Absent or impaired rectoanal inhibitory reflex as a diagnostic factor for high-grade (grade III–V) rectal prolapse: a retrospective study View Full Text


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Article Info

DATE

2021-04-07

AUTHORS

Byung-Soo Park, Sung Hwan Cho, Gyung Mo Son, Hyun Sung Kim, Yong-Hoon Cho, Dae Gon Ryu, Su Jin Kim, Su Bum Park, Cheol Woong Choi, Hyung Wook Kim, Tae Un Kim, Dong Soo Suh, Myunghee Yoon, Hong Jae Jo

ABSTRACT

BackgroundClinically diagnosing high-grade (III–V) rectal prolapse might be difficult, and the prolapse can often be overlooked. Even though defecography is the significant diagnostic tool for rectal prolapse, it is noticed that rectoanal inhibitory reflex (RAIR) can be associated with rectal prolapse. This study investigated whether RAIR can be used as a diagnostic factor for rectal prolapse.MethodsIn this retrospective study, we evaluated 107 patients who underwent both anorectal manometry and defecography between July 2012 and December 2019. Rectal prolapse was classified in accordance with the Oxford Rectal Prolapse Grading System. Patients in the high-grade (III–V) rectal prolapse (high-grade group, n = 30), and patients with no rectal prolapse or low-grade (I, II) rectal prolapse (low-grade group, n = 77) were analyzed. Clinical variables, including symptoms such as fecal incontinence, feeling of prolapse, and history were collected. Symptoms were assessed using yes/no surveys answered by the patients. The manometric results were also evaluated.ResultsFrequencies of fecal incontinence (p = 0.002) and feeling of prolapse (p < 0.001) were significantly higher in the high-grade group. The maximum resting (77.5 vs. 96 mmHg, p = 0.011) and squeezing (128.7 vs. 165 mmHg, p = 0.010) anal pressures were significantly lower in the high-grade group. The frequency of absent or impaired RAIR was significantly higher in the high-grade group (19 cases, 63% vs. 20 cases, 26%, p < 0.001). In a multivariate analysis, the feeling of prolapse (odds ratio [OR], 23.88; 95% confidence interval [CI], 4.43–128.78; p < 0.001) and absent or impaired RAIR (OR, 5.36; 95% CI, 1.91–15.04, p = 0.001) were independent factors of high-grade (III–V) rectal prolapse. In addition, the percentage of the absent or impaired RAIR significantly increased with grading increase of rectal prolapse (p < 0.001). The sensitivity of absent or impaired RAIR as a predictor of high-grade prolapse was 63.3% and specificity 74.0%.ConclusionsAbsent or impaired RAIR was a meaningful diagnostic factor of high-grade (III–V) rectal prolapse. Furthermore, the absent or impaired reflex had a positive linear trend according to the increase of rectal prolapse grading. More... »

PAGES

157

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12876-021-01729-1

DOI

http://dx.doi.org/10.1186/s12876-021-01729-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1136994122

