Fomenko O Y, Morozov S V, Scott S, Knowles H, Morozov D A, Shelygin Y A, Maev I V, Nikityuk D B, Shkoda A S, Kashnikov V N, Bordin D S, Isakov V A, Biryukov O M, Belousova S V, Pimenova E S, Rumiantsev A S, Fedorov E D, Gvozdev M Y, Trukhmanov A S, Storonova O A, Indeykina L H, Biryukova M G, Andreev D N, Kucheryavyy Y A, Achkasov S I
Ryzhikh National Medical Research Centre for Coloproctology.
Federal Research Center of Nutrition and Biotechnology.
Ter Arkh. 2020 Dec 15;92(12):105-119. doi: 10.26442/00403660.2020.12.200472.
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.
本手稿总结了国际肛门直肠生理学工作组（IAPWG）就肛门直肠功能测试的操作、所用术语及解读达成的共识，这些测试包括肛门直肠测压（重点是高分辨率测压）、直肠感觉测试和气囊排出试验。基于这些测量结果，提出了一种肛门直肠功能障碍分类系统。旨在向广泛的专科医生、全科医生、治疗师、胃肠病学家、结直肠外科医生等提供有关功能性肛门直肠疾病诊断方法和新分类的信息，这些医生在日常实践中都会遇到这些疾病的表现，并确定诊断和治疗算法。本文提供了IAPWG共识的商定声明以及俄罗斯专家对实际应用的评论（斜体），主要涉及检查方法。这些评论绝无意减损国际专家小组商定的条款。我们希望这些评论将有助于通过对使用所讨论方法及获得结果的本地经验进行系统化，提高检查质量。关键建议：IAPWG关于肛门直肠功能测试操作的方案推荐了一套标准化的动作顺序，以测试直肠肛门反射、肛门张力和收缩性、直肠肛门协调性以及直肠感觉。分类中定义的健康对照中未出现的主要发现如下：直肠肛门反射消失、肛门低血压和收缩功能减退、直肠感觉减退和感觉过敏。健康状态下可能出现且诊断前需要更多信息的次要和不确定发现包括肛门高血压和协同失调。
