The Experts below are selected from a list of 1539 Experts worldwide ranked by ideXlab platform
Mark S Scott - One of the best experts on this subject based on the ideXlab platform.
-
systematic evaluation of cough Anorectal Pressure responses in health and in fecal incontinence a high resolution Anorectal manometry study
Neurogastroenterology and Motility, 2021Co-Authors: Annika M P Rasijeff, Emma V Carrington, Charles H Knowles, Karla Rocio Garciazermeno, Mark S ScottAbstract:BACKGROUND Anorectal manometry is the most commonly performed test of Anorectal function. The cough-Anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined Anorectal Pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements. METHODS High-resolution Anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-Anorectal Pressure responses were analyzed between groups by qualitative and quantitative approaches. KEY RESULTS In health, traditional anal Pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal Pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P < 0.036). This measure also differed significantly between nulliparous HVs and patients with FI (-2 mm Hg (95% CI: -15-12), P < 0.001), but not between parous HVs and FI. Qualitatively, a color-contour trace resembling a "spear" in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%. CONCLUSIONS AND INFERENCES Novel HR-ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough-Anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.
-
diagnostic accuracy study of Anorectal manometry for diagnosis of dyssynergic defecation
Gut, 2016Co-Authors: Ugo Grossi, Emma V Carrington, Adil E Bharucha, Emma J Horrocks, Mark S Scott, Charles H KnowlesAbstract:Objective The diagnostic accuracy of Anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design Derived line plots of Anorectal Pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these Pressure profiles were characterised as normal (ie, increased rectal Pressure coordinated with anal relaxation) or types I–IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I–IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia (‘paradoxical’ contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as ‘abnormal’ by AM. Hence, AM is of limited utility for distinguishing between FC and HV.
Satish S C Rao - One of the best experts on this subject based on the ideXlab platform.
-
Anorectal manometry in defecatory disorders a comparative analysis of high resolution Pressure topography and waveform manometry
Journal of Neurogastroenterology and Motility, 2018Co-Authors: Yeong Yeh Lee, Askin Erdogan, Annie Dewitt, Satish S C RaoAbstract:Background/Aims Whether high-resolution Anorectal Pressure topography (HRPT), having better fidelity and spatio-temporal resolution is comparable to waveform manometry (WM) in the diagnosis and characterization of defecatory disorders (DD) is not known. Methods Patients with chronic constipation (Rome III) were evaluated for DD with HRPT and WM during bearing-down "on-bed" without inflated rectal balloon and "on-commode (toilet)" with 60-mL inflated rectal balloon. Eleven healthy volunteers were also evaluated. Results Ninety-three of 117 screened participants (F/M = 77/16) were included. Balloon expulsion time was abnormal (＞ 60 seconds) in 56% (mean 214.4 seconds). A modest correlation between HRPT and WM was observed for sphincter length (R = 0.4) and likewise agreement between dyssynergic subtypes (κ = 0.4). During bearing down, 2 or more anal Pressure-segments (distal and proximal) could be appreciated and their expansion measured with HRPT but not WM. In constipated vs healthy participants, the proximal segment was more expanded (2.0 cm vs 1.0 cm, P = 0.003) and of greater Pressure (94.8 mmHg vs 54.0 mmHg, P = 0.010) during bearing down on-commode but not on-bed. Conclusions Because of its better resolution, HRPT may identify more structural and functional abnormalities including puborectal dysfunction (proximal expansion) than WM. Bearing down on-commode with an inflated rectal balloon may provide additional dimension in characterizing DD.
-
accuracy and reproducibility of high definition Anorectal manometry and Pressure topography analyses in healthy subjects
Clinical Gastroenterology and Hepatology, 2015Co-Authors: Enrique Cossadame, Satish S C Rao, Jessica Valestin, Amyra Aliazamar, J M RemestrocheAbstract:Background & Aims High-definition Anorectal manometry (HDAM-3D) provides a topographic and 3-dimensional profile of Anorectal Pressure. We assessed Anorectal sensorimotor function and the reproducibility of measurements made with HDAM-3D in healthy adults, and the accuracy of data analysis by its software. Methods Anal sphincter Pressures and rectal sensory thresholds were measured in 78 healthy subjects via placement of a 10-mm rigid probe, with 256 circumferentially arrayed Pressure sensors, and a balloon in the rectum. The bearing down maneuver was assessed in a subset of 18 subjects. We compared data analyzed by an expert with findings from automated software analysis. Measurements made in a subset of 16 subjects, 2 weeks apart, were compared to determine reproducibility. Results Resting, squeezing, and sustained squeezing Pressures were significantly higher in men than in women ( P P 50 years) had significantly lower resting ( P P r = 0.81), as did analyses made by an expert vs software analyses of data ( r = 0.99). Conclusions On the basis of HDAM-3D measurements in healthy adults, anal sphincter Pressures are higher in men than in women, but sensory and other parameters are similar; older subjects have weaker sphincters. Many people were found to have dyssynergic patterns of defecation, which could be related to the probe or other technical issues, so this technique may not be suitable for assessing defecation patterns. Measurements made by HDAM-3D are reproducible, and data can be accurately analyzed by its software.
Charles H Knowles - One of the best experts on this subject based on the ideXlab platform.
