Anorectal Motility and Sensation Abnormalities and Its Correlation with Anorectal Symptoms in Patients with Systemic Sclerosis: A Preliminary Study

Abstract

Gastrointestinal (GI) hypomotility and symptoms are common in Scleroderma (SSc) patients yet so far uncorrelated. Eight SSc patients and matched controls were queried about their GI dysmotility symptoms and quality of life (QoL) and underwent anorectal motility and sensory tests. Specific scoring systems were developed for anorectal symptoms and anorectal dysmotility. We found that (1) the SSc patients showed low QoL and marked overall GI symptoms. The most common anorectal symptom was incomplete bowel movement (50%). (2) Compared to normal controls, SSc patients showed impaired anorectal pressures, sensations, and rectal compliance (P ≤ .01 for each). (3) The anorectal motility/sensation abnormality score was robustly correlated with the total anorectal symptom score (r s = .78, P = .02). In conclusion, scleroderma patients have impaired anorectal motor and sensory functions, and the abnormality score of these anorectal functions is correlated with the total anorectal symptoms score. These scoring systems may assist clinicians in predicting dysmotility based on patient symptoms.

The Impact of Pelvic Floor and Lower Gastrointestinal Symptoms on Quality of Life in Women With Systemic Sclerosis

“…These findings are consistent with prior studies showing that SSc patients experience both abnormal anorectal function and sensation. 15,18,19 Thoua et al 20 compared 44 SSc patients to incontinent controls and healthy volunteers and found that the FI associated with SSc appeared to be related to a neuropathic process rather than rectal fibrosis or sphincter atrophy because anal squeeze and resting pressures were actually lower in the incontinent control patients than in those with SSc.…”

Stubborn rectal prolapse in systemic sclerosis

“…Nevertheless, SSc patients show impaired anorectal pressures, sensations, and rectal compliance [15]. …”

Quality of life in systemic sclerosis

“…Anorrectal involvement occurs in 50-70% of SSc patients, but they are often reticent to report these symptoms to their physicians [90] and therefore are undertreated, resulting in a significant negative effect on HR-QoL [95]. Patients with anorectal dysmotility experience considerably reduced QoL in physical and social dimensions [90,96], with increased mortality of up to 85% compared to patients with minor GI complaints.…”

“…It has a 4-week recall period. The SF-36 instrument is not specific to any organ system and has a significant correlation to systemic [90] and between patients and the physician. This score has been validated in SSc.…”

“…Gastrointestinal involvement (GI) occurs in 90% of patients with SSc [89][90][91] and is associated with increased morbidity and mortality as well as a negative impact on HR-QoL [89,92], although the correlation between symptoms and GI motility disorders is difficult to establish [90].…”