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Cangemi DJ, Lacy BE. A Practical Approach to the Diagnosis and Treatment of Abdominal Bloating and Distension. Gastroenterol Hepatol (N Y) 2022; 18:75-84. [PMID: 35505814 PMCID: PMC9053509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Abdominal bloating and distension are highly prevalent symptoms that can negatively impact quality of life and lead to medical consultation. Despite their prevalence, symptoms of bloating and distension pose a unique diagnostic and therapeutic challenge, as they are inherently nonspecific symptoms with a complex etiology, and no uniform diagnostic or treatment algorithm currently exists. Additionally, bloating is common among disorders of gut-brain interaction, which can be difficult to treat. This article offers a practical approach for evaluating and treating symptoms of bloating and distension through discussion of 5 common etiologies: diet, small intestinal bacterial over-growth, constipation, visceral hypersensitivity, and abdomino-phrenic dyssynergia. An effective personalized evaluation and treatment plan can be established to address symptoms of bloating and distension through consideration of these etiologies in the context of the patient's individual characteristics and presentation.
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Affiliation(s)
- David J Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Brian E Lacy
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida
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53
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Disorders of anorectal motility: Functional defecation disorders and fecal incontinence. J Visc Surg 2022; 159:S40-S50. [DOI: 10.1016/j.jviscsurg.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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54
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Liedberg F, Hagberg O, Baseckas G, Brändstedt J, Kollberg P, Lind AK, Lydrup ML, Löfgren A, Stenzelius K, Sörenby A, Starck M. Anorectal dysfunction after radical cystectomy for bladder cancer. Scand J Urol 2022; 56:155-161. [PMID: 35019814 DOI: 10.1080/21681805.2021.2025423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To prospectively assess anorectal dysfunction using patient-reported outcomes using validated questionnaires, manovolumetry and endoanal ultrasound before and 12 months after RC.Patients and methods: From 2014 to 2019, we prospectively included 44 patients scheduled for RC. Preoperatively and 12 months after surgery, 41 patients filled in a low anterior resection syndrome score (LARS-score) to assess fecal incontinence, increased frequency, urgency and emptying difficulties and a St Mark's score to assess fecal incontinence in conjunction with manovolumetry and endoanal ultrasound examinations. Pre- and postoperative patient-reported anorectal dysfunction were assessed by LARS-score and St Marks's score. At the same time-points, anorectal function was evaluated by measuring mean anal resting and maximal squeeze pressures, volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry. Wilcoxon's signed rank test was used to compare pre- and postoperative outcomes by questionnaires.Results: Postoperatively 6/41 (15%) patients reported flatus incontinence assessed by the LARS-questionnaire, and correspondingly the St Mark's score increased postoperatively. The median anal resting pressure decreased from 57 mmHg preoperatively to 46 mmHg after RC, but without any postoperative anatomic defects detected by endoanal ultrasound. Volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry all increased after RC, indicating decreased postoperative rectal sensation, as rectal compliance was unaltered.Conclusions: Postoperative flatus incontinence is reported by one out of seven patients after RC, which corresponds to decreased anal resting pressures. The finding of decreased rectal sensation might also contribute to patient-reported symptoms and anorectal dysfunction after RC.
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Affiliation(s)
- Fredrik Liedberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Gediminas Baseckas
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Johan Brändstedt
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Petter Kollberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
| | - Anna-Karin Lind
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annica Löfgren
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Stenzelius
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anne Sörenby
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Marianne Starck
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
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Meling S, Bertoli D, Sangnes DA, Brock C, Drewes A, Ejskjaer N, Dimcevski G, Søfteland E. Diabetic Gastroenteropathy: Soothe the Symptoms or Unravel a Cure? Curr Diabetes Rev 2022; 18:e220321192412. [PMID: 34225633 DOI: 10.2174/1573399817666210322154618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
Autonomic neuropathy in patients with diabetes mellitus, and especially complications related to gastrointestinal neuropathy, are often overlooked in the clinic. Diabetic gastroenteropathy affects every segment of the gastrointestinal tract and generates symptoms that may include nausea, early satiety, vomiting, abdominal pain, constipation, and diarrhea. Severe cases can be complicated by weight loss, dehydration, and electrolyte disturbances. The pathophysiology is complex, the diagnostics and treatment options are multidisciplinary, and there is generally a lack of evidence for the treatment options. The aims for this review are first to summarize the pathophysiology and describe possible and expected symptoms and complications.Further, we will try to supply the clinician with a straightforward tool for diagnostics, and then, we shall summarize established treatment options, including diet recommendations, pharmacological and non-pharmacological options. Finally, we will explore the multiple possibilities of novel treatment, looking at medications related to the pathophysiology of neuropathy, other manifestations of autonomic neuropathies, and symptomatic treatment for other gastrointestinal disorders, also including new knowledge of endosurgical and neuromodulatory treatment. The overall goal is to increase awareness and knowledge on this frequent diabetic complication and to provide better tools for diagnosis and treatment. Ultimately, we hope to encourage further research in this field, as there are clear shortcomings in terms of biomarkers, pathophysiology, as well as treatment possibilities. In conclusion, diagnosis and management of diabetic gastroenteropathy are challenging and often require multidisciplinary teams and multimodal therapies. Treatment options are sparse, but new pharmacological, endoscopic, and neuromodulatory techniques have shown promising results in initial studies.
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Affiliation(s)
- Sondre Meling
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Davide Bertoli
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Dag A Sangnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christina Brock
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Asbjørn Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Jutland, Aalborg, Denmark
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Georg Dimcevski
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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56
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Fomenko OY, Shelygin YA, Nikityuk DB, Morozov SV, Bashankaev BN, Poryadin GV, Martynov MY, Morozov DA, Apolihina IA, Teterina TA, Dreval ON, Chagava DA, Salmasi ZM, Nikitin SS, Katunina EA, Kasyan GR, Gvozdev MY, Troshina EM, Kopachka MM, Kulikov AG, Turova EA, Romanov DV, Shkoda AS, Reutova AA, Rumiantsev AS, Fomenko ES, Popov AA, Fedorov AA, Komancev VN, Ekusheva EV, Vojtenkov VB, Nikolaev SG, Groshilin VS, Genov PG, Romih VV, Zaharchenko AV, Shornikov PV, Sinkin MV, Dilanyan OE, Isagulyan ED, Markaryan DR, Gluhov EY, Kiselev VN, Malinina OY, Marchenko VA, Silant'eva ES, Pimenova ES, Borodulina IV, Kanaev SP, Kan'shina DS, Kashnikov VN, Aleshin DV, Belousova SV, Nekrasov MA, Achkasov SI. [Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. Khirurgiia (Mosk) 2022:6-25. [PMID: 36562669 DOI: 10.17116/hirurgia20221226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.
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Affiliation(s)
- O Yu Fomenko
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - Yu A Shelygin
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - D B Nikityuk
- Federal Research Center of Nutrition and Biotechnology, Moscow, Russia
| | - S V Morozov
- Federal Research Center of Nutrition and Biotechnology, Moscow, Russia
| | - B N Bashankaev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - G V Poryadin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D A Morozov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Sechenov University, Moscow, Russia
| | - I A Apolihina
- Sechenov University, Moscow, Russia.,National medical research center for obstetrics, gynecology and perinatology named after academician V.I. Kulakov, Moscow, Russia
| | - T A Teterina
- National medical research center for obstetrics, gynecology and perinatology named after academician V.I. Kulakov, Moscow, Russia
| | - O N Dreval
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - D A Chagava
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital of Civil Aviation, Moscow, Russia
| | - Zh M Salmasi
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S S Nikitin
- Research Centre for Medical Genetics, Moscow, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia.,PRCCID, Moscow, Russia
| | - G R Kasyan
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M Yu Gvozdev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - E M Troshina
- National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko, Moscow, Russia
| | - M M Kopachka
- National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko, Moscow, Russia
| | - A G Kulikov
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine Moscow Health Department, Moscow, Russia
| | - E A Turova
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine Moscow Health Department, Moscow, Russia
| | - D V Romanov
- Sechenov University, Moscow, Russia.,Mental Health Research Center, Moscow, Russia
| | - A S Shkoda
- City Hospital No 67 named after L.A. Vorokhobov, Moscow Health Department, Moscow, Russia
| | - A A Reutova
- City Hospital No 67 named after L.A. Vorokhobov, Moscow Health Department, Moscow, Russia
| | - A S Rumiantsev
- City Hospital No 67 named after L.A. Vorokhobov, Moscow Health Department, Moscow, Russia
| | - E S Fomenko
- City Hospital No 67 named after L.A. Vorokhobov, Moscow Health Department, Moscow, Russia
| | - A A Popov
- Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - A A Fedorov
- Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - V N Komancev
- Saint - Petersburg Postgraduate Institute of Medical experts, St. Petersburg, Russia
| | - E V Ekusheva
- PRCCID, Moscow, Russia.,Belgorod National Research University, Belgorod, Russia
| | | | | | - V S Groshilin
- Rostov State Medical Univercity, Rostov-on-Don, Russia
| | - P G Genov
- City HospitalNo 52, Moscow Health Department, Moscow, Russia
| | - V V Romih
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Zaharchenko
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - P V Shornikov
- Research Institute - Regional clinical hospital No 1 named after Professor S.V. Ochapovskiy, Krasnodar, Russia
| | - M V Sinkin
- N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | | | - E D Isagulyan
- National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko, Moscow, Russia
| | - D R Markaryan
- Lomonosov Moscow State University - Medical Scientific and Educational Center, Moscow, Russia
| | - E Yu Gluhov
- Ural State Medical University, Ekaterinburg, Russia
| | - V N Kiselev
- The Nikiforov Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia
| | | | | | | | | | - I V Borodulina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S P Kanaev
- City Hospital No 67 named after L.A. Vorokhobov, Moscow Health Department, Moscow, Russia
| | - D S Kan'shina
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - V N Kashnikov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - D V Aleshin
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - S V Belousova
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - M A Nekrasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - S I Achkasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
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Smith M, Donnelly GM, Berry L, Innes S, Dixon J. Point of care ultrasound in pelvic health: scope of practice, education and governance for physiotherapists. Int Urogynecol J 2022; 33:2669-2680. [PMID: 35552775 PMCID: PMC9477927 DOI: 10.1007/s00192-022-05200-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 02/05/2023]
Abstract
Pelvic health and pelvic floor dysfunction have wide-reaching implications across a range of patient groups. Placing ultrasound imaging into the hands of assessing and treating clinicians (i.e. point of care ultrasound, PoCUS) can provide a step change in clinical effectiveness and efficiency. Pelvic floor dysfunction is managed by one or more members of a multi-disciplinary team that includes physiotherapists. Physiotherapists' involvement includes diagnosis, patient education, identifying shared treatment goals, using rehabilitative strategies and empowering patients through self-management. Drawing upon existing publications in this area and applying framework principles, the authors propose a clinical and sonographic scope of practice for physiotherapists as part of supporting the consolidation and expansion of pelvic health PoCUS. Education and governance considerations are detailed to ensure the robust and safe use of this modality. Alongside empowering the use of ultrasound imaging by clinicians such as physiotherapists in the UK and internationally, we provide clarity to other members of the care pathway and ultrasound imaging professionals.
