Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis

Abstract

We studied 14 unselected patients with progressive systemic sclerosis (PSS), six with constipation, and eight with normal bowel habits. A control group, matched for age and sex, comprised six patients with idiopathic constipation and seven healthy subjects. Anorectal manometry was performed with perfused catheters and segmental colonic transit was measured by a radiopaque marker technique. The resting pressure of the anal canal was significantly reduced in PSS with constipation (P < 0.05). The rectoanal inhibitory reflex was detected in only one PSS patient with constipation, but was present in seven of eight PSS patients with normal bowel habits and in all controls (P < 0.01). Total and right colonic transit times were significantly delayed in PSS with constipation and in patients with idiopathic constipation (P < 0.05). In patients with PSS, colonic transit was delayed and anal sphincter function was impaired in constipated patients, suggesting involvement of both the colon and the anorectum by the disease.

Gastrointestinal motility disorders in scleroderma

“…In the later phases of SSc, decreases in resting pressures of the internal and external anal sphincters, decreased length of the anal canal, decreased maximum squeeze pressure, and finally, decreased rectal compliance due to collagen deposition occur (4, 106,107,110,111). The only changes that correlate with symptoms are decreased squeeze pressures (106) and decreased rectal compliance (107), which correlate with diarrhea.…”

“…The only changes that correlate with symptoms are decreased squeeze pressures (106) and decreased rectal compliance (107), which correlate with diarrhea. Presence of a rectal prolapse further decreases anal sphincter pressures and can contribute to incontinence (1 10,111).…”

Anorectal Physiologic Evaluation of Constipation

“…This is abnormal in patients with Hirschsprung's disease, scleroderma, or Chagas' disease. 16,17 Rectal sensation is measured by filling the balloon in the rectum with increasing amounts of water or air and recording the volume at which the patient first feels the balloon and at the point of maximal tolerated volume. Poor rectal sensation is seen in patients whose volume at first sensation and maximal tolerated volumes are high.…”

Investigation of anal function in patients with systemic sclerosis.

“…8 Resting pressures in the anal canal were reported to be significantly less than in controls only in the subgroup with constipation, though results suggested that there was a trend towards abnormality in the asymptomatic SSc group.…”