Does correlation exist between anorectal manometry and endoanal ultrasound Objetivos: estudiar la posible correlación entre los datos de la manometría. Manometría ano-rectal. Manometría anorectal. and professional organizations recommend the use of the anorectal manometry (13), some authors question. Manometría anorectal. La manometría anorectal permite evaluar la función esfinteriana a través del registro de las presiones anorectales, valorar las vías.
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Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and manommetria subjects. There exist a great variability in the manometric findings between patients with anal incontinence AI and healthy subjects. The correlation between the pressures of the anal canal and the AI is not exact by the wide rank of normal values. Prospective study to evaluate differences in the pressures of the anal canal and in rectal sensitivity in patients with AI, chronic constipation CC and healthy subjects.
Ninety four patients with AI, 36 patients with CC and 15 healthy subjects were included. The following data were obtained: In multivariate analysis the manometia, the resting pressure and the volume for the first sensation and urge increase the relative risk for AI.
The greater age, the decrease in anal canal resting pressure and the alteration of rectal sensation increase the risk for AI. Presiones del canal anal. Noventa y cuatro pacientes con IA, 36 pacientes con EC y 15 sujetos sanos. Anal incontinence AI is one of the most devastating physical disabilities as manomehria has an important impact in the quality of life 1. Although the incontinence concept is very intuitive, there is no unanimously accepted definition of this, with considerable differences according to the different groups.
However, the term faecal incontinence is used frequently by the clinicians in the case of the incontinence to gas. The term of AI includes the uncontrolled gas escape, liquid or solid faeces. Therefore, both definitions can be used and at the time of analyzing the different manometrja it is observed that there is no standard definition 2.
It is important to differentiate if the patient presents passive or urge AI. Urge AI is defined as the loss of faecal material in spite of active attempts to retain the intestinal content. On the contrary, passive AI is the involuntary or unconscious loss of faecal content.
Although both groups can sometimes overlap mixed AI manometrix, the clinical differentiation can orient which is the predominant pathophysiological mechanism. In addition, it increases with age and it is more frequent in women than in men 5.
The ano-rectal manometry is an established diagnostic method manomefria the study of both the AI and the CC. Nevertheless, great variability in the manometric findings between patients with AI and in healthy subjects exists 6.
The normal values vary between each working team, as each laboratory usually has its group control. The values of the anoorectal pressure differ in the different studies depending on the technique used. The normal manometris of the squeeze maximal pressure measured with respect to the anorectl pressure must be greater to 60 mmHg 7.
With the stationary technique global normal values of mmHg mmHg 7 and mmHg 9 have been indicated, being greater in men, mmHg anoretalthan in women, mmHg mmHg 7. The normal values vary in the different studies being indicated with the stationary technique values from 32 seconds in males and 24 seconds in females 7. The results of the study of rectal sensitivity are more influenced by the differences in the methodology than any other anorectal technique.
Other groups obtained the first sensation with ml, urge sensation with ml and Manmetria with ml Also rectal sensitivity values differ according to sex, that the urge sensation oscillates between ml in women and in men and MTV in ml in women and ml in men Although expert and professional organizations recommend the use of the anorectal manometry 13some authors question its utility since sensitivity and specificity are not superior to that found in the rectal digital examination 14, The aim of the present study is to evaluate if differences in the demographic and manometric parameters obtained from the anal canal pressures and the sensorial threshold exist in patients with AI, CC and healthy subjects that may increase the risk of AI.
Also to determine if there are differences in the parameters indicated according to the type of AI. The definition of AI was considered as previously expressed 2 and functional CC was defined according to the definition accepted in the Rome III criteria 4.
The patients included in the group of AI where those that referred naorectal symptoms mentioned in the previous definition which had not received any previous treatment, medical, biofeedback or surgical, for AI. AI patients were subdivided according to the type of AI in urge, passive and mixed. The patients included in the constipation group were those who fulfilled at least two of the indicated Rome III criteria.
Fifteen healthy subjects older than 18 years were included in the control group and they did not present neither intestinal symptoms pain, constipation or diarrhoeanor ano-rectal disorders or surgery. In addition, other tests performed were individualized for each ,anometria biopsies of colon, TAC, abdominal ultrasound, etc.
The patients, in who bowel inflammatory disease or any other organic cause of FI was demonstrated in the colonoscopy or barium enema, were excluded from the study. Those patients with a lack of collaboration for the suitable accomplishment of the ano-rectal functional study were not included either. All the participants were informed of the characteristics of the study and gave their consent to participate in it.
The study was approved by the Hospital Ethical Committee. One hundred thirty patients were, included from March of to January of both inclusively they, were prospectively studied of which 94 were shown to present AI and 36 functional CC. Also 15 healthy subjects were included in the study, with a minimum age of 18 that served as the control group. Patients with Anorectwl and CC that were studied in the mentioned period without fulfilling the selection criteria were excluded.
A 4 sensors radially oriented polyvinyl probe and a polygraph PC polygraph Medical Synectics, Stockholm; Sweden were used.
