Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé
{"title":"Study of the Corticoanorectal Neurophysiology in Women With Fecal Incontinence.","authors":"Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé","doi":"10.14309/ajg.0000000000003295","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Fecal incontinence (FI) is a prevalent condition that disproportionately affects women. Although sphincter biomechanics are well studied, the integrity of the corticoanal motor pathway remains elusive. We evaluated the corticospinoanorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.</p><p><strong>Methods: </strong>Observational study with 18 women with FI (mean age: 63.4 ± 11.1), 15 AM-HV (60.7 ± 9.01), and 15 Y-HV (24.2 ± 5.39) conducted in a tertiary hospital. Patients underwent clinical evaluation, high-resolution anorectal manometry, endoanal ultrasound, and transcranial/translumbosacral magnetic stimulation to assess anorectal motor-evoked potentials (MEP). Clinical severity was measured with St. Mark score and quality of life with Fecal Incontinence Quality of Life and EQ5D.</p><p><strong>Results: </strong>Patients had longer MEP latencies than AM-HV in the cortico-anal (25.93 ± 3.67 ms vs 22.89 ± 1.38 ms) and right lumbo-rectal segments (5.64 ± 1.35 ms vs 4.39 ± 1.27 ms; P < 0.05), but not in the tibial segment (control) (33.35 ± 2.88 ms vs 32.08 ± 2.05 ms; P > 0.05). However, tibial latencies were longer in AM-HV compared with Y-HV (32.08 ± 2.05 ms vs 29.21 ± 2.75 ms; P = 0.003). In FI, 41.1% had corticoanorectal impairments, 50% lumboanal, and 44.4% sacral. Overall, 82.4% showed delayed latencies in at least one of the 12 segments. High-resolution anorectal manometry revealed 83.24% had external anal sphincter dysfunction, 40% internal sphincter dysfunction, and 23.57% both. MEP latencies inversely correlated with external anal sphincter squeeze strength. FI patients had significantly poorer EQ5D scores compared with both control groups.</p><p><strong>Discussion: </strong>Women with FI show significant neuropathy in the corticospinoanorectal pathway linked to impaired anorectal function. These findings underscore the brain-gut axis's role in FI pathophysiology, advocating for advanced neurophysiological diagnostics and targeted interventions.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14309/ajg.0000000000003295","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Fecal incontinence (FI) is a prevalent condition that disproportionately affects women. Although sphincter biomechanics are well studied, the integrity of the corticoanal motor pathway remains elusive. We evaluated the corticospinoanorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.
Methods: Observational study with 18 women with FI (mean age: 63.4 ± 11.1), 15 AM-HV (60.7 ± 9.01), and 15 Y-HV (24.2 ± 5.39) conducted in a tertiary hospital. Patients underwent clinical evaluation, high-resolution anorectal manometry, endoanal ultrasound, and transcranial/translumbosacral magnetic stimulation to assess anorectal motor-evoked potentials (MEP). Clinical severity was measured with St. Mark score and quality of life with Fecal Incontinence Quality of Life and EQ5D.
Results: Patients had longer MEP latencies than AM-HV in the cortico-anal (25.93 ± 3.67 ms vs 22.89 ± 1.38 ms) and right lumbo-rectal segments (5.64 ± 1.35 ms vs 4.39 ± 1.27 ms; P < 0.05), but not in the tibial segment (control) (33.35 ± 2.88 ms vs 32.08 ± 2.05 ms; P > 0.05). However, tibial latencies were longer in AM-HV compared with Y-HV (32.08 ± 2.05 ms vs 29.21 ± 2.75 ms; P = 0.003). In FI, 41.1% had corticoanorectal impairments, 50% lumboanal, and 44.4% sacral. Overall, 82.4% showed delayed latencies in at least one of the 12 segments. High-resolution anorectal manometry revealed 83.24% had external anal sphincter dysfunction, 40% internal sphincter dysfunction, and 23.57% both. MEP latencies inversely correlated with external anal sphincter squeeze strength. FI patients had significantly poorer EQ5D scores compared with both control groups.
Discussion: Women with FI show significant neuropathy in the corticospinoanorectal pathway linked to impaired anorectal function. These findings underscore the brain-gut axis's role in FI pathophysiology, advocating for advanced neurophysiological diagnostics and targeted interventions.
背景:大便失禁(FI)是一种普遍的条件,不成比例地影响妇女。尽管括约肌生物力学已经得到了很好的研究,但皮质-肛门运动通路的完整性仍然难以捉摸。我们评估了FI女性与年龄匹配(AM-HV)和年轻健康(Y-HV)志愿者的皮质-脊髓-肛肠通路。方法:对某三级医院18例女性FI患者(平均年龄:63.4±11.1),15例AM-HV患者(60.7±9.01),15例Y-HV患者(24.2±5.39)进行观察性研究。参与者通过临床评估、高分辨率肛管直肠测压(HRAM)、肛管内超声和经颅/经腰骶磁刺激来评估肛管直肠运动诱发电位(MEP)。临床严重程度采用St. Mark评分,生活质量采用FIQL和EQ5D。结果:患者在皮质-肛门段(25.93±3.67 ms vs 22.89±1.38 ms)和右腰直肠段(5.64±1.35 ms vs4.39±1.27 ms)的MEP潜伏期长于AM-HV;p0.05)。然而,与Y-HV相比,AM-HV患者的胫骨潜伏期更长(32.08±2.05 ms vs 29.21±2.75 ms;p = 0.003)。在FI中,41.1%有皮质肛肠损伤,50%有腰肛门损伤,44.4%有骶骨损伤。总体而言,82.4%的人在12个片段中至少有一个显示延迟。HRAM显示83.24%存在外肛门括约肌功能障碍,40%存在内括约肌功能障碍,23.57%存在外肛门括约肌功能障碍。MEP潜伏期与EAS挤压强度呈负相关。与对照组相比,FI患者的EQ5D评分明显较低。结论:患有FI的女性在与肛肠功能受损相关的皮质-脊髓-肛肠通路中表现出明显的神经病变。这些发现强调了脑肠轴在FI病理生理中的作用,提倡先进的神经生理学诊断和有针对性的干预。
期刊介绍:
Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.