Suresh Nikhil, Karanth Ranjitha, Cheah Ramsah, Casey John, Jayne David G, Del Galdo Francesco
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
NIHR Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK.
J Scleroderma Relat Disord. 2024 Oct;9(3):210-215. doi: 10.1177/23971983241241203. Epub 2024 Apr 8.
Systemic sclerosis is an autoimmune disorder which frequently affects the gastrointestinal tract. Anorectal dysfunction is common in systemic sclerosis and is manifested mainly by atrophy of internal anal sphincter. Faecal incontinence is the result of internal anal sphincter atrophy secondary to systemic sclerosis. In this study, we aimed to assess the internal anal sphincter in 17 patients with faecal incontinence and systemic sclerosis using anorectal manometry and endoanal ultrasound and compare them with an age and gender-matched control group without systemic sclerosis. Most patients have limited cutaneous systemic sclerosis. Majority of the patients with systemic sclerosis and faecal incontinence presented with symptoms of faecal leakage and urgency. Systemic sclerosis patients had low basal sphincter pressures. The mean thickness of internal anal sphincter in systemic sclerosis group was significantly lower than the control group (p < 0.001). Rectal sensation is preserved in systemic sclerosis. There was no difference in the mean thickness of the external anal sphincter between the two groups. To conclude internal anal sphincter is atrophic in systemic sclerosis resulting in decreased resting sphincter pressures and passive faecal leakage. Further investigations and studies are needed to determine the natural course of faecal incontinence in systemic sclerosis, associated risk factors and efficacy of therapeutic interventions.
系统性硬化症是一种常累及胃肠道的自身免疫性疾病。肛门直肠功能障碍在系统性硬化症中很常见，主要表现为肛门内括约肌萎缩。大便失禁是系统性硬化症继发肛门内括约肌萎缩的结果。在本研究中，我们旨在使用肛门直肠测压法和肛管超声评估17例大便失禁合并系统性硬化症患者的肛门内括约肌，并将其与年龄和性别匹配的无系统性硬化症对照组进行比较。大多数患者为局限性皮肤型系统性硬化症。大多数系统性硬化症合并大便失禁的患者表现为大便渗漏和便急症状。系统性硬化症患者的基础括约肌压力较低。系统性硬化症组肛门内括约肌的平均厚度显著低于对照组（p < 0.001）。系统性硬化症患者的直肠感觉保留。两组之间肛门外括约肌的平均厚度无差异。总之，系统性硬化症患者的肛门内括约肌萎缩，导致静息括约肌压力降低和被动性大便渗漏。需要进一步的调查和研究来确定系统性硬化症患者大便失禁的自然病程、相关危险因素以及治疗干预的疗效。
