The Diagnostic Value of Barium Enema in Children and Infants Evaluated for Hirschsprung Disease; to Do or Not to Do?

Abstract

Purpose: Compare the diagnostic value for barium enema to suction rectal biopsies in children based on different age groups. Methods: Retrospectively reviewed the records of all children who underwent both barium enema (BE) and suction or full thickness rectal biopsies (RB) at our institution between 2004 and 2008. Results: Total 77 patients were identified. Twenty one patient less than one year of age, Fifty one males (66.2%) and 26 females (33.8%) were part of study. For the patients over one year the age was ranging from 1 to 18 years with a mean age of 5 years. The indications were constipation and/or delayed passage of meconium. In the selected patients less than one year of age compared to over one year of age BE and RB were both normal in 57.2% and 55.3% respectively. In patients with abnormal BE, Hirschsprung disease was diagnosed in 19% and 1.8% respectively, and the RB was normal in 23.8% and 39.2% respectively. All children less than one year of age, with normal BE had no Hirschsprung disease on RB compared to 2/56 (3.7%) in older patients. Conclusion: In patients less than one year of age, the BE diagnostic yield for Hirschsprung disease was higher compared to older patients, but can be used as a useful non-invasive screening tool in all age groups, that in difference to the recommendations of the constipation guideline committee of the North American society for pediatric gastroenterology, hepatology and nutrition (NASPGHAN), as BE considered unnecessary beyond infancy.