Adolescent ; Anal Canal ; physiopathology ; Child ; Constipation ; physiopathology ; Female ; Gastrointestinal Motility ; physiology ; Humans ; Male ; Rectum ; physiopathology

Adult ; Anus/*physiopathology ; Constipation/etiology ; Esophagus/physiopathology ; Female ; Human ; Manometry ; Middle Age ; Rectum/*physiopathology ; Scleroderma, Systemic/*physiopathology

OBJECTIVEHirschsprung's disease (HD), one of the most common causes resulting in lower intestinal obstruction in children, is prone to be misdiagnosed or to be missed from diagnosis because of its atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by increased comprehension of anorectal kinetics and improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry (ARMM) has been regarded as a routine means for functional assessment and diagnosis for anorectal disease. Nevertheless, the accuracy rate of diagnosis of HD in neonate by ARMM remains to be elucidated. In this study the clinical evaluation of anorectal manometry as an early diagnostic method for neonates with Hirschsprung's disease was appraised.

METHODSForty-two HD patients defined by pathological study of rectal tissue obtained via rectal mucous membrane biopsy or operation were recruited in this study. ARMM was performed in liquid transmission using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR, CTD-synectics, Sweden), with 4-lumen catheter with which a small 5-cm-long balloon was connected at the terminus. All children were positioned on their left side or back during the procedure and the pressure transducers were placed in the mid-axillary line level. The results of ARMM performed before operation or biopsy were compared with the results of barium enema X-ray testing. The decrease of internal anal sphincter pressure as rectoanal inhibitory reflex (RAIR) was measured based on the fluctuation curve of pressure detected. HD was defined when no decrease of anal catheter pressure was detected after insufflation (RAIR positive), and suspected HD state was assessed with the presentation of incomplete relaxation or positive/negative results coexisted (RAIR abnormal) in canal.

RESULTSThirty patients (71.43%) were diagnosed as HD by ARMM including 18 patients who showed negative response to RAIR and 12 patients whose response was abnormal. While barium enema examinations were carried out in all the 45 patients, the results showed 5 HD patients and 14 suspected HD patients, giving an overall diagnostic accuracy of 45.24%. There were also 16 patients with positive ARMM response and negative barium enema findings together, and 5 patients with negative ARMM results and positive barium enema findings at the same time. There was a significant difference between the two diagnostic methods (chi(m)(2) = 4.76, P < 0.05).

CONCLUSIONAnorectal manometry seems to be a more reliable method for diagnosis of Hirschsprung's disease in neonate than barium enema X-ray. Because ARMM is a simple, safe and non-invasive method, it can be used as a screening test of choice in neonates with clinically suspected HD. But for final diagnosis, it is reasonable to combine ARMM with other diagnostic methods in HD patients.

Anal Canal ; physiopathology ; Barium Sulfate ; Enema ; Hirschsprung Disease ; diagnosis ; Humans ; Infant, Newborn ; Manometry ; Rectum ; pathology ; physiopathology

OBJECTIVETo study the value of measuring electrical discharge of external oblique in assessment of young rat model of visceral hypersensitivity.

METHODSEight-day-old neonatal Sprague-Dawley rats were randomly assigned to two groups: an experimental group and a control group (n=16 each). Rats in the experimental group were subjected to mechanical colorectal irritation daily for 7 consecutive days, while the rats in the control group did not received colorectal irritation treatment. On the 6th week of their lives, the spike amplitude of external oblique were measured to evaluate the bowel sensitivity.

RESULTSWhen the colorectal distention (CRD) pressure was 30 and 45 mmHg, the 95% confidence interval of the spike amplitude in the experimental group was significantly higher than that in the control group (P<0.01). When the CRD pressure were 60 and 75 mmHg, the 95% confidence interval of the spike amplitude in female rats was significantly higher than that in males (P<0.05).

CONCLUSIONSThe electrical discharge of external oblique confirmed that chronic colorectal irritation in neonatal rats can result in a chronic visceral hypersensitivity in the juvenile stage, with gender differences. Electrophysiological assessment is a quantitative test, and can objectively reflect visceral sensibility of pain.

