Provocative tests of anal sphincter function correlate with symptoms and subtypes of faecal incontinence.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Alexander O'Connor, Donghua Liao, Matthew Davenport, Abhiram Sharma, Dipesh H Vasant, Niels Klarskov, Asbjørn Mohr Drewes, Edward Kiff, John McLaughlin, Karen Telford
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引用次数: 0

Abstract

Objectives: High-resolution anorectal manometry (HRAM) is the established investigation in faecal incontinence (FI). However, provocative tests (functional lumen imaging probe (FLIP) and anal acoustic reflectometry (AAR)) have been proposed as alternatives. This study uniquely explores all three methods in correlation with FI symptoms and subtypes.

Methods: This was a prospective observational study of patients with FI attending a tertiary pelvic floor unit between August 2022 and January 2024. Patients underwent HRAM, FLIP and AAR with the order randomised. FI severity was assessed with the Vaizey score and quality-of-life with the Manchester Health Questionnaire.

Results: 40 patients (39 women, median age: 62 (range: 38-85)) were recruited with 27 (67.5%) reporting urge FI, 8 (20%) mixed and 5 (12.5%) passive incontinence. FLIP squeeze measurements correlated with the Vaizey score, including incremental squeeze pressure at 40 mL (rs=-0.412; p=0.008) and 50 mL (rs=-0.414; p=0.009) and the pressure-diameter volume loop at 50 mL (rs=-0.402; p=0.011). Incremental squeeze opening pressure with AAR correlated with the Vaizey score (rs=-0.339; p=0.032). There was no correlation between symptom severity and HRAM parameters, or any parameter and quality-of-life scores. Resting parameters with all three modalities were lower in passive FI: mean resting pressure (HRAM; p=0.010), yield pressure (FLIP; p=0.031) and opening pressure (AAR; p=0.006). With FLIP, there was a trend towards reduced squeeze function in the urge group (pressure-diameter volume loop at 50 mL; p=0.295).

Conclusions: FLIP and AAR correlate better with FI symptoms compared with HRAM. Therefore, these provocative tests could be used to guide the management of FI in prospective studies.

肛门括约肌功能的刺激性试验与大便失禁的症状和亚型相关。
目的:高分辨率肛管直肠测压(HRAM)是一种确定的调查大便失禁(FI)的方法。然而,挑衅性测试(功能性管腔成像探针(FLIP)和肛门声反射仪(AAR))已被提议作为替代方案。本研究独特地探讨了这三种方法与FI症状和亚型的关系。方法:这是一项前瞻性观察研究,研究对象是2022年8月至2024年1月期间在第三盆底单位就诊的FI患者。患者接受HRAM、FLIP和AAR随机排序。FI严重程度用Vaizey评分评估,生活质量用曼彻斯特健康问卷评估。结果:40例患者(39名女性,中位年龄:62岁(范围:38-85))被招募,其中27例(67.5%)报告急迫性失禁,8例(20%)报告混合性失禁,5例(12.5%)报告被动失禁。FLIP挤压测量与Vaizey评分相关,包括40 mL时的增量挤压压力(rs=-0.412;p=0.008)和50 mL (rs=-0.414;p=0.009), 50 mL时压力-直径体积回路(rs=-0.402;p = 0.011)。随AAR增加的挤压开启压力与Vaizey评分相关(rs=-0.339;p = 0.032)。症状严重程度与HRAM参数或任何参数与生活质量评分之间没有相关性。三种模式的静息参数均较低:平均静息压(HRAM;p=0.010),屈服压力(FLIP;p=0.031)和开启压力(AAR;p = 0.006)。在FLIP中,冲动组的挤压功能有降低的趋势(压力-直径体积回路在50 mL;p = 0.295)。结论:与HRAM相比,FLIP和AAR与FI症状的相关性更好。因此,这些具有挑衅性的试验可用于指导前瞻性研究中FI的管理。
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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