JMJ van der Zande et al. J Pediatr Gastroenterol Nutr. 2026;82:980–987. Interrater reliability in pediatric high-resolution anorectal manometry recordings

This study analyzed the interpretation of 10 pediatric high-resolution anorectal manometry (HR-ARM) by 10 pediatric experts in neurogastroenterology, including one of my partners, Dr. Jose Garza.

Key findings:

• There was only fair agreement among readings with regard to rectoanal inhibitory reflex  (κ = 0.35), the bear down maneuver, and the final interpretation of the study either being normal or abnormal (κ = 0.50 and κ = 0.43, respectively).
• There was excellent agreement with regard to assessment of the anal canal resting pressure, the squeeze pressure, as well as the squeeze duration

My take: This is a cautionary study indicating a high-rate of variability in the interpretation of key components of HR-ARM; the results are similar to a 2012 study of colonic manometry (see below). Thus, clinical context and supporting data (eg. histology) are quite important as well for clinical decision-making.

Related blog posts:

• Reliability of colonic manometry
• You Can Do Anorectal Manometry in Your Sleep, But Should You?
• Is It a ‘Waste’ to Do Colonic Manometry in Kids with Autism?
• How Reliable is a Motilist in Interpreting Manometry and FLIP Studies?