COLONIC MANOMETRY PREDICTS RESPONSE TO TEGASEROD IN CHILDREN WITH INTRACTABLE CONSTIPATION

Abstract

Background: Tegaserod has been evaluated in adults with constipation and IBS-Constipation; no significant information is available for children. We describe the colonic manometry (CM) parameters that predict response to tegaserod in the treatment of intractable constipation (IC) in children. Methods: Retrospective review of patients with idiopathic IC (poor response to stools softeners and laxatives) between 2002 and 2006. Exclusion criteria: internal anal sphincter achalasia, Hirschsprung's disease, other known causes of constipation and use of bisacodyl. Previous use of enemas and concomitant use of stool softeners with tegaserod was not an exclusion criteria. Patients took tegaserod for a minimum of 4 weeks. Outcome was the response to tegaserod measured by the change in frequency and consistency of bowel movements as reported by the parents. Parameters evaluated in the CM were gastrocolonic response (GC) to a meal and high amplitude peristaltic contractions (HAPC). Results: Thirty patients were included (21 F). Ten patients (33%, 6 F) reported improvement with tegaserod, 8 (80%) had normal GC and 6 (60%) had normal HAPC's. Nine of those are still on tegaserod, one successfully tapered off. Twenty patients did not respond to tegaserod, 3 (15%) had normal GC and 5 (25%) had normal HAPC's. Normal GC was strongly associated with success of tegaserod treatment (OR = 22.7, 95% CI 3.1, 164). Normal HAPC's tended toward a significant association with success of treatment (OR = 4.5, 95% CI 0.9, 22.8). Seven patients had a normal CM (normal GC and normal HAPC's), 5 (71%) responded to tegaserod. Of the 20 patients that failed tegaserod, 3 required an ileostomy, 2 are well on daily bisacodyl, one had a left hemicolectomy and 14 are well with antegrade colonic enemas via cecostomy tube. Overall stool frequency improved on tegaserod (P < 0.001). Conclusions: Colonic manometry is helpful to predict the response to tegaserod in the treatment of IC in children. Further studies are needed to determine the role of tegaserod in pediatric constipation.