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Affiliation(s)
- Mike Smith
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | | | - Lucia Berry
- College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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58
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Yan Y, Sharma A, Herekar AA, Jimenez E, Hudgi AR, Gu QG, Rao SSC. Translumbosacral Anorectal Magnetic Stimulation Test for Fecal Incontinence. Dis Colon Rectum 2022; 65:83-92. [PMID: 34670958 PMCID: PMC8665062 DOI: 10.1097/dcr.0000000000002152] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neuropathy may cause fecal incontinence and mixed fecal incontinence/constipation, but its prevalence is unclear, partly due to the lack of comprehensive testing of spino-anorectal innervation. OBJECTIVE This study aimed to develop and determine the clinical usefulness of a novel test, translumbosacral anorectal magnetic stimulation for fecal incontinence. DESIGN This observational cohort study was conducted from 2012 to 2018. SETTINGS This study was performed at a tertiary referral center. PATIENTS Patients with fecal incontinence, patients with mixed fecal incontinence/constipation, and healthy controls were included. INTERVENTIONS A translumbosacral anorectal magnetic stimulation test was performed by using an anorectal probe with 4 ring electrodes and magnetic coil, and by stimulating bilateral lumbar and sacral plexuses, uses and recording 8 motor-evoked potentials at anal and rectal sites. MAIN OUTCOME MEASURES The prevalence of lumbar and/or sacral neuropathy was examined. Secondary outcomes were correlation of neuropathy with anorectal sensorimotor function(s) and morphological changes. RESULTS We evaluated 220 patients: 144 with fecal incontinence, 76 with mixed fecal incontinence/constipation, and 31 healthy controls. All 8 lumbar and sacral motor-evoked potential latencies were significantly prolonged (p < 0.01) in fecal incontinence and mixed fecal incontinence/constipation groups compared with controls. Neuropathy was patchy and involved 4.0 (3.0) (median (interquartile range)) sites. Lumbar neuropathy was seen in 29% to 65% of the patients in the fecal incontinence group and 22% to 61% of the patients in the mixed fecal incontinence/constipation group, and sacral neuropathy was seen in 24% to 64% and 29% to 61% of these patients. Anal neuropathy was significantly more (p < 0.001) prevalent than rectal neuropathy in both groups. There was no correlation between motor-evoked potential latencies and anal sphincter pressures, rectal sensation, or anal sphincter defects. LIMITATIONS No comparative analysis with electromyography was performed. CONCLUSION Lumbar or sacral plexus neuropathy was detected in 40% to 75% of patients with fecal incontinence with a 2-fold greater prevalence at the anal region than the rectum. Lumbosacral neuropathy appears to be an independent mechanism in the pathogenesis of fecal incontinence, unassociated with other sensorimotor dysfunctions. Translumbosacral anorectal magnetic stimulation has a high yield and is a safe and clinically useful neurophysiological test. See Video Abstract at http://links.lww.com/DCR/B728. PRUEBA DE ESTIMULACIN MAGNTICA TRANSLUMBOSACRAL ANORECTAL PARA LA INCONTINENCIA FECAL ANTECEDENTES:La neuropatía puede causar incontinencia fecal y una combinación de incontinencia fe-cal/estreñimiento, pero su prevalencia no está clara, en parte debido a la falta de pruebas comple-tas de inervación espino-anorrectal.OBJETIVO:Desarrollar y determinar la utilidad clínica de una nueva prueba, estimulación magnética trans-lumbosacral anorrectal para la incontinencia fecal.DISEÑO:Estudio de cohorte observacional del 2012 al 2018.ENTORNO CLINICO:Centro de referencia terciario.PACIENTES:Pacientes con incontinencia fecal, combinación de incontinencia fecal/estreñimiento y controles sanos.INTERVENCIONES:Se realizó una prueba de estimulación magnética translumbosacral anorrectal utilizando una sonda anorrectal con 4 electrodos anulares y bobina magnética, y estimulando los plexos lumbares y sacros bilaterales y registrando ocho potenciales evocados motores las regiones anal y rectal.PRINCIPALES MEDIDAS DE RESULTADO:Se examinó la prevalencia de neuropatía lumbar y/o sacra. Los resultados secundarios fueron la correlación de la neuropatía con las funciones sensitivomotoras anorrectales y cambios morfológi-cos.RESULTADOS:Evaluamos 220 pacientes, 144 con incontinencia fecal, 76 con combinación de incontinencia fe-cal/estreñimiento y 31 sujetos sanos. Las ocho latencias de los potenciales evocadas motoras lum-bares y sacras se prolongaron significativamente (p <0,01) en la incontinencia fecal y el grupo mixto en comparación con los controles. La neuropatía fue irregular y afectaba 4,0 (3,0) (mediana (rango intercuartílico) sitios. Se observó neuropatía lumbar en 29-65% en la incontinencia fecal y 22-61% en el grupo mixto, y neuropatía sacra en 24-64% y 29-61 % de pacientes respectivamen-te. La neuropatía anal fue significativamente más prevalente (p <0,001) que la rectal en ambos grupos. No hubo correlación entre las latencias de los potenciales evocadas motoras y las presio-nes del esfínter anal, la sensación rectal o los defectos del esfínter anal.LIMITACIONES:Sin análisis comparativo con electromiografía.CONCLUSIÓNES:Se detectó neuropatía del plexo lumbar o sacro en el 40-75% de los pacientes con incontinencia fecal con una prevalencia dos veces mayor en la región anal que en el recto. La neuropatía lumbo-sacra parece ser un mecanismo independiente en la patogenia de la incontinencia fecal, no asocia-do con otras disfunciones sensitivomotoras. La estimulación magnética translumbosacral anorrec-tal tiene un alto rendimiento, es una prueba neurofisiológica segura y clínicamente útil. Consulte Video Resumen en http://links.lww.com/DCR/B728.
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Affiliation(s)
- Yun Yan
- Division of Neurogastroenterology/Motility, Medical College of Georgia, Augusta University, Augusta, Georgia
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Tuttle LJ, Zifan A, Swartz J, Mittal RK. Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence? Neurogastroenterol Motil 2022; 34:e14212. [PMID: 34236123 PMCID: PMC8712345 DOI: 10.1111/nmo.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
AIM To determine if a biofeedback therapy that includes concentric resistance exercise for the anal sphincter muscles can improve muscle strength/function and improve AI symptoms compared to the traditional/non-resistance biofeedback therapy. BACKGROUND Biofeedback therapy is the current gold standard treatment for patients with anal incontinence (AI). Lack of resistance exercise biofeedback programs is a limitation in current practice. METHODS Thirty-three women with AI (mean age 60 years) were randomly assigned to concentric (resistance) or isometric (non-resistance) biofeedback training. Concentric training utilized the Functional Luminal Imaging Probe to provide progressive resistance exercises based on the patient's ability to collapse the anal canal lumen. Isometric training utilized a non-collapsible 10 mm diameter probe. Both groups performed a biofeedback protocol once per week in the clinic for 12 weeks and at home daily. High definition anal manometry was used to assess anal sphincter strength; symptoms were measured using FISI and UDI-6. 3D transperineal ultrasound imaging was used to assess the anal sphincter muscle integrity. RESULTS Concentric and isometric groups improved FISI and UDI-6 scores to a similar degree. Both the concentric and isometric groups showed small improvement in the anal high-pressure zone; however, there was no difference between the two groups. Ultrasound image analysis revealed significant damage to the anal sphincter muscles in both patient groups. CONCLUSIONS Concentric resistance biofeedback training did not improve the anal sphincter muscle function or AI symptoms beyond traditional biofeedback training. Anal sphincter muscle damage may be an important factor that limits the success of biofeedback training.
