Anorectal pressures measured with high-resolution manometry in healthy people-Normal values and asymptomatic pelvic floor dysfunction
Anorectal pressures measured with high-resolution manometry in healthy people-Normal values and asymptomatic pelvic floor dysfunction
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DOI：
10.1111/nmo.13597
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发表时间：
2019-07-01
影响因子：
3.5
通讯作者：
Bharucha, Adil E.
中科院分区：
文献类型：
--
作者：
Oblizajek, Nicholas R.;Gandhi, Sangeetha;Bharucha, Adil E.
背景高分辨率测压(HRM)用于测量排便障碍和大便失禁患者的直肠肛管压力。这项研究试图确定直肠肛门HRM的正常值，确定年龄和BMI对直肠肛门压力的影响，并比较无症状女性气囊排出时间(BET)正常和延长的压力。方法对163例无症状健康受试者进行高分辨率测压和BET测定。使用美敦力4.2 mm直径的直肠肛管，对BET正常的女性(96例)和男性(47例)进行正常值估计和年龄/BMI对压力的影响。关键结果在女性和男性中，年龄与较低的静息压、较高的排便时直肠压力和较高的直肠肛门倾斜度有关。在女性中，BET也与年龄呈负相关，而BMI与更高的不适阈值体积和更长的BET相关。男性的肛门挤压压力增量、挤压持续时间和HPZ长度均高于女性。BET异常的无症状女性在排便过程中直肠肛门倾斜度也较低(即，更负)。结论&推论这些发现为男性和女性肛门直肠HRM的正常值提供了一个扩展的数据库。年龄和性别分别影响肛门休息和肛门挤压压力；老年人排便时的直肠压力也较高。不到15%的无症状患者有60秒的时间，这与疏散障碍的测压特征有关。
Background High-resolution manometry (HRM) is used to measure rectoanal pressures in defecatory disorders and fecal incontinence. This study sought to define normal values for rectoanal HRM, ascertain the effects of age and BMI on rectoanal pressures, and compare pressures in asymptomatic women with normal and prolonged balloon expulsion time (BET). Methods High-resolution manometry pressures and BET were measured in 163 asymptomatic healthy participants. Women (96) and men (47) with normal BET were used to estimate normal values and the effects of age/BMI on pressures using a Medtronic 4.2-mm-diameter rectoanal catheter. Key Results Age is associated with lower resting pressure, higher rectal pressure during evacuation, and a higher rectoanal gradient during evacuation in women and men. In women, the BET is also inversely correlated with age while the BMI is correlated with a higher threshold volume for discomfort and a longer BET. The anal squeeze pressure increment, squeeze duration, and HPZ length are higher in men than women. The rectoanal gradient during evacuation is also lower (ie, more negative) in asymptomatic women with an abnormal than a normal BET. Conclusions & Inferences These findings provide an expanded database of normal values for anorectal HRM in men and women. Age and sex affect anal resting and squeeze pressures, respectively; rectal pressure during evacuation is also higher in older people. Less than 15% of asymptomatic people have BET >60 seconds, which is associated with manometry features of impaired evacuation.