Characteristics of recoanal inhibitory reflex in patients with functional constipation: analysis of 100 cases

doi:10.3877/cma.j.issn.1674-0785.2023.08.005

Abstract

Abstract:

Objective

To explore the characteristics of anorectal dynamics, rectal sensory function, and nerve reflex function in patients with functional constipation by high-resolution anorectal manometry.

Methods

One hundred functional constipation patients and 100 healthy volunteers were selected to compare their differences in anal resting pressure, maximum compressive pressure, rectal defecation pressure, anal residual pressure, initial sensory threshold, initial defecation threshold, maximum volume sensory threshold, and recoanal inhibitory reflex (RAIR) related parameters by high-resolution anorectal manometry. The differences in RAIR related parameters among patients with different subtypes of functional constipation were also compared.

Results

Compared with healthy volunteers, patients with functional constipation had significantly higher initial sensory threshold, initial defecation threshold, maximum volume sensory threshold, RAIR, RAIR residual pressure, RAIR relaxation rate, and RAIR relaxation time [(37.74±20.89) mmHg vs (24.45±11.55) mmHg, (68.31±25.53) ml vs (52.22±19.02) ml, (152.32±55.87) ml vs (138.22±41.28) ml, (16.90±8.12) ml vs (11.90±4.42) ml, (31.08±18.84) mmHg vs (20.30±12.13) mmHg, (34.61±18.81)% vs (57.41±20.28)%, and (8.30±5.41) s vs (14.89±3.73) s, respectively, P＜0.05], while there was no significant difference in anal resting pressure, maximum compressive pressure, rectal pressure, or anal residual pressure [(70.62±22.28) mmHg vs (69.80±15.19) mmHg, (132.61±39.94) mmHg vs (141.41±39.91) mmHg, (46.24±24.10) mmHg vs (51.51±44.61) mmHg, and (81.29±27.34) mmHg vs (77.55±25.25) mmHg, P＞0.05] between them.

Conclusion

Rectal hypoesthesia and abnormal RAIR are common in patients with functional constipation, suggesting that abnormal neural pathway is one of the main mechanisms of functional constipation.

Key words: Functional constipation, High-resolution anorectal manometry, Recoanal inhibitory reflex

Xiuli Zheng, Min Ni. Characteristics of recoanal inhibitory reflex in patients with functional constipation: analysis of 100 cases[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 870-875.

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References 22

1	Black CJ, Ford AC. Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management [J]. Med J Aust, 2018, 209(2): 86-91.
2	Rao SS, Singh S. Clinical utility of colonic and anorectal manometry in chronic constipation [J]. J Clin Gastroenterol, 2010, 44(9): 597-609.
3	闫小妮, 殷燕, 任晓阳, 等. 不同性别、年龄及伴随症状功能性便秘患者肛门直肠动力学特点研究 [J]. 中国全科医学, 2019, 22(24): 2913-2917, 2923.
4	Zhao Y, Ren X, Qiao W, et al. High-resolution anorectal manometry in the diagnosis of functional defecation disorder in patients with functional constipation: A retrospective cohort study [J]. J Neurogastroenterol Motil, 2019, 25(2): 250-257.
5	Rao SS, Meduri K. What is necessary to diagnose constipation? [J]. Best Pract Res Clin Gastroenterol, 2011, 25(1): 127-140.
6	Ratuapli SK, Bharucha AE, Noelting J, et al. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry [J]. Gastroenterology, 2013, 144(2): 314-322.e2.
7	Wald A, Bharucha AE, Limketkai B, et al. ACG clinical guidelines: Management of benign anorectal disorders [J]. Am J Gastroenterol, 2021, 116(10): 1987-2008.
8	Fathy A, Megahed A, Barakat T, et al. Anorectal functional abnormalities in Egyptian children with chronic functional constipation [J]. Arab J Gastroenterol, 2013, 14(1): 6-9.
9	Patcharatrakul T, Rao SSC. Update on the pathophysiology and management of anorectal disorders [J]. Gut Liver, 2018, 12(4): 375-384.
10	林细州, 陈艳, 陆小锋, 等. 高分辨率肛门直肠测压与生物反馈治疗在出口梗阻型便秘患者中的应用 [J]. 实用医学杂志, 2015, 31(17): 2851-2854.
11	El-Shabrawi M, Hanafi HM, Abdelgawad MMAH, et al. High-resolution anorectal manometry in children with functional constipation: A single-centre experience before and after treatment [J]. Prz Gastroenterol, 2018, 13(4): 305-312.
12	Oblizajek NR, Gandhi S, Sharma M, et al. Anorectal pressures measured with high-resolution manometry in healthy people-Normal values and asymptomatic pelvic floor dysfunction [J]. Neurogastroenterol Motil, 2019, 31(7): e13597.
13	Gundling F, Seidl H, Scalercio N, et al. Influence of gender and age on anorectal function: normal values from anorectal manometry in a large caucasian population [J]. Digestion, 2010, 81(4): 207-213.
14	Basilisco G, Bharucha AE. High-resolution anorectal manometry: An expensive hobby or worth every penny? [J]. Neurogastroenterol Motil, 2017, 29(8): 10.1111/nmo.13125.
15	Park BS, Cho SH, Son GM, et al. Absent or impaired rectoanal inhibitory reflex as a diagnostic factor for high-grade (grade Ⅲ-Ⅴ) rectal prolapse: a retrospective study [J]. BMC Gastroenterol, 2021, 21(1): 157.
16	Shim L, Hansen RD, Prott GM, et al. Altered temporal characteristics of the rectoanal inhibitory reflex in patients with abdominal distension [J]. Am J Physiol Gastrointest Liver Physiol, 2012, 302(11): G1343-G1346.
17	Pucciani F, Trafeli M. Sampling reflex: pathogenic role in functional defecation disorder [J]. Tech Coloproctol, 2021, 25(5): 521-530.
18	Thiruppathy K, Roy A, Preziosi G, et al. Morphological abnormalities of the recto-anal inhibitory reflex reflects symptom pattern in neurogenic bowel [J]. Dig Dis Sci, 2012, 57(7): 1908-1914.
19	Xu X, Pasricha PJ, Sallam HS, et al. Clinical significance of quantitative assessment of rectoanal inhibitory reflex (RAIR) in patients with constipation [J]. J Clin Gastroenterol, 2008, 42(6): 692-698.
20	Liu TT, Chen CL, Yi CH. Anorectal manometry in patients with chronic constipation: a single-center experience [J]. Hepatogastroenterology, 2008, 55(82-83): 426-429.
21	连娟, 李俊达, 白倩茹, 等. 高分辨率肛门直肠测压法用于功能性排便障碍的表型鉴定和分类 [J]. 河北医药, 2017, 39(8): 1172-1175.
22	赵玥. 慢性便秘患者高分辨率肛门直肠测压特点及便秘症状的研究 [D]. 山东大学, 2021.