Animals ; Colon ; physiopathology ; Disease Models, Animal ; Female ; Irritable Bowel Syndrome ; physiopathology ; Male ; Rats ; Rats, Sprague-Dawley ; Rectum ; physiopathology ; Reflex ; physiology

OBJECTIVETo investigate the anorectal status in patients with lumbosacral spinal cord injury (SCI).

METHODSTwenty six patients (23 males, 3 females) with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years (ranging 17-68 years) and the median time of patients since injury was 59.1 months (ranging 8 months-15 years). They were diagnosed as complete lumbosacral SCI (n =2, American Spinal Injury Association (ASIA) score A), or incomplete lumbosacral SCI (n=24, ASIA score B-D) with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study.

RESULTSThe maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group (One-way ANOVA: P=0.939). During defecatory maneuvers, 23 of 26 (88.5%) patients with lumbosacral SCI and 1 of 13 (7.7%) in the control group showed pelvic floor dysfunction (PFD) (Fisher's exact test: P<0.0001). Rectoanal inhibitory reflex (RAIR) was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group (Independent-Samples t test: P<0.0001). The mean rectal volume to generate the first sensation was 92.7 ml+/-57.1 ml in SCI patients, 41.5 ml+/-13.4 ml in the control group (Independent-Samples t test: P<0.0001).

CONCLUSIONSMost of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectal manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system (CNS).

Adolescent ; Anal Canal ; physiopathology ; Constipation ; etiology ; physiopathology ; Fecal Incontinence ; etiology ; physiopathology ; Female ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Rectum ; physiopathology ; Sacrum ; injuries ; Sensation ; Spinal Cord Injuries ; complications ; physiopathology

OBJECTIVETo compare the effects of electroacupuncture (EA) and mild-warm moxibustion (Mox) therapies for constipation-predominant irritable bowel syndrome (C-IBS) patients.

METHODSSixty C-IBS patients were assigned to 2 groups by simple randomized method, i.e. EA group (30 cases) and Mox group (30 cases). Both EA and Mox treatments were performed on bilateral Tianshu (ST 25) and Shangjuxu (ST 37) for 30 min each time, 6 times per week, for 4 consecutive weeks. The gastrointestinal symptoms and psychological symptoms of the two groups were scored before and after treatment. The effects on the corresponding functional brain areas, namely the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging (fMRI) before and after treatment.

RESULTSCompared with the Mox group, greater improvements in abdominal distension, defecation frequency, diffificulty in defecation and stool features were observed in the EA group (all P<0.01), both Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores were signifificantly decreased in the EA group (all P<0.01). Finally, decreased activated voxel values were observed in the ACC, right IC and PFC brain regions of EA group with 150 mL colorectal distension stimulation (P<0.05 or P<0.01).

CONCLUSIONSBoth EA and Mox could signifificantly improve some of the most intrusive symptoms of C-IBS patients, and EA was more effective than Mox. The therapeutic effect of these two therapies might through modulating of the brain-gut axis function. (Registration No. ChiCTRTRC-11001349).

Adult ; Brain ; physiopathology ; Constipation ; physiopathology ; therapy ; Electroacupuncture ; adverse effects ; Humans ; Irritable Bowel Syndrome ; physiopathology ; therapy ; Magnetic Resonance Imaging ; Moxibustion ; adverse effects ; Pain Measurement ; Rectum ; physiopathology ; Sensory Thresholds ; physiology

OBJECTIVESTo assess the tendency of manometric asymmetry, and to quantitatively evaluate the function of the anal sphincter.

METHODSUsing the PC polygram HR at the states of relax and squeeze, we compared the values of pressure asymmetry in the anorectum of 27 normal children with that of 12 children with fecal incontinence.

RESULTSIn the two states, the anal sphincter in normal children showed not only the gradient of pressure, but also a gradient of pressure asymmetry. Children with fecal incontinence did not show any gradients.

