cocjin
authors.forename: Nonko
authors.initials: N
authors.lastname: Pehlivanov
authors.forename: Caroline
authors.initials: C
authors.lastname: Danda
authors.forename: Paul E
authors.initials: PE
authors.lastname: Hyman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology / Q000503:physiopathology*; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis*; D003248:Constipation / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005242:Fecal Incontinence / Q000150:complications / Q000175:diagnosis; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry / Q000379:methods*; D009468:Neuromuscular Diseases / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies