Jordan M. Shapiro, MD1, Jill Deutsch, MD2, Lydia Watts, BS, BA3, Moira Armstrong, BS3, Gabrielle J. Ezell, MS3, Jason Baker, PhD4, William D. Chey, MD, FACG3; 1Baylor College of Medicine, Houston, TX; 2Yale New Haven Hospital, New Haven, CT; 3University of Michigan Health System, Ann Arbor, MI; 4University of North Carolina, Charlotte, NC
Introduction: Defecation disorders such as chronic constipation (CC) and fecal incontinence (FI) are common in the general population and patients with ulcerative colitis (UC). Differences in anorectal physiology in patients with UC+CC/FI versus those with CC or FI alone have not been characterized.
Aim: To determine differences in high resolution anorectal manometry (ARM) and balloon expulsion testing (BET) for patients with UC+CC and UC+FI vs. to CC and FI alone. Methods: We performed a single-center retrospective analysis (6/2015 – 10/2019) of 47 patients with UC+CC and 24 patients with UC+FI who underwent ARM+BET. We used age-/sex-matched controls with CC and FI but no UC (2:1 ratio). ARM variables included resting & max. squeeze pressures, sphincter response to simulated defecation (SD), BET (ability to pass a 50 mL balloon in < 60 sec.), and rectal sensation. Dyssynergic defecation (DD) was defined as inability to relax the sphincter > 20% during SD and abnormal BET. We used chi-squared and independent t-tests, with p-values < 0.05 considered statistically significant. Results: UC+CC (n=47) and CC (n=94) groups were matched for age (48.8±14.1 and 48±16.4 years of age, respectively) and gender (84.4% and 85.1% female, respectively). Mean resting pressure was lower in UC+CC than CC (UC+CC: 71.7±36.9 mmHg vs. CC: 91.3±32.7, p=0.003). The prevalence of DD was 27% in both groups. There were no other significant differences in patients with UC+CC and CC [Table 1]. UC+FI (n=24) and FI (n=48) groups were matched for age (60.1±16 and 58.4± 5.4 years of age, respectively) and gender (female: 78.3% and 70.2%, respectively). Mean resting pressure was lower in patients with UC+FI compared to FI patients (50.3±26.6 mmHg vs 67.5±32.5 mmHg, p=0.03) [Table 2]. Abnormal BET was significantly more common in patients with UC+FI versus FI alone (50% vs 21.7%, p=0.02). First sensation (63.2 ± 45.4 mL vs 35.8±24.7 mL, p=0.01) and urgency (100.7±53.5 mL vs 76±45.5 mL, p=0.05) in UC+FI patients were significantly higher compared to FI patients [Table 2]. Discussion: Patients with UC+CC and CC had similar anorectal function and sensation. DD was present in > 25% of patients in both groups. Clinicians should consider DD in ALL laxative refractory patients with CC. Patients with UC+FI have lower resting pressure, greater likelihood of abnormal BET, and more rectal hyposensitivity versus patients with FI alone. Whether these differences influence clinical presentation or treatment require further research.
Anorectal physiology testing and balloon expulsion testing in patients with ulcerative colitis + chronic constipation and patients with chronic constipation alone
Anorectal physiology testing and balloon expulsion testing in patients with ulcerative colitis + fecal incontinence and patients with fecal incontinence alone
Disclosures: Jordan Shapiro indicated no relevant financial relationships. Jill Deutsch indicated no relevant financial relationships. Lydia Watts indicated no relevant financial relationships. Moira Armstrong indicated no relevant financial relationships. Gabrielle Ezell indicated no relevant financial relationships. Jason Baker indicated no relevant financial relationships. William Chey: Allergan – Consultant. Biomerica – Consultant. Biomerica – Grant/Research Support. Commonwealth Diagnostics – Grant/Research Support. IM Health – Consultant. Ironwood – Consultant. Ironwood – Grant/Research Support. QOL Medical – Grant/Research Support. QOL Medical – Consultant. Ritter – Consultant. Salix/Valeant – Consultant. Salix/Valeant – Grant/Research Support. Takeda – Consultant. Urovant – Consultant. Urovant – Grant/Research Support. Vibrant – Grant/Research Support. Zespri – Grant/Research Support.