Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2024 Mar;69(3):884-891. doi: 10.1007/s10620-023-08246-z. Epub 2024 Jan 6.
Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between obesity and anorectal function on physiologic testing in patients presenting with CC.
This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m) vs non-obese (BMI < 30 kg/m) groups at the time of HRAM. Fisher-exact/student t-test for univariate analyses and general linear regression for multivariable analysis were performed.
383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg, p = 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg, p = 0.043). No significant differences in dyssynergia (61% vs 53%, p = 0.294) and failed balloon expulsion (18% vs 25%, p = 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL, p = 0.042) and urge sensation (113.9 vs 103.7 mL, p = 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (β-coefficient 13.7, p = 0.049).
Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.
排便功能障碍可能导致慢性便秘（CC），但肥胖对 CC 患者肛直肠生理学的影响尚不清楚。我们旨在评估肥胖与生理检测中 CC 患者肛直肠功能之间的关系。
这是一项回顾性队列研究，纳入了在一家三级中心因 CC 接受高分辨率肛门直肠测压（HRAM）的连续成年患者。回顾了患者的人口统计学、临床病史、手术/产科史、药物和 HRAM 结果。在 HRAM 时，患者被分为肥胖（BMI>30 kg/m）与非肥胖（BMI<30 kg/m）组。使用 Fisher 精确检验/学生 t 检验进行单变量分析，使用一般线性回归进行多变量分析。
纳入了 383 名 CC 成年患者（平均年龄 50.3 岁；85.8%为女性）。在 HRAM 上，肥胖患者的肛门括约肌静息压较低（37.3 与 48.5 mmHg，p=0.005）和最大收缩压较低（104.8 与 120.0 mmHg，p=0.043）。肥胖与非肥胖组之间在协同失调（61%与 53%，p=0.294）和球囊排出失败（18%与 25%，p=0.381）方面无显著差异。在球囊扩张试验中，肥胖患者的最大耐受量（163.5 与 147.6 mL，p=0.042）和紧迫感容量（113.9 与 103.7 mL，p=0.048）显著增加。在调整潜在混杂因素后，肥胖与最大耐受量的增加独立相关（β系数 13.7，p=0.049）。
肥胖与 CC 患者直肠敏感性改变独立相关。直肠感觉改变可能在肥胖 CC 患者中发挥重要作用。应考虑进行肛直肠生理检测，以了解病理生理学并指导管理。
