Measurement of anal pressure and motility.

Hancock, Brian

doi:10.1136/gut.17.8.645

Cited by 126 publications

(46 citation statements)

References 11 publications

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“…Based on previously reported criteria, we proposed the criteria described below to exclude some USW-like conditions. 1) Rhythmical pressure fluctuations with a frequency less than 2/min 2) Amplitude greater than 25 cmH 2 O 3) Lack of synchronicity with rectal contractions 4) Lack of complete disappearance of anal slow waves at the nadir of the wave The first two criteria for USWs were proposed by Hancock (1976). The second criterion is required to exclude the weaning and waxing of slow waves which may cause periodic change in the shape of the waves without prominent fluctuations of the basic pressure (Fig.…”

Section: Criteria For Uswsmentioning

confidence: 99%

Multiple Clinical Presentations of Anal Ultra Slow Waves and High Anal Pressure: Megacolon, Hemorrhoids and Constipation

Yoshino

Kayaba

Morii

et al. 2007

Tohoku J. Exp. Med.

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The physiopathology of idiopathic chronic constipation is complex and yet to be investigated. In the manometric studies of the patients with severe chronic constipation, we noticed that some patients with megacolon show very slow periodical (< 2/min) pressure change in the anal canal, namely ultra slow waves (USWs). USWs are considered to represent the hyperactivity of the internal anal sphincter; however, USWrelated clinical presentations have yet to be investigated. We retrospectively re-evaluated the patient records and manometric studies of 85 cases, 51 subjects without defecatory problems and 34 patients with constipation, to elucidate USW-related clinical presentations. USWs were seen in 10 patients, including eight patients with chronic constipation and two subjects without defecatory problems. Out of the eight patients with constipation, one had no organic change in the anorectum, three had hemorrhoids and four exhibited megacolon. Manometric and pathological studies proved that none of the four patients with magacolon was suffering from Hirschsprung's disease. Among the 51 subjects without defecatory problems, only two had USWs. Anal pressure in the USW-positive group (106.0 ± 37.0 cmH 2 O) was significantly higher than that in the group without defecatory problems (56.0 ± 27.0 cmH 2 O) or constipated patients without USWs (55.0 ± 26.0 cmH 2 O). Megacolon and high anal pressure, as well as chronic constipation and hemorrhoids, were the clinical presentations related to USWs. This is the first report to show the clinical relevance of USWs to megacolon. USWs should be recognized as an important manometric finding indicating a possible new clinical entity in chronic constipation. ultra slow wave; manometry; constipation; megacolon; high anal pressure

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Section: Criteria For Uswsmentioning

confidence: 99%

Multiple Clinical Presentations of Anal Ultra Slow Waves and High Anal Pressure: Megacolon, Hemorrhoids and Constipation

Yoshino

Kayaba

Morii

et al. 2007

Tohoku J. Exp. Med.

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“…Er beobachtete einen verän-derten Motilitätsgradienten im Rahmen der langsamen Wellen und häufigere ultralangsame Wellen ± ein Ergebnis, das jedoch von anderen Untersuchern nicht bestätigt wurde [1,3,4]. Die Dehnbarkeit des Rectums und der Schwellenwert für die rectale Füllung sind unverändert.…”

Section: Hämorrhoidenassoziierte Funktionelle Veränderungenunclassified

Pathophysiologie des Hämorrhoidalleidens

Bruch

Roblick

2001

Chirurg

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It is not easy to define haemorrhoidal complaints precisely since this automatically means the entire aetiology and pathogenesis. What Stelzner describes as a complex compound of arteriovenous links in the rectal mucosa with an interlace of unstriated muscles, elastic fibres and connective tissue forms the anatomic base of the "corpus cavernosum recti". This cavernous vascular padding is a crucial component of the continence organ and ensures a gas-tight seal. According to Thomson's studies, haemorrhoids are to be regarded as a consequence of the disintegration of muscular and elastic components, caused by a distal shift of the vascular padding. The changes can cause growth up to prolapse, as well as haemorrhage or congestion. The reasons have not yet been conclusively clarified. Malfunctioning intestines--in particular constipational changes with hard stool--seem to be causal factors. The mechanisms of function and control of arteriovenous links as well as the influence of hereditary, social and cultural disposition continue to be unclear.

