Manometric study in ulcerative colitis patients with modified ileal pouch--anal anastomosis

The usefulness of anorectal manometry in patients with a stoma before and after surgery to restore the continuity of the gastrointestinal tract

The operation to restore the continuity of the gastrointestinal tract is another surgical intervention in a given patient, which directly translates into an increased risk of complications during and after surgery. That is why proper qualification is important for the operation to restore the continuity of the gastrointestinal tract in terms of performance and efficiency of the anal sphincter apparatus, among other things. The aim of the study was to evaluate the effect of restoring physiological defecation routes on the sphincter function and to observe the parameters of anorectal manometry in patients before and after surgery to restore the continuity of the gastrointestinal tract.

MATERIAL AND METHODS

The study included 29 patients scheduled for restoration of the continuity of the gastrointestinal tract, 12 women and 17 men. The average age in the group was 62 years. Anorectal manometry was performed both before surgery as well as one month and three months afterwards in all patients. The average time to have a stoma was 12 months.

RESULTS

The resting pressure in the anal canal (MRP) three months after the restoration of the continuity of the gastrointestinal tract increased by 30.4%. The maximum systolic blood pressure in the anal canal (MSP) increased by 22.2%. The value of recto-anal inhibitory reflex (RAIR) decreased by 19.2%. The length of the high pressure zone in the anal canal (HPZL) increased by 27%. The study results of visceral rectal sensation thresholds decreased by 23.3% for the sensation threshold, and 14.4% for the pressure threshold.

CONCLUSIONS

Restoring the continuity of the gastrointestinal tract improves the anal sphincter function which is evident in the parameters of anorectal manometry. The restoration of passage improves the sphincter function, and these changes are statistically significant.

Motility Evaluation in the Patient with Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) suffer frequently from functional bowel diseases (FBD) and motility disorders. Management of FBD and motility disorders in IBD combined with continued treatment of a patient's IBD symptoms will likely lead to better clinical outcomes and improve the patient's quality of life. The goals of this review were to summarize the most recent literature on motility disturbances in patients with IBD and to give a brief overview of the ranges of motility disturbances, from reflux disease to anorectal disorders, and discuss their diagnosis and specific management.

Neurological function of the puborectalis muscle in patients with or without soiling after ileal J-pouch-anal anastomosis for ulcerative colitis in childhood

BACKGROUND

To clarify the puborectalis muscle (PM) function in pediatric patients with soiling after ileal J-pouch-anal anastomosis (IPAA) for ulcerative colitis, the author examined the neurological functions of the PM.

METHODS

Twelve patients 3 months after IPAA were studied (average age 13.6 years). Five patients showed soiling every day (group A1) and 7 patients showed soiling 2 to 3 days per week (Group A2). All patients 1.5 years after IPAA showed continence (group B). Twenty subjects served as a control (Group C; average age 13.5 years). Right, left and posterior sides of the sacral nerve terminal motor latency (SNTML) were measured by magnetic stimulation.

RESULTS

On the right, left and posterior sides, patients in group A1 exhibited significant prolongation of the SNTML compared with patients in groups A2, B and C (P<.05 each). Group A2 exhibited significant prolongation compared with groups B and C (P<.05 each). There were no significant differences of the SNTML between right and left sides, between right and posterior sides and between left and posterior sides in groups A1, A2, B and C.

CONCLUSIONS

The SNTML of the PM demonstrates significant latency in those children who have early post-IPAA soilage. The neurological function of the PM potentially injured during an operation may recover, and correlates with normalization of continence.

Manometric evaluation of evacuatory difficulty (dyschezia) in ileal pouch patients

BACKGROUND

Dyschezia occurs in patients with ileal pouch-anal anastomosis. There are limited data on the mechanisms of this condition. We hypothesized that paradoxical contractions may contribute to dyschezia in those patients with mechanical or inflammatory pouch conditions. This study was aimed to evaluate the underlying manometric abnormalities in this population.

METHODS

In this retrospective analysis, we screened our Pouchitis Registry for patients with dyschezia and underlying inflammatory bowel disease. Patients having undergone anopouch manometry were considered eligible and included. Patients without inflammatory or structural diseases of the pouch (the functional pouch disorder [FPD] group) were compared with those with inflammatory or structural diseases (the inflammatory/structural pouch disorder [ISPD] group). Demographic, clinical, manometric, and laboratory variables were analyzed.

RESULTS

A total of 45 patients were included; of which, 21 (46.7%) were female. The median age of patients in the FPD group (n = 10) and ISPD group (n = 35) were 41 (interquartile range =32.5-56) years and 40 (interquartile range = 28-49) years, respectively (P = 0.469). There were no differences in the demographic, clinical, and laboratory variables between the 2 groups, with the exception of the modified Pouch Disease Activity Index. For manometric evaluations, paradoxical contractions and failure of balloon expulsion occurred in 50.0% and 60.0%, respectively, of the FPD group and in 17.1% and 20.0%, respectively, of the ISPD group (P = 0.048 and 0.043, respectively).

CONCLUSIONS

In this cohort, manometric evaluation demonstrated that paradoxical contractions occurred more frequently in patients with FPD than in those with inflammatory/structural conditions. This suggests that the underlying physiologic mechanisms of dyschezia in these patients differ.