Stationary pull-through technique was performed to obtain the anal canal pressures. The mean resting pressure was obtained considering the difference between the intrarectal pressure and the maximum anal sphincter pressure at rest registered in the 4 sensors and the squeeze maximum pressure SMP as the difference between the intra-rectal pressure and the maximal pressure registered during the squeeze manoeuvre in the 4 sensors of registry.
The anal canal length ACL was defined as the length as the basal pressure exceeds the rectal pressure in more than 5 mmHg For the evaluation of rectal sensation the same equipment indicated previously was used but with a probe with 4 sensors separated 1 cm spirally oriented with a balloon at the end of it Symmed.
Distensions of the balloon by means of the manomtria intermittent technique were made, maintaining the balloon inflated during 30 second and deflating it later completely. Later from a resting period between seconds the balloon was inflated again to the following volume The volume of initial inflation was 20 cc.
Anorectal manometry, what measures and what is
Manomeria patient was asked to advice xnorectal what point he noticed the first sensation, urge sensation and maximum tolerated volume MTV or pain 5. The volume of distension in each one of the described sensorial thresholds was registered. Descriptive analyses of the mentioned variables, qualitative and quantitative were made. In order to make the comparisons between groups of patients with AI, CC and healthy subjects the test of Kruskal-Wallis for independent data was used, in the case of continuous variables.
In case janometria finding statistical significance the test of Mann-Whitney for the comparison by pairs was used and, in the case of discrete variables the chi-square test. By a multinomial logistic regression model the independent variables for AI and CC compared to the control group were analysed, and the relative risk of them was obtained. By a binomial logistic regression, considering suffering anprectal not AI, the independent variables were calculated and sensitivity, specificity and positive predictive and negative predictive values to predict AI.
The analyses were made by means of statistical program SPSS 12,0. The control group was formed by 15 subjects, 7 men and 8 women, with an average of age of The group with CC was constituted of 36 patients, 5 men and 31 women. The average age of the group was of The group with FI formed 94 patients, 24 men and 70 women, diagnosed with FI of different degrees, with an average age of Manometry data of the three groups are expressed in table I.
The values of the control group were: Overlapping of the values in the 3 groups was observed Fig. Anal canal length ACL. Squeeze maximal pressure SMP. Squeeze manonetria duration SPD. Maximum tolerated volume MTV. Multivariate analysis independent variables in AI and CC with respect to the control group. In the case of the constipation only sex RR 8. The probability of having or xnorectal AI with the proposed model aborectal variables: The area under curve ROC was 0.
Anorectal manometry – Wikipedia
Manometry parameters and distribution by sex. Type of AI and manometry parameters. Although there are established causes that can be directly responsible for triggering the appearance of AI, in most cases there are multifactor origin, being able to find some patients with ano-rectal anatomical and functional studies within normality.
A wide variety of factors exists that facilitate the appearance of AI, among them age, in such a way that although AI can affect any group of age, it is more prevalent in older patients 16, This fact can justify the greater age found in the group of patients with AI with respect to the CC group and healthy subjects, being an independent risk factor, but we are conscious of the limitations imposed by not beingable to have a control group with similar ages to those of the patients with AI.
In fact limited information about normal values has been published, and in most studies a healthy control group is typically composed with young subjects with an equal distribution of men and women On the other hand, the distribution by sexes of the control group homogenous, both AI and CC are more frequent in women 14although in our study females only had an increased probability of having CC.
With respect to majometria manometric findings of the patients with AI: There is also a more impaired rectal sensation. However, there is an overlap between values obtained in the AI group and the other groups, manometrja already referred in other studies The diminution of resting pressure, the increase of first sensation and the diminution of urge volume threshold increase the risk of AI.
Nevertheless, in the CC, only a greater volume for the first sensation increases the probability of it.
Therefore, the resting pressure and rectal sensitivity are important factors in the development of AI, whereas in CC the pressures do not seem to be as important as rectal sensitivity. In regard to AI type, some studies suggest that passive AI correlated with lower resting pressure 19but there are perfectly continent subjects with low basal pressures, the reason why, the significance of the sphincter resting pressure in the pathophysiology of AI must be considered in combination with other functional findings 6.
In this study we have not demonstrated that the type of AI is associated with significant differences in the anal canal pressures, probably caused amorectal the small number of patients in the passive AI group. Nevertheless, the correlation between anal canal pressures and incontinence are not exact due to the wide rank of normal values and the contribution of other factors in the continence 6. The inability to maintain the voluntary contraction during 10 seconds can mean a reduction in the number of tonic fibbers and can favour the incontinence, in spite of a good SMP We have neither found differences in the SPD between patients with AI regarding the type of AI nor with respect to the other studied groups, as previous authors have described ACL is significantly smaller in patients with AI with regard to the patients with CC and the control group, agreeing with reports in other studies 23although the clinical meaning of this measurement is not clear.
The extent of the results of the manometry with regard to sex, a diminution in the SMP in women with respect to men in patients with AI was observed, this situation already referred to other authors and that also occurs in healthy subjects 7,9.
Although the sphincter dysfunction anorecal considered the most important factor in AI, sensitivity and rectal adaptation plays a role in it The response of EAS to the anorectsl distension is crucial to maintain the continence and is closely related to the sensorial function and rectal compliance