Anal sphincter function in rectal intussusception and high and low “take-off” external rectal prolapse—A prospective observational study

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2024-10-06 DOI:10.1111/codi.17191

Alexander O'Connor, Caroline M. Byrne, Nick Heywood, Matthew Davenport, Niels Klarskov, Abhiram Sharma, Edward Kiff, Karen Telford

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Abstract

Aim

Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low “take-off”.

Methods

A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade.

Results

A total of 108 (102 [94%] female, median age 62 years [range: 26–95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra-anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra-anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05).

There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take-off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take-off ERP (n = 19).

Conclusion

Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take-off ERP with sphincter function in the former similar to that seen in grade IV RI.

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直肠肠套叠及高位和低位 "起飞 "直肠外脱垂的肛门括约肌功能--一项前瞻性观察研究。

目的：直肠肠套叠（RI）和直肠外脱垂（ERP）与肛门括约肌功能障碍有关。本研究旨在通过肛门声反射测量法（AAR）检查 RI 和两种不同表型的 ERP（称为高 "起飞 "和低 "起飞"）的括约肌功能：方法：一项前瞻性研究，研究对象为就诊于一家三级盆底医院的 RI 和 ERP 患者。根据牛津脱垂分级对临床数据、AAR和传统肛门测压法进行分析：共招募了 108 名患者（102 名[94%]女性，中位年龄 62 岁[26-95 岁]），根据脱垂等级分为三组：牛津 I 级和 II 级（直肠内 RI，34 人）、牛津 III 级和 IV 级（肛门内 RI，35 人）以及牛津 V 级（ERP，39 人）。随着脱垂等级的增加，静息 AAR 测量的张开压力、张开弹性、闭合压力和闭合弹性均有所下降（P 0.05）。四级 RI（n = 18）和高起飞 ERP（n = 20）之间的 AAR 或测压变量没有差异（p > 0.05）。相比之下，低起飞ERP（n = 19）患者的开放压（p = 0.010）、闭合压（p = 0.019）和弹性（p = 0.022）均有所降低：结论：直肠脱垂等级的增加与静息状态下肛门括约肌功能的降低有关，表明肛门内括约肌功能障碍。高起飞ERP和低起飞ERP之间存在生理差异，前者的括约肌功能与IV级RI相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.