Transrectal ultrasonography: relationship with anorectal manometry, electromyography and sensitivity tests in irritable bowel syndrome

Development of colonic transit time and ultrasound imaging tools as objective indicators for assessing abnormal defecation associated with food intake: a narrative review based on previous scientific knowledge

Background

Functional gastrointestinal disorders (FGIDs) involve chronic or persistent gastrointestinal symptoms. Laboratory tests show no organic lesions, and the symptoms are due to dysfunction. The most typical FGID is irritable bowel syndrome (IBS). In IBS patients, defecation disorders are common and have adverse effects on daily life. The proper evaluation and analysis of colonic transit are important for the management of defecation disorders in IBS patients. In addition, dietary intake and lifestyle affect colonic transit. An accurate assessment of such factors can guide management, leading to improvements in colonic transit and the resolution of defecation disorders.

Main topic

The Rome IV diagnostic criteria for IBS are based on subjective symptoms, which must be communicated and explained by the patient, limiting their application. Colonic transit time and ultrasonography are objective tools that can be used to diagnose IBS. In particular, previous studies used colonic transit to accurately distinguish between constipation and normal stool passage and to assess delayed gastrointestinal motility. Diet and lifestyle modifications can improve colonic transit and ameliorate bowel dysfunction.

Conclusion

Colonic transit can be improved by modifying lifestyle factors. Defecation disorders in IBS patients may be resolved by focusing on such factors. In the future, methods of visualizing defecation disorders due to impaired gastrointestinal motility and objective indicators of the associated abdominal symptoms need to be investigated.

Can irritable bowel syndrome be detected by ultrasound?

Functional gastrointestinal disease is one in which gastrointestinal symptoms persist chronically or recurrently. This disease is challenging because it does not have an organic cause that can be detected in routine laboratory tests. Among them, the symptoms of irritable bowel syndrome (IBS), which is a type of functional gastrointestinal tract disease, include abnormal bowel movements associated with abdominal pain. However, no specific test has been established to definitively diagnose these diseases, including IBS. The traditional Rome IV diagnostic criteria are used to diagnose IBS by assessing subjective symptoms. However, it has been suggested that IBS is difficult to diagnose using the Rome IV criteria among unconscious or cognitively impaired patients. It is recommended that abdominal ultrasonography be used to assess IBS with diarrhea and constipation. Previously, constipation among elderly people who ingested food orally was objectively assessed by ultrasound, and colonic fecal distribution patterns were classified in constipated patients and healthy people. Objective visualization of the large intestine was used to assess constipation. Therefore, fecal retention among adults and elderly individuals was reported using ultrasonography. It was suggested that stool retention could be confirmed by observing the hyperechoic region of the rectum. Strong hyperechoic regions with acoustic shadows in the rectum indicate the presence of hard stools, thus enabling medical workers to identify constipation. In the future, ultrasonography may be useful for diagnosing IBS in unconscious patients or those with cognitive decline.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: mucus in feces, abdominal distension, nausea and gastritis; and women more frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

Anorectal function and dyssynergic defecation in different subgroups of patients with irritable bowel syndrome

PURPOSE

The purpose of this study was to evaluate anorectal function in different subgroups of patients with irritable bowel syndrome (IBS), including those with mixed bowel habits.

MATERIALS AND METHODS

Sixty-six IBS patients selected according to Rome III criteria (39 female and 27 male patients; mean age, 41.5 +/- 15.4) and 20 subjects in the control group (13 female and 7 male patients; mean age, 41.4 +/- 13.7) were examined. The IBS patients were divided into three subgroups according to bowel movement pattern: patients with constipation (27%), patients with diarrhea (27%), and patients with mixed bowel habits (46%). Anorectal manometry and rectal distension test were performed using a four-lumen water-perfused catheter with a polyethylene balloon.

RESULTS

No significant differences in manometric parameters between the subgroups of IBS patients and the control group were found, except for pelvic floor dyssynergia (PFD), which was more frequent in all subgroups of IBS (41% of patients) than in controls (5% of subjects) (p < 0.01). Lower rectal pain threshold was observed particularly in IBS patients with diarrhea and mixed bowel habits (p < 0.01).

CONCLUSION

Manometric parameters characterizing anal sphincter function are not correlated with the predominant bowel movement pattern in IBS. The features of PFD are significantly more frequent in all subgroups of IBS patients than in controls, suggesting that, in general, IBS patients show changes in the mobility of the pelvic floor. Hypersensitivity to rectal distension is commonly observed in IBS, but it does not seem to be a highly specific marker of the disorder.

Rectal sensation, pelvic floor function and symptom severity in Hispanic population with irritable bowel syndrome with constipation

OBJECTIVE

In patients with irritable bowel syndrome with constipation (IBS-C, Rome II) we determined if pelvic floor function correlates with rectal sensitivity and tone, and if the pelvic and rectal measurements correlate with symptoms.

PATIENTS AND METHODS

Sensory thresholds and tone in fasting and postprandial states were evaluated with an electronic barostat in 34 patients and 10 normal controls. The pelvic floor was assessed by defaecography.

RESULTS

Pain threshold to rectal distension was lower in IBS-C patients (P = 0.007). Postprandially, IBS-C patients showed lower values for sensation of gas, perception of urge, and pain threshold compared with controls. In IBS-C the anorectal angle widened less and showed less perineal mobility during defecation; the rectal tone in fasting IBS-C patients correlated with the angle at rest (P = 0.04) and with the perineal descent at rest (P = 0.01). The severity of abdominal discomfort or pain, and abdominal fullness correlated with the anorectal angle. The duration of symptoms and frequency of bowel movements correlated with perineal descent. Straining, mucus expulsion, and the feeling of incomplete evacuation correlated with rectal sensitivity variables.

CONCLUSION

Patients with IBS-C have lowered sensory thresholds for noxious and non-noxious stimuli, increased visceral sensitivity after food, less perineal mobility during defecation, and symptoms that correlate with rectal sensitivity and pelvic floor parameters.

Diagnosis of irritable bowel syndrome

Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.