Phenotypic Variation in Functional Disorders of Defecation

Bharucha, Adil E.; Fletcher, Joel G.; Seide, Barbara M.; Riederer, Stephen J.; Zinsmeister, Alan R.

doi:10.1053/j.gastro.2005.03.021

Cited by 128 publications

(159 citation statements)

References 35 publications

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“…Its measurements are reproducible among observers. 58,59 However, MR defecography is an expensive test and is not commonly available at hospitals. Endovaginal or endoanal sonography can be used to evaluate pelvic floor anatomy in patients with evacuation dysfunction.…”

Section: Statement: Anorectal Manometry Is Useful For Diagnosing Defementioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

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Section: Statement: Anorectal Manometry Is Useful For Diagnosing Defementioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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“…Before the MRI, with patient in lying lateral position, 120 ml gel of ultrasound into the rectum instilled [10]. In supine position, the anatomical abnormalities of pelvic floor were assessed by "coronal and axial fast spin-echo, T2-weighted" images.…”

Section: Mr Defecography Proceduresmentioning

confidence: 99%

“…In supine position, the anatomical abnormalities of pelvic floor were assessed by "coronal and axial fast spin-echo, T2-weighted" images. Then a "single-shot fast spin echo, T2-weighted" imaging technique in the sagittal plane at rest, and squeezing with maximal contraction of the puborectalis muscle and sphincter of anal, also at straining each 1.5-2 s was obtained [15].The maneuver accuracy could be monitored by "real-time" imaging [10]. The specifications of the images obtained, were; "field of view (FOV)=25 mm", "matrix size=256 × 256", "repetition time (TR)=896 ms", "echo time (TE)=83 ms", "rectangular FOV=84.4-100 cm (according to each patient's size)", "section thickness=6 mm", "inter-slice gap=20%", "bandwidth=416 kH", "flip angle=150".…”

Section: Mr Defecography Proceduresmentioning

confidence: 99%

“…It also reveals multiplanar information of impairments of the pelvic floor along with defecation imaging "real-time". Furthermore, "high temporal resolution", "Soft-tissue contrast" and absence of "radiation exposure" make this modality suitable in evaluating of the dysfunction of pelvic floor that can help to manage a more precise treating program [2,5,[8][9][10]. In patient with dyssynergic pattern, MR defecography can show "ARA" get closed and absence of the pelvic floor descending in defecation as illustrated in (Figure 2).…”

Section: Introductionmentioning

confidence: 99%

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Accurate Differentiation of Dyssynergic Defecation Patients from Normal Subjects Based on Abnormal Anorectal Angle in MR Defecography

Nikjooy¹,

Maroufi²,

Ebrahimi³

et al. 2016

J Yoga Phys Ther

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“…2 Even though it appears now quite clear that this is a heterogeneous entity, 3,4 traditionally obstructed defecation has been considered as due to rectoanal dysfunction, including failure to relax or paradoxical contraction of the pelvic floor while attempting to defecate, [5][6][7] lack of rectal motor activity, 8 and abnormal rectal sensitivity. [9][10][11] However, there is also evidence that pathophysiological abnormalities in obstructed defecation may be not be confined to the very distal colonic area.…”

mentioning

confidence: 99%

Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation

et al. 2007

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One of the most frequent subtypes of constipation is represented by obstructed defecation, and it has recently been reported that these patients may have colonic motor abnormalities in addition to alterations of the anorectal area. However, it is unknown whether these patients display abnormalities of the enteric nervous system, as reported in other groups of constipated subjects. For this reason, we evaluated the neuropathologic aspects of the enteric nervous system in a homogeneous group of patients with obstructed defecation. Colonic specimens from 11 patients (nine women, age range 39-66 years) undergoing surgery for symptoms refractory to any therapeutic measure, including biofeedback training, were obtained and examined by means of conventional histological methods and immunohistochemistry (NSE, S100, c-Kit, formamide-mAb, Bcl-2, CD34, alfa-actin). Analysis of the specimens showed that the enteric neurons were significantly decreased only in the submucosal plexus of patients (Po0.0001 vs controls), whereas the enteric glial cells of constipated patients were reduced in both the myenteric (P ¼ 0.018 vs controls) and the submucosal plexus (P ¼ 0.004 vs controls). No difference between patients and controls were found concerning c-Kit and CD34 expression, and the number of apoptotic neurons. These findings support the concept that at least a subgroup of patients with obstructed defecation and severe, intractable symptoms display abnormalities of the enteric nervous system, mostly related to the enteric glial cells. These findings might explain some of the pathophysiological abnormalities, and help to better understand this condition.

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Phenotypic Variation in Functional Disorders of Defecation

Cited by 128 publications

References 35 publications

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Accurate Differentiation of Dyssynergic Defecation Patients from Normal Subjects Based on Abnormal Anorectal Angle in MR Defecography

Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation

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