A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Abstract

AIM:To compare dyssynergic sub type patterns between SARM and HRM. METHODS: Patients with dyssynergic defecation diagnosed by ARM that had maintained the same stool patterns and frequency were re-evaluated with HRM while on waiting list for biofeedback training. Anorectal resting and squeezing pressure on the bed and commode were analyzed and compared between the two modalities. Paired t-test was used to compare the pressures and sensations. RESULTS: 25 dyssynergic patients diagnosed with SARM (F=21, age 41±12.9) underwent HRM. Twenty four patients had dyssynergia on HRM (96%). Twelve (48%) had similar patterns on≥one position, and five (20%) had similar patterns in both positions. When comparing between HRM and SARM, the maximum resting pressure (70 vs 55.6 mmHg p<0.01), anal straining on bed (73 vs 46.4 mHg, p<0.01), rectal straining on commode (107.4 vs 71.8 mmHg, p<0.01) and anal straining pressures on commode (76.3 vs 48.9 mmHg, p<0.01) significantly deferred between the exams respectively.

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

“…Our results indicate a good correlation in pressure metrics between the 2 techniques except for the length of sphincter and pressures during the bearing down on-commode. The agreement of DD types between the 2 techniques were poor, in keeping with a recently published data, 16 and this is probably because of better resolution of HRPT. Likewise, agreement between DD patterns described by Rao et al, 3 Rao and Singh, 4 and Ratuapli et al 5 (Fig.…”

“…Pressures derived from solid state and water-perfused anorectal manometry were shown in studies to correlate well, although these studies found higher anal sphincter pressures and a shorter sphincter with solid state HR manometry. [13][14][15][16] In these correlation studies, both techniques were performed on the same participants but on separate days, with intervals not clearly defined, and hence there is a potential for measurement bias due to changes in the anorectal physiology over time. Other factors to consider that might affect measurement include catheter design, number of sensors and diameter of the catheter, but these were eliminated with the current study design.…”

The use of colonic and anorectal high‐resolution manometry and its place in clinical work and in research

“…Of the 27 principal studies published, 24 are in adults and 3 are in pediatric populations . Seventeen studies are in various patient groups (constipation: n = 8; constipation or fecal incontinence: n = 5; anal fissure, perineal descent, rectal cancer and Hirschsprung disease: all n = 1), of which only 4 are controlled the by inclusion of healthy volunteers .…”

“…Three studies (all in patients) have compared parameters of anal sphincter function and anorectal coordination within individuals, measured using both contemporary HRAM/3‐D HDAM and also traditional water‐perfused manometry performed within the same study session . One study has compared ‘traditional’ solid‐state manometry with HRAM, and a further study subsampled HRAM data to derive traditional manometric recordings . All studies report good correlation of values between techniques (interclass correlation coefficients ranging from 0.42 to 0.9) .…”

“…However, despite its availability, the clinical uptake has been extremely slow. At the time of finalizing this review (February 2015), only 27 original articles and 5 individual case‐studies have been published in the scientific literature, all but 3 of which having appeared within the past 3 years. In the colon, HRM catheters are a more recent development; as such, the number of original articles currently stands at 7 .…”