M Zakari1, J Nee1, W Hirsch1, B Kuo2, A Lembo1, K Staller2. 1. Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 2. Center for Neurointestinal Health and Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: The epidemiology of chronic constipation (CC) skews toward female predominance, yet men make up an important component of those suffering from CC. We sought to determine whether there are sex-specific differences in symptoms and physiologic parameters on anorectal manometry (ARM). METHODS: We performed a case-control analysis of sequential men and age-matched women (2:1 ratio) presenting for ARM as part of the evaluation of CC. We collected physiologic parameters derived from 3D high-resolution ARM in addition to the ROME III constipation module and the Pelvic Floor Distress Inventory 20 (PFDI-20) questionnaires. We analyzed univariate, sex-specific differences in ARM physiologic parameters and PFDI-20 parameters and adjusted for putative confounders using multivariate logistic regression. KEY RESULTS: Our study enrolled 80 men and 165 age-matched women. Men had a higher median sphincter resting pressure (81.2 vs 75.2 mm Hg, P=.01) and mean squeeze pressure (257.0 vs 170.5 mm Hg, P<.0001) than women. Although men reported significantly less severe straining and incomplete evacuation, they had greater mean rectoanal pressure differential (-106.7 vs -71.1 mm Hg, P<.0001), smaller mean defecation index (0.17 vs 0.27, P=.03) and higher volume threshold for urgency (115.2 v. 103.4 mL, P=.03). However, women were more likely to have abnormal balloon expulsion time (BET) than men (52.7% vs 35.0%, P=.01). After multivariate analysis, male gender was the only independent predictor of a normal BET (OR: 0.48, 95% CI: 0.27-0.86, P=.01). CONCLUSIONS & INFERENCES: Men and women with CC differ with regard to symptom severity and physiologic parameters derived from ARM suggesting differences in their pathophysiology.
BACKGROUND: The epidemiology of chronic constipation (CC) skews toward female predominance, yet men make up an important component of those suffering from CC. We sought to determine whether there are sex-specific differences in symptoms and physiologic parameters on anorectal manometry (ARM). METHODS: We performed a case-control analysis of sequential men and age-matched women (2:1 ratio) presenting for ARM as part of the evaluation of CC. We collected physiologic parameters derived from 3D high-resolution ARM in addition to the ROME III constipation module and the Pelvic Floor Distress Inventory 20 (PFDI-20) questionnaires. We analyzed univariate, sex-specific differences in ARM physiologic parameters and PFDI-20 parameters and adjusted for putative confounders using multivariate logistic regression. KEY RESULTS: Our study enrolled 80 men and 165 age-matched women. Men had a higher median sphincter resting pressure (81.2 vs 75.2 mm Hg, P=.01) and mean squeeze pressure (257.0 vs 170.5 mm Hg, P<.0001) than women. Although men reported significantly less severe straining and incomplete evacuation, they had greater mean rectoanal pressure differential (-106.7 vs -71.1 mm Hg, P<.0001), smaller mean defecation index (0.17 vs 0.27, P=.03) and higher volume threshold for urgency (115.2 v. 103.4 mL, P=.03). However, women were more likely to have abnormal balloon expulsion time (BET) than men (52.7% vs 35.0%, P=.01). After multivariate analysis, male gender was the only independent predictor of a normal BET (OR: 0.48, 95% CI: 0.27-0.86, P=.01). CONCLUSIONS & INFERENCES: Men and women with CC differ with regard to symptom severity and physiologic parameters derived from ARM suggesting differences in their pathophysiology.
Authors: Xiaoshan Du; Shuai Liu; Peifei Jia; Xiaodan Wang; Jinghuan Gan; Wenzheng Hu; Han Zhu; Yehua Song; Jianping Niu; Yong Ji Journal: Front Public Health Date: 2022-06-15
Authors: Peter I Duncan; Catherine F Enters-Weijnen; Nashmil Emami; Peter McLean; Tiago Nunes; Maurice Beaumont; Rafael Crabbe; Kevin Whelan; S Mark Scott; Niek J deWit; Teunis Weits; Gabriela Bergonzelli; Diederick E Grobbee Journal: Nutrients Date: 2018-07-19 Impact factor: 5.717
Authors: Miguel A Simón; Ana M Bueno; Patricia Otero; Fernando L Vázquez; Vanessa Blanco Journal: Int J Environ Res Public Health Date: 2019-09-04 Impact factor: 3.390
Authors: Mi Li; Lijuan Zhao; Li Ma; Wen Zhang; Hua Huang; Jun Wei; Jun Sun; Fenying Lu; Lijiang Ji Journal: Evid Based Complement Alternat Med Date: 2021-11-25 Impact factor: 2.629
Authors: Prashant Singh; Yoonjin Seo; Sarah Ballou; Andrew Ludwig; William Hirsch; Vikram Rangan; Johanna Iturrino; Anthony Lembo; Judy W Nee Journal: J Neurogastroenterol Motil Date: 2019-01-31 Impact factor: 4.924