组别	例数	静息压（mmHg）	最大缩榨压（mmHg）	直肠排便压力（mmHg）	肛管残余压（mmHg）	初始感觉阈值（ml）	初始便意阈值（ml）	最大容量感觉阈值（ml）
试验组	100	70.62±22.28	132.61±39.94	46.24±24.10	81.29±27.34	37.74±20.89	68.31±25.53	152.32±55.87
对照组	100	69.80±15.19	141.41±39.91	51.51±44.61	77.55±25.25	24.45±11.55	52.22±19.02	138.22±41.28
t值		0.304	-1.559	-1.039	1.002	5.565	5.053	2.030
P值		0.761	0.121	0.300	0.317	＜0.001	＜0.001	0.044

组别	例数	静息压（mmHg）	最大缩榨压（mmHg）	直肠排便压力（mmHg）	肛管残余压（mmHg）	初始感觉阈值（ml）	初始便意阈值（ml）	最大容量感觉阈值（ml）
试验组	100	70.62±22.28	132.61±39.94	46.24±24.10	81.29±27.34	37.74±20.89	68.31±25.53	152.32±55.87
对照组	100	69.80±15.19	141.41±39.91	51.51±44.61	77.55±25.25	24.45±11.55	52.22±19.02	138.22±41.28
t值		0.304	-1.559	-1.039	1.002	5.565	5.053	2.030
P值		0.761	0.121	0.300	0.317	＜0.001	＜0.001	0.044

组别	例数	RAIR（ml）	RAIR残余压（mmHg）	RAIR松弛率（%）	RAIR松弛时间（s）
试验组	100	16.90±8.12	31.08±18.84	34.61±18.81	8.30±5.41
对照组	100	11.90±4.42	20.30±12.13	57.41±20.28	14.89±3.73
t值		5.403	4.809	-8.240	-10.022
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	RAIR（ml）	RAIR残余压（mmHg）	RAIR松弛率（%）	RAIR松弛时间（s）
试验组	100	16.90±8.12	31.08±18.84	34.61±18.81	8.30±5.41
对照组	100	11.90±4.42	20.30±12.13	57.41±20.28	14.89±3.73
t值		5.403	4.809	-8.240	-10.022
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	RAIR（ml）	RAIR残余压（mmHg）	RAIR松弛率（%）	RAIR松弛时间（s）
性别	男（46）	15.65±7.49	28.47±16.48	38.28±17.20	9.08±5.05
	女（54）	17.96±8.55	31.77±19.42	35.56±20.68	8.16±5.70
	t值	-1.424	-0.907	0.708	0.847
	P值	0.157	0.367	0.481	0.399
年龄	青年（46）	15.86±7.47	30.23±17.61	35.17±19.05	7.80±5.20
	中老年（54）	17.77±8.61	31.79±19.97	34.14±18.77	8.72±5.59
	t值	-1.172	-0.41	0.271	-0.844
	P值	0.244	0.683	0.787	0.401
病程（年）	0~2（35）	14.28±7.39	28.94±19.98	36.01±16.19	7.74±4.30
	2~5（33）	16.66±7.77	33.03±20.31	30.65±19.60	8.57±5.77
	＞5（32）	20.31±8.22	31.65±16.07	36.81±20.49	8.96±6.05
	F值	5.047	0.412	1.048	0.453
	P值	0.008	0.664	0.355	0.637

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