A Novel Technique to Identify Patients with Megarectum

Gladman, Marc A.; Dvorkin, Lee; Scott, S. M.; Lunniss, Peter J.; Williams, Norman S.

doi:10.1007/s10350-006-0805-x

Cited by 21 publications

(26 citation statements)

References 30 publications

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“…The degree of dilatation is, however, related to the technique of the procedures carried out, and no established criteria for rectal dilatation are available in paediatrics. With contrast studies, an underestimation of the rectal diameter may occur due to incomplete rectal distension 30. Since radiographic studies do not control for the distensible properties of the rectum, rectal barostat is more valuable in measuring rectal volume.…”

Section: Discussionmentioning

confidence: 99%

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

Berg

Voskuijl

Boeckxstaens

et al. 2007

Gut

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Section: Discussionmentioning

confidence: 99%

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

Berg

Voskuijl

Boeckxstaens

et al. 2007

Gut

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“…Rectal compliance is most commonly used as a measure of biomechanical properties in clinical practice, and may be determined by constructing pressure–volume curves during phasic isobaric distension, using the barostat 18,19 . By contrast, the assessment of rectal structure (diameter) is more controversial due to inherent methodological limitations of traditional techniques 20 . However, a recently described technique, also utilizing the barostat, has enabled patients with megarectum to be more accurately identified during fluoroscopic screening by measuring rectal diameter at minimum distending pressure 20 .…”

Section: Introductionmentioning

confidence: 99%

“…Assessment of rectal diameter Evaluation of rectal diameter was performed as previously described 20 . Continuous stepwise isobaric distension was performed using a barostat with 1 mmHg increments of pressure every 60 s until the minimum distending pressure (MDP) was reached.…”

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confidence: 99%

“…An image was captured during fluoroscopic screening (Siemens, Berkshire, UK), and stored and analysed using magicview 300 image tool software (Siemens), calibrated to the known dimensions of the rectal catheter. Subsequently, rectal diameter was recorded by measuring the widest transverse diameter at 90° to the rectal lumen 17,27 between the anorectal junction and the pelvic brim 20 …”

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confidence: 99%

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Rectal hyposensitivity: pathophysiological mechanisms

Gladman¹,

Aziz²,

Scott³

et al. 2009

Neurogastroenterology Motil

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Rectal hyposensitivity (RH) relates to a diminished perception of rectal distension. It may occur due to afferent nerve dysfunction and/or secondary to abnormal structural or biomechanical properties of the rectum. The aim of this study was to determine the contribution of these underlying pathophysiological mechanisms by systematically evaluating rectal diameter, compliance and afferent nerve sensitivity in patients with RH, using methodology employed in clinical practice. The study population comprised 45 (33 women; median age 48, range 25-72 years) constipated patients (Rome II criteria) with RH and 20 with normal rectal sensitivity on balloon distension and 20 healthy volunteers. Rectal diameter was measured at minimum distending pressure during isobaric distension under fluoroscopic screening. Rectal compliance was assessed during phasic isobaric distension by measuring the slope of the pressure-volume curve. Electrical stimulation of the rectal mucosa was employed to determine afferent nerve function. Values were compared to normal ranges established in healthy volunteers. The upper limits of normal for rectal diameter, compliance and electrosensitivity were 6.3 cm, 17.9 mL mmHg(-1) and 21.3 mA respectively. Among patients with RH, rectal diameter, but not compliance, was increased above the normal range (megarectum) in seven patients (16%), two of whom had elevated electrosensitivity thresholds. Rectal diameter and compliance were elevated in 23 patients (51%), nine of whom had elevated electrosensitivity thresholds. The remaining 15 patients (33%) with RH had normal rectal compliance and diameter, all of whom had elevated electrosensitivity thresholds. Two-third of the patients with RH on simple balloon distension have elevated rectal compliance and/or diameter, suggesting that impaired perception of rectal distension is due to inadequate stimulation of the rectal afferent pathway. However, a proportion of such patients also appear to have impaired nerve function. In the remaining one-third of the patients, rectal diameter and compliance are normal, while electrosensitivity thresholds are elevated, suggestive of true impaired afferent nerve function. Identification of these subgroups of patients with RH may have implications regarding their management.

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“…Although RH is generally diagnosed on the basis of elevation of sensory thresholds to rectal distension, recent studies involving complementary modalities (barostat, electrical and thermal stimulation, and fluoroscopic screening during distension studies13,21,51) have allowed subdivision of RH into "primary" RH (thought due to direct disruption/dysfunction of the afferent pathway); "secondary" RH (proposed to be due to altered rectal biomechanical properties, such as an enlarged [mega] rectum, or increased compliance/stretch of the rectal wall, thus requiring elevated distension volumes to induce the same sensory stimulus); or both. Primary RH is elevation of thresholds to all modalities of stimulation in the presence of normal rectal biomechanical properties.…”

Section: Pathophysiologymentioning

confidence: 99%

Rectal Hyposensitivity

Burgell¹,

Scott²

2012

J Neurogastroenterol Motil

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Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.

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A Novel Technique to Identify Patients with Megarectum

Cited by 21 publications

References 30 publications

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

Rectal hyposensitivity: pathophysiological mechanisms

Rectal Hyposensitivity

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