3D High-definition anorectal manometry: Values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD).
BACKGROUND
3D-high definition anorectal manometry (3DARM) may aid the diagnosis of functional anorectal disorders, but data comparing asymptomatic and symptomatic subjects are scarce. We aimed to describe 3DARM values in asymptomatic volunteers and those with fecal incontinence (FI) or chronic constipation (CC), and identify which variables differentiate best these groups.


METHODS
Asymptomatic subjects were stratified by sex, age, and parity. Those with FI or CC were included according to anorectal symptom questionnaires. Endoanal ultrasound examination and 3DARM were performed the same day. Anal pressures were analyzed at rest, during voluntary squeeze, and during push maneuver, and compared between the 3 groups. Anal pressure defects were defined and compared to ultrasound defects.


KEY RESULTS
A total of 126 subjects (113 female, mean age 52 years, range 18-83) were included; 36 asymptomatic, 38 FI, 42 CC. Anal resting and squeeze pressures, and rectal sensitivity values were lower in FI women than in the other groups. Typical anal sphincter asymmetry during squeezing was less frequently observed in FI women. A dyssynergic pattern during push maneuver was found in 70% of asymptomatic subjects, and with a similar frequency in the 2 symptomatic groups. There was slight concordance between 3D-pressure defects and ultrasound defects.


CONCLUSIONS & INFERENCES
3D anal pressures in asymptomatic women were significantly lower than in men, and in FI compared to asymptomatic women. The classical dyssynergic pattern during push maneuver was found as frequently in asymptomatic and symptomatic patients. Further studies should try to identify 3DARM variables that could reliably identify dyssynergic defecation.
['Mion|F|F|http://orcid.org/0000-0002-2908-1591', 'Garros|A|A|', 'Brochard|C|C|http://orcid.org/0000-0001-7354-6301', 'Vitton|V|V|', 'Ropert|A|A|', 'Bouvier|M|M|', 'Damon|H|H|', 'Siproudhis|L|L|', 'Roman|S|S|http://orcid.org/0000-0002-7798-7638']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001003:Anal Canal D002908:Chronic Disease D003248:Constipation D005242:Fecal Incontinence D005260:Female D006801:Humans D007090:Image Interpretation, Computer-Assisted D021621:Imaging, Three-Dimensional D008297:Male D008365:Manometry D008875:Middle Aged D011446:Prospective Studies D012007:Rectum D055815:Young Adult
fecal incontinence chronic constipation 3D high-resolution anorectal manometry normal values