Introduction: Investigation of evacuation disorders is often pursued in patients with symptoms of obstructive defecation. High-resolution anorectal manometry (HR-ARM) is a simple, safe and widely available test to diagnose pelvic floor dysfunction. A more costly and less accessible test is magnetic resonance defecography (MRD). This study aims to qualify the added value of MRD in diagnosing pelvic floor disorders. Methods: HR-ARM and MRD performed in patients with a diagnosis of constipation between 1/1/2020 and 5/15/22 at Mayo Clinic were identified using Epic SlicerDicer. Univariate and multivariate analyses were used to compare findings on MRD in patients with and without abnormal HR-ARM. Results: Seventy-six consecutive patients (81.8% female, 94.8% white, age 19-82) who underwent both HR-ARM and MRD were included. The majority had evidence of dyssynergia on HR-ARM (n549, 64.5%). Patients with dyssynergia on HR-ARM were significantly more likely to have prolonged balloon expulsion at both .60 and .30 seconds (p, 0.00001) and incomplete gel expulsion on MRD (p50.00008) (Table ). However, they were not more likely to have a clinically significant rectocele measuring .2cm (p50.5093) or evidence of rectal prolapse (p50.071). An increased number of vaginal deliveries was correlated with a higher likelihood of having a rectocele .2cm (r50.24, p, 0.05). Conclusion: Anatomic findings on MRD were similar between patients with and without evidence of dyssynergia identified by HR-ARM. In this retrospective review, undergoing MRD in addition to HR-ARM does not appear to provide additional diagnostic information to guide therapeutic recommendations. Large prospective studies to evaluate the added value of MRD are needed.
We report a case of severe refractory esophageal strictures in the setting of rheumatological disease found to be secondary to isolated esophageal autoimmune bullous disease. She had a history of Sjogren syndrome and esophageal strictures with many previous dilations. After rheumatological workup, she was diagnosed with mixed connective tissue disease. Biopsy showed complement and immunoglobulin G deposition in the basement membrane consistent with bullous lupus or bullous pemphigoid. She had no cutaneous bullae and was diagnosed with isolated esophageal bullous disease. She required multiple dilatations over several months of treatment and was started on mycophenolate mofetil with clinical improvement.
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