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Affiliation(s)
- Lori J. Tuttle
- Doctor of Physical Therapy Program, School of Exercise & Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Ali Zifan
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jessica Swartz
- Doctor of Physical Therapy Program, School of Exercise & Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Ravinder K. Mittal
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA
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60
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Evaluation of Anorectal Function in Perianal Crohn's Disease: A Pilot Study. J Clin Med 2021; 10:jcm10245909. [PMID: 34945205 PMCID: PMC8707088 DOI: 10.3390/jcm10245909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Perianal Crohn’s disease is a disabling condition, with little known about anorectal function in healed/inactive perianal Crohn’s disease; Aim: To evaluate anorectal function in a cohort of patients with treated/healed perianal Crohn’s disease; Methods: Prospective cohort study, including high-resolution anorectal manometry, balloon expulsion test, and 3D-endoanal ultrasound in all patients; Results: Of the 16 patients studied (mean age ± SD, 42 ± 13 years), 12 (75%) were men. A laceration of the internal anal sphincter and/or anal scarring was seen in nine (56%) patients; there was no laceration of the external anal sphincter. Five (56%) of these nine patients had never experienced faecal incontinence. All had normal anal resting and squeeze pressures. Manometry suggested dyssynergia in 11 (69%) patients, with only one (6%) fulfilling the criteria for obstructed defecation. Hyposensitivity for at least one sensory parameter was seen in 11 (69%) patients and hypersensitivity in five (31%) patients; Conclusions: This study detected sphincter abnormalities in more than half of patients, many of whom were asymptomatic. Alterations in rectal sensation were frequently seen, more commonly with rectal hyposensitivity. Trial registration: ClinicalTrials.gov (NCT03819257).
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Cohen DL, Richter V, Malikov I, Bermont A, Shirin H. The Effect of a Didactic Course on Gastroenterology Nurses' Knowledge and Interest in Anorectal Manometry. Gastroenterol Nurs 2021; 44:412-417. [PMID: 34690296 DOI: 10.1097/sga.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Anorectal manometry may be performed by a nurse or physician, yet little has been written about what training is needed. Additionally, many gastroenterology nurses receive little exposure to motility studies such as anorectal manometry, limiting their ability to learn these procedures. We therefore sought to evaluate whether a short didactic course on anorectal manometry would increase nurses' knowledge about the procedure and stimulate their interest in becoming trained to perform it. To accomplish this, gastroenterology nurses attended a series of three lectures on anorectal manometry. A 15-question quiz was given as a pre-test and again as a post-test after completing the course. Thirteen nurses participated (11 female, mean age 46). None had experience performing anorectal manometry. Due to the course, test scores increased from a mean of 8.4 (55.9%) correct to 13.3 (88.7%) (p < .001), with improvements noted in 12 of 13 participants (92.3%). All of the nurses felt that the course increased their knowledge of anorectal manometry and reported that they would recommend it to other nurses. Most (61.5%) also expressed an interest in becoming trained to perform anorectal manometry. In conclusion, a short didactic course has been shown to increase nurses' knowledge and interest in performing anorectal manometry.
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Affiliation(s)
- Daniel L Cohen
- Daniel L. Cohen, MD, is Gastroenterologist and Head of the GI Motility Laboratory at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Irena Malikov, MA, Head of GI Nursing at Shamir Medical Center, Zerifin, Israel
- Anton Bermont, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel, and Professor of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Richter
- Daniel L. Cohen, MD, is Gastroenterologist and Head of the GI Motility Laboratory at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Irena Malikov, MA, Head of GI Nursing at Shamir Medical Center, Zerifin, Israel
- Anton Bermont, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel, and Professor of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irena Malikov
- Daniel L. Cohen, MD, is Gastroenterologist and Head of the GI Motility Laboratory at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Irena Malikov, MA, Head of GI Nursing at Shamir Medical Center, Zerifin, Israel
- Anton Bermont, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel, and Professor of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anton Bermont
- Daniel L. Cohen, MD, is Gastroenterologist and Head of the GI Motility Laboratory at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Irena Malikov, MA, Head of GI Nursing at Shamir Medical Center, Zerifin, Israel
- Anton Bermont, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel, and Professor of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Shirin
- Daniel L. Cohen, MD, is Gastroenterologist and Head of the GI Motility Laboratory at Shamir Medical Center, Zerifin, Israel
- Vered Richter, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Irena Malikov, MA, Head of GI Nursing at Shamir Medical Center, Zerifin, Israel
- Anton Bermont, MD, is Gastroenterologist at Shamir Medical Center, Zerifin, Israel
- Haim Shirin, MD, is Director of the Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, Israel, and Professor of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Female Pelvic Med Reconstr Surg 2021; 27:e645-e656. [PMID: 34506350 DOI: 10.1097/spv.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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63
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Mohan Paspulati R, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2021; 64:1184-1197. [PMID: 34516442 DOI: 10.1097/dcr.0000000000002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, California
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, Ohio
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, Illinois
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, New York
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, California
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, New York
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, Virginia
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
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64
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR Am J Roentgenol 2021; 217:800-812. [PMID: 34505543 DOI: 10.2214/ajr.21.26488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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Cuong LM, Van Quyet H, Hung TM, Anh NN, Ha TT, Van Du V, Van Loi D, Khai HHH, Kien VD. Normal values for high-resolution anorectal manometry in healthy young adults: evidence from Vietnam. BMC Gastroenterol 2021; 21:295. [PMID: 34266417 PMCID: PMC8281378 DOI: 10.1186/s12876-021-01865-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-resolution anorectal manometry (HRAM) has been developed to improve measurement of anorectal functions. This study aims to identify normal HRAM values in healthy young Vietnamese adults. METHODS We conducted a cross-sectional study at the National Hospital of Traditional Medicine (Hanoi, Vietnam) from July through December 2014. Healthy young adults were invited to participate in the study. All anorectal measurement values were performed using the ISOLAB high-resolution manometry system. Differences between groups were analyzed using Student's t-tests. RESULTS Thirty healthy young adults, including 15 males and 15 females aged 19-26 years, were recruited. Mean functional anal canal length was 3.4 ± 0.5 cm (range: 2.4-4.8 mm). Mean maximum resting pressure, mean maximum squeezing pressure, mean maximum coughing pressure, and mean maximum strain pressure were 65.5, 168.0, 125.9, and 84.2 mm Hg, respectively. All anal pressure values were significantly different between males and females. For rectal sensation measurements, only the volume at first sensation was significantly higher in males than in females. CONCLUSIONS This study provides normal HRAM value for healthy young adults in Vietnam. Sex may influence anal pressure and first rectal sensation values in this cohort. Further studies should be conducted in order to improve the quality of HRAM normal values and to confirm the effects of sex.
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Affiliation(s)
- Le Manh Cuong
- National Hospital of Traditional Medicine, No. 29 Nguyen Binh Khiem Street, Hanoi, Vietnam.
| | - Ha Van Quyet
- Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Vietnam
| | - Tran Manh Hung
- Bach Mai Hospital, No. 78 Giai Phong Street, Hanoi, Vietnam
| | - Nguyen Ngoc Anh
- Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Vietnam
| | - Tran Thu Ha
- National Hospital of Traditional Medicine, No. 29 Nguyen Binh Khiem Street, Hanoi, Vietnam
| | - Vu Van Du
- National Hospital of Obstetrics and Gynecology, No. 43 Trang Thi Street, Hanoi, Vietnam
| | - Do Van Loi
- National Hospital of Obstetrics and Gynecology, No. 43 Trang Thi Street, Hanoi, Vietnam
| | - Ha Huu Hoang Khai
- Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Vietnam
| | - Vu Duy Kien
- OnCare Medical Technology Company Limited, No. 77/508 Lang Street, Hanoi, Vietnam
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Neshatian L, Williams MJOU, Quigley EM. Rectal Distension Increased the Rectoanal Gradient in Patients with Normal Rectal Sensory Function. Dig Dis Sci 2021; 66:2345-2352. [PMID: 32761289 DOI: 10.1007/s10620-020-06519-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/23/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Frequent observation of abnormal manometric patterns consistent with dyssynergia in healthy volunteers has warranted the need for reassessment of the current methods to enhance the diagnostic value of anorectal manometry in functional defecatory disorders. Whether rectal distention at simulated evacuation will affect anorectal pressure profile and increase rectoanal gradient is not known. METHODS One hundred and eight consecutive patients with chronic constipation, 93 females, median age 53 years (interquartile range: 40-65), were studied. Simulated evacuation was performed firstly with empty balloon and subsequently after balloon distention to 50 and 100 ml. Anorectal pressures were compared. We also performed subgroup analysis in relation to outcome of balloon expulsion test (BET). In addition, we studied the effect of rectal distension on the rectoanal pressure gradient with respect to rectal sensory function. RESULTS Rectal balloon distension at simulated evacuation improved rectoanal gradient and decreased the rate of dyssynergia during high-resolution anorectal manometry. In subgroup analysis, the increase in rectoanal gradient and correction of dyssynergia with rectal distension was limited to the patients who had normal BET and normal rectal sensory function. Rate of anal relaxation, residual anal pressures, and rectoanal gradient were significantly different between patients with and without normal BET at 50 ml of rectal distension. Rectoanal gradient recorded only after rectal distension, along with BMI and maximum tolerable volumes, could predict BET results independently in patients with chronic constipation. CONCLUSIONS Rectal distension during simulated evacuation will affect the anorectal pressure profile. Increase in rectoanal gradient and correction of dyssynergia was only significant in patients with normal rectal sensory function and normal BET.
