Adil E Bharucha1, Guido Basilisco2, Allison Malcolm3, Tae Hee Lee4, Matthew B Hoy5, S Mark Scott6, Satish S C Rao7. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 2. UO Gastroenterologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy. 3. Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia. 4. Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Korea. 5. Mayo Medical Library, Mayo Clinic, Rochester, Minnesota, USA. 6. National Bowel Research Centre, Queen Mary University of London, London, UK. 7. Department of Gastroenterology, Augusta University, Augusta, Georgia, USA.
Abstract
BACKGROUND: Anorectal manometry (ARM) comprehensively assesses anorectal sensorimotor functions. PURPOSE: This review examines the indications, techniques, interpretation, strengths, and weaknesses of high-resolution ARM (HR-ARM), 3-dimensional high-resolution anorectal manometry (3D-HR-ARM), and portable ARM, and other assessments (i.e., rectal sensation and rectal balloon expulsion test) that are performed alongside manometry. It is based on a literature search of articles related to ARM in adults. HR-ARM and 3D-HR-ARM are useful for diagnosing defecatory disorders (DD), to identify anorectal sensorimotor dysfunction and guide management in patients with fecal incontinence (FI), constipation, megacolon, and megarectum; and to screen for anorectal structural (e.g., rectal intussusception) abnormalities. The rectal balloon expulsion test is a useful, low-cost, radiation-free, outpatient assessment tool for impaired evacuation that is performed and interpreted in conjunction with ARM. The anorectal function tests should be interpreted with reference to age- and sex-matched normal values, clinical features, and results of other tests. A larger database of technique-specific normal values and newer paradigms of analyzing anorectal pressure profiles will increase the precision and diagnostic utility of HR-ARM for identifying abnormal mechanisms of defecation and continence.
BACKGROUND: Anorectal manometry (ARM) comprehensively assesses anorectal sensorimotor functions. PURPOSE: This review examines the indications, techniques, interpretation, strengths, and weaknesses of high-resolution ARM (HR-ARM), 3-dimensional high-resolution anorectal manometry (3D-HR-ARM), and portable ARM, and other assessments (i.e., rectal sensation and rectal balloon expulsion test) that are performed alongside manometry. It is based on a literature search of articles related to ARM in adults. HR-ARM and 3D-HR-ARM are useful for diagnosing defecatory disorders (DD), to identify anorectal sensorimotor dysfunction and guide management in patients with fecal incontinence (FI), constipation, megacolon, and megarectum; and to screen for anorectal structural (e.g., rectal intussusception) abnormalities. The rectal balloon expulsion test is a useful, low-cost, radiation-free, outpatient assessment tool for impaired evacuation that is performed and interpreted in conjunction with ARM. The anorectal function tests should be interpreted with reference to age- and sex-matched normal values, clinical features, and results of other tests. A larger database of technique-specific normal values and newer paradigms of analyzing anorectal pressure profiles will increase the precision and diagnostic utility of HR-ARM for identifying abnormal mechanisms of defecation and continence.
Authors: Mayank Sharma; Anjani Muthyala; Kelly Feuerhak; Susrutha Puthanmadhom Narayanan; Kent R Bailey; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2020-07-01 Impact factor: 3.598
Authors: Arnold Wald; Adil E Bharucha; Berkeley Limketkai; Allison Malcolm; Jose M Remes-Troche; William E Whitehead; Massarat Zutshi Journal: Am J Gastroenterol Date: 2021-10-01 Impact factor: 10.864
Authors: E V Carrington; A Brokjaer; H Craven; N Zarate; E J Horrocks; S Palit; W Jackson; G S Duthie; C H Knowles; P J Lunniss; S M Scott Journal: Neurogastroenterol Motil Date: 2014-03-13 Impact factor: 3.598