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177 Solid-state colonic manometry 8 INTRODUCTION Constipation is a common problem faced in pediatric healthcare. 1 Symptoms include infrequent defecation, hard, painful stools, abdominal pain and fecal incontinence. 2 These symptoms are often bothersome and can have a significant impact on the quality of life. 3,4 In most children, no underlying organic disease can be identified, resulting in a diagnosis of functional constipation (FC) as defined by the Rome IV criteria. 5 Conventional treatment of FC consists of behavioral interventions and pharmacological treatment with laxatives. However, if intensive conventional treatment fails, surgery is sometimes considered as a treatment of last resort. 6 Surgical decision-making in children with FC is based on a range of diagnostic tests, one of which can be colonic manometry. 7,8 Colonic manometry recordings are generally considered to be normal when there is an increase in motility after a meal and the occurrence of spontaneous, postprandial or bisacodyl-induced high-amplitude propagating contractions (HAPCs) propagating to the recto-sigmoid junction. 7,9–11 HAPCs are temporally associated with defecation and are therefore considered to be an important hallmark of functional integrity of the colon. 12 In our recent studies utilizing high-resolution colonic manometry, we have shown that colonic motor pattern abnormalities in severely constipated patients extend beyond diminished or absent HAPCs. 13–15 For example, in healthy adults, retrograde propagating cyclic motor patterns in the distal colon have been shown to increase in number after a high caloric meal 16 and this response was diminished or absent in both adults 14 and children 13 with severe FC. As this postprandial meal response is likely to be mediated via extrinsic neural input 17 , this finding supports a hypothesis that an extrinsic neuropathy exists in children with intractable FC. Another finding in our recent study was that the average count of antegrade propagating long single motor patterns prior to a meal was significantly higher in children with FC, when compared with healthy adults. 13 These long single motor patterns consist of low-amplitude pressure events that propagate rapidly (~2cm/s) over the length of the entire recording area, characteristics that separate them from HAPC. 16 Interestingly, while these motor patterns have been described in vivo in healthy adults and adults with slow transit constipation 14,16 , they are more commonly recorded (1 per 1-3 min intervals) in intact sections of human colon ex vivo in an organ bath 18 , perhaps indicating that these motor patterns are normally suppressed in vivo when extrinsic input to the colon remains intact. 18 While the findings in our recent study shed further light upon potential colonic motor abnormalities in children with FC, 13 a criticismwas the fact that we compared data recorded by two different manometry systems; water-perfused manometry in children and fiber-