No abstract

Background and Aims Fecal incontinence is an important complaint reported by patients with Crohn’s disease and it is associated with several disease-related mechanisms, including anorectal functional disorders. This study aimed to assess the anorectal function and clinical characteristics to identify parameters associated with fecal incontinence in Crohn’s disease patients. Methods This is a cross-sectional study of 104 patients with Crohn’s disease, aged 18 years or older, from a referral center between August 2019 and May 2021. Patients responded to a specific questionnaire, and underwent medical record review, proctological examination, and anorectal functional assessment with anorectal manometry. Results Of the 104 patients, 49% were incontinent. Patients with incontinence had a lower mean resting pressure (43.5 mmHg versus 53.1 mmHg; p = 0.038), lower mean squeeze pressure (62.1 mmHg versus 94.1 mmHg; p = 0.036), and lower maximum rectal capacity (140 ml versus 180 ml; p < 0.001). Fecal incontinence was also associated with disease activity (p < 0.001), loose stools (p = 0.02), perianal disease (p = 0.006), previous anoperineal surgery (p = 0.048), and the number of anorectal surgeries (p = 0.036). Conclusions This is the largest reported study describing manometric findings of Crohn’s disease patients with and without fecal incontinence. Our results identified an association between FI and functional disorders, in addition to clinical features in these patients. Functional assessment with anorectal manometry may help choose the best treatment for FI in patients with CD.

Background Anoperineal damage in Crohn’s Disease (CD) is caused by inflammation, its sequelae, and the surgery’s sequelae. Fecal incontinence (FI) is an important complaint reported by patients with CD. Literature data regarding to FI, anatomical and functional abnormalities and its associated clinical factors are controversial, with few surveys with a limited number of participants.1 The aim of this study is to analyze FI and the associated manometric and clinical findings in patients with CD. Methods Observational, cross-sectional study in patients older than 18 years old with CD under outpatient follow-up at a tertiary center, who, after sign informed consent, were submitted to specific questionnaire, anorectal manometry and medical record review. The Jorge and Wexner Fecal Incontinence Scale was applied to grade incontinence.2 SPSS 21.0 (SPSS, Chicago, IL, USA) was used for statistical analysis, with description of categorical variables with absolute and relative frequency, and continuous variables with median and interquartile range (IIQ). To study the association, we used Pearson’s Chi-Square and Mann Whitney test. The null hypothesis was rejected with p<0.05. Results Of 104 patients with CD, 51% were male, median age of 41 years old (IIQ 29.2–50.0) and median disease duration of 6.1 years (IIQ 2.5 to 11 .5). Most of the sample was diagnosed between 17 and 40 years old, (68.3%), with non-penetrating, non-stricturing disease (63.4%), with colonic location (77.9%), isolated (30.8%) or with ileal involvement (47.1%); 78.8% had disease in remission and 11.5% had mild disease, representing 90,4% of our casuistic, according to the Harvey Bradshaw Index. Among patients; 41.3% had perianal disease, and 49% were incontinent, of these 66.7% had mild incontinence and 33.3% had moderate and severe incontinence. It was found association between FI and lower mean resting pressures (p=0.04) and lower mean squeeze pressures (p=0.04) along the anal canal. There was also association between FI and perianal disease (p=0.02), and FI and disease activity (p<0.01). Conclusion The study, unprecedented in America Latin, showed a high frequency of FI and found its association with disease activity, structural abnormalities (perianal disease) and anorectal disfunction (lower resting and squeeze pressures), reenforcing the importance of controlling CD activity. Furthermore, the data showed to be crucial during follow-up of CD patients the adequate manometric assessment and specialized evaluation for the management of FI. References 1. Litta, F, Ratto C, et al. Anorectal function and quality of life in IBD patients with a perianal complaint, J Invest Surg. 2019 Oct 18;1–6 2. Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97