Manometric Investigation of Anorectal Dysfunction in Patients with Progressive Systemic Sclerosis

Choi, Hong Jo; Lim, Hyun Sung; Park, Ki Jae; Chung, Won Tae; Lee, Sung Won

Abstract

PURPOSE: The aim of this study was to investigate the anorectal function in patients with progressive systemic sclerosis (PSS), thus to define the clinical role of anorectal manometry in the earlier diagnosis of anorectal involvement of PSS.
METHODS
Seventeen consecutive patients (all females) with PSS were evaluated with anorectal manometry by the stationary pullthrough technique using the 8-channel hydraulic capillary infusion system for anorectal function. Functional parameters of the manometry were compared between patients with PSS and 20 normal control subjects, matched for age and sex.
RESULTS
The mean resting pressure over the high pressure zone (HPZ) in patients with PSS was significantly lower than that in the control group (70.8 3.4 mmHg vs. 81.5 3.2 mmHg: P=0.046). The HPZ in patients with PSS was also significantly reduced compared with that in the control (1.5 0.1 cm vs. 2.5 0.1 cm: P=0002). The rectoanal inhibitory reflex (RAIR) was detected in only 10 patients (59%) in the PSS group, but was present in all except one (95%) in the control (P=0.022). More interestingly, RAIR in patients with PSS responded at a higher volume of the air insufflated than that in the control (74% vs. 30% at 20 cc, 21% vs. 30% at 30 cc, and 0% vs. 40% at 50 cc, respectively: P=0.031). Other functional parameters, including maximal squeeze pressure, minimal sensory and maximal tolerable volume of the rectum, and rectal compliance were not significantly different between two groups.
CONCLUSIONS
Anorectal involvement reflected by the anorectal manometric dysfunction may be rather an earlier event in patients with PSS. An awareness to perform an anorectal manometric study in every case of PSS may be necessary for earlier subclinical detection of anorectal involvement by the disease.