A high‐resolution anorectal manometry parameter based on integrated pressurized volume: A study based on 204 male patients with constipation and 26 controls

Seo, Myung-Ji; Joo, Segyeong; Jung, Kee Wook; Lee, Jeonghyun; Lee, H. J.; Soh, Jae Seung; Yoon, In Ja; Koo, Hyun; Seo, So Young; Kim, D.; Hwang, Sung Wook; Park, S. H.; Yang, Dong Hoon; Ye, B. D.; Byeon, Jung Sik; Jung, Hwoon‐Yong; Yang, Suk Kyun; Rao, Satish S.C.; Myung, Seung Jae

doi:10.1111/nmo.13376

Cited by 21 publications

(23 citation statements)

References 41 publications

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“…In studies of constipated patients, a Korean group has extrapolated analysis concepts routinely utilized in HR oesophageal manometry recordings to derive a 'three-dimensional integrated pressurised volume'(IPV) calculation (akin to the distal contractile integral [DCI]) [39], which describes the coordination of anorectal activity during simulated defecation [40]. IPV pressure ratio between the upper 1 cm and lower 4 cm of the anal canal during push was found to be significantly more effective in predicting the results of the balloon expulsion test in 204 constipated male patients than conventional measures (RAPG) (receiver operator curve area under curve, 0.74, 95% CI: 0.67 to 0.80; vs. 0.60, 95% CI: 0.52-0.67) [41]. However, others from Europe have found no difference in IPV ratio between asymptomatic and constipated subjects [42].…”

Section: Future Considerationsmentioning

confidence: 94%

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

Scott

Carrington

2020

Curr Gastroenterol Rep

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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.

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Section: Future Considerationsmentioning

confidence: 94%

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

Scott

Carrington

2020

Curr Gastroenterol Rep

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“…The defecation index is simple and easy to calculate and is very effective in assessing disorders that are related to rectoanal coordination. This index is often referred to in studies involving certain anorectal diseases [21,22]. If we consider a defecation index < 1.3 as indicative of an anorectal disorder, approximately 50% of participants in our study displayed such a condition.…”

Section: Discussionmentioning

confidence: 81%

Normal values and associated factors in high-resolution anorectal manometry in healthy Vietnamese adults

Anh

Tung

Khoa

et al. 2020

Preprint

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Background This study aims to identify normal HRAM values and related factors in healthy Vietnamese adults. Methods This cross-sectional study was conducted at Viet Duc hospital, Hanoi, Vietnam, during April and May, 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values including pressure and an electromyographical signal from the digestive tract were recorded. Differences between groups were analyzed using paired t-tests, and linear regression models was used to compare anorectal values between men and women. Results A total of the 76 healthy volunteers was recruited. The mean functional anal canal length was 4.2 ± 0.5 cm while the mean anal high-pressure zone (HPZ) length was 3.4 ± 0.5 cm. The mean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit RAIR was 18.1 mL. Mean rectal sensation values were 32.4 mL, 81.6 mL, and 159 mL at the first sensation, the desire to defecate, and the urge to defecate, respectively. Dyssynergic patterns occurred in approximately 50% of study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between males and females in maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p < 0.01). Conclusions This study establishes normal HRAM values in healthy Vietnamese adults, particularly with regards to normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted in order to further confirm the constants and their relationships.

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“…También se han descrito nuevos parámetros específicos de MAR-AR que podrían diferenciar mejor entre los pacientes con defecación disinérgica y los sujetos sanos, como el volumen de presión integrada (VPI), medido en el canal anal y del recto para calcular la relación VPI, un parámetro utilizado en la manometría esofágica de alta resolución, y su correlación con la prueba de expulsión del balón 42 . Esta medida puede predecir mejor el retraso en la prueba de expulsión del balón con respecto a los parámetros convencionales 43 . Ratuapli, et al 44 mediante un análisis de componentes principales de la presión generada durante la MAR-AR, idearon una clasificación de la disinergia en cuatro fenotipos diferentes, la cual es difícil de aplicar en la práctica clínica.…”

Section: Aspectos Clínicos Y Utilidad De La Mar-arunclassified

Manometría anorrectal: ¿alta resolución o alta definición? Pros y contras

Troche¹

2019

NGL

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Aspectos técnicos La manometría anorrectal (MAR) es una técnica que permite, mediante el registro simultáneo a diferentes niveles de los cambios de ABSTRACT Anorectal disorders can affect up to 15% of the population and are a consequence of neuromuscular alterations of the pelvic floor. The neurophysiological tests that evaluate the motor and sensory function of the anorectum provide very important information regarding the physiopathological mechanisms involved in anorectal disorders. Anorectal manometry (ARM) is considered the ideal test to evaluate the motor and sensory function of the anorectum. High resolution ARM (HR-ARM) and high definition (HD-ARM) are technologies that represent an evolution in the study of the physiology and anatomy of the structures involved in continence and evacuation. The objective of this review is to evaluate and compare HR-ARM, HD-ARM and conventional ARM in terms of its technological development, analysis and interpretation of these tests, as well as its usefulness in clinical practice. According to our review, HR-ARM and HD-ARM have greater recording capacity, are less variable, more reproducible, but also more expensive compared to conventional ARM. HD-ARM has the advantage of providing a reconstruction in 3 planes that could be compared with the endoanal ultrasound. It is important to mention that new parameters are being developed that will allow a better understanding of anorectal function, which probably leads to a reclassification of anorectal disorders. Up to now, HR-ARM and HD-ARM do not seem to have made a major diagnostic advance in routine clinical practice with respect to conventional ARM. This is an important issue to highlight since, in many parts of the world, the latter technology is the only one available and it is very useful.

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A high‐resolution anorectal manometry parameter based on integrated pressurized volume: A study based on 204 male patients with constipation and 26 controls

Cited by 21 publications

References 41 publications

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

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

Normal values and associated factors in high-resolution anorectal manometry in healthy Vietnamese adults

Manometría anorrectal: ¿alta resolución o alta definición? Pros y contras

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