Omesh Goyal
D.M.C. and Hospital, India
Biography
Statement of the Problem: Functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) are a part of functional bowel disorders, and have a significant personal, healthcare, and social impact. Evaluation by anorectal manometry is essential in these cases for targeted treatment. Data on the anorectal manometric abnormalities in these patients is scarce. We aimed to study the anorectal manometric abnormalities in patients with functional constipation and constipation-predominant IBS in northern India. Methodology & Theoretical Orientation: A total of 114 consecutive patients with the history of chronic constipation who underwent anorectal manometry from January 2013 to December 2016 in a tertiary care institute were enrolled. Standard laboratory tests and colonoscopy were normal. Twenty-six healthy volunteers served as controls. Finding: The mean age was 46.7 years, 75.4% were males, and the median duration of constipation was 60 months. Sixty-two patients satisfied ROME IV criteria for functional constipation (FC) and 52 had Irritable bowel syndrome- constipation predominant (IBS-C). A comparison of the anorectal motor and sensory manometry parameters along with healthy controls is shown in the table. The resting anal pressure and the squeeze pressure were similar in all subgroups. Dyssynergic pattern of defecation was seen in significantly more patients in the FC group (p<0.001). The first sensation threshold was significantly higher among FC patients. The thresholds for the desire to defecate and maximum tolerable volume were significantly higher among FC and IBS-C patients compared to controls. Conclusions and significance: Dyssynergic pattern of defecation is seen in significantly more patients with FC compared to IBS-C. Patients with FC have marked the elevation of all sensory thresholds, while IBS-C patients have similar first sensation threshold with the elevated threshold for urge and maximum tolerance.