771 Characterization of Dyssynergia Phenotypes With High Resolution Anorectal Manometry (HRAM)

Rao, Satish S.; Leelasinjaroen, Pornchai; Amieva-Balmori, Mercedes; Sharma, Amol; Patcharatrakul, Tanisa; Dewitt, Annie

doi:10.1016/s0016-5085(16)30626-6

Cited by 13 publications

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“…Type IV: The patient is unable to generate an adequate pushing force and demonstrates an absent or incomplete anal sphincter relaxation. Four additional subtypes were described recently by using a high-resolution manometry catheter which provides greater resolution of the anal sphincter and puborectalis morphology, 42 although this needs further confirmation. Although dyssynergia patterns are reproducible 39 and has high interobserver agreement rates especially for type I and IV, 43 several studies have found that these dyssynergic patterns were also observed in nearly 90% of asymptomatic controls and in chronic proctalgia without constipation.…”

Section: Anorectal Manometrymentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

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195

149

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Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

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Section: Anorectal Manometrymentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

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195

149

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“…16 An abstract reported that 27% of patients with dyssynergia during HRM in the left lateral position had a normal pattern in the seated position. 17 However, none of these studies evaluated the diagnostic utility of HRM in healthy controls or patients. A statistical comparison of the diagnostic utility of solid-state manometry in the seated and LL positions was not performed.…”

Section: Introductionmentioning

confidence: 99%

Improving the utility of high‐resolution manometry for the diagnosis of defecatory disorders in women with chronic constipation

Sharma

Muthyala

Feuerhak

et al. 2020

Neurogastroenterology Motil

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Background We compared the utility of existing and modified versions of high‐resolution manometry for diagnosing defecatory disorders (DD). Methods In 64 healthy and 136 constipated women, we compared left lateral (LL) and seated manometry, and analyzed with existing (ManoView™) and new methods, for discriminating between constipated patients with normal and prolonged rectal balloon expulsion time (BET). In both positions, the rectoanal gradient (RAG) and, for the new analysis, the pressure topography pattern during evacuation were used to discriminate between constipated patients without and with DD. Key Results The BET was prolonged, suggestive of a DD, in 52 patients (38%). During evacuation, rectoanal pressures and the RAG were greater in the seated than the LL position (P≤.001). The new analysis identified 4 rectoanal pressure patterns. In the seated position, the BET was associated with the pattern (P=.0001), being prolonged in, respectively, 45%, 15%, 53%, and 0% of patients with minimal change, anal relaxation, paradoxical contraction, and transmission. Within each pattern, the RAG was greater (ie, less negative, P<.0001) in patients with a normal than a prolonged BET. Compared to the ManoView™ RAG in the LL position, the integrated analysis (ie, pattern and new RAG) in the LL position (P<.01) and the seated ManoView™ gradient (P=.02) were more effective for discriminating between constipated patients without and with DD. Conclusions & Inferences Anorectal HRM ideally should be performed in the more physiological seated position and analyzed by a two‐tier approach, which incorporates the overall pattern followed by the rectoanal gradient. These findings reinforce the utility of manometry for diagnosing DD.

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“…Recently 8 subtypes of dyssynergia have been described us- ing HRPT and this includes 2 subtypes where puborectalis appears to be dyssynergic whereas external anal sphincter shows normal relaxation. 19 This indicates that the puborectalis muscle rather than the longitudinal muscles may be more important in characterizing subtypes of DD. Indeed, abnormal contractions of the puborectalis muscle are often seen in obstructed defecation, and patients with these abnormal contractions seem to respond favorably to biofeedback treatment.…”

Section: Discussionmentioning

confidence: 99%

Anorectal Manometry in Defecatory Disorders: A Comparative Analysis of High-resolution Pressure Topography and Waveform Manometry

Lee

Erdoğan

et al. 2018

J Neurogastroenterol Motil

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Background/AimsWhether high-resolution anorectal pressure topography (HRPT), having better fidelity and spatio-temporal resolution is comparable to waveform manometry (WM) in the diagnosis and characterization of defecatory disorders (DD) is not known.MethodsPatients with chronic constipation (Rome III) were evaluated for DD with HRPT and WM during bearing-down “on-bed” without inflated rectal balloon and “on-commode (toilet)” with 60-mL inflated rectal balloon. Eleven healthy volunteers were also evaluated.ResultsNinety-three of 117 screened participants (F/M = 77/16) were included. Balloon expulsion time was abnormal (> 60 seconds) in 56% (mean 214.4 seconds). A modest correlation between HRPT and WM was observed for sphincter length (R = 0.4) and likewise agreement between dyssynergic subtypes (κ = 0.4). During bearing down, 2 or more anal pressure-segments (distal and proximal) could be appreciated and their expansion measured with HRPT but not WM. In constipated vs healthy participants, the proximal segment was more expanded (2.0 cm vs 1.0 cm, P = 0.003) and of greater pressure (94.8 mmHg vs 54.0 mmHg, P = 0.010) during bearing down on-commode but not on-bed.ConclusionsBecause of its better resolution, HRPT may identify more structural and functional abnormalities including puborectal dysfunction (proximal expansion) than WM. Bearing down on-commode with an inflated rectal balloon may provide additional dimension in characterizing DD.

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771 Characterization of Dyssynergia Phenotypes With High Resolution Anorectal Manometry (HRAM)

Cited by 13 publications

References 0 publications

Diagnosis and Treatment of Dyssynergic Defecation

Diagnosis and Treatment of Dyssynergic Defecation

Improving the utility of high‐resolution manometry for the diagnosis of defecatory disorders in women with chronic constipation

Anorectal Manometry in Defecatory Disorders: A Comparative Analysis of High-resolution Pressure Topography and Waveform Manometry

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