Comparative evaluation of the effect of sustained inflation and rapid inflation/deflation of the intrarectal balloon upon rectoanal inhibitory reflex parameters in asymptomatic subjects

Monteiro, F. J. R.; Regadas, Francisco Sérgio Pinheiro; Murad-Regadas, Sthela M.; Rodrigues, Lusmar Veras; Leal, Vilmar Moura

doi:10.1007/s10151-007-0374-6

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…Because the response is invariably triggered with the onset of a need to defecate, we suspect that this must be centrally modulated. Additionally, much like the graded changes in RAIR (12,22), the SMR also exhibits a larger response at higher volumes of rectal distention (5). Supra spinal and parasympathetic pathways are implicated in the modulation of RAIR.…”

Section: Discussionmentioning

confidence: 98%

“…RAIR is an enteric neuronal reflex that is mediated by nitric oxide, vasoactive intestinal peptide, and adenosine triphosphate and causes relaxation of internal anal sphincter (IAS) (18). The rate and method of rectal distention (intermittent vs. ramp) affect the properties of the RAIR, and this reflex response is classically absent in Hirschsprung's disease and other conditions such as after circular rectal myotomy and after lower anterior resection (4,12,22).…”

mentioning

confidence: 99%

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Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Cheeney

Troche

Attaluri

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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Desire to defecate is associated with a unique anal contractile response, the sensorimotor response (SMR). However, the precise muscle(s) involved is not known. We aimed to examine the role of external and internal anal sphincter and the puborectalis muscle in the genesis of SMR. Anorectal 3-D pressure topography was performed in 10 healthy subjects during graded rectal balloon distention using a novel high-definition manometry system consisting of a probe with 256 pressure sensors arranged circumferentially. The anal pressure changes before, during, and after the onset of SMR were measured at every millimeter along the length of anal canal and in 3-D by dividing the anal canal into 4 ϫ 2.1-mm grids. Pressures were assessed in the longitudinal and anterior-posterior axis. Anal ultrasound was performed to assess puborectalis morphology. 3-D topography demonstrated that rectal distention produced an SMR coinciding with desire to defecate and predominantly induced by contraction of puborectalis. Anal ultrasound showed that the puborectalis was located at mean distance of 3.5 cm from anal verge, which corresponded with peak pressure difference between the anterior and posterior vectors observed at 3.4 cm with 3-D topography (r ϭ 0.77). The highest absolute and percentage increases in pressure during SMR were seen in the superior-posterior portion of anal canal, reaffirming the role of puborectalis. The SMR anal pressure profile showed a peak pressure at 1.6 cm from anal verge in the anterior and posterior vectors and distinct increase in pressure only posteriorly at 3.2 cm corresponding to puborectalis. We concluded that SMR is primarily induced by the activation and contraction of the puborectalis muscle in response to a sensation of a desire to defecate. anal manometry; puborectalis IN HUMANS, BALLOON DISTENTION of the rectum normally induces the recto-anal inhibitory reflex (RAIR) (6, 11) as well as the recto-anal contractile reflex (RACR) (9, 10, 21). RAIR is an enteric neuronal reflex that is mediated by nitric oxide, vasoactive intestinal peptide, and adenosine triphosphate and causes relaxation of internal anal sphincter (IAS) (18). The rate and method of rectal distention (intermittent vs. ramp) affect the properties of the RAIR, and this reflex response is classically absent in Hirschsprung's disease and other conditions such as after circular rectal myotomy and after lower anterior resection (4,12,22).In addition to the aforementioned reflexes, recently, we have described the sensorimotor response (SMR) (5) that is also seen during balloon distention of the rectum. The SMR is a transient anal contraction that is usually seen overlying the initial relaxation phase of the RAIR (5). In healthy subjects, it coincides with the onset of a sensation for defecation (5). A recent study showed that the SMR was abnormal in patients with rectal hyposensitivity, suggesting a pathophysiological role for this response in anorectal disorders (19). However, the precise origin of the anal contractile response, in particular...

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Cheeney

Troche

Attaluri

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Similar technical factors are likely to influence EAS EMG activity during deflation suggesting that caution should be adopted in the acceptance of a 'deflation reflex' as advocated by Shafik as a measure of anorectal functional disturbance [121]. This approach has recently been corroborated by Monteiro et al who have confirmed that parametric observations of rectoanal inhibition during inflation/deflation cycles are highly operator-/technique-dependent [122].…”

Section: Anal and Perineal Reflexesmentioning

confidence: 83%

Anorectal morphology and function: analysis of the Shafik legacy

Zbar

Guo

Pescatori³

2008

Tech Coloproctol

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Following the untimely death of Professor Ahmed Shafik, the authors decided to analyse his published work on the anatomy and physiology of the anorectal area, reconciling this body of data with current imaging and physiological techniques. All available papers as indexed by PubMed pertaining to the anorectal area were obtained and reviewed. The anatomical data was compared with historical representations and current new imaging modalities. The original 'triple-loop' theory of the anatomical disposition of the external anal sphincter has been confirmed by coronal and coronally reconstructed imaging modalities. There is variance between the Shafik and other descriptions of the anatomy of the longitudinal muscle and its importance in the definition of perianal spaces which are important in the spread of perirectal sepsis and in intersphincteric rectal dissection. Current dynamic defaecography would suggest a more complex levator plate function in squeeze and straining than that originally suggested by Shafik as a primary defaecatory role for the levator muscle. The body of work by Professor Shafik has reorganized our understanding of the external anal sphincter and the function of the levator during defaecation. Future studies should assess anatomical and physiological variances using new technology in health and in specific disease states.

