H Pearlstein et al. JPGN 2024;79:519–524. Significance of retrograde flow with antegrade continence enemas in children with fecal incontinence and constipation

Key findings:

• Fifty-nine (36%) antegrade contrast studies showed retrograde flow: 28/59 children (48%) were not responding adequately and 21/59 (36%) had symptoms with ACE.
• Children with retrograde flow were more likely to have symptoms with ACE than those without (36% vs. 15%, p < 0.01). 

The authors hypothesize that symptoms, including nausea, abdominal pain, and vomiting, related to antegrade enemas are potentially similar to those experienced by patients with dumping syndrome related to the osmolar content of the flush and subsequent fluid shifts under hormonal and autonomic control.

My take: Our motility team follow most of our patients with ACEs. This study helps provide a better explanation why some children do not do well with ACEs and potential interventions.

Related blog posts:

• Do You Know the Best Way to Use Antegrade Enemas?
• ACE report -10 year effectiveness
• Pelvic AnoRectal Care Program (PARC)
• Soiling Stinks!