P0396 - Anorectal Function in Chronically Constipated Patients With Diabetes Mellitus: Evidence of Diminished Anal Sphincter Pressure and Rectal Hyposensitivity

Award: Presidential Poster Award

Award: Presidential Poster Award

Eden Koo, BS¹, Borko Nojkov, MD², William D. Chey, MD, FACG³, Gabrielle Ezell, MS², Jiande DZ Chen, PhD^2
1John A. Burns School of Medicine, University of Hawaii, Ann Arbor, MI; ²Michigan Medicine, Ann Arbor, MI; ³Michigan Bowel Control Program, University of Michigan, Ann Arbor, MI

Introduction: Chronic constipation (CC) in patients with diabetes mellitus (DM) may represent a manifestation of sensorimotor neuropathy. However, the impact of DM on anorectal function in chronically constipated patients is not well studied but potentially relevant to the pathogenesis of CC in these patients. We evaluated anorectal function testing (AFT) characteristics in CC patients with DM compared to those without DM.

Methods: Retrospective analysis of prospectively collected data from consecutive adults with CC (Rome 3) presenting at a tertiary care center (2018-2020) for AFT. AFT variables included anal sphincter pressures (resting and squeeze) and response during simulated defecation, balloon expulsion test (BET/ abnormal = inability to pass a 50 ml water filled balloon in < 60 seconds) and rectal sensation measurement via ramp balloon distension (First Sensation, Urgency and Maximum Tolerated sensation). Dyssynergic Defecation (DD) was defined as both the inability to relax the sphincter during simulated defecation and an abnormal BET. Statistical analyses included chi-square analysis, independent t-test, and a multivariable regression model. P-values < 0.05 were considered statistically significant.

Results: 1630 CC patients were included in this study. The mean age of the study cohort was 48 years (range: 18-90) and most patients were women (79%). Patients with DM (n=194, 11.9%) were significantly older, predominantly female, and had higher BMI than non-DM patients (Table 1). Patients with DM had significantly higher mean rectal volume thresholds to perceive First sensation and Urgency to defecate and there was a trend toward a higher Maximum Tolerated sensation threshold. DM patients had significantly lower mean resting and squeeze anal sphincter pressures compared to non-DM patients. There was no difference in the prevalence of abnormal BET or DD between the groups. On a multivariable regression model, squeeze anal sphincter pressures were inversely associated with DM (OR 0.995, p< 0.014) but rectal sensation differences between the groups were no longer significant (Table 1).

Discussion: CC patients with DM have lower resting and squeeze anal sphincter pressures and tend to have rectal hyposensitivity in comparison to CC patients without DM. These abnormalities suggest anorectal sensorimotor neuropathy in a subset of DM patients. The clinical significance of these findings in relation to constipation symptoms severity and therapeutic outcomes deserve further investigation.

Table: Table 1. Baseline, rectal sensation, and anal sphincter pressure measurements via ARM: Chronically constipated patients with Diabetes Mellitus (DM) vs. no Diabetes Mellitus


Disclosures:
Eden Koo indicated no relevant financial relationships.
Borko Nojkov indicated no relevant financial relationships.
William Chey indicated no relevant financial relationships.
Gabrielle Ezell indicated no relevant financial relationships.
Jiande DZ Chen indicated no relevant financial relationships.


Eden Koo, BS¹, Borko Nojkov, MD², William D. Chey, MD, FACG³, Gabrielle Ezell, MS², Jiande DZ Chen, PhD². P0396 - Anorectal Function in Chronically Constipated Patients With Diabetes Mellitus: Evidence of Diminished Anal Sphincter Pressure and Rectal Hyposensitivity, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.