The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry

Abstract

Purpose of Review Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice. Recent Findings This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. Summary The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice.

Evaluation of constipation in children using high-resolution anorectal manometry

“…HRAM should become a routine screening investigation to supplement other modalities such as magnetic resonance or fluoroscopic defecography, endoscopic anal ultrasound and gut transit studies in children with defecation disorders. 17,18…”

Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives

“…High-resolution anorectal manometry and high-definition anorectal manometry are increasingly used in clinical practice to evaluate continence and regulation of defecation, primarily in patients with either difficult evacuation of stools or fecal incontinence who do not respond to standard treatment modalities [ 92 ]. A consensus guideline for standardization of the methods was recently published [ 93 ].…”

“…Compared with conventional manometry, additional pressure sensors are closely incorporated within either a solid-state or a water-perfused catheter (often ≥8 sensors). A high-definition rigid catheter containing 256 pressure sensors arranged in a circumferential grid has also been developed [ 92 , 94 ]. In combination with anorectal sensibility tests or other diagnostic investigations, contractions in the distal rectum and anal canal in response to various stimuli may establish a diagnosis and direct different treatment modalities [ 93 ].…”

Diagnostic approach to faecal incontinence: What test and when to perform?

“…According to American College of Gastroenterology guidelines, in cases of FI, it is worth testing with AM[ 17 ]. HRAM is an important diagnostic tool for the assessment of anorectal motor and sensory function[ 18 ]. The utilization of HRAM is a necessary diagnostic key tool in the evaluation of FI, as it enhances the understanding of the underlying pathophysiological bases of FI, permitting the delivering of optimal therapy for each specific patient.…”

“…The utilization of HRAM is a necessary diagnostic key tool in the evaluation of FI, as it enhances the understanding of the underlying pathophysiological bases of FI, permitting the delivering of optimal therapy for each specific patient. HRAM, which provides a dynamic recording of the anal sphincters and intraluminal rectal pressures, is considered to be the best-established diagnostic tool that permits an objective evaluation of several factors of anal and rectal function including basal tone and contractility, recto-anal coordination, and reflex function (such as recto-anal inhibitory reflux) as well as rectal sensation thresholds[ 18 , 19 ], which is an important predictor of response to biofeedback training[ 19 ]. The recently established international anorectal physiology working group published a consensus guideline paper that proposes a practical standardized protocol for the performance and analysis of anorectal manometry, named the London Classification[ 20 ].…”