{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:41:08Z","timestamp":1789753268566,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,4]],"date-time":"2018-10-04T00:00:00Z","timestamp":1538611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The colo\u2010anal reflex is a distinct reflex whereby the internal anal sphincter (IAS) relaxes in association with colonic high amplitude propagating contractions (HAPCs) in contrast to the recto\u2010anal inhibitory reflex (RAIR), which is characterized by IAS relaxation upon rectal distension. The RAIR is mediated by the myenteric plexus and therefore absent in Hirschsprung disease. We retrospectively assessed the presence and the characteristics of the colo\u2010anal reflex in children in whom large bowel continuity had been surgically disrupted to assess the role of the extrinsic nervous system in the reflex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010resolution (HR) colonic manometry and HR\u2010anorectal manometry were used to evaluate both colonic and anal motor activity in ten children with treatment\u2010unresponsive slow transit constipation (STC), who had previously undergone left\u2010sided colostomy formation with consequent disruption of the bowel continuity, and in two children with Hirschsprung's disease (HSCR), who had previously undergone distal colon resection followed by Duhamel pull\u2010through. Eight children with STC, normal colonic motor activity, and preserved large bowel continuity served as a control group. The presence and characteristics of colo\u2010anal reflex were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>In the study group, all patients showed the presence of both normal HAPCs and the presence of the colo\u2010anal reflex. In two cases of HSCR, RAIR was absent; however, both patients demonstrated a colo\u2010anal reflex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In children with disrupted continuity of the colon and\/or abnormal anal reflex, the colo\u2010anal reflex is still preserved suggesting that it is mediated by a different pathway from the RAIR, possibly an extrinsic neural pathway.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13472","type":"journal-article","created":{"date-parts":[[2018,10,6]],"date-time":"2018-10-06T03:18:06Z","timestamp":1538795886000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Preservation of the colo\u2010anal reflex in colonic transection and post\u2010operative Hirschsprung's disease: Potential extrinsic neural pathway"],"prefix":"10.1111","volume":"31","author":[{"given":"Palittiya","family":"Sintusek","sequence":"first","affiliation":[{"name":"Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology Great Ormond Street Hospital NHS Foundation Trust London UK"},{"name":"Department of Paediatrics, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8233-5490","authenticated-orcid":false,"given":"Anna","family":"Rybak","sequence":"additional","affiliation":[{"name":"Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology Great Ormond Street Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Mutalib","sequence":"additional","affiliation":[{"name":"Department of Paediatric Gastroenterology Evelina London Children\u2019s Hospital London 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