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176 Chapter 8 ABSTRACT Background: Our aim was to evaluate colonic motor patterns in children and adolescents with intractable functional constipation (FC) using colonic manometry. Methods: We performed a retrospective analysis of patients with FCwho underwent colonic manometry with a solid-state catheter (36 sensors, 3 cm apart). Data were compared with previously published data from children with FC, measured with a water-perfused catheter (36 sensors, 1.5 cm apart). Key Results: We included 19 patients (median age 11.1 years, 58% male). In most patients ( n =16, 84%), long single motor patterns were recorded, these occurred in 12 children (63%) before the meal at a mean frequency of 4.1 ± 6.4 per hour and in 15 children (79%) after the meal at 7.2 ± 13.7 per hour. HAPCs were observed in four children (21%) before the meal, in five (26%) after the meal and in 16 (84%) after administration of bisacodyl. In all patients without HAPCs, long single motor patterns were recorded and in all patients without long single motor patterns, HAPCs were observed. Similar to the previous pediatric study performed with water-perfused manometry, the post-prandial increase in distal 2–4 cycle per minute activity that is observed in healthy adults was diminished in children with FC. Conclusions & Inferences: Despite having coordinated propagating colonic contractions spanning the entire colon, children and adolescents with intractable FC have an impaired colonic response to a meal. Since this response is likely mediated via extrinsic neural input, this supports the hypothesis that an extrinsic neuropathy exists in these patients.