Inhibitory Anorectal Reflex in Acquired Megacolon is Rectal Volume Dependent in Manometric Evaluation
Background: The pathophysiology of acquired chagasic megacolon is based on the destruction of the enteric nervous system, leading to dysmotility, achalasia of the internal anal sphincter, and consequently constipation and colon dilation. This study reappraises the role of internal anal sphincter a...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-01-01
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| Series: | World Journal of Colorectal Surgery |
| Subjects: | |
| Online Access: | https://journals.lww.com/wjcs/fulltext/2024/13010/inhibitory_anorectal_reflex_in_acquired_megacolon.3.aspx |
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| Summary: | Background:
The pathophysiology of acquired chagasic megacolon is based on the destruction of the enteric nervous system, leading to dysmotility, achalasia of the internal anal sphincter, and consequently constipation and colon dilation. This study reappraises the role of internal anal sphincter achalasia in such patients.
Objectives:
To test patients with megarectum, megacolon without megarectum, and normal colon with progressive air volumes trying to elicit the rectoanal inhibitory reflex (RAIR).
Design:
Single center, prospective cohort study.
Setting:
Núcleo de Estudo de Doença de Chagas, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil.
Patients and Methods:
Anorectal manometry was performed in chagasic patients with different grades of colon involvement. Patients with positive serology for Chagas’ disease were included. Patients were divided in three groups according to barium enema: patients with normal colon (C), patients with megacolon (MC), and patients with megarectum (MR). Anorectal manometry with stationary technique was performed. The parameters analyzed are as follows: thresholds for first sensation, urgency to defecate, the lowest balloon volume that elicited RAIR and resting and squeeze pressures.
Main Outcome Measures:
To test RAIR with volumes up to 150 mL of air.
Sample Size:
A total of 60 patients were included.
Results:
The patients included 35 women and 25 men with a mean age of 58.8 years. RAIR was demonstrated in all groups: C in 86.4%, MC in 73.9%, and 40% in MR (P = 0.01). Constipation did not influence RAIR (P = 0.20) No statistical difference was observed in the three groups in relation to resting pressure, total contraction pressure, external anal sphincter pressure, and size of the functional anal canal. Volume to first sensation and maximal tolerable volume were higher in the MR group (P = 0.01).
Conclusion:
Most chagasic patients have RAIR in manometry studies and those with megacolon and megarectum need higher volumes of air in the rectal balloon to elicit RAIR. Constipation does not influence the presence of RAIR.
Limitations:
Barium enema is not a precise exam to define colorectal dilation.
Conflict of Interest:
The authors have no conflict of interest to declare. |
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| ISSN: | 1941-8213 |