O'Connor Alexander, Liao Donghua, Davenport Matthew, Sharma Abhiram, Vasant Dipesh H, Klarskov Niels, Drewes Asbjørn Mohr, Kiff Edward, McLaughlin John, Telford Karen
Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre Manchester, Manchester, UK
Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
BMJ Open Gastroenterol. 2025 Feb 11;12(1):e001600. doi: 10.1136/bmjgast-2024-001600.
High-resolution anorectal manometry (HRAM) is the established investigation in faecal incontinence (FI). However, provocative tests (functional lumen imaging probe (FLIP) and anal acoustic reflectometry (AAR)) have been proposed as alternatives. This study uniquely explores all three methods in correlation with FI symptoms and subtypes.
This was a prospective observational study of patients with FI attending a tertiary pelvic floor unit between August 2022 and January 2024. Patients underwent HRAM, FLIP and AAR with the order randomised. FI severity was assessed with the Vaizey score and quality-of-life with the Manchester Health Questionnaire.
40 patients (39 women, median age: 62 (range: 38-85)) were recruited with 27 (67.5%) reporting urge FI, 8 (20%) mixed and 5 (12.5%) passive incontinence. FLIP squeeze measurements correlated with the Vaizey score, including incremental squeeze pressure at 40 mL (r=-0.412; p=0.008) and 50 mL (r=-0.414; p=0.009) and the pressure-diameter volume loop at 50 mL (r=-0.402; p=0.011). Incremental squeeze opening pressure with AAR correlated with the Vaizey score (r=-0.339; p=0.032). There was no correlation between symptom severity and HRAM parameters, or any parameter and quality-of-life scores. Resting parameters with all three modalities were lower in passive FI: mean resting pressure (HRAM; p=0.010), yield pressure (FLIP; p=0.031) and opening pressure (AAR; p=0.006). With FLIP, there was a trend towards reduced squeeze function in the urge group (pressure-diameter volume loop at 50 mL; p=0.295).
FLIP and AAR correlate better with FI symptoms compared with HRAM. Therefore, these provocative tests could be used to guide the management of FI in prospective studies.
高分辨率肛门直肠测压法（HRAM）是目前用于大便失禁（FI）的既定检查方法。然而，有人提出激发试验（功能性管腔成像探头（FLIP）和肛门声学反射测量法（AAR））可作为替代方法。本研究独特地探讨了这三种方法与FI症状及亚型之间的相关性。
这是一项对2022年8月至2024年1月期间在一家三级盆底疾病治疗中心就诊的FI患者进行的前瞻性观察研究。患者按随机顺序接受HRAM、FLIP和AAR检查。采用Vaizey评分评估FI严重程度，采用曼彻斯特健康问卷评估生活质量。
招募了40名患者（39名女性，中位年龄：62岁（范围：38 - 85岁）），其中27名（67.5%）报告有急迫性FI，8名（20%）为混合型，5名（12.5%）为被动性失禁。FLIP挤压测量值与Vaizey评分相关，包括40毫升时的增量挤压压力（r = -0.412；p = 0.008）和50毫升时的增量挤压压力（r = -0.414；p = 0.009）以及50毫升时的压力 - 直径 - 容积环（r = -0.402；p = 0.011）。AAR的增量挤压开放压力与Vaizey评分相关（r = -0.339；p = 0.032）。症状严重程度与HRAM参数之间，以及任何参数与生活质量评分之间均无相关性。被动性FI患者在所有三种检查方式下的静息参数均较低：平均静息压力（HRAM；p = 0.010）、屈服压力（FLIP；p = 0.031）和开放压力（AAR；p = 0.006）。对于FLIP，急迫性FI组存在挤压功能降低的趋势（50毫升时的压力 - 直径 - 容积环；p = 0.295）。
与HRAM相比，FLIP和AAR与FI症状的相关性更好。因此，这些激发试验可用于在前瞻性研究中指导FI的管理。
