J Neurogastroenterol Motil.  2025 Apr;31(2):276-284. 10.5056/jnm24019.

Validation of the London Classification for Rectal Hyposensitivity in an Anorectal Manometry Database of 2540 Patients With Functional Defecatory Disorder

• Seo J
• Jung KW
• Kim S
• Hong SW
• Hwang SW
• Park SH
• Yang DH
• Ye BD
• Byeon JS
• Myung SJ
• Yang SK

• KMID: 2567128
• DOI: http://doi.org/10.5056/jnm24019

Abstract

Background/Aims
Rectal hyposensitivity (RH), as defined by the London Classification, has been linked to sensory dysfunction caused by diabetes mellitus and Parkinson’s disease (PD); however, its clinical interpretation has not been sufficiently validated. In this study, we aim to explore the correlations between rectal sensory thresholds and the clinical characteristics of patients with functional defecatory disorders.
Methods
We reviewed data from patients who underwent high-resolution anorectal manometry and acquired their clinical characteristics using a standardized questionnaire. The associations between RH based on either 1 (borderline RH) or 2 (RH) abnormal rectal sensory thresholds and patients’ clinical and demographic characteristics were analyzed using linear and logistic regression models in the overall sex-stratified populations.
Results
We enrolled 2540 patients, of whom 1046 (41.2%) were men. Overall, 150 (5.9%) patients were diagnosed with RH, whereas 422 (16.6%) had borderline RH. Multivariate linear regression analysis revealed that the Cleveland Clinic Constipation Score (CCCS) increased linearly with the increase in the number of abnormal rectal sensory thresholds (effect per threshold: 0.900 [standard deviation: 0.188]). Upon stratification by sex, borderline RH was positively associated with diabetes mellitus, PD, and CCCS (adjusted odds ratio [aOR] = 2.11, 95% confidence interval [1.08, 4.15]; aOR = 1.49 [1.03, 2.14]; aOR = 1.03 [1.01, 1.05], respectively) in women. However, RH was positively associated with only the CCCS.
Conclusions
Defining RH based on 1 or more abnormal sensory thresholds showed better clinical correlation with patient characteristics. However, further prospective studies are needed to validate these findings before proposing revisions to the current London classification criteria.

Keyword

Anorectal manometry; Constipation; Defecatory disorder; Rectal hyposensitivity