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Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry.
Gastroenterology. 2013 Feb; 144(2):314-322.e2.G

Abstract

BACKGROUND & AIMS

Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry.

METHODS

We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry.

RESULTS

Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal high-pressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times.

CONCLUSIONS

Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Video-Audio Media

Language

eng

PubMed ID

23142135

Citation

Ratuapli, Shiva K., et al. "Phenotypic Identification and Classification of Functional Defecatory Disorders Using High-resolution Anorectal Manometry." Gastroenterology, vol. 144, no. 2, 2013, pp. 314-322.e2.
Ratuapli SK, Bharucha AE, Noelting J, et al. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology. 2013;144(2):314-322.e2.
Ratuapli, S. K., Bharucha, A. E., Noelting, J., Harvey, D. M., & Zinsmeister, A. R. (2013). Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology, 144(2), 314-e2. https://doi.org/10.1053/j.gastro.2012.10.049
Ratuapli SK, et al. Phenotypic Identification and Classification of Functional Defecatory Disorders Using High-resolution Anorectal Manometry. Gastroenterology. 2013;144(2):314-322.e2. PubMed PMID: 23142135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. AU - Ratuapli,Shiva K, AU - Bharucha,Adil E, AU - Noelting,Jessica, AU - Harvey,Doris M, AU - Zinsmeister,Alan R, Y1 - 2012/11/07/ PY - 2012/05/16/received PY - 2012/10/23/revised PY - 2012/10/28/accepted PY - 2012/11/13/entrez PY - 2012/11/13/pubmed PY - 2013/8/16/medline SP - 314 EP - 322.e2 JF - Gastroenterology JO - Gastroenterology VL - 144 IS - 2 N2 - BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry. METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry. RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal high-pressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times. CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/23142135/Phenotypic_identification_and_classification_of_functional_defecatory_disorders_using_high_resolution_anorectal_manometry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(12)01608-3 DB - PRIME DP - Unbound Medicine ER -