Normal Values For High-resolution Anorectal Manometry In126Healthy Adults And The Study Of Its Affecting Factors

Backgrounds and objectives:Anorectal manometry can help us understand,quantify and evaluate the anorectalfunction of defecation homemade, it provides the pathophysiology basis and clinicalguide for the treatment of anorectal disease.At the sametime,anorectal manometrycan also be used to guide biofeedback therapy, and help to determine the surgery ofanorectal disease is useful.It is a simple, non-invasive and objective detectiontechnology. Anorectal manometry has been widely used in clinical diagnosis andresearch.Initially from the microtip manometry system to traditional water-perfusedmanometry system, to the high-resolution anorectal manometry system, until theemergence of3D high-resolution manometry system, the technology of anorectalmanometry has also rapidly development.There have been previous studies usingthese systems to obtain the normal range for each parameter of anorectal function inhealthy adults. Because of this, there is still a lack of study use uniform manometrytechniques and methods to obtain the normal range for each parameter of anorectalfunction.Even they use the uniform manometry techniques and methods, there is alsoexist problems that the existence of different race, different age and gender,differentsample size in selection of subjects.It resulting in limitations use of anorectalmanometry in clinical and in scientific research. Therefore, our study aimed to use auniform high resolution anorectal manometry system and test method,to establishnormal range for each parameters of anorectal function in healthy adults,and toinvestigate the effects of age, gender, cold stimulation on the anorectal manometry.Methods:Ⅰ.Normal values of high-resolution anorectal manometry in healthy adults andits age and gender differences.A total of110volunteers (including76females and50males)were recruited.Allthe patients volunteers were required to meet the inclusion criteria and exclusioncriteria.Their age was range from19-65years old (67members under the age of40years old,59members over40years old),all of them were taken anorectal manometry in the left lateral position,and then successively recorded and analyzed the analresting pressure, maximum squeeze pressure, the length of the anal sphincter (highpressure zone length),parameters of anorectal function when bear down as indefecation (anal residual pressure,rectoanal pressure differential, anal relaxation rate),rectal perception threshold(first sensation threshold,desire to defecate threshold,urgeto defecate threshold,the maximum tolerated threshold).Finally investigate the ageand gender differences of anorectal manometry.Groups divided as follows:①Gender group:76females and50males;②Age group:67members under the age of40years old,59members over40years old.Ⅱ.Cold stimulation conditions on the effects of high resolution anorectalmanometry of health adults.Against these healthy adult volunteers who meet the inclusion and exclusioncriteria above, to seek their consent in the case and to consider their personaltolerance,complete of64of them in the cold stimulation after normal anorectalmanometry.The methods was allowed the volunteers continue to urge the right handcompletely immersed in thermostatic container containing0℃cold water after afternormal manometry,1min each times at intervals of15s, repeated cycles and repeatthe data collection process as above.End of the cold stimulation manometryexperiments until all the data have been recorded,and then analysis its difference withthe normal group.Results:Ⅰ.Normal values of high-resolution anorectal manometry in healthy adults andits age and gender differences.①Normal values of high-resolution anorectal manometry in healthy adults:normal values of anorectal manometry of126healthy adults was as follows(x±SD):mean resting pressure was71.8±17.3mmHg; maximum resting pressure was79.3±17.8mmHg; maximum squeeze pressure178.7±52.8mmHg;duration ofsustained squeeze was12.2±3.6s;anal sphincter length (high pressure zone length)was3.4±0.6cm; anal residual pressure was63.8±20.5mmHg, rectoanal pressuredifferential was-10.1±20.4mmHg,anal relaxation rate was37.0±11.5%;first sensation threshold was47.4±10.0ml,desire to defecate threshold was84.5±18.2ml,urge todefecate threshold was125.8±28.5ml,the maximum tolerated threshold was175.5±36.1ml.②Gender differences in high-resolution manometry:There was no significantdifference in mean resting pressure,maximum resting pressure and the length of theanal sphincter between males and females.The maximum squeeze pressure wassignificantly higher in males compared to females.When bear down as indefecation,anal residual pressure was higher in males compared to females,analrelaxation rate was lower in males compared to females. There was no differencebetween the two groups in rectoanal pressure differential. In rectal sensory thresholds,the first sensation threshold, desire to defecate threshold and urge to defecatethreshold were no statistical difference between males and females, males have highermaximum tolerance threshold than females.③Comparison of different age groups in high-resolution manometry:Thecontrast between the two (≤40years old and>40years old) age groups, there is nosignificant difference in the younger group and the older group on the anal sphincterlength and duration of sustained squeeze.The mean resting pressure,maximum restingpressure,and maximum squeeze pressure were inversely correlated values were higherin younger than in older healthy volunteers.When bear down as in defecation,Therewas no difference in anal residual pressure,rectoanal pressure differential and analrelaxation rate in the younger group and the older group. In rectal sensory thresholds,the first sensation threshold, desire to defecate threshold and maximum tolerancethreshold were no statistical difference between younger and older group, and theformer have higher urge to defecate threshold than the latter.Ⅱ.Cold stimulation conditions on the effects of high resolution anorectalmanometry of health adults:In the cold stimulus conditions:The mean resting pressureand maximum resting pressure was higher in cold stimulation conditions.There wasno significant difference in the duration of sustained squeeze and maximum squeezepressure between the two conditions.It was higher of anal sphincter length whenvolunteers manometry in cold stimulation conditions.When bear down as indefecation,the negative of rectoanal pressure differential was lower in cold stimulation conditions. There was no difference between the two groups in analresidual pressure and anal relaxation rate.In rectal sensory thresholds, the firstsensation threshold, desire to defecate threshold were no statistical differencebetween cold stimulation and normal group.In cold stimulation conditions,themaximum tolerance threshold and urge to defecate threshold was higher than normalgroup.Conclusion:1.This article through high resolution anorectal manometry on126healthy adultsinitially built the normal value for each parameter of anorectal function in China.2.Age and gender are related factors which can influence high resolutionanorectal manometry.The volunteer who have older age, means lower restingpressure,maximum resting pressure,and maximum squeeze pressure.The maximumsqueeze pressure was significantly higher in males compared to females.When beardown as in defecation,anal residual pressure was higher in males compared tofemales,anal relaxation rate was lower in males compared to females. Males havehigher maximum tolerance threshold than females.3.The mean resting pressure and maximum resting pressure was higher in coldstimulation conditions,and the anal sphincter length may change to be shorter.Themaximum tolerance threshold and urge to defecate threshold in cold stimulationconditions was higher than normal group.