CONCLUSIONGradients of pressure and pressure asymmetry can quantitatively evaluate the function of the anal sphincter.

Adolescent ; Anal Canal ; physiology ; Child ; Child, Preschool ; Fecal Incontinence ; physiopathology ; Female ; Humans ; Male ; Manometry ; Rectum ; physiology

Constipation ; diagnosis ; therapy ; Humans ; Medicine, Chinese Traditional ; Rectum ; physiopathology ; Syndrome ; Touch

OBJECTIVETo study postoperative anorectal dynamic change in ultra-low rectal cancer patients undergoing laparoscopic intersphincteric resection.

METHODSClinical and follow-up data of 26 ultra-low rectal cancer patients undergoing laparoscopic intersphincteric resection in our department from January 2007 to January 2013 were retrospectively analyzed (observation group). Thirty rectal cancer patients undergoing laparoscopic low anterior resection by the same surgical team in the same period from the Medical Record Room were randomly extracted as control group. The observation indexes included preoperative and postoperative anal resting pressure(ARP), anal maximum squeeze pressure (AMSP), rectal maximum tolerable volume (RMTV), rectal anal inhibition reflex (RAIR) and Wexner anal function scores (0 means normal).

RESULTSThere were no significant differences in clinical baseline data between the two groups(all P>0.05), except the distance from lower edge of tumor to dentate line [(2.9±0.4) cm in observation group vs. (5.0±0.5) cm in control group, P=0.000]. There were no differences in preoperative anorectal manometry and Wexner anal function score between two groups (all P>0.05). The average follow-up time in observation group and control group was 14.5 months and 14.0 months respectively. Three months after operation, significant differences between observation group and control group (all P=0.000) were as follows: defecation frequency [(6.0±1.5) times/day vs. (2.5±1.0) times/day], Wexner anal function score(5.0±0.9 vs. 2.9±1.2), ARP [(32.0±6.7) mmHg vs. (45.0±8.2) mmHg], AMSP [(90.1±6.9) mmHg vs. (110.0±7.5) mmHg], RMTV [(61.0±7.2) ml vs. (91.1±7.5) ml] and positive rate of RAIR [11.5%(3/26) vs. 66.7%(20/30)]. One year after surgery, there were no significant differences in defecation frequency, Wexner anal function scores, ARP, AMSP and RMTV between the two groups (all P>0.05), however the difference in positive rate of RAIR was still significant[38.5%(10/26) vs. 93.3%(28/30), P=0.000].

CONCLUSIONLaparoscopic intersphincteric resection for ultra- low rectal cancer can achieve satisfactory anorectal dynamic effect.

Aged ; Anal Canal ; physiopathology ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Postoperative Period ; Pressure ; Rectal Neoplasms ; surgery ; Rectum ; physiopathology ; Retrospective Studies

OBJECTIVETo evaluate the treatment outcomes of sacral nerve stimulation(SNS) for functional anorectal pain(FAP).

METHODSA total of 32 patients of FAP received SNS treatment through S3 from March 2011 to December 2011. Visual analogue scale(VAS), anal pressure measure, and health survey(SF-36) before and after treatment were used to evaluate the outcomes.

RESULTSAfter treatment, VAS score was significantly decreased, rectal anal reflex threshold volume elevated, and anal maximum contraction pressure (AMCP) and anal rest pressure significantly decreased compared with those before treatment(all P<0.01). Except for general health, the remaining dimension score of the SF-36 increased significantly after treatment, and the differences were statistically significant(P<0.05 or P<0.01). After SNS treatment, 19 cases were cured, 12 improved, 1 was refractory. The total effective rate was 96.9% during 3 months after treatment.

CONCLUSIONSNS is a safe and effective alternative for FAP and can alleviate the pain symptom and improve the quality of life.

Fecal Incontinence ; Humans ; Lumbosacral Plexus ; Pain ; Pain Management ; Quality of Life ; Rectum ; physiopathology ; Spinal Cord ; physiopathology ; Treatment Outcome