Transrectal ultrasonography: relationship with anorectal manometry, electromyography and sensitivity tests in irritable bowel syndrome

Abstract

Irritable bowel syndrome is the most frequently diagnosed disorder in gastroenterology. It has been demonstrated with specialized motility studies that these patients compared to healthy subjects show changes in rectoanal electrical and mechanical activity and in rectoanal sensitivity. However, until now no report has been published on morphological alterations in the rectum or the internal anal sphincter. Twenty-five consecutive patients with irritable bowel syndrome (mean age 32, range 17-47 years; 24 females) were evaluated prospectively by transrectal ultrasonography, rectal sensitivity studies, and recordings of both electrical and mechanical activity of the distal rectum and internal anal sphincter during a 2-h inter-digestive period. Ten healthy volunteers (mean age 34.5, range 19-50 years) served as a control group. Paired and non-paired Student's two-tailed t test and linear regression analysis were used. It was shown that muscle thickness of the rectum during rest (4.7 +/- 0.1 mm) was correlated neither with its rectal spike amplitude (0.73 +/- 0.1 mV) nor with rectal spike frequency (17.06 +/- 3.6 spike/2 h). In addition, the diameter of the internal anal sphincter (1.2 +/- 0.1 mm) was correlated neither with its resting pressure, nor with frequency (17.1 +/- 3.2/2 h), duration (14.9 +/- 1.5 s), or amplitude (14.1 +/- 1.9 mmHg), of inhibition of the spontaneous rectoanal inhibitory reflex. No correlation was found between ultrasonographic parameters and rectal distension variables (r = 0.03). This study demonstrates for the first time morphological anorectal changes in patients with irritable bowel syndrome compared to healthy subjects, in addition to showing that morphological changes are independent of physiological ones. Therefore both transrectal ultrasonography to determine anorectal morphology and electromanometry to assess anorectal function are important measures in the evaluation of patients with irritable bowel syndrome.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

“…Regarding IBS, our patients mainly fell into the group of those with alternating bowel habits. Our experience in Latin America does not fully agree with the percentages reported abroad, as the IBS corresponding to the alternating group is noteworthy in our Hispanic population (Awad 1993, Awad et al 1995, 1998, 2000, Awad and Quilici 2005, Gerson et al 2008. Our data agree with a recent report from the United States where most of the patients with IBS reports alternating constipation and diarrhea (Hungin et al 2005).…”

“…From there, the patients are referred to our unit. In addition, previous publications have identified the population from which we gathered our patients as representative of the general Mexico population (Awad 1993, 2005, Awad et al 1995, 1998, 2000, Awad and Camacho 2002, Gerson et al 2008. Another limitation in this work could be that we do not use Rome III criteria.…”

“…The latter were scored using a 4-point scale from 0 (no symptom) through 1 (mild: hardly perceived symptoms, only a slight impairment of general well being) and 2 (moderate: clearly noticeable symptoms, but tolerable without immediate relief) to 3 (severe: overwhelming discomfort, urgent desire for immediate relief). We have already used a Spanish language version of this questionnaire in our Mexican population (Awad 1993, Awad et al 1998, Awad and Camacho 2002, Gerson et al 2008. After a meticulous evaluation by a gastroenterologist to exclude structural and biochemical abnormalities, patients were diagnosed with IBS according to Rome I criteria (Thompson et al 1989) if they reported a total of at least three months of abdominal pain or discomfort over the past 12 months with at least one of the following characteristics: the abdominal pain or discomfort was relieved with defecation and it was associated with a change in the frequency or consistency of stool.…”

Irritable Bowel Syndrome in Mexico

“…Of the original studies, 5 were excluded because they did not address standard diagnostic or physiological criteria [10][11][12][13][14][15]. Three publications were duplicated because they were published in abstract form as well as in full text, in this case the full text was cited [16][17][18]. Furthermore, one of these abstracts was published in a local as well as in an international journal [19].…”

“…Furthermore, one of these abstracts was published in a local as well as in an international journal [19]. Finally a total of 18 studies were included, 8 published in full text [16][17][18][20][21][22][23][24] and 10 in abstract form [25][26][27][28][29][30][31][32][33][34]. This information was supplemented by data from an epidemiological study conducted between 1999 and 2000 by the Mexican Gastroenterological Association that has not yet been published, but the results were presented at the national meeting of the same association [34].…”