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“…Diese Konzeption Shafiks schafft einige Verwirrung in Bezug darauf, was eine stimulierende rektale Dehnung darstellt, die imstande ist, einen rektoanalen Stimulus hervorzurufen [112][113][114], wenn ein ungehemmtes rektales Detrusor-"Syndrom" als eine "Ursache" von Stuhlinkontinenz vorliegt [115,116]. von der Untersuchungstechnik abhängen [122]. Dies ist teilweise ein Charakteristikum der exzessiven rektalen Füllung, bei der der EAS sich mit dem Risiko (oder der Realität) des Stuhlverlusts während des Vorgangs zusammenzieht [118][119][120].…”

Section: Anale Und Perineale Reflexeunclassified

Anorektale Morphologie und Funktion: Analyse der Arbeiten von Shafik

Zbar

Guo

Pescatori³

2009

Coloproctol

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ZusammenfassungFragestellung: Der zu frühe Tod von Professor Ahmed Shafik veranlasste die Autoren, eine Analyse seiner veröffentlichten Arbeiten zur Anatomie und Physiologie des Anorektums vorzunehmen und dabei seine Daten mit den aktuellen bildgebenden und physiologischen Untersuchungen abzugleichen.Methodik: Alle bei PubMed katalogisierten verfügbaren Arbeiten, das Anorektum betreffend, wurden gesichtet und beurteilt. Die anatomischen Daten wurden mit historischen Darstellungen und aktuellen Bildgebungsmethoden verglichen. Die ursprüngliche "Triple Loop"-Theorie der anatomischen Beschaffenheit des externen analen Sphinkters wurde durch koronare und koronar rekonstruierte Abbildungen bestätigt.Ergebnisse: Es gibt einen Unterschied zwischen den Beschreibungen von Shafik und anderen Autoren hinsichtlich der Anatomie des Längsmuskels und dessen Bedeutung bei der Definition perianaler Räume, die eine wichtige Rolle bei der Ausbreitung perirektaler Entzündungen und bei intersphinktären rektalen Präparationen spielen. Die aktuelle dynamische Defäkographie würde eine komplexere Levatorfunktion beim Pressen und Kneifen nahelegen, als ursprünglich von Shafik angenommen wurde, der die Funktion des Levatormuskels in einer primären Entleerungsrolle sah.Schlussfolgerung: Die Arbeiten von Professor Shafik waren grundlegend für unser heutiges Verständnis des externen analen Sphinkters sowie der Funktion des Levatormuskels während der Defäkation. Weitere Studien sollten die anatomischen und physiologischen Unterschiede unter Einsatz neuer Gesundheitstechnologie und in spezifischen Krankheitsstadien untersuchen. coloproctology Standorte Zbar AP, et al. Shafiks Arbeiten zur anorektalen Morphologie und Funktion 270 coloproctology 31 · 2009 · Nr. 5Abstract Purpose: Following the untimely death of Professor Ahmed Shafik, the authors decided to analyse his published work on the anatomy and physiology of the anorectal area, reconciling this body of data with current imaging and physiological techniques.Methods: All available papers as indexed by PubMed pertaining to the anorectal area were obtained and reviewed. The anatomical data was compared with historical representations and current new imaging modalities. The original "triple-loop" theory of the anatomical disposition of the external anal sphincter has been confirmed by coronal and coronally reconstructed imaging modalities. Results:There is variance between the Shafik and other descriptions of the anatomy of the longitudinal muscle and its importance in the definition of perianal spaces which are important in the spread of perirectal sepsis and in intersphincteric rectal dissection. Current dynamic defaecography would suggest a more complex levator plate function in squeeze and straining than that originally suggested by Shafik as a primary defaecatory role for the levator muscle. Conclusion:The body of work by Professor Shafik has reorganized our understanding of the external anal sphincter and the function of the levator during defaecation. Future studies should assess anatom...

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Comparative evaluation of the effect of sustained inflation and rapid inflation/deflation of the intrarectal balloon upon rectoanal inhibitory reflex parameters in asymptomatic subjects

Abstract: RAIR parameters are influenced by the choice of inflation pattern. Further studies are required to establish a standard intrarectal balloon inflation pattern.

Cited by 7 publications

References 21 publications

Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Anorectal morphology and function: analysis of the Shafik legacy

Anorektale Morphologie und Funktion: Analyse der Arbeiten von Shafik

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