-
systematic evaluation of cough Anorectal Pressure responses in health and in fecal incontinence a high resolution Anorectal manometry study
Neurogastroenterology and Motility, 2021Co-Authors: Annika M P Rasijeff, Emma V Carrington, Charles H Knowles, Karla Rocio Garciazermeno, Mark S ScottAbstract:BACKGROUND Anorectal manometry is the most commonly performed test of Anorectal function. The cough-Anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined Anorectal Pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements. METHODS High-resolution Anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-Anorectal Pressure responses were analyzed between groups by qualitative and quantitative approaches. KEY RESULTS In health, traditional anal Pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal Pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P < 0.036). This measure also differed significantly between nulliparous HVs and patients with FI (-2 mm Hg (95% CI: -15-12), P < 0.001), but not between parous HVs and FI. Qualitatively, a color-contour trace resembling a "spear" in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%. CONCLUSIONS AND INFERENCES Novel HR-ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough-Anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.
-
diagnostic accuracy study of Anorectal manometry for diagnosis of dyssynergic defecation
Gut, 2016Co-Authors: Ugo Grossi, Emma V Carrington, Adil E Bharucha, Emma J Horrocks, Mark S Scott, Charles H KnowlesAbstract:Objective The diagnostic accuracy of Anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design Derived line plots of Anorectal Pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these Pressure profiles were characterised as normal (ie, increased rectal Pressure coordinated with anal relaxation) or types I–IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I–IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia (‘paradoxical’ contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as ‘abnormal’ by AM. Hence, AM is of limited utility for distinguishing between FC and HV.
Emma V Carrington - One of the best experts on this subject based on the ideXlab platform.
-
systematic evaluation of cough Anorectal Pressure responses in health and in fecal incontinence a high resolution Anorectal manometry study
Neurogastroenterology and Motility, 2021Co-Authors: Annika M P Rasijeff, Emma V Carrington, Charles H Knowles, Karla Rocio Garciazermeno, Mark S ScottAbstract:BACKGROUND Anorectal manometry is the most commonly performed test of Anorectal function. The cough-Anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined Anorectal Pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements. METHODS High-resolution Anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-Anorectal Pressure responses were analyzed between groups by qualitative and quantitative approaches. KEY RESULTS In health, traditional anal Pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal Pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P < 0.036). This measure also differed significantly between nulliparous HVs and patients with FI (-2 mm Hg (95% CI: -15-12), P < 0.001), but not between parous HVs and FI. Qualitatively, a color-contour trace resembling a "spear" in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%. CONCLUSIONS AND INFERENCES Novel HR-ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough-Anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.
-
diagnostic accuracy study of Anorectal manometry for diagnosis of dyssynergic defecation
Gut, 2016Co-Authors: Ugo Grossi, Emma V Carrington, Adil E Bharucha, Emma J Horrocks, Mark S Scott, Charles H KnowlesAbstract:Objective The diagnostic accuracy of Anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design Derived line plots of Anorectal Pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these Pressure profiles were characterised as normal (ie, increased rectal Pressure coordinated with anal relaxation) or types I–IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I–IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia (‘paradoxical’ contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as ‘abnormal’ by AM. Hence, AM is of limited utility for distinguishing between FC and HV.
Adil E Bharucha - One of the best experts on this subject based on the ideXlab platform.
-
high resolution Anorectal manometry an expensive hobby or worth every penny
Neurogastroenterology and Motility, 2017Co-Authors: G Basilisco, Adil E BharuchaAbstract:Introduced approximately 10 years ago, high-resolution manometry catheters have fostered interest in Anorectal manometry. This review, which accompanies two articles in this issue of Neurogastroenterology and Motility, reviews the methods, clinical indications, utility, and pitfalls of Anorectal manometry and revisits the American Gastroenterological Association (AGA) Medical Position Statement on Anorectal Testing Techniques, which was last published in 1999. High-resolution manometry provides a refined assessment of the Anorectal Pressure profile, obviates the need for station pull-through maneuvers, and minimizes movement artifacts. In selected cases, this refined assessment may be useful for identifying structural abnormalities or anal weakness. However, many manometry patterns that were previously regarded as abnormal are also observed in a majority of healthy patients, which substantially limits the utility of manometry for identifying defecatory disorders. It is our impression that most conclusions of the AGA medical position statement from 1999 remain valid today. High-resolution techniques have not substantially affected the number of publications on or management of Anorectal disorders. The ongoing efforts of an international working group to standardize techniques for Anorectal manometry are welcome. Although high-resolution manometry is more than an expensive hobby, improvements in catheter design and further research to rigorously define and evaluate these techniques are necessary to determine if they are worth every penny.
-
diagnostic accuracy study of Anorectal manometry for diagnosis of dyssynergic defecation
Gut, 2016Co-Authors: Ugo Grossi, Emma V Carrington, Adil E Bharucha, Emma J Horrocks, Mark S Scott, Charles H KnowlesAbstract:Objective The diagnostic accuracy of Anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design Derived line plots of Anorectal Pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these Pressure profiles were characterised as normal (ie, increased rectal Pressure coordinated with anal relaxation) or types I–IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I–IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia (‘paradoxical’ contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as ‘abnormal’ by AM. Hence, AM is of limited utility for distinguishing between FC and HV.