title: Rectal biopsies for Hirschsprung disease: Patient characteristics by diagnosis and attending specialty.
abstract: OBJECTIVE
  Hirschsprung disease (HD) is diagnosed with rectal biopsy. At our institution two services perform these biopsies: pediatric surgery and gastroenterology. Our objective was to review our institutional experience with rectal biopsies to diagnose HD and compare patients and outcomes between the two services.
  
  
  METHODS
  We reviewed all children undergoing a rectal biopsy for the evaluation of HD at our institution over a 10-year period. Comparisons were made using multiple logistic regression models.
  
  
  RESULTS
  We identified 518 children who underwent rectal biopsy for evaluation of HD; 451/518 (87%) were adequate and 56/518 (11%) were positive for HD. A positive biopsy was more likely with delayed passage of meconium (p<0.001), obstructive symptoms (p<0.001), trisomy 21 (p<0.001), full-term gestation (p=0.03), and male gender (p=0.02). Pediatric surgeons biopsied younger patients with more classic symptoms for HD compared to gastroenterologists. Pediatric surgeons were more likely to take adequate (OR 6.0, 95% CI 2.9-12.4, p<0.001) and positive biopsies (OR 6.7 95% CI 2.1-21.2, p=0.001) compared to gastroenterologists.
  
  
  CONCLUSIONS
  Infants with classic symptoms can reliably be diagnosed with HD by a pediatric surgeon. The work up for HD in older children with constipation should be a collaborative effort between pediatric surgery and gastroenterology.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th, Ave., Aurora, CO 80045, USA; Division of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO 80045, USA. Electronic address: Camille.Stewart@ucdenve.edu.
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th, Ave., Aurora, CO 80045, USA; Division of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO 80045, USA. Electronic address: Ann.Kulungowski@childrenscolorado.org.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kulungowski
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, 12631 E. 17th, Ave., Aurora, CO 80045, USA. Electronic address: Suhong.Tong@ucdenver.edu.
authors.forename: Suhong
authors.initials: S
authors.lastname: Tong
authors.affiliation: Division of Pediatric Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada. Electronic address: jacob.langer@sickkids.ca.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.affiliation: Division of Pediatric Gastroenterology, Children's Hospital Colorado, 13123 East, 16th Ave., Aurora, CO 80045, USA. Electronic address: Jason.Soden@childrenscolorado.org.
authors.forename: Jason
authors.initials: J
authors.lastname: Soden
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th, Ave., Aurora, CO 80045, USA; Division of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO 80045, USA. Electronic address: Stig.Somme@childrenscolorado.org.
authors.forename: Stig
authors.initials: S
authors.lastname: Sømme
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D003248:Constipation / Q000209:etiology; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D005865:Gestational Age; D006627:Hirschsprung Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies
keywords: Hirschsprung disease; Rectal biopsy