Analysis On The Characteristics Of Anorectal Functions In Patients With Ulcerative Colitis

Objective: To investigate the characteristics of anorectal functions by high resolution manometry,and then to prelimanarily explore the correlations between anorectal functions and clinical symptoms,and psychological health state in patients with ulcerative colitis(UC).Methods: UC and diarrhea-predominant irritable bowel syndrome(IBS-D)patietns were included in this study who were admitted into the Department of gastroenterology,the First Affiliated Hospital of Fujian Medical University from September 2020 to January 2021.The medical records were recorded in detail,and the gastrointestinal symptoms(GSRS Chinese version)were evaluated.Hospital Anxiety and Depression Scale(HADS)was used to evaluate psychological health status.Fecal calprotectin,erythrocyte sedimentation rate(ESR)and serum C-reactive protein were tested.Anorectal motor function and rectal sensation function were detected using the high-resolution anorectal manometry equipment produced by MMS Company in the Netherlands.Results: Fifteen IBS-D patients and 39 UC patients were included in the study.Among 39 UC cases,there were 16 cases in active stage(group UCA),10 cases with IBS-like symptoms in remission stage(group UCR+IBS),and 13 cases without IBS-like symptoms in remission stage(group UCR-IBS).There was no significant difference in baseline characteristics among the groups(P>0.05).(1)There was no significant difference in anal canal rest pressure,anal canal systolic pressure and anal canal maximum squeeze pressure between group UC(including active and remission)and group IBS-D(P>0.05).However,the rectal sensory threshold showed significantly change in different UC patients and IBS-D patients,which in UCA patients was the lowest,and followed by IBS-D patients and UCR+IBS patients(UCA<IBS-D=UCR+IBS<UCR-IBS)(P<0.05).(2)In UC patients(including active and remission),the symptom scores of diarrhea,and urgency were negatively correlated with the maximal tolerance threshold of the rectum respectively(r=-0.617,-0.416,P<0.05).(3)The scores of HADS-A and HADS-D in group UCR+IBS were respectively higher than in group UCR-IBS.In remission UC patients,the HADS-A score was negatively correlated with the strong defecation threshold and the maximum tolerance threshold(r=-0.456,-0.522,P<0.05),and the HADS-D score only was negatively correlated with the maximum tolerance threshold(r=-0.440,P<0.05).Conclusion:In these UC patients,the occurrence of symptoms such as diarrhea,urgent stool and incomplete defecation does not seem to be related to the change of of the anal sphincter pressure,however,it’s mainly related to the increased rectal sensitivity and the contradictory movement of anal sphincter.And psychological factors may involve in the phathogenesis of IBS-like symptoms in patients with remission UC.