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Affiliation(s)
- Leila Neshatian
- Lynda K and David M Underwood Center for Digestive Disorders Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, 6550 Fannin St Suite 1201, Houston, TX, 77030, USA.
- Stanford University, 430 Broadway, Pavilion C, 3rd floor, Redwood City, CA, 94063, USA.
| | - Mary-Jane O U Williams
- Department of Internal Medicine, Sunrise Health GME Consortium, Mountain View Hospital, Las Vegas, NV, USA
| | - Eamonn M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, 6550 Fannin St Suite 1201, Houston, TX, 77030, USA
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Sharma M, Lowry AC, Rao SS, Whitehead WE, Szarka LA, Hamilton FA, Bharucha AE. A multicenter study of anorectal pressures and rectal sensation measured with portable manometry in healthy women and men. Neurogastroenterol Motil 2021; 33:e14067. [PMID: 33462889 PMCID: PMC8169521 DOI: 10.1111/nmo.14067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/22/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The equipment and methods for performing anorectal manometry and biofeedback therapy are different and not standardized. Normal values are influenced by age and sex. Our aims were to generate reference values, examine effects of gender and age, and compare anorectal pressures measured with diagnostic and biofeedback catheters and a portable manometry system. METHODS In this multicenter study, anorectal pressures at rest, during squeeze, and evacuation were measured with diagnostic and biofeedback catheters using Mcompass™ portable device in healthy subjects. Balloon expulsion time and rectal sensation were evaluated. The effects of age and gender were assessed. RESULTS The final dataset comprised 108 (74 women) of 124 participants with normal rectal balloon expulsion time (less than 60 s). During squeeze, anal resting pressure increased by approximately twofold in women and threefold in men. During evacuation, anal pressure exceeded rectal pressure in 87 participants (diagnostic catheter). The specific rectoanal pressures (e.g., resting pressure) were significantly correlated and not different between diagnostic and biofeedback catheters. With the diagnostic catheter, the anal squeeze pressure and rectal pressure during evacuation were greater in men than women (p ≤ 0.02). Among women, women aged 50 years and older had lower anal resting pressure; rectal pressure and the rectoanal gradient during evacuation were greater in older than younger women (p ≤ 0.01). CONCLUSIONS Anal and rectal pressures measured with diagnostic and biofeedback manometry catheters were correlated and not significantly different. Pressures were influenced by age and sex, providing reference values in men and women.
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Affiliation(s)
- Mayank Sharma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
| | - Ann C. Lowry
- Colon and Rectal Surgery Associates, Minneapolis, Mn
| | - Satish S. Rao
- Division of Gastroenterology, Augusta University, Augusta, Ga
| | - William E. Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | | | - Frank A. Hamilton
- National Institute of Digestive Diseases, Kidney, and Diabetes, Bethesda, MD
| | - Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
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Sharma A, Rao SSC, Kearns K, Orleck KD, Waldman SA. Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders. Aliment Pharmacol Ther 2021; 53:1250-1267. [PMID: 33909919 PMCID: PMC8252518 DOI: 10.1111/apt.16369] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/24/2020] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders. AIM To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient's perspective of constipation. METHODS Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices. RESULTS Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects. CONCLUSIONS Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider.
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Affiliation(s)
- Amol Sharma
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | - Satish S. C. Rao
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | | | | | - Scott A. Waldman
- Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPAUSA
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Scott SM, Simrén M, Farmer AD, Dinning PG, Carrington EV, Benninga MA, Burgell RE, Dimidi E, Fikree A, Ford AC, Fox M, Hoad CL, Knowles CH, Krogh K, Nugent K, Remes-Troche JM, Whelan K, Corsetti M. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterol Motil 2021; 33:e14050. [PMID: 33263938 DOI: 10.1111/nmo.14050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic constipation is a prevalent disorder that affects patients' quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published (2009; 21 (Suppl.2)). This included seven articles, disseminating all themes covered during a preceding 2-day meeting held in London, entitled "Current perspectives in chronic constipation: a scientific and clinical symposium." In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held, again over 2 days. All faculty members were invited to author two new review articles, which represent a collective synthesis of talks presented and discussions held during this meeting. PURPOSE This article represents the first of these reviews, addressing epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. Clearly, not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular "hot topics" and themes that are of contemporary interest. The second review addresses management of chronic constipation, covering behavioral, conservative, medical, and surgical therapies.
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Affiliation(s)
- S Mark Scott
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam D Farmer
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Institute of Applied Clinical Science, University of Keele, Keele, UK
| | - Philip G Dinning
- College of Medicine and Public Health, Flinders Medical Centre, Flinders University & Discipline of Gastroenterology, Adelaide, SA, Australia
| | - Emma V Carrington
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca E Burgell
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - Eirini Dimidi
- Department of Nutritional Sciences, King's College London, London, UK
| | - Asma Fikree
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James's, Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
| | - Caroline L Hoad
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham University, Nottingham, UK
| | - Charles H Knowles
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Nugent
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Jose Maria Remes-Troche
- Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, Mexico
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham University, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Sbeit W, Khoury T, Mari A. Diagnostic approach to faecal incontinence: What test and when to perform? World J Gastroenterol 2021; 27:1553-1562. [PMID: 33958842 PMCID: PMC8058654 DOI: 10.3748/wjg.v27.i15.1553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/01/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Faecal incontinence (FI) is a debilitating common end result of several diseases affecting the quality of life and leading to patient disability, morbidity, and increased societal burden. Given the various causes of FI, it is important to assess and identify the underlying pathomechanisms. Several investigatory tools are available including high-resolution anorectal manometry, transrectal ultrasound, magnetic resonance imaging, and electromyography. This review article provides an overview on the causes and pathophysiology of FI and the author’s perspective of the stepwise investigation of patients with FI based on the available literature. Overall, high-resolution anorectal manometry should be the first investigatory tool for FI, followed by either transrectal ultrasound or magnetic resonance imaging for anal internal sphincter and external anal sphincter injury, respectively.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Naharia 2210001, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Naharia 2210001, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Gastroenterology and Endoscopy Unit, The Nazareth Hospital, EMMS, Nazareth 464000, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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72
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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73
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Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
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74
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Clinical Impact of Rectal Hyposensitivity: A Cross-Sectional Study of 2,876 Patients With Refractory Functional Constipation. Am J Gastroenterol 2021; 116:758-768. [PMID: 33982946 DOI: 10.14309/ajg.0000000000001039] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Normal bowel function requires intact sensory pathways. Diminished rectal sensation (rectal hyposensitivity [RH]) is associated with constipation, although its clinical importance remains unclear. METHODS Consecutive patients (aged 18-80) attending a tertiary center (2004-2016) for investigation of refractory functional constipation (Rome IV core criteria defined, applied post hoc) were included. Patients completed a clinical symptom questionnaire and underwent anorectal physiologic investigations, including rectal sensory testing (balloon distension) to determine 3 well-established sensory thresholds. Multivariate regression analyses were performed to evaluate associations between RH, symptomology, and allied physiologic investigations. RESULTS Of 2,876 patients meeting inclusion criteria, 722 (25%) had RH based on ≥1 elevated sensory thresholds (0: n = 2,154 [74.9%]; 1: n = 327 [11.4%]; 2: n = 209 [7.3%]; and 3: n = 186 [6.5%]). A linear relationship existed between increasing number of elevated sensory thresholds and constipation severity (Cleveland Clinic constipation score: mean difference per threshold [95% confidence interval] 0.69 [0.48-0.90]; P < 0.001). Several symptoms were significantly (P < 0.05) associated with RH including: infrequent defecation (odds ratio 1.29 [1.17-1.42]), painful evacuation (1.15 [1.05-1.27]), prolonged toileting (1.14 [1.05-1.24]), and digitation or enema use (1.18 [1.08-1.30]). On defecography, a "functional" evacuation disorder was also associated with RH (1.37 [1.25-1.50], P < 0.001), as was megarectum (2.52 [2.08-3.05], P < 0.001). DISCUSSION RH occurs in 25% of patients with refractory functional constipation. Increased number of elevated sensory thresholds is associated with more severe constipation phenotype. These data, in the largest study to date, provide for the first time evidence to show that RH is a major pathophysiologic mechanism in constipation, with recognized clinical impact (http://links.lww.com/AJG/B765).(Equation is included in full-text article.).
