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.
Dig Dis Sci. 2021 Jul;66(7):2345-2352. doi: 10.1007/s10620-020-06519-5. Epub 2020 Aug 5.
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.
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.
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.
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.
在健康志愿者中频繁观察到与协同失调一致的异常测压模式，这使得有必要重新评估当前的方法，以提高肛门直肠测压在功能性排便障碍中的诊断价值。直肠扩张在模拟排便时是否会影响肛门直肠压力曲线并增加直肠肛门梯度尚不清楚。
对 108 例慢性便秘患者（93 例女性，中位年龄 53 岁[四分位间距：40-65]）进行了研究。首先在排空状态下用空球囊进行模拟排便，然后分别用 50ml 和 100ml 球囊进行扩张。比较肛门直肠压力。我们还根据球囊排出试验（BET）的结果进行了亚组分析。此外，我们研究了直肠扩张对直肠感觉功能的直肠肛门压力梯度的影响。
模拟排便时直肠球囊扩张改善了直肠肛门梯度，并降低了高分辨率肛门直肠测压时的协同失调发生率。在亚组分析中，直肠扩张增加直肠肛门梯度和纠正协同失调仅局限于 BET 正常和直肠感觉功能正常的患者。在直肠扩张 50ml 时，有和无正常 BET 的患者之间的肛门松弛率、残余肛门压力和直肠肛门梯度有显著差异。仅在直肠扩张后记录的直肠肛门梯度，以及 BMI 和最大耐受量，可独立预测慢性便秘患者的 BET 结果。
模拟排便时直肠扩张会影响肛门直肠压力曲线。只有在直肠感觉功能正常和 BET 正常的患者中，直肠肛门梯度的增加和协同失调的纠正才有意义。
