Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Neurogastroenterol Motil. 2024 Jul;36(7):e14781. doi: 10.1111/nmo.14781. Epub 2024 Mar 15.
Whether patients with defecatory disorders (DDs) with favorable response to a footstool have distinctive anorectal pressure characteristics is unknown. We aimed to identify the clinical phenotype and anorectal pressure profile of patients with DDs who benefit from a footstool.
This is a retrospective review of patients with high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) from a tertiary referral center. BET was repeated with a 7-inch-high footstool in those who failed it after 120 s. Data were compared among groups with respect to BET results.
Of the 667 patients with DDs, a total of 251 (38%) had failed BET. A footstool corrected BET in 41 (16%) of those with failed BET. Gender-specific differences were noted in anorectal pressures, among patients with and without normal BET, revealing gender-based nuances in pathophysiology of DDs. Comparing patients who passed BET with footstool with those who did not, the presence of optimal stool consistency, with reduced instances of loose stools and decreased reliance on laxatives were significant. Additionally, in women who benefited from a footstool, lower anal pressures at rest and simulated defecation were observed. Independent factors associated with a successful BET with a footstool in women included age <50, Bristol 3 or 4 stool consistency, lower anal resting pressure and higher rectoanal pressure gradient.
CONCLUSION & INFERENCES: Identification of distinctive clinical and anorectal phenotype of patients who benefited from a footstool could provide insight into the factors influencing the efficacy of footstool utilization and allow for an individualized treatment approach in patients with DDs.
对于排便障碍（DD）患者，是否存在对脚凳有良好反应的患者具有独特的肛肠压力特征尚不清楚。我们旨在确定受益于脚凳的 DD 患者的临床表型和肛肠压力特征。
这是对来自三级转诊中心的高分辨率肛肠测压（HR-ARM）和球囊排出试验（BET）的患者进行的回顾性研究。在 120 秒后 BET 失败的患者中，使用 7 英寸高的脚凳重复 BET。根据 BET 结果比较各组之间的数据。
在 667 例 DD 患者中，共有 251 例（38%）BET 失败。在 BET 失败的患者中，脚凳纠正了 41 例（16%）的 BET。在具有正常 BET 和无正常 BET 的患者中，肛肠压力存在性别特异性差异，揭示了 DD 病理生理学中的性别差异。与使用脚凳通过 BET 的患者相比，那些没有通过 BET 的患者的最佳粪便稠度、较少出现稀便和减少对泻药的依赖是显著的。此外，在受益于脚凳的女性中，观察到静息时和模拟排便时的肛门压力较低。女性使用脚凳成功 BET 的独立相关因素包括年龄<50 岁、Bristol 3 或 4 粪便稠度、静息时肛门压力较低和直肠肛门压力梯度较高。
识别受益于脚凳的患者的独特临床和肛肠表型可以深入了解影响脚凳使用效果的因素，并为 DD 患者提供个体化的治疗方法。