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75
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Reischauer C, Cancelli T, Malekzadeh S, Froehlich JM, Thoeny HC. How to improve image quality of DWI of the prostate-enema or catheter preparation? Eur Radiol 2021; 31:6708-6716. [PMID: 33758955 PMCID: PMC8379127 DOI: 10.1007/s00330-021-07842-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To compare the impact of laxative enema preparation versus air/gas suction through a small catheter on image quality of prostate DWI. METHODS In this single-center study, 200 consecutive patients (100 in each arm) with either enema or catheter preparation were retrospectively included. Two blinded readers independently assessed aspects of image quality on 5-point Likert scales. Scores were compared between groups and the influence of confounding factors evaluated using multivariable logistic regression. Prostate diameters were compared on DWI and T2-weighted imaging using intraclass correlation coefficients. RESULTS Image quality was significantly higher in the enema group regarding the severity of susceptibility-related artifacts (reader 1: 0.34 ± 0.77 vs. 1.73 ± 1.34, reader 2: 0.38 ± 0.86 vs. 1.76 ± 1.39), the differentiability of the anatomy (reader 1: 3.36 ± 1.05 vs. 2.08 ± 1.31, reader 2: 3.37 ± 1.05 vs. 2.09 ± 1.35), and the overall image quality (reader 1: 3.66 ± 0.77 vs. 2.26 ± 1.33, Reader 2: 3.59 ± 0.87 vs. 2.23 ± 1.38) with almost perfect inter-observer agreement (κ = 0.92-0.95). In the enema group, rectal distention was significantly lower and strongly correlated with the severity of artifacts (reader 1: ρ = 0.79, reader 2: ρ = 0.73). Furthermore, there were significantly fewer substantial image distortions, with odds ratios of 0.051 and 0.084 for the two readers which coincided with a higher agreement of the prostate diameters in the phase-encoding direction (0.96 vs. 0.89). CONCLUSIONS Enema preparation is superior to catheter preparation and yields substantial improvements in image quality. KEY POINTS • Enema preparation is superior to decompression of the rectum using air/gas suction through a small catheter. • Enema preparation markedly improves the image quality of prostate DWI regarding the severity of susceptibility-related artifacts, the differentiability of the anatomy, and the overall image quality and considerably reduces substantial artifacts that may impair a reliable diagnosis.
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Affiliation(s)
- Carolin Reischauer
- Department of Medicine, University of Fribourg, Chemin du Musée 8, 1700, Fribourg, CH, Switzerland.
- Department of Radiology, Cantonal Hospital Fribourg, Fribourg, Switzerland.
| | - Timmy Cancelli
- Department of Radiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Sonaz Malekzadeh
- Department of Medicine, University of Fribourg, Chemin du Musée 8, 1700, Fribourg, CH, Switzerland
- Department of Radiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Johannes M Froehlich
- Department of Medicine, University of Fribourg, Chemin du Musée 8, 1700, Fribourg, CH, Switzerland
- Department of Radiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Harriet C Thoeny
- Department of Medicine, University of Fribourg, Chemin du Musée 8, 1700, Fribourg, CH, Switzerland
- Department of Radiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
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Abstract
IMPORTANCE The prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments. OBSERVATIONS Validation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective. CONCLUSIONS AND RELEVANCE Advances in the identification of specific dysfunctions as causes of individual symptoms in the "IBS spectrum" leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.
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Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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77
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Chen Y, Cheng J, Zhang Y, Chen JDZ, Seralu FM. Electroacupuncture at ST36 Relieves Visceral Hypersensitivity via the NGF/TrkA/TRPV1 Peripheral Afferent Pathway in a Rodent Model of Post-Inflammation Rectal Hypersensitivity. J Inflamm Res 2021; 14:325-339. [PMID: 33584100 PMCID: PMC7875081 DOI: 10.2147/jir.s285146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of the study was to investigate the effects of electroacupuncture (EA) at ST36 on rectal hypersensitivity and compliance in DSS-treated post-inflammation rats. In addition, we explored the involvement of mast cells-triggered NGF/TrkA/TRPV1 peripheral afferent pathway. Methods Rats were provided water with 5% dextran sulphate sodium (DSS) for 7 days. Two weeks after the DSS treatment they were subjected to initial and repetitive EA. Different sets of parameters were compared in the initial test and then EA with the selected parameters were performed for 2 weeks. Rectal compliance was assessed by colorectal distension while visceral sensitivity was evaluated by abdominal withdraw reflexes (AWR) and electromyogram (EMG). Masson's trichrome staining was performed to stain collagen and toluidine blue staining was applied to assess the degranulation of mast cells. Nerve growth factor (NGF), tryptase, TrkA and TRPV1 were measured by Western blot or immunofluorescence staining. Results EA at 100 Hz was more effective in improving rectal compliance and visceral hypersensitivity. Daily EA improved visceral hypersensitivity but not rectal compliance. Five weeks after DSS treatment, fibrosis was noted in both sham-EA and EA groups. The expression and activation of mast cells were significantly reduced after the 2-week EA treatment with a concurrent decrease in the expression of colonic NGF/TrkA and TRPV1 in both colon and dorsal root ganglions. Conclusion EA at ST36 with a special set of parameters has no effect on reduced rectal compliance but relieves visceral hypersensitivity via the mast cells-triggered NGF/TrkA/TRPV1 peripheral afferent pathway in DSS-treated post-inflammation rats.
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Affiliation(s)
- Yan Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, People's Republic of China
| | - Jiafei Cheng
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yiling Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Florin M Seralu
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol 2021; 19:219-231.e1. [PMID: 32246999 DOI: 10.1016/j.cgh.2020.03.056] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
Abdominal bloating and distension are 2 of the most commonly reported gastrointestinal symptoms. Abdominal bloating is characterized by symptoms of trapped gas, abdominal pressure, and fullness. Abdominal distension is defined as a measurable increase in abdominal girth. These symptoms frequently co-exist, although they can occur separately. Defined by Rome IV criteria, functional abdominal bloating and distension commonly coincide with other functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome, and functional constipation. Abdominal bloating and distension can develop for multiple reasons, including food intolerances, a previous infection that perturbed the intestinal microbiota, disordered visceral sensation, delayed intestinal transit, or an abnormal viscero-somatic reflux. Treatment can be challenging to patients and providers-no regimen has been consistently successful. Successful treatment involves identifying the etiology, assessing severity, educating and reassuring patients, and setting expectations. Therapeutic options include dietary changes, probiotics, antibiotics, prokinetic agents, antispasmodics, neuromodulators, and biofeedback. We review the epidemiology and effects of chronic bloating and distension and pathophysiology, discuss appropriate diagnostic strategies, and assess available treatment options.
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Affiliation(s)
- Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
| | - David Cangemi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Maria Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders : Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Tech Coloproctol 2021; 25:3-17. [PMID: 33394215 DOI: 10.1007/s10151-020-02376-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
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Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Female Pelvic Med Reconstr Surg 2021; 27:e1-e12. [PMID: 33315623 DOI: 10.1097/spv.0000000000000956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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81
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Paquette I, Rosman D, El Sayed R, Hull T, Kocjancic E, Quiroz L, Palmer S, Shobeiri A, Weinstein M, Khatri G, Bordeianou L. Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2021; 64:31-44. [PMID: 33306530 DOI: 10.1097/dcr.0000000000001829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ian Paquette
- Department Colorectal Surgery, University of Cincinnati, Cincinnati, Ohio
| | - David Rosman
- Department of Radiology, Pelvic Floor Disorders Center at the Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rania El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab at Cairo University Faculty of Medicine and Teaching Hospitals, Cairo, Egypt
| | - Tracy Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, Ohio
| | - Ervin Kocjancic
- Department of Urology, University of Illinois, Chicago, Illinois
| | - Lieschen Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Susan Palmer
- Department of Radiology, Keck Medical Center of USC, Los Angeles, California
| | - Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, Virginia
| | - Milena Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Gaurav Khatri
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Liliana Bordeianou
- Section of Colorectal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
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Athanasakos E, Cleeve S. Audit on awake anorectal manometry: tolerability in children. Arch Dis Child 2020; 106:archdischild-2020-321083. [PMID: 33355163 DOI: 10.1136/archdischild-2020-321083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/03/2022]
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83
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Fomenko OY, Morozov SV, Scott S, Knowles H, Morozov DA, Shelygin YA, Maev IV, Nikityuk DB, Shkoda AS, Kashnikov VN, Bordin DS, Isakov VA, Biryukov OM, Belousova SV, Pimenova ES, Rumiantsev AS, Fedorov ED, Gvozdev MY, Trukhmanov AS, Storonova OA, Indeykina LH, Biryukova MG, Andreev DN, Kucheryavyy YA, Achkasov SI. [Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice]. TERAPEVT ARKH 2020; 92:105-119. [PMID: 33720582 DOI: 10.26442/00403660.2020.12.200472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/07/2023]
Abstract
This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.
