Document Detail

Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry.
MedLine Citation:
PMID:  23142135     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry.
METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry.
RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal high-pressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times.
CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.
Shiva K Ratuapli; Adil E Bharucha; Jessica Noelting; Doris M Harvey; Alan R Zinsmeister
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Publication Detail:
Type:  Comparative Study; Journal Article; Video-Audio Media     Date:  2012-11-07
Journal Detail:
Title:  Gastroenterology     Volume:  144     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-06-12     Completed Date:  2013-08-15     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  314-322.e2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Anal Canal / physiopathology*
Constipation / classification*,  genetics*,  physiopathology
Defecation / physiology*
Follow-Up Studies
Manometry / methods
Middle Aged
Pelvic Floor Disorders / complications,  genetics,  physiopathology
Rectum / physiopathology*
Retrospective Studies
Grant Support
Comment In:
Gastroenterology. 2013 Feb;144(2):263-5   [PMID:  23260494 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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