Tu2029 Does Dyssynergy on High Resolution Anorectal Manometry Correlate With Specific Symptoms?

Abstract

BACKGROUND: Although the pathophysiology and management of dyssynergic defecation (DD) differs from that of other types of constipation, it shares many of the same symptoms. The diagnosis of DD relies largely on anorectal manometry, defecography, or balloon expulsion tests, which are not available in all practices. Ideally, a specific symptom from the history could suggest DD, leading the physician to efficiently utilize these resources. METHODS: For 5months, data was prospectively collected frompatients undergoing high resolution anorectal manometry (HRARM) for an indication of constipation. Patients completed the validated questionnaire “patient assessment of constipation” (PAC-SYM) and a 7 item bowel habits questionnaire (BHQ) prior to HRARM. The BHQ was designed to further characterize the evacuation process such as need and frequency for digital extraction of stool (TABLE 1). HRARM was performed using a solid state catheter with 10 circumferential sensors spaced at 0.6cm intervals. Sensation was assessed by inflating the rectal balloon with saline at 10cc increments. HRARMs were analyzed and mean anorectal pressures were collected. Presence of a dyssynergy pattern (either paradoxical contraction or inadequate relaxation of the anal sphincter) was noted. Statistical analysis was performed using Spearman's correlation coefficient and the point biserial correlation coefficient. RESULTS: Thirty patients presenting for HRARM fully completed the questionnaires. The median age was 39, 83.4% patients were female, 16.6% male, 70% were white, 23.3% black, and 6.7% other races. The mean total PAC-SYM score was 21 (range 7-41) of which 0 is the minimum and 48 the maximum score possible. The mean total BHQ score was 6.7 (range 2-12) of which 0 is the minimum and 28 the maximum score possible. On HRARM, a dyssynergy pattern was seen in 70% of the patients, of which 58.8%were characterized by paradoxical contraction of the sphincter and 41.2% by inadequate relaxation. Impaired rectal sensation was seen in 79% of patients. There was no statistically significant correlation between the total PAC-SYM score, total BHQ score, or score from any individual question and the presence of dyssynergy. There was no significant correlation between the total PAC-SYM score, total BHQ score, or score from any individual question and the percent anal relaxation during bear down maneuvers (TABLE 2). CONCLUSION: Even with the inclusion of a customized bowel habit questionnaire that aimed totarget anorectal symptoms, a significant correlation between symptoms and dyssynergy could not be found. This highlights the importance of a focused rectal exam and physiologic testing such as anorectal manometry in the diagnosis of DD. Bowel Habits Questionnaire (BHQ)