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Affiliation(s)
- O Y Fomenko
- Ryzhikh National Medical Research Centre for Coloproctology
| | - S V Morozov
- Federal Research Center of Nutrition and Biotechnology
| | - S Scott
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - H Knowles
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - D A Morozov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - Y A Shelygin
- Ryzhikh National Medical Research Centre for Coloproctology
| | - I V Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - D B Nikityuk
- Federal Research Center of Nutrition and Biotechnology
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - V N Kashnikov
- Ryzhikh National Medical Research Centre for Coloproctology
| | - D S Bordin
- Yevdokimov Moscow State University of Medicine and Dentistry
- Loginov Moscow Clinical Research Center
- Tver State Medical University
| | - V A Isakov
- Federal Research Center of Nutrition and Biotechnology
| | - O M Biryukov
- Ryzhikh National Medical Research Centre for Coloproctology
| | - S V Belousova
- Ryzhikh National Medical Research Centre for Coloproctology
| | - E S Pimenova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - E D Fedorov
- Pirogov Russian National Research Medical University
| | - M Y Gvozdev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - A S Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O A Storonova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L H Indeykina
- Loginov Moscow Clinical Research Center
- Research Institute of Health Care Organization and Medical Management
| | - M G Biryukova
- Federal Research Center of Nutrition and Biotechnology
| | - D N Andreev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - Y A Kucheryavyy
- Yevdokimov Moscow State University of Medicine and Dentistry
- Ilyinsky Hospital
| | - S I Achkasov
- Ryzhikh National Medical Research Centre for Coloproctology
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Leo CA, Leeuwenburgh M, Orlando A, Corr A, Scott SM, Murphy J, Knowles CH, Vaizey CJ, Giordano P. Initial experience with SphinKeeper™ intersphincteric implants for faecal incontinence in the UK: a two-centre retrospective clinical audit. Colorectal Dis 2020; 22:2161-2169. [PMID: 32686233 DOI: 10.1111/codi.15277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The SphinKeeper™ artificial bowel sphincter implant is a relatively new surgical technique for the treatment of refractory faecal incontinence. This study presents the first experience in two UK tertiary centres. METHOD This is a retrospective audit of prospectively collected clinical data in relation to technique, safety, feasibility and short-term effectiveness from patients undergoing surgery from January 2016 to April 2019. Baseline data, intra-operative and postoperative complications, symptoms [using St Mark's incontinence score (SMIS)] and radiological outcomes were analysed. RESULTS Twenty-seven patients [18 women, median age 57 years (range 27-87)] underwent SphinKeeper. In 30% of the patients, the firing device jammed and not all prostheses were delivered. There were no intra-operative complications and all patients were discharged the same or the following day. SMIS significantly improved from baseline [median -6 points (range -12 to +3); P < 0.00016] with 14/27 (51.9%) patients achieving a 50% reduction in the SMIS score. On postoperative imaging, a median of seven prostheses (range 0-10) were identified with a median of five (range 0-10) optimally placed. There was no relationship between number of well-sited prostheses on postoperative imaging and categorical success based on 50% reduction in SMIS (χ2 test, P = 0.79). CONCLUSION SphinKeeper appears to be a safe procedure for faecal incontinence. Overall, about 50% patients achieved a meaningful improvement in symptoms. However, clinical benefit was unrelated to the rate of misplaced/migrated implants. This has implications for confidence in proof of mechanism and also the need for technical refinement.
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Affiliation(s)
- C A Leo
- Imperial College London, London, UK.,Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | | | - A Orlando
- Imperial College London, London, UK.,Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | - A Corr
- Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | - S M Scott
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Royal London Hospital, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C H Knowles
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Royal London Hospital, London, UK
| | - C J Vaizey
- Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
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85
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Godbole L, Godbole C, Bulchandani S. Evaluation of the Anopress® device in assessment of obstetric anal sphincter injuries in a specialist urogynaecology service. Eur J Obstet Gynecol Reprod Biol 2020; 256:397-399. [PMID: 33285495 DOI: 10.1016/j.ejogrb.2020.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/11/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES THD Anopress® is a new portable anal manometry device which can be used in an outpatient clinic setting. In this study, we aimed to: STUDY DESIGN: A retrospective analysis was conducted of women with OASI seen in a specialist clinic at 3- and 6-months post-delivery from November 2016 to December 2019. 72 women who attended their 6-month appointment and underwent anal manometry with Anopress were included. St Mark's Faecal incontinence score (FI) was calculated and for the purpose of analysis patients were classified into two groups - FI score less than 5 and 5 or more. EAUSS findings were classified as sphincter defect or no defect. RAVP and MSP were measured with Anopress and compared with the variables (symptoms and EAUSS findings) using the Mann-Whitney U test. RESULTS A total of 72 women were included in the study. There were 19 (27 %), 41 (57 %), 6 (8 %) and 6 (8 %) 3a, 3b, 3c and 4th degree perineal tears respectively. The median RAVP was 17 mm Hg (Inter-Quartile Range 10.75-24 mmHg) and median MSP was 47.5 mm Hg (IQR 33-68 mmHg). 38 patients (53 %) had a demonstrable sphincter defect on EAUSS. 37 patients (51.3 %) had FI score < 5 and 35 patients (48.6 %) had FI score of 5 or more. RAVP and MSP were significantly lower with EAUSS demonstrable sphincter defect (p < 0.001). Symptom severity correlated with RAVP (p = 0.016) though its correlation with MSP was not statistically significant (p = 0.096). CONCLUSION Anopress seems promising in the assessment of anal sphincter function in women with OASI and can potentially make anal manometry testing easily accessible to urogynecologists.
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Affiliation(s)
- Lakshmi Godbole
- Department of Urogynaecology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Chintamani Godbole
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Supriya Bulchandani
- Department of Urogynaecology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
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86
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Caetano AC, Costa D, Gonçalves R, Correia-Pinto J, Rolanda C. Does sequential balloon expulsion test improve the screening of defecation disorders? BMC Gastroenterol 2020; 20:338. [PMID: 33054847 PMCID: PMC7559767 DOI: 10.1186/s12876-020-01490-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD—a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)]. Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.
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Affiliation(s)
- A C Caetano
- Department of Gastroenterology, Hospital of Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal. .,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. .,ICVS/3B's-PT, Government Associate Laboratory, 4710-057, Braga, Guimarães, Portugal.
| | - D Costa
- Department of Gastroenterology, Hospital of Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, 4710-057, Braga, Guimarães, Portugal
| | - R Gonçalves
- Department of Gastroenterology, Hospital of Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - J Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, 4710-057, Braga, Guimarães, Portugal
| | - C Rolanda
- Department of Gastroenterology, Hospital of Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, 4710-057, Braga, Guimarães, Portugal
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87
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Zhang Q, Liu Y, Zhang Q, Zhang Y, Wu S, Jiang B, Ni M. Impaired Anorectal Afferents Is a Potential Pathophysiological Factor Associated to Functional Anorectal Pain. Front Neurol 2020; 11:577025. [PMID: 33162929 PMCID: PMC7581696 DOI: 10.3389/fneur.2020.577025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qi Zhang
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yanni Liu
- Baoji City Hospital of Traditional Chinese Medicine, Baoji, China
| | - Qiong Zhang
- Shuyang County Hospital of Traditional Chinese Medicine, Suqian, China
| | - Yuqing Zhang
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, China
| | - Sangsang Wu
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Jiang
- National Centre of Colorectal Disease, Nanjing Hospital of Chinese Medicine, Nanjing, China
| | - Min Ni
- National Centre of Colorectal Disease, Nanjing Hospital of Chinese Medicine, Nanjing, China
- *Correspondence: Min Ni
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88
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Camargo HPD, Machado VF, Parra RS, FÉres O, Rocha JJRD, Feitosa MR. MAIN MANOMETRIC FINDINGS AND POTENTIAL FOR ANORECTAL PHYSICAL THERAPY IN THE TREATMENT OF PATIENTS WITH EVACUATION DISORDERS. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:306-310. [PMID: 33027482 DOI: 10.1590/s0004-2803.202000000-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evacuation disorders are prevalent in the adult population, and a significant portion of cases may originate from pelvic floor muscle dysfunctions. Anorectal manometry (ARM) is an important diagnostic tool and can guide conservative treatment. OBJECTIVE To evaluate the prevalence of pelvic dysfunction in patients with evacuation disorders through clinical and manometric findings and to evaluate, using the same findings, whether there are published protocols that could be guided by anorectal manometry. METHODS A retrospective analysis of a prospective database of 278 anorectal manometries performed for the investigation of evacuation disorders in patients seen at the anorectal physiology outpatient clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto between January 2015 to June 2019 was conducted. The following parameters were calculated: resting pressure (RP), squeeze pressure (SP), high-pressure zone (HPZ), rectal sensitivity (RS) and rectal capacity (RC). The pressure measurements and manometric plots were reviewed to determine the diagnosis and to propose potential pelvic physical therapy procedures. Analysis of variance (ANOVA) and Fisher's exact test were used to compare the continuous variables and to evaluate the equality of variances between groups of patients with fecal incontinence (FI) and chronic constipation (CC). Results with a significance level lower than 0.05 (P-value <0.05) were considered statistically significant. Statistical analysis was performed using IBM® SPSS® Statistics version 20. RESULTS The mean age of the sample was 45±22 years, with a predominance of females (64.4%) and economically inactive (72.7%) patients. The indications for exam performance were FI (65.8%) and CC (34.2%). Patients with FI had lower RP (41.9 mmHg x 67.6 mmHg; P<0.001), SP (85.4 mmHg x 116.0 mmHg; P<0.001), HPZ (1.49 cm x 2.42 cm; P<0.001), RS (57.9 mL x 71.5 mL; P=0.044) and RC (146.2 mL x 195.5 mL; P<0.001) compared to those of patients with CC. For patients with FI, the main diagnosis was the absence of a functional anal canal (49.7%). For patients with CC, the main diagnosis was outflow tract obstruction (54.7%). For patients with FI, the main protocol involved a combination of anorectal biofeedback (aBF) with tibial nerve stimulation (TNS) (57.9%). For patients with CC, the most indicated protocol was aBF combined with TNS and rectal balloon training (RBT) (54.7%). CONCLUSION There was a high prevalence of pelvic floor changes in patients with evacuation disorders. There was a high potential for performing pelvic floor physical therapy based on the clinical and manometric findings.
