So Young Seo

The diagnostic value of a digital rectal examination compared with high-resolution anorectal manometry in patients with chronic constipation and fecal incontinence.

Objectives:Digital rectal examination (DRE) is a simple clinical method to diagnose anorectal disorders. High-resolution antorectal manometry (HRAM) based on a spatiotemporal plot is expected to promote improved diagnostic accuracy. However, there are no reports comparing the effectiveness of DRE and HRAM. The aim of our study was therefore to evaluate the diagnostic value of DRE compared with HRAM.Methods:A total of 309 consecutive patients with chronic constipation (n=268) or fecal incontinence (n=41) who underwent a standardized DRE, HRAM, and balloon expulsion test were enrolled in this study. The diagnostic yield of DRE compared with HRAM was determined, and agreement between DRE and HRAM data was evaluated.Results:Of the constipated patients, 207 (77.2%) were diagnosed with dyssynergia using HRAM. The sensitivity, specificity, and positive predictive value of DRE in the diagnosis of dyssynergia were 93.2%, 58.7%, and 91.0%, respectively, and moderate agreement was seen between the two modalities (κ-coefficient =0.542, P<0.001). In patients with fecal incontinence, there was moderate agreement in terms of anal squeeze pressure between the two modalities (κ-coefficient =0.418, P=0.006); however, there was poor agreement for anal resting tone (κ-coefficient =0.079, P=0.368).Conclusions:DRE shows high sensitivity and positive predictive value in detecting dyssynergia compared with HRAM, and could therefore be used as a bedside screening test for the diagnosis of this disorder. Further studies are warranted to evaluate the correlation between DRE and HRAM in assessing anal sphincter pressure.

A novel high-resolution anorectal manometry parameter based on a three-dimensional integrated pressurized volume of a spatiotemporal plot, for predicting balloon expulsion in asymptomatic normal individuals

Anorectal manometry with simulated evacuation (SE) has limited applicability in predicting balloon expulsion (BE) test results. The newly developed high‐resolution anorectal manometry (HRAM) technique can yield spatiotemporal plots with three‐dimensional pressurization. We aimed to define new parameters based on three‐dimensional integrated pressurized volume (IPV) for predicting the BE test results in asymptomatic normal individuals.

Anorectal function and the effect of biofeedback therapy in ambulatory spinal cord disease patients having constipation

Abstract Objective. Constipation in patients with mild spinal cord disease is not well investigated yet. We aimed to investigate anorectal function and the effect of biofeedback therapy in constipated patients with mild spinal cord diseases. Material and methods. A total of 14 constipated patients with myelopathy and 32 with radiculopathy were enrolled retrospectively. All patients were able to walk independently. The control group comprised of 100 constipated patients without any neurologic problem. Colonic transit time and the presence of dyssynergia were assessed before biofeedback therapy. All patients answered structured questionnaires on constipation, before and after biofeedback therapy. Results. The mean rectosigmoid colonic transit time of the myelopathy group was significantly delayed (myelopathy, 18.6 ± 14.6 h; radiculopathy, 12.8 ± 11.9 h; control, 9.6 ± 11.2 h; p = 0.032). Delay in total colonic transit time was more frequent in the myelopathy group (myelopathy, 57.1%; radiculopathy, 23.3%; control, 18.5%; p = 0.004). On anorectal manometry, the squeezing pressure of the anal sphincter was decreased in the myelopathy group (myelopathy, 132.3 ± 73.3 mmHg; radiculopathy, 179.9 ± 86.1 mmHg; control 200.4 ± 82.4 mmHg; p < 0.05). The success rate of biofeedback therapy was lower in the myelopathy group (28.6% for myelopathy vs. 62.0% for control group; p = 0.034). The response rate to biofeedback therapy was similar between radiculopathy and control group (62.5% for radiculopathy vs. 62.0% for control group; p = 1.000). Conclusions. In constipation associated with mild myelopathy, delayed colonic transit and dyssynergic defecation were major pathophysiologic abnormalities and biofeedback was less effective compared with control group. However, in the radiculopathy group, biofeedback was as effective as in the control group.

Effect of biofeedback therapy in constipation according to rectal sensation.

Background/Aims The pathophysiologic mechanism of rectal hyposensitivity (RH) is not well documented, and the significance of RH in biofeedback therapy (BFT) has not been evaluated. Thus, we aimed to assess the effect of BFT in constipated patients according to the presence of RH. Methods Five hundred and ninety constipated patients (238 males and 352 females) underwent anorectal physiologic assessments. Of these, anorectal manometry was performed before and after BFT in 244 patients (63 RH and 181 non-RH patients). Results The success rate of BFT was 56% in the RH and 61% in the non-RH group (p=0.604). The measurements of resting pressure, squeezing pressure, desire to defecate volume, urge to defecate volume, and maximum volume were decreased after BFT in the RH group (p<0.05), whereas only resting and squeezing pressures were decreased in the non-RH group (p<0.05). Among the RH group, individuals who responded to BFT showed decreased resting pressure, squeezing pressure, desire to defecate, urge to defecate, and maximum volume and increased balloon expulsion rate; among those who did not respond to BFT, only desire to defecate volume was improved. Conclusions In constipated patients with RH, changes of anorectal manometric findings differed in comparison to patients without RH. The responses to BFT showed both anorectal muscle relaxation and restoration of rectal sensation.

Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth

Background/Aims Fructose malabsorption (FM) mimics symptoms of irritable bowel syndrome (IBS), and its prevalence has increased. Diagnosing FM in IBS is challenging because of its overlap with small intestinal bacterial overgrowth (SIBO). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding SIBO using the glucose hydrogen breath test (HBT). Methods Patients diagnosed with IBS and asymptomatic control individuals were enrolled prospectively. Dietary habits were assessed with the Food Frequency Questionnaire. After excluding SIBO, participants underwent HBTs with both 15 g and 25 g of fructose. Results Thirty-five patients with IBS and 35 age- and sex-matched asymptomatic control individuals were enrolled. The 15-g fructose HBT yielded positive results in 7 of the 35 (20.0%) patients with IBS and in 2 of 35 (5.7%) controls (P = 0.070). The 25-g fructose HBT was positive in 16 of the 35 (45.7%) patients with IBS and in 8 of the 35 (22.9%) controls (P = 0.040). Analysis of the Food Frequency Questionnaire responses showed no significant differences between the 2 groups in dietary intake, although patients with IBS showed a significantly higher mean fiber intake than controls (21.24 ± 11.35 g vs 15.87 ± 7.07 g, respectively, P = 0.040). Conclusions The 25-g fructose HBT identified FM in a significantly higher percentage of SIBO-negative patients with IBS than in asymptomatic control individuals, suggesting that FM may correlate with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of patients with IBS.

Sa2040 Normal Values for High-Resolution Anorectal Manometry in a Healthy Population: Effects of Gender and Age

New High-Resolution Anorectal Manometry Parameter for Predicting Balloon Expulsion in Both Constipated Patients and Asymptomatic Controls on the Basis of a Three-Dimensional Integrated Pressurized Volume of Spatiotemporal Plot: The Comparison Between Conventional Supine and Physiological Sitting Positions During Simulated Evacuation Kee Wook Jung, Segyeong Joo, Seung-Jae Myung, Dong-Hoon Yang, In Ja Yoon, So Young Seo, Hyun Sook Koo, Hyo Jeong Lee, Ji-Beom Kim, Jong Wook Kim, Soo-kyung Park, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim

Sa1197 The Additional Diagnostic Yield of Newly Developed, Three-Dimensional Animation Plot of High-Resolution Manometry: Comparison to Conventional Linear and Spatiotemporal Plot

Background: The High resolution manometry (HRM) provides a colorful representation of esophageal motility based on its spatiotemporal plot (STP) compared to the previously used conventional linear plot (LP). The diagnostic accuracy of STP compared to the LP has been reported to be increased, especially higher diagnostic yield in novice than advanced learners. Three-dimensional animation plot (3-DP) (SandhillTM, Highland Ranch, CO) can aggregate the information from the STP profiles and regenerate the esophageal motion as threedimensional model with moving pictures. However, the clinical usefulness and diagnostic yield of 3-DP have not been fully validated. We aimed to investigate the additional diagnostic yield and ease of interpretation of 3-DP compared to STP and LP among nurses, medical students, and gastrointestinal (GI) fellows. Methods: After standardized electronic tutorials, 20 medical students, 10 nurses, and 6 GI fellows, all of whom were never spoiled from the conventional manometry or HRM previously, were asked to answer to the questionnaire regarding diagnosis to the classified 30 examples of esophageal motility findings in LP, STP, and 3-DP formats in random order ((normalcy (n=15), type I achalasia (n=6), type II or III achalasia (n=7), ineffective esophageal motility (IEM) (n=2)), and asked about subjective preference and availability of interpretation among 3 formats. The diagnostic accuracy was compared among the 3 different display formats, as well as a subjective rating of preference in the diagnosis. The diagnostic accuracy in 3 formats was calculated and compared by logistic regression with generalized estimating equation. Results: The diagnostic accuracy was significantly higher in fellow group (OR=1.62, 95%CI: 1.12 to 2.35, P=0.01), especially in case of normalcy (OR=2.42, 95% CI: 1.42 to 4.11, P<0.01) and IEM (OR=9.42, 95% CI: 3.00 to 29.62, P<0.01). There was no significant difference in diagnostic accuracy among the 3 different display formats. However, 3-DP gained significantly higher diagnostic yield in type I achalasia (OR=1.72, 95%CI: 1.08 to 2.76, P=0.02) than other findings, but lower diagnostic yield in ineffective esophageal motility (OR=0.39, 95%CI: 0.22 to 0.69, P<0.01) than other findings. Students and GI fellows favored STP (58.3%) over 3-DP (36.1%) and LP (5.6%) due to intuitively rapid interpretation. However, nurses preferred 3-DP (80%) over STP (20%) or LP (0%) due to easy understanding. Conclusions: The newly developed 3-DP did not provide more diagnostic yield than LP or STP. However, in type I achalasia, 3-DP showed significantly additional diagnostic yield than other esophageal findings. Groups of less medical knowledge, nurses, showed higher preference to 3-DP over STP or LP. A prospective study based on a large number of laymen might be warranted to validate the usefulness of 3-DP format in HRM.