{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:10:25Z","timestamp":1760058625491,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. Objectives: This study aims to evaluate the effectiveness of ARM in predicting therapeutic responses among children with functional constipation. Methods: A retrospective chart review was conducted at two tertiary centers examining pediatric patients who underwent ARM between January 2018 and July 2022. Key ARM parameters were analyzed, including anal resting pressure, recto-anal inhibitory reflex (RAIR), first rectal sensation, and bear-down maneuver (BDM). Therapeutic responses were assessed post-ARM, with success defined as an increase in bowel movement frequency and\/or a decrease in fecal incontinence. In addition, we also intended to evaluate the eventual need for surgical intervention as another outcome. Results: The study included 327 patients, with a median age of 8.2 years. The overall therapeutic response rate was 40.7%, with stimulant laxatives showing a 48% response. Notably, lower anal resting pressures and delayed rectal sensations were associated with better therapeutic outcomes. Abnormal BDM correlated with a lack of response to therapies, while the presence of abnormal RAIR was linked to a higher eventual need for surgical intervention. Conclusions: ARM is instrumental in predicting therapeutic responses in pediatric patients with functional constipation. In addition to diagnosing HD, ARM could be an instrumental tool in identifying patients with dyssynergic defecation for early intervention with targeted therapy in age-appropriate patients.<\/jats:p>","DOI":"10.3390\/children12040512","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T06:12:06Z","timestamp":1744783926000},"page":"512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Utility of Anorectal Manometry in Children with Functional Constipation: Can Anorectal Manometry Help Predict the Therapeutic Response?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-0814","authenticated-orcid":false,"given":"Dhiren","family":"Patel","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children\u2019s Medical Center, Saint Louis University School of Medicine, St Louis, MO 63104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney","family":"Decker","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO 63104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7128-6048","authenticated-orcid":false,"given":"Leonel","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, New Haven Children\u2019s Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e12944","DOI":"10.1111\/nmo.12944","article-title":"An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children","volume":"29","author":"Rodriguez","year":"2017","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13797","DOI":"10.1111\/nmo.13797","article-title":"Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement","volume":"32","author":"Athanasakos","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_3","first-page":"524","article-title":"3D high resolution anorectal manometry in functional anorectal evaluation","volume":"93","author":"Ihnat","year":"2014","journal-title":"Rozhl. Chir."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e14006","DOI":"10.1111\/nmo.14006","article-title":"Anorectal manometry in pediatric settings: A systematic review of 227 studies","volume":"33","author":"Yates","year":"2021","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2727","DOI":"10.1016\/j.cgh.2023.05.025","article-title":"Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations","volume":"21","author":"Rao","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_6","first-page":"305","article-title":"High-resolution anorectal manometry in children with functional constipation: A single-centre experience before and after treatment","volume":"13","author":"Hanafi","year":"2018","journal-title":"Prz. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s00383-004-1233-4","article-title":"Thickening of the internal anal sphincter in idiopathic constipation in children","volume":"20","author":"Keshtgar","year":"2004","journal-title":"Pediatr. Surg. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1111\/nmo.12628","article-title":"Resting anal pressure, not outlet obstruction or transit, predicts healthcare utilization in chronic constipation: A retrospective cohort analysis","volume":"27","author":"Staller","year":"2015","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00383-014-3536-4","article-title":"Botulinum toxin use in paediatric colorectal surgery","volume":"30","author":"Basson","year":"2014","journal-title":"Pediatr. Surg. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1038\/ajg.2008.110","article-title":"Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter","volume":"104","author":"Chumpitazi","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.jpedsurg.2006.12.045","article-title":"Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: Long-term follow-up of a double-blind randomized trial","volume":"42","author":"Keshtgar","year":"2007","journal-title":"J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jpedsurg.2017.12.007","article-title":"Botulinum toxin injection for childhood constipation is safe and can be effective regardless of anal sphincter dynamics","volume":"53","author":"Kuo","year":"2018","journal-title":"J. Pediatr. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/4\/512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:15:26Z","timestamp":1760030126000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/4\/512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,16]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["children12040512"],"URL":"https:\/\/doi.org\/10.3390\/children12040512","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,4,16]]}}}