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Affiliation(s)
- Hugo Parra de Camargo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
| | - Vanessa Foresto Machado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
| | - Rogério Serafim Parra
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
| | - Omar FÉres
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
| | - José Joaquim Ribeiro da Rocha
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
| | - Marley Ribeiro Feitosa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil
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89
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Basilisco G, Corsetti M. Seated anorectal manometry during simulated evacuation: A physiologic exercise or a new clinically useful diagnostic test? Neurogastroenterol Motil 2020; 32:e14001. [PMID: 32990409 DOI: 10.1111/nmo.14001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022]
Abstract
Symptoms such as a feeling of incomplete evacuation, straining, absence of the call to stool, anal blockage, or digitation suggest the presence a functional defecation disorder. As symptoms do not distinguish between patients with and without functional defecation disorder, Rome IV criteria recommend that this disorder is diagnosed when two of three tests are positive: balloon expulsion test (BET), anorectal manometry (ARM), and defecography. However, previous studies have demonstrated that the agreement among these tests is limited. In this issue of Neurogastroenterology and Motility, Sharma et al tested the hypothesis that conducting the ARM in a seated position would increase the diagnostic accuracy of the test in discriminating between patients with normal and prolonged BET. This minireview discusses the current knowledge on the role of the techniques to diagnose defecation disorder and the potential role of the ARM in a seated position.
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Affiliation(s)
- Guido Basilisco
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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90
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Dyssynergic Defecation and Anal Sphincter Disorders in Children in High-Resolution Anorectal Manometry Investigation. J Pediatr Gastroenterol Nutr 2020; 71:484-490. [PMID: 32960538 DOI: 10.1097/mpg.0000000000002819] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Dyssynergic defecation is a common disorder in children with functional constipation (FC) because of relaxation disorders of the sphincter apparatus and intra-rectal pressure during defecation. The aim of the study was to determine frequency and type of dyssynergic defecation and to assess pressure in the anal canal poles during simulated evacuation and function of puborectalis muscle in defecation in children with FC. METHODS Three-dimensional (3D) high-resolution anorectal manometries (3D HRAM) were performed in 131 children with FC. In the manometric test, resting pressure measurements were assessed in 4 measuring poles of the anal canal. RESULTS One hundred thirty-one children ages 5 to 17 years (mean age 10.2; SD ± 3.8; median 10) were involved in the study (69 girls and 62 boys). Dyssynergic defecation was shown in 106/131 (80.9%) examined children. A statistically significant difference between the age of examined children (P < 0.02) and intrarectal pressures at the anal canal measuring points (left P < 0.009, right P < 0.005, anterior P < 0.01) was found. Correlation between the residual pressure values in lateral anal canal measurement poles and intrarectal pressure was demonstrated in all types of dyssynergy (left: r = 0.69, P < 0.0005; right: r = 0.74, P < 0.0005). In a group of 53/131 (40.5%) children, 3D HRAM showed a rectal pressure increase during simulated defecation, because of the dysfunction of the puborectalis muscle. CONCLUSION The increase in sphincter pressure in lateral and posterior poles in I and II types of dyssynergia and in lateral poles in other types of dyssynergia may depend on relaxation disorders of the puborectalis muscle during defecation.
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91
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Sharma M, Muthyala A, Feuerhak K, Puthanmadhom Narayanan S, Bailey KR, Bharucha AE. Improving the utility of high-resolution manometry for the diagnosis of defecatory disorders in women with chronic constipation. Neurogastroenterol Motil 2020; 32:e13910. [PMID: 32613711 PMCID: PMC7529936 DOI: 10.1111/nmo.13910] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We compared the utility of existing and modified versions of high-resolution manometry for diagnosing defecatory disorders (DD). METHODS In 64 healthy and 136 constipated women, we compared left lateral (LL) and seated manometry, and analyzed with existing (ManoView™) and new methods, for discriminating between constipated patients with normal and prolonged rectal balloon expulsion time (BET). In both positions, the rectoanal gradient (RAG) and, for the new analysis, the pressure topography pattern during evacuation were used to discriminate between constipated patients without and with DD. KEY RESULTS The BET was prolonged, suggestive of a DD, in 52 patients (38%). During evacuation, rectoanal pressures and the RAG were greater in the seated than the LL position (P≤.001). The new analysis identified 4 rectoanal pressure patterns. In the seated position, the BET was associated with the pattern (P=.0001), being prolonged in, respectively, 45%, 15%, 53%, and 0% of patients with minimal change, anal relaxation, paradoxical contraction, and transmission. Within each pattern, the RAG was greater (ie, less negative, P<.0001) in patients with a normal than a prolonged BET. Compared to the ManoView™ RAG in the LL position, the integrated analysis (ie, pattern and new RAG) in the LL position (P<.01) and the seated ManoView™ gradient (P=.02) were more effective for discriminating between constipated patients without and with DD. CONCLUSIONS & INFERENCES Anorectal HRM ideally should be performed in the more physiological seated position and analyzed by a two-tier approach, which incorporates the overall pattern followed by the rectoanal gradient. These findings reinforce the utility of manometry for diagnosing DD.
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Affiliation(s)
- Mayank Sharma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Anjani Muthyala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Kelly Feuerhak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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92
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Attari A, Chey WD, Baker JR, Ashton-Miller JA. Comparison of anorectal function measured using wearable digital manometry and a high resolution manometry system. PLoS One 2020; 15:e0228761. [PMID: 32991595 PMCID: PMC7523952 DOI: 10.1371/journal.pone.0228761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022] Open
Abstract
There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed "digital manometry") and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were -7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, -37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and -20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.
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Affiliation(s)
- Ali Attari
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - William D. Chey
- Division of Gastroenterology and Hepatology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, United States of America
| | - Jason R. Baker
- Division of Gastroenterology and Hepatology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, United States of America
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States of America
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93
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Scott SM, Carrington EV. The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry. Curr Gastroenterol Rep 2020; 22:55. [PMID: 32935278 PMCID: PMC7497505 DOI: 10.1007/s11894-020-00793-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice. RECENT FINDINGS This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice.
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Affiliation(s)
- S Mark Scott
- Neurogastroenterology Group and GI Physiology Unit, Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University London, London, UK.
| | - Emma V Carrington
- Neurogastroenterology Group and GI Physiology Unit, Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University London, London, UK
- Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland
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94
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Jiang AC, Panara A, Yan Y, Rao SSC. Assessing Anorectal Function in Constipation and Fecal Incontinence. Gastroenterol Clin North Am 2020; 49:589-606. [PMID: 32718572 DOI: 10.1016/j.gtc.2020.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Constipation and fecal incontinence are commonly encountered complaints in the gastrointestinal clinic. Assessment of anorectal function includes comprehensive history, rectal examination, and prospective stool diary or electronic App diary that accurately captures bowel symptoms, evaluation of severity, and quality of life of measure. Evaluation of a suspected patient with dyssynergic constipation includes anorectal manometry, balloon expulsion test, and defecography. Investigation of a suspected patient with fecal incontinence includes high-resolution anorectal manometry; anal ultrasound or MRI; and neurophysiology tests, such as translumbosacral anorectal magnetic stimulation or pudendal nerve latency. This article provides an approach to the assessment of anorectal function.
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Affiliation(s)
- Alice C Jiang
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, 600 S Paulina St, Chicago, IL 60612, USA
| | - Ami Panara
- Division of Gastroenterology, Department of Internal Medicine, University of Miami Leonard M. Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA
| | - Yun Yan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, GA, USA
| | - Satish S C Rao
- Division of Gastroenterology and Hepatology, Augusta University Medical Center, 1120 15th Street, AD 2226, Augusta, GA 30912, USA.
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95
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Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJ. Comparison between high-resolution water-perfused anorectal manometry and THD ® Anopress anal manometry: a prospective observational study. Colorectal Dis 2020; 22:923-930. [PMID: 31994307 PMCID: PMC7496679 DOI: 10.1111/codi.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high-resolution water-perfused manometry (WPM) with the newer THD® Anopress manometry system. METHOD This was a prospective observational study. Conventional manometry was carried out using a water-perfused catheter with high-resolution manometry and compared with the Anopress system with air-filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed. RESULTS Between 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10-17 s] versus 100 s (IQR 67-121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time-efficient than the WPM. CONCLUSION The pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time-consuming, user-friendly and better tolerated by patients.
