Pathophysiology of Anorectal Disorders

肛门直肠疾病的病理生理学

• 批准号: 10452611
• 负责人: ADIL E. BHARUCHA
• 金额: $ 38.66万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452611
• 关键词: Abdomen; Abdominal Muscles; Abnormal coordination; Address; Anus; Barium; Biofeedback Training; Chronic; Constipation; Controlled Clinical Trials; Data; Defecation; Defecography; Diagnosis; Diagnostic tests; Disease; Feces; Female; Floor; Fluoroscopy; Functional disorder; Grant; Human; Image; Impairment; Intestines; Knowledge; Lateral; Left; Magnetic Resonance Imaging; Manometry; Measurement; Measures; Motion; Muscle; Patient Care; Patients; Pelvic floor structure; Persons; Phase; Positioning Attribute; Preparation; Process; Randomized; Rectum; Relaxation; Resolution; Rest; Role; Symptoms; Test Result; Testing; Time; Valsalva Maneuver; Woman; abdominal wall; anorectal disorder; base; design; foot; improved; innovation; insight; male; men; multidisciplinary; preservation; pressure; prevent; rectal; sphincter ani muscle structure; symptomatic improvement; ultrasound

PROJECT SUMMARY/ABSTRACT Defecation is a viscerosomatic process that requires increased rectal pressure coordinated with anal sphincter and pelvic floor relaxation. Defecatory disorders (DD) are defined by symptoms and objective features of impaired defecation. Our understanding of normal and disordered defecation are derived either from measurements of pressures (high-resolution manometry [HRM]) or emptying (defecography, rectal balloon expulsion test), but never both. HRM is usually conducted in the left lateral position with an empty rectum. This may partly explain why the rectoanal gradient (rectal – anal pressure) during evacuation is negative, even in most asymptomatic people, which undermines our concept of the mechanisms of normal defecation. Among patients, results of these tests are often inconsistent, hindering the diagnosis of DD. Excessive straining and “maladaptive” pelvic floor contraction during defecation is implicated to cause DD. However, abdominal wall motion during defecation and its coordination with pelvic floor motion have not been studied in healthy people or those with DD. Finally, even in controlled clinical trials, pelvic floor biofeedback therapy, the cornerstone of managing DD, only benefits 60% of DD patients. This treatment is not widely available or reimbursable; therefore additional therapies are necessary. Each study is designed to improve patient care in humans. Specific Aim 1: Address fundamental gaps in our knowledge of the mechanisms of normal and disordered defecation and the diagnosis of DD: 1a) Redefine the phases of normal evacuation using manodefecography; 1b) Identify the primary causes of DD in men versus women. Recto anal pressures and evacuation will be measured with HRM, barium, and MR manodefecography in 120 male and female healthy controls and 120 male and female DD patients. Specific Aim 2: Role of abdominal wall motion in normal and disordered defecation: 2a) Evaluate abdominopelvic coordination during defecation in healthy and DD women; 2b) Evaluate abdominopelvic coordination during defecation before and after biofeedback therapy. Abdominal wall motion and rectoanal pressures will be evaluated at rest and during various maneuvers, including simulated evacuation, in 30 healthy women and 60 women with DD. Specific Aim 3: Incorporating these concepts to manage DD: 3a) To assess the effects of a footstool on recto- anal functions in DD; 3b) To assess the symptoms in DD. Recto anal pressures and emptying as well as bowel symptoms will be evaluated before and after 85 female DD patients are randomized to a footstool. A multi-disciplinary collaborative team will apply innovative approaches to address these hypotheses in a highly refined manner.

项目摘要/摘要 排便是一个内脏过程，需要增加直肠压力和肛门括约肌的配合。 和盆底放松。排便障碍(DD)是由以下症状和客观特征来定义的 排便障碍。我们对正常排便和排便紊乱的理解源于 测量压力(高分辨率测压[HRM])或排空(排粪造影术、直肠气囊 开除测试)，但永远不能两者兼得。HRM通常在左侧卧位进行，直肠空位。这 可能部分解释了为什么在排便过程中直肠肛门倾斜度(直肠-肛门压力)是负的，即使在 大多数无症状的人，这破坏了我们对正常排便机制的概念。其中 对于患者，这些测试的结果往往不一致，阻碍了DD的诊断。过度紧张和过度紧张 排便过程中“不适应”的盆底收缩与引起DD有关。然而，腹壁 在健康人中，排便时的运动及其与盆底运动的协调性尚未被研究。 或者那些患有DD的人。最后，即使在对照临床试验中，盆底生物反馈疗法也是 管理DD，只有60%的DD患者受益。这种治疗不能广泛获得，也不能报销； 因此，额外的治疗是必要的。每项研究都旨在改善人类对患者的护理。 具体目标1：解决我们对正常和无序机制的认识上的根本差距 排便和DD的诊断：1A)使用排便造影术重新定义正常排空的阶段； 1b)找出男性与女性中引起DD的主要原因。 在120年中，将使用HRM、X线和磁共振排粪造影术测量直肠肛管压力和排空 男性和女性健康对照组和120名男性和女性DD患者。 具体目标2：腹壁运动在正常排便和排便障碍中的作用：评估 健康和DD女性排便时的腹盆协调；2b)评估腹盆 生物反馈治疗前后排便协调。 腹壁运动和直肠肛管压力将在休息和各种动作中进行评估， 包括模拟疏散，在30名健康妇女和60名患有DD的妇女中。 具体目标3：将这些概念纳入管理DD：3A)以评估脚凳对直肠的影响-- 3)评估DD患者的肛门功能。 将在85名女性之前和之后评估直肠肛门压力、排空和肠道症状。 DD患者被随机分配到一个脚凳上。多学科协作团队将应用创新 以高度精炼的方式解决这些假设的方法。