Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry

Shiva K. Ratuapli, Adil Eddie Bharucha, Jessica Noelting, Doris M. Harvey, Alan R. Zinsmeister

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry. METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry. RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal highpressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times. CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.

Original languageEnglish (US)
JournalGastroenterology
Volume144
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Manometry
Phenotype
Pressure
Constipation
Principal Component Analysis
Pelvic Floor
Defecation
Ataxia
Logistic Models
Sensitivity and Specificity

Keywords

  • Anismus
  • Anorectal test
  • Dyssynergic defecation
  • Pelvic floor dysfunction

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. / Ratuapli, Shiva K.; Bharucha, Adil Eddie; Noelting, Jessica; Harvey, Doris M.; Zinsmeister, Alan R.

In: Gastroenterology, Vol. 144, No. 2, 02.2013.

Research output: Contribution to journalArticle

Ratuapli, Shiva K. ; Bharucha, Adil Eddie ; Noelting, Jessica ; Harvey, Doris M. ; Zinsmeister, Alan R. / Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. In: Gastroenterology. 2013 ; Vol. 144, No. 2.
@article{bec89c36ae104c2a8c38b22c65c2d808,
title = "Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry",
abstract = "BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry. METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry. RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75{\%} sensitivity and a specificity of 75{\%}. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal highpressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times. CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.",
keywords = "Anismus, Anorectal test, Dyssynergic defecation, Pelvic floor dysfunction",
author = "Ratuapli, {Shiva K.} and Bharucha, {Adil Eddie} and Jessica Noelting and Harvey, {Doris M.} and Zinsmeister, {Alan R.}",
year = "2013",
month = "2",
doi = "10.1053/j.gastro.2012.10.049",
language = "English (US)",
volume = "144",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry

AU - Ratuapli, Shiva K.

AU - Bharucha, Adil Eddie

AU - Noelting, Jessica

AU - Harvey, Doris M.

AU - Zinsmeister, Alan R.

PY - 2013/2

Y1 - 2013/2

N2 - BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry. METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry. RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal highpressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times. CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.

AB - BACKGROUND & AIMS: Disordered defecation is attributed to pelvic floor dyssynergia. However, clinical observations indicate a spectrum of anorectal dysfunctions. The extent to which these disorders are distinct or overlap is unclear; anorectal manometry might be used in diagnosis, but healthy persons also can have abnormal rectoanal pressure gradients during simulated evacuation. We aimed to characterize phenotypic variation in constipated patients through high-resolution anorectal manometry. METHODS: We evaluated anorectal pressures, measured with high-resolution anorectal manometry, and rectal balloon expulsion time in 62 healthy women and 295 women with chronic constipation. Phenotypes were characterized by principal components analysis of high-resolution anorectal manometry. RESULTS: Two healthy persons and 71 patients had prolonged (>180 s) rectal balloon expulsion time. A principal components logistic model discriminated healthy people from patients with prolonged balloon expulsion time with 75% sensitivity and a specificity of 75%. Four phenotypes discriminated healthy people from patients with abnormal balloon expulsion times; 2 phenotypes discriminated healthy people from those with constipation but normal balloon expulsion time. Phenotypes were characterized based on high anal pressure at rest and during evacuation (high anal), low rectal pressure alone (low rectal) or low rectal pressure with impaired anal relaxation during evacuation (hybrid), and a short anal highpressure zone. Symptoms were not useful for predicting which patients had prolonged balloon expulsion times. CONCLUSIONS: Principal components analysis of rectoanal pressures identified 3 phenotypes (high anal, low rectal, and hybrid) that can discriminate among patients with normal and abnormal balloon expulsion time. These phenotypes might be useful to classify patients and increase our understanding of the pathogenesis of defecatory disorders.

KW - Anismus

KW - Anorectal test

KW - Dyssynergic defecation

KW - Pelvic floor dysfunction

UR - http://www.scopus.com/inward/record.url?scp=84881540612&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881540612&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2012.10.049

DO - 10.1053/j.gastro.2012.10.049

M3 - Article

VL - 144

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 2

ER -