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Affiliation(s)
- C. A. Leo
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK,The Royal London HospitalLondonUK
| | - E. Cavazzoni
- Santa Maria della Misericordia HospitalUniversità degli Studi di PerugiaPerugiaItaly
| | | | - G. P. Thomas
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | - A. Dennis
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - J. D. Hodgkinson
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK
| | - J. Warusavitarne
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - C. J. Vaizey
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
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96
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Paskaranandavadivel N, Varghese C, Lara J, Ramachandran S, Cheng L, Holobar A, Gharibans A, Bissett I, Collinson R, Stinear C, O'Grady G. A Novel High-Density Electromyography Probe for Evaluating Anorectal Neurophysiology: Design, Human Feasibility Study, and Validation with Trans-Sacral Magnetic Stimulation. Ann Biomed Eng 2020; 49:502-514. [PMID: 32737639 DOI: 10.1007/s10439-020-02581-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
Fecal incontinence (FI) substantially impairs quality of life and imparts a major socioeconomic burden. Anal sphincter injury and possibly pudendal nerve damage are considered common causes, however, current clinical methods for evaluating their function remain suboptimal. Electromyography (EMG) and pudendal nerve terminal latencies have been applied with some success, but are not considered standard practice due to uncertain accuracy and clinical value. In this study we developed and applied a novel anorectal high-density (HD) EMG probe in humans and pigs to acquire quantitative electrophysiological metrics of the anorectum. In the human trial we assessed somatic pathways and showed that EMG amplitude was greater for tight voluntary squeezes than light voluntary squeezes (0.03 ± 0.02 mV vs. 0.05 ± 0.03 mV). In a porcine model we applied trans-sacral magnetic stimulation to evoke extrinsically activated involuntary pathways and the resulting motor evoked potentials (MEP) were captured using the HD-EMG probe. The mean MEP amplitude at 50% magnetic stimulation intensity output (MSO) was significantly lower that the MEP amplitude at 85, 95 and 100% MSO (1.52 ± 0.50 mV vs. 3.10 ± 0.60 mV). In conclusion, the use of HD-EMG probe in conjunction with trans-sacral magnetic stimulation, for spatiotemporal mapping of anorectal EMG and MEP activity is anticipated to achieve new insights into FI and could offer improved diagnostic and prognostic biomarkers for anorectal dysfunction.
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Affiliation(s)
- Niranchan Paskaranandavadivel
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jaime Lara
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Shasti Ramachandran
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Vanderbilt University, Nashville, TN, USA
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Armen Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | | | - Cathy Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
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97
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Magnetic imaging defecography results are comparable to high-resolution manometry and conventional X-ray defecography in the assessment of functional pelvic floor disorders. Tech Coloproctol 2020; 24:1155-1161. [DOI: 10.1007/s10151-020-02292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
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98
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[Anal tone: Physiology, clinical and instrumental characteristics]. Prog Urol 2020; 30:588-596. [PMID: 32636059 DOI: 10.1016/j.purol.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The anal tone allows the maintenance of anorectal continence. Its regulation depends on spinal segmental mechanisms under supra-sacral control. MATERIAL AND METHODS A systematic review was performed using Medline database, according to PRISMA methodology, using following keywords anal tone ; anal sphincter ; anorectal function ; reflex ; digital rectal examination. RESULTS Anal hypertonia is an increase in the muscle's resistance to passive stretching. Muscular hypotonia is a decrease in muscle tone. It is associated with a decrease in resistance to passive mobilization. It is not possible to quantify the prevalence of anal tone alterations in the general population and in specific pathological conditions (urinary disorders, neurogenic or non-neurogenic anorectal disorders). In case of hypotonia, most often due to a lower motor neuron lesion, fecal incontinence may occur. Hypertonia (anal sphincter overactivity) is not always due to perineal spasticity. Indeed, in the majority of the cases, the cause of this anal hypertonia in a neurologic context, can be secondary to an upper motor neuron disease due to spinal or encephalic lesion, leading to recto-anal dyssynergia, giving distal constipation. In another way, this anal hypertonia can be purely behavioral, with no direct pathological significance. The evaluation of anal tone is clinical with validated scores but whose sensitivity is not absolute, and instrumental with, on the one hand, the measurement of anal pressure in manometry and, on the other hand, electrophysiological testing which still require validation in this indication. CONCLUSION Anal tone assessment is of interest in clinical practice because it gives diagnostic arguments for the neurological lesion and its level, in the presence of urinary or anorectal symptoms.
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99
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Sharma A, Rao SSC. Epidemiologic Trends and Diagnostic Evaluation of Fecal Incontinence. Gastroenterol Hepatol (N Y) 2020; 16:302-309. [PMID: 34035733 PMCID: PMC8132710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fecal incontinence (FI) is a prevalent condition that occurs in up to 15% of the Western population and significantly impairs quality of life. The current understanding of the epidemiology of FI is shifting because of an increasing recognition of FI in men, better appreciation for the impact of changing obstetric practices on FI in women, and comprehension of the effect of modifiable risk factors on the development of FI over time. The pathophysiology of FI is complex and multifactorial, which necessitates the use of multiple diagnostic tests, including tests of anorectal sensorimotor function, peripheral nerve function, and anatomic structure. Translumbosacral anorectal magnetic stimulation is an emerging noninvasive diagnostic test for assessing lumbosacral neuropathy. This article is not intended as a comprehensive recitation of the literature, but rather focuses on recent developments in the understanding of the epidemiology of FI, as well as on the diagnostic evaluation of this condition. This article aims to increase awareness of FI and to outline an initial diagnostic approach to affected patients.
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Affiliation(s)
- Amol Sharma
- Dr Sharma is an associate professor of medicine and Dr Rao is a professor of medicine and the J. Harold Harrison, MD, Distinguished University Chair in Gastroenterology in the Division of Gastroenterology and Hepatology in the Medical College of Georgia at Augusta University in Augusta, Georgia
| | - Satish S C Rao
- Dr Sharma is an associate professor of medicine and Dr Rao is a professor of medicine and the J. Harold Harrison, MD, Distinguished University Chair in Gastroenterology in the Division of Gastroenterology and Hepatology in the Medical College of Georgia at Augusta University in Augusta, Georgia
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100
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Shelygin YA, Fomenko OY, Morozov SV, Maev IV, Nikityuk DB, Aleshin DV, Achkasov SI, Баркалова EB, Bashankaev BN, Biryukov OM, Biryukova MG, Bordin DS, Vardanyan AV, Veselov AV, Gvozdev MY, Indeykina LH, Isakov VA, Kasyan GR, Kuzminov AM, Kucheryavyi YA, Pilipenko VI, Pimenova ES, Popov AA, Пучков KV, Rybakov EG, Titov AY, Fedorov AA, Fedorov ED, Chernyshov SV, Shapina MV, Shornikov PV. High resolution anorectal manometry. Recommendations on russian-language terminology based on interdisciplinary consensus. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2020. [DOI: 10.31146/1682-8658-ecg-174-2-55-64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of the paper — is to present the results of the consensus on the terminology used to describe data of high-resolution anorectal manometry.Methods: Online survey was conducted with the help of the public platform “Google forms” with the aim to harmonize the terms, which are used to conduct high-resolution anorectal manometry (HRAM), to agree the conformity of the proposed Russian-language terms to those used in English-language literature, and their abbreviations.Results: According to the aim, 56 specialists of different medical specialties who perform and use the results of HRAM in clinical practice and research were invited to participate in the survey. We received 45 answers from the respondents (42.2% coloproctologists, 22.2% gastroenterologists, 15.6% surgeons, 20% — representatives of other specialties). The response rate was 80.3%. According to the survey, 95.6% of respondents supported the need for harmonization of terms. Ten out of the 11 terms reached consensus level C1 (excellent), 1 term level of consistency was C2 (moderate). 90.9% of respondents (consensus level C1) were in favor of the appropriateness of using common abbreviations. However, the proposed abbreviations of the terms used in the conduct and description of the results of the HRAM can be accepted with reservations (in 10 cases out of 11 consensus level was C2).Conclusions: The agreed in interdisciplinary consensus terms can be approved and recommended for the use in clinical practice and when research data are published in Russian-language scientific literature.
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Affiliation(s)
- Yu. A. Shelygin
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | - O. Yu. Fomenko
- State Scientific Centre of Coloproctology Ministry of Health of Russia
| | - S. V. Morozov
- Federal Research Center of Nutrition and Biotechnology
| | | | - D. B. Nikityuk
- First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University)
| | - D. V. Aleshin
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | - S. I. Achkasov
- State Scientific Centre of Coloproctology Ministry of Health of Russia
| | | | - B. N. Bashankaev
- Center of Surgery “Global medical system. Clinics and hospitals"
| | - O. M. Biryukov
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | | | - D. S. Bordin
- MSMSU named after A. I. Evdokimov; Moscow clinical research center named after A. S. Loginov; ANO “Center for clinical and experimental surgery”
| | - A. V. Vardanyan
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | - A. V. Veselov
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | | | | | - V. A. Isakov
- Federal Research Center of Nutrition and Biotechnology
| | - G. R. Kasyan
- City clinical hospital named after S. I. Spasokukotsky of Department of Health Care of Moscow
| | - A. M. Kuzminov
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | | | | | - E. S. Pimenova
- First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University); City hospital #9 named after G. N. Speranskiy of Department of Health Care of Moscow
| | - A. A. Popov
- Moscow regional research Institute of obstetrics and gynecology
| | - K. V. Пучков
- ANO “Center for clinical and experimental surgery”
| | - E. G. Rybakov
- State Scientific Centre of Coloproctology Ministry of Health of Russia
| | - A. Yu. Titov
- State Scientifi c Centre of Coloproctology Ministry of Health of Russia
| | - A. A. Fedorov
- Moscow regional research Institute of obstetrics and gynecology
| | - E. D. Fedorov
- City Clinical Hospital #31 of Department of Health Care of Moscow
| | - S. V. Chernyshov
- State Scientific Centre of Coloproctology Ministry of Health of Russia
| | - M. V. Shapina
- State Scientific Centre of Coloproctology Ministry of Health of Russia
| | - P. V. Shornikov
- Research Institute — Regional clinical hospital № 1 named after Professor S. V. Ochapovskiy; Kuban State Medical University of Ministry of Healthcare of Russia
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