In the literature, data on the effects of gender and age on the pressure data of anorectal manometry differ. Possible reasons are investigation of only small numbers of healthy people and comparison ...of only 2 groups with large age differences. In addition, data about the influence of gender or age on anorectal sensation are sparse. Therefore, the aim of the present study was to determine the influence of gender and age on anorectal manometry in a large healthy female and male cohort spanning a great age range.
Anorectal manometry was performed in 72 women and 74 men with a median age of 64 years in both groups (ranges: women 22-90 years; men 23-88 years). We determined mean anal resting and squeeze pressure as well as minimal rectal balloon volume for perception and for urge/desire to defecate. The Mann-Whitney U test was used to analyze for gender differences, regression analysis to search for age influences.
Squeeze pressure (p = 0.007) and perception threshold (p < 0.001) are significantly lower in females, while the mean resting pressure and urge threshold are similar in females and males. Mean resting pressure (women p < 0.0001; men p = 0.03) and mean squeeze pressure decrease (women p < 0.0001; men p = 0.004) with age. An age-related increase in sensory thresholds (= decreased rectal sensitivity) is only seen in females (perception threshold p = 0.01; urge threshold p = 0.04).
Most of the parameters measured by anorectal manometry (anal canal pressure, sensory thresholds) are influenced by gender and age. Therefore, the results of anorectal manometry must be interpreted in relation to sex- and age-adapted normal values.
Background Knowledge about human cyclic fasting motility (MMC) and the postprandial response is mostly based on manometric findings in the upper small intestine. Hardly any data exist on human ileal ...motility, as the acquisition of data has been limited by methodological concerns.
The aim was to study human jejunal and ileal motility in an optimized manometric setting.
Methods Solid‐state 24‐h‐manometry was performed in the jejunum and ileum of healthy individuals, applying a strict protocol for fasting, resting, and the consumption of a standardized meal. Both visual qualitative and validated computerized quantitative contraction and propagation analysis were performed.
Key Results MMC occurs in similar frequency in the jejunum and ileum, but it was significantly shorter in the jejunum at night. By many characteristics, ileal motility was less intense and propagative than jejunal: less migrating clustered contractions, and slower propagation velocity and shorter distance in phases II and III, and postprandially – possibly slowing and enhancing nutrient absorption. Prolonged propagated contractions in some individuals were identified as a unique ileal propulsive pattern. Postprandially, an abrupt conversion to a digestive motility pattern occurs simultaneously independent of the region.
Conclusions & Inferences We found similar basic phenomena of fasting and postprandial motility in the jejunum and ileum of healthy humans. However, different calibration of propagative and contractile activity and special motor events in the ileum may account for a different physiological role in digestion. Future studies of small‐bowel motility in healthy and diseased subjects focusing on segmental differences of proximal and distal intestine may be rewarded.
Summary
Background
As treatments for constipation become increasingly available, it is important to know when to progress along the treatment algorithm if the patient is not better.
Aim
To establish ...the definition of failure of a treatment to provide adequate relief (F‐PAR) to support this management and referral process in patients with chronic constipation.
Methods
We conducted an international Delphi Survey among gastroenterologists and general practitioners with a special interest in chronic constipation. An initial questionnaire based on recognised rating scales was developed following a focus group. Data were collected from two subsequent rounds of questionnaires completed by all authors. Likert scales were used to establish a consensus on a shorter list of more severe symptoms.
Results
The initial focus group yielded a first round questionnaire with 84 statements. There was good consensus on symptom severity and a clear severity response curve, allowing 67 of the symptom‐severity pairings to be eliminated. Subsequently, a clear consensus was established on further reduction to eight symptom statements in the final definition, condensed by the steering committee into five diagnostic statements (after replicate statements had been removed).
Conclusions
We present an international consensus on chronic constipation, of five symptoms and their severities, any of which would be sufficient to provide clinical evidence of treatment failure. We also provide data representing an expert calibration of commonly used rating scales, thus allowing results of clinical trials expressed in terms of those scales to be converted into estimates of rates of provision of adequate relief.
Data were collected concerning the patient satisfaction in the treatment of chronic constipation with laxatives.
An internet-based survey of female patients with chronic constipation and an online ...enquiry addressed to gastroenterologists in Germany were carried out.
492 female patients and 104 physicians participated in the survey. Only 20 % of the patients were currently consuming laxatives. Around one-third of those not using laxatives have had unsatisfactory experiences. Only 32 % of the participants currently taking laxatives were totally satisfied with their drugs. As a general rule several different preparations were tried. The laxatives most closely associated with satisfied patients were bisacodyl and sodium picosulfate, followed by macrogol. The main reasons for dissatisfaction were an insufficient relief of the constipation and a bloated feeling. The majority of the participants expressed an interest in new drugs for the treatment of constipation. The participating physicians stated that they saw several female patients per week who were not satisfied with their constipation treatment, but probably overestimate the proportion.
The present survey shows that the majority of women suffering from constipation do not take laxatives and also that about half of them were not satisfied with the agents tried. Only about one-third of the chronic users were totally satisfied. Thus, there is a clear need for new laxatives.
Patients with fecal incontinence (FI) have lower anal resting (MRP) and squeeze (MSP) pressure and an impaired sensitivity compared to healthy people. However, whether anorectal manometry (ARM) can ...separate precisely between health and disease is discussed controversially. The aim was to evaluate the accuracy of ARM in a huge cohort of patients and controls.
ARM was obtained in 144 controls and in 559 FI patients. MRP, MSP, and balloon volume at first perception (BVP) and urge sensation (BVU) were determined. Receiver operating curve analysis was used to determine optimal cut-offs and sensitivity, specificity and accuracy calculated.
FI patients showed lower MRP, MSP, BVU (p < 0.001) and a higher BVP (p = 0.007). Deterioration of the ARM parameter increased with FI severity. ARM demonstrated an excellent sensitivity (91.4%) and accuracy (85.8%), but only a moderate specificity (62.5%). The sensitivity of ARM rose with FI severity. The pressure data showed higher sensitivity and accuracy than the sensory data despite comparable specificity.
Sensitivity and accuracy of single ARM parameters is only moderate for the pressure data and poor for the sensory data. In contrast, ARM demonstrated an excellent sensitivity, a moderate specificity, and a convincing accuracy justifying its use in clinical routine.
Summary
Background
An induction of gastro‐oesophageal reflux has been reported after ingestion of alcoholic beverages in healthy volunteers. However, it is unknown whether reflux in ...gastro‐oesophageal reflux disease patients will be enhanced by the ingestion of alcoholic beverages.
Aim
To investigate the effects of wine and beer on postprandial reflux in reflux patients.
Methods
Twenty‐five patients (reflux oesophagitis 15, non‐erosive reflux disease 10; 18 men and seven women) drank 300‐mL white wine (n = 17), 500‐mL beer (n = 8), or identical amounts of tap water (controls) together with a standardized meal in a randomized order. pH‐measurement was carried out during three postprandial hours by pH