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/33827447


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    "description": "BackgroundClinically diagnosing high-grade (III\u2013V) rectal prolapse might be difficult, and the prolapse can often be overlooked. Even though defecography is the significant diagnostic tool for rectal prolapse, it is noticed that rectoanal inhibitory reflex (RAIR) can be associated with rectal prolapse. This study investigated whether RAIR can be used as a diagnostic factor for rectal prolapse.MethodsIn this retrospective study, we evaluated 107 patients who underwent both anorectal manometry and defecography between July 2012 and December 2019. Rectal prolapse was classified in accordance with the Oxford Rectal Prolapse Grading System. Patients in the high-grade (III\u2013V) rectal prolapse (high-grade group, n\u2009=\u200930), and patients with no rectal prolapse or low-grade (I, II) rectal prolapse (low-grade group, n\u2009=\u200977) were analyzed. Clinical variables, including symptoms such as fecal incontinence, feeling of prolapse, and history were collected. Symptoms were assessed using yes/no surveys answered by the patients. The manometric results were also evaluated.ResultsFrequencies of fecal incontinence (p\u2009=\u20090.002) and feeling of prolapse (p\u2009<\u20090.001) were significantly higher in the high-grade group. The maximum resting (77.5 vs. 96\u00a0mmHg, p\u2009=\u20090.011) and squeezing (128.7 vs. 165\u00a0mmHg, p\u2009=\u20090.010) anal pressures were significantly lower in the high-grade group. The frequency of absent or impaired RAIR was significantly higher in the high-grade group (19 cases, 63% vs. 20 cases, 26%, p\u2009<\u20090.001). In a multivariate analysis, the feeling of prolapse (odds ratio [OR], 23.88; 95% confidence interval [CI], 4.43\u2013128.78; p\u2009<\u20090.001) and absent or impaired RAIR (OR, 5.36; 95% CI, 1.91\u201315.04, p\u2009=\u20090.001) were independent factors of high-grade (III\u2013V) rectal prolapse. In addition, the percentage of the absent or impaired RAIR significantly increased with grading increase of rectal prolapse (p\u2009<\u20090.001). The sensitivity of absent or impaired RAIR as a predictor of high-grade prolapse was 63.3% and specificity 74.0%.ConclusionsAbsent or impaired RAIR was a meaningful diagnostic factor of high-grade (III\u2013V) rectal prolapse. Furthermore, the absent or impaired reflex had a positive linear trend according to the increase of rectal prolapse grading.", 
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19 schema:description BackgroundClinically diagnosing high-grade (III–V) rectal prolapse might be difficult, and the prolapse can often be overlooked. Even though defecography is the significant diagnostic tool for rectal prolapse, it is noticed that rectoanal inhibitory reflex (RAIR) can be associated with rectal prolapse. This study investigated whether RAIR can be used as a diagnostic factor for rectal prolapse.MethodsIn this retrospective study, we evaluated 107 patients who underwent both anorectal manometry and defecography between July 2012 and December 2019. Rectal prolapse was classified in accordance with the Oxford Rectal Prolapse Grading System. Patients in the high-grade (III–V) rectal prolapse (high-grade group, n = 30), and patients with no rectal prolapse or low-grade (I, II) rectal prolapse (low-grade group, n = 77) were analyzed. Clinical variables, including symptoms such as fecal incontinence, feeling of prolapse, and history were collected. Symptoms were assessed using yes/no surveys answered by the patients. The manometric results were also evaluated.ResultsFrequencies of fecal incontinence (p = 0.002) and feeling of prolapse (p < 0.001) were significantly higher in the high-grade group. The maximum resting (77.5 vs. 96 mmHg, p = 0.011) and squeezing (128.7 vs. 165 mmHg, p = 0.010) anal pressures were significantly lower in the high-grade group. The frequency of absent or impaired RAIR was significantly higher in the high-grade group (19 cases, 63% vs. 20 cases, 26%, p < 0.001). In a multivariate analysis, the feeling of prolapse (odds ratio [OR], 23.88; 95% confidence interval [CI], 4.43–128.78; p < 0.001) and absent or impaired RAIR (OR, 5.36; 95% CI, 1.91–15.04, p = 0.001) were independent factors of high-grade (III–V) rectal prolapse. In addition, the percentage of the absent or impaired RAIR significantly increased with grading increase of rectal prolapse (p < 0.001). The sensitivity of absent or impaired RAIR as a predictor of high-grade prolapse was 63.3% and specificity 74.0%.ConclusionsAbsent or impaired RAIR was a meaningful diagnostic factor of high-grade (III–V) rectal prolapse. Furthermore, the absent or impaired reflex had a positive linear trend according to the increase of rectal prolapse grading.
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26 schema:keywords MethodsIn
27 ResultsFrequency
28 absent
29 accordance
30 addition
31 anal pressure
32 analysis
33 anorectal manometry
34 clinical variables
35 defecography
36 diagnostic factors
37 diagnostic tool
38 factors
39 fecal incontinence
40 feelings
41 frequency
42 grading
43 grading system
44 group
45 high-grade group
46 high-grade prolapse
47 history
48 incontinence
49 increase
50 independent factors
51 inhibitory reflex
52 linear trend
53 manometric results
54 manometry
55 maximum resting
56 multivariate analysis
57 patients
58 percentage
59 positive linear trend
60 predictors
61 pressure
62 prolapse
63 prolapse grading
64 rectal prolapse
65 rectoanal inhibitory reflex
66 reflex
67 resting
68 results
69 retrospective study
70 sensitivity
71 significant diagnostic tool
72 study
73 survey
74 symptoms
75 system
76 tool
77 trends
78 variables
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