Young Investigator: Use of High Resolution Anorectal Manometry in UC Patients in Remission With Persistent Anorectal Symptoms

Abstract

BACKGROUND: A group of patients with UC continue to present symptomatology despite being in remission. Previous studies with conventional anorectal manometry in patients with active UC or remission, decreased rectal compliance was reported, and sphincter pressures within normal parameters. Because of inflammation-induced fibrosis in activity periods, decreased rectal compliance has been proposed as the cause of persistent symptomatology, in remission. Our aim was evaluated UC patients in remission with persistent anorectal symptoms with HRAM. METHODS: Patients in remission in the Montreal and Mayo activity score for colonoscopy, from July 1, 2015 to June 31, 2016. Inclusion criteria:> 18 years, anorectal symptoms, signing of consent for HRAM. Exclusion criteria: alterations in proctological examination, loss of remission, anorectal surgery. A Manoscan 360 Sierra Scientific device with solid-state catheter, Manoview 2.1 software, was used. The mean volume for the first sensation, sensation and urgency of defecation, mean basal pressure of the sphincter and maximum contraction were reported. We analyzed the association between symptoms and HRAM results with the t test, and the association between symptoms and the extent of disease and evolution with X2. P=<0.5 to two tails was taken as significant. Analyzed with SPSS v22. RESULTS: The inclusion criteria were 17 patients with anorectal symptoms, 9 accepted HRAM. The median age: 59 years, with 14 years of evolution, 66.7% female gender. Patients who accepted HRAM, according to Montreal: E3 44.4%, E1 33.3% and E2 22.2%; 66.7% were Mayo 1 and Mayo 0, 33.3%. 55.6% had tenesmus, fecal incontinence 22.2%, proctalgia 22.2% and constipation 22.2%. Two patients had constipation and tenesmus, one proctalgia and tenesmus. The median anal resting and squeeze of female patients: anal resting 71.25 mmHg (42.5-75.9), squeeze 132 mmHg (86.7-267.5). In male patients: anal resting 84.6 (82.6-92.3) and squeeze 251.4 mmHg (208.9-273.2). Volume for first sensation in female: 40 mL (30-50) and urge to defecate 150 mL (120-160). Volume in male: first sensation 50 mL (20-60) and urge to defecate 140 mL (140-150). Two presented paradoxical contraction. We found correlation of proctalgia with first sensation with P=0.210 and urge to defecate P=0.015. There was no relationship of symptoms with years of evolution or extension of UC. CONCLUSION(S): The persistence of anorectal symptoms in patients with UC in remission is high. In our study, the most frequent symptom is tenesmus (55.6%). Patients had hyposensitivity and decreased rectal capacity. The anorectal symptoms are not related to years of evolution and extent of disease. There is correlation between proctalgia and changes in rectal capacity reported in HRAM.