Anorectal manometry is a functional diagnostic study of the anorectal zone by the method of manometry in order to obtain information about the tone of the anorectal muscle complex and the coordination of contractions of the rectum and anus sphincters . Procedure code A05.19.002. [one]
Medical care standards approved by the Ministry of Health and Social Development of Russia determine the need for anorectal manometry in 100% of patients with Hirschsprung’s disease [1] [2] , diverticular bowel disease [3] and megacolon . [four]
Content
- 1 Intestinal manometry
- 2 Indications for anorectal manometry
- 3 Indications for colonic manometry
- 4 Technical means
- 4.1 Anorectal and colonic catheters
- 5 Test characteristics
- 6 Sources
Colonic manometry
Colonic manometry is a method for examining the human colon , based on recording pressure in the colon. It is a development of anorectal manometry. Some researchers do not distinguish colonic manometry as a separate method, but consider it a variant of anorectal manometry.
Indications for anorectal manometry
Indications for anorectal manometry are:
- constipation [5] (constipation of inorganic origin);
- Hirschsprung's disease ; [1] [2]
- megacolon ; [four]
- diverticular bowel disease; [3]
- irritable bowel syndrome ;
- fecal incontinence ;
- the need for accurate identification and functional assessment of the external and internal anal sphincters ;
- the need to identify resistance to taking various drugs; [6] [7]
- the need to evaluate the effectiveness of the treatment;
- the need to assess the functional state of the colon before and after surgery; [6]
- the need to assess the volume of surgical intervention in operations for anal fissure ; [8]
- non-drug biofeedback therapy for pelvic floor dysfunction and fecal incontinence. [6]
Indications for colonic manometry
Indications for colonic manometry are:
- persistent constipation resistant to conventional therapy;
- the need to prove the correspondence of the symptoms of chronic intestinal pseudo-obstruction by involvement in the colon process;
- the need to identify the causes of intestinal manifestations after a successful operation for Hirschsprung's disease;
- unexplained causes of impaired colon motility;
- the need to address the preservation of colon function before surgery on the intestine. [9]
Hardware
Anorectal and colonic catheters
In anorectal (colonic) manometry, catheters or water-perfusion, or with solid-state sensors can be used. Solid-state pressure sensors are characterized by their fragility and high cost, which significantly limits their application. [10] [11]
By design, water-perfusion anorectal catheters can be balloon or standard. The design of the balloon differs from other types of catheters used, for example, with esophageal or antroduodenal manometry , in that a balloon is located at its end. Of the standard design catheters, 4 or 8 channel water-perfusion catheters are used with ports radially located at an angle of 45 ° to each other and with a distance of 7 cm between them. [12]
Test Characteristics
In the process of research, the following parameters and characteristics are determined:
- maximum and average compression pressure of the external sphincter of the anus ;
- asymmetry of compression of the sphincter;
- inhibitory rectoanal reflex;
- vector volume;
- sphincter length;
- pressure profile in the rectum in 1 cm increments. [12]
The use of a catheter with a balloon allows you to determine:
- threshold of rectal sensitivity (the minimum volume necessary for the appearance of a feeling of intestinal fullness is less than or equal to 25 ml);
- the minimum volume for relaxing the internal anal sphincter (the volume at which the first urge to defecate occurs; normally 10–20 ml);
- the threshold for a constant urge to defecate (the volume required for the appearance of a constant urge; normally less than or equal to 220 ml) and
- maximum tolerated volume (normal - 110-280 ml). [12]
Sources
- ↑ 1 2 3 Standard of care for patients with Hirschsprung’s disease . Approved by order of the Ministry of Health and Social Development of Russia dated February 9, 2006 No. 73. (Retrieved June 21, 2011)
- ↑ 1 2 Standard of medical care for patients with Hirschsprung's disease (in the provision of specialized care) . Approved by order of the Ministry of Health and Social Development of Russia dated May 29, 2007 No. 362. (Retrieved June 21, 2011)
- ↑ 1 2 Standard of care for patients with diverticular bowel disease . Approved by order of the Ministry of Health and Social Development of Russia dated February 9, 2006 No. 72. (Retrieved June 21, 2011)
- ↑ 1 2 Standard of care for patients with megacolon. Approved by order of the Ministry of Health and Social Development of Russia dated February 9, 2006 No. 67. (Retrieved June 21, 2011)
- ↑ Practical Guide for the World Organization of Gastroenterologists . Constipation (inaccessible link) .
- ↑ 1 2 3 Therapeutic clinic of the road clinical hospital at Khabarovsk-I station .
- ↑ Venorm
- ↑ Pankratov I.V., Karpovich A.V. Use of anorectal manometry and profilometry in the treatment of chronic anal fissure . Theses of participants of the III Congress of Surgeons of Siberia and the Far East (Tomsk). 2009.
- ↑ Potapov A.S., Tsimbalova E.G., Baranov K.N., Polyakova S.I. Combined Therapy for Chronic Constipation in Children Archived April 14, 2009 by Wayback Machine . Scientific Center for Children's Health RAMS.
- ↑ Onopriev V.I. , Korotko G.F., Korochanskaya N.V. Complicated forms of duodenal ulcer / Publisher of the Kuban State Medical Academy. - Krasnodar, 2004 .-- 540 s. ISBN 5-88301-074-1 .
- ↑ Ravich WJ Pharyngeal Manometry. - Gastrointestinal Motility in Health and Disease. 2-d edition. 2002, BC Decker Inc. Hamilton, London. (eng.)
- ↑ 1 2 3 Stendal Ch. Practical Guide to Gastrointestinal Function Testing. Blackwell Science Ltd., 1997, 280 p. ISBN 0-632-04918-9 . (eng.) .