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“…Haemorrhoids may be treated by reducing mucosal prolapse by injection (Blanchard, 1928), rubber band ligation (Barron, 1963) or cryosurgery (Lewis et al, 1969), or by reducing the activity of the internal sphincter by manual dilatation of the anus (Lord, 1969) or lateral subcutaneous sphincterotomy (Notaras, 1971). The rationale of these last two procedures is based upon the belief that the internal sphincter is overactive in patients with haemorrhoids (Hancock, 1976).A trial to compare rubber bandligation with manual dilatation of the anus has already been conducted in this clinic (Hood and Alexander-Williams, 1971). The short term results indicated that rubber band ligation was significantly more effective.…”

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confidence: 98%

Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of haemorrhoids

Arabi

Gatehouse

Alexander-Williams

et al. 1977

Journal of British Surgery

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SUMMARYA randomized trial has been conducted to compare treatment for first-and second-degree haemorrhoids by rubber band ligation and lateral subcutaneous sphincterotomy. The symptomatic results of both procedures were similar at one year, though the initial results of sphincterotomy were poor. Eleven patients later required haemorrhoidectomy-5after lateralsubcutaneoussphincterotomy and 6 after rubber band ligation. Rebanding was necessary in I1 patients treated by rubber band ligation (22 per cent). Immediate complications of pain and bleeding were reported in 27 per cent of patients treated by rubber band ligation compared with 14 per cent after lateral subcutaneous sphincterotomy, whereas 2 patients developed a fistula a/ier lateral subcutaneous sphincterotomy .Lateral subcutaneous sphincterotomy was associated with a 30 per cent reduction in anal sphincter pressure at 4 4 months and the anal pressure was also reduced (by 24 per cent) at I year. Rubber band ligation had no influence on anal pressure.The poor results of lateral subcutaneous sphincterotomy occurred in patients with prolapse and with anal pressures of less than 100 cm H,O. Although lateral subcutaneous sphincterotomy is a satisfactory means of treating patients with first-and second-degree haemorrhoids, it requires admission to a day case unit. For this reason lateral subcutaneous sphincberotomy is unlikely to be preferred to rubber band ligation in the outpatient management of piles.THE long term results of conservative therapy for firstand second-degree piles indicate that haemorrhoidectomy can usually be avoided in 90 per cent of patients (Hancock and Smith, 1975;Steinberg et al., 1975;Kaufman, 1976). During the past decade there has been an increasing tendency to use minor outpatient procedures for treatment of haemorrhoids (Leading Article, 1975). Haemorrhoids may be treated by reducing mucosal prolapse by injection (Blanchard, 1928), rubber band ligation (Barron, 1963) or cryosurgery (Lewis et al., 1969), or by reducing the activity of the internal sphincter by manual dilatation of the anus (Lord, 1969) or lateral subcutaneous sphincterotomy (Notaras, 1971). The rationale of these last two procedures is based upon the belief that the internal sphincter is overactive in patients with haemorrhoids (Hancock, 1976).A trial to compare rubber bandligation with manual dilatation of the anus has already been conducted in this clinic (Hood and Alexander-Williams, 1971). The short term results indicated that rubber band ligation was significantly more effective. However, over half the patients receiving rubber band ligation in this study had to attend outpatients at least three times Furthermore, manual dilatation has been criticized because it is imprecise (Eisenhammer, 1953) and may cause anal prolapse in the elderly (Bates, 1972).We have therefore undertaken a study to compare multiple rubber band ligation at one outpatient visit using the Baron applicator with lateral subcutaneous sphincterotomy performed as a day case. Patients and methodsO...

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Measurement of anal pressure and motility.

Cited by 126 publications

References 11 publications

Multiple Clinical Presentations of Anal Ultra Slow Waves and High Anal Pressure: Megacolon, Hemorrhoids and Constipation

Multiple Clinical Presentations of Anal Ultra Slow Waves and High Anal Pressure: Megacolon, Hemorrhoids and Constipation

Pathophysiologie des Hämorrhoidalleidens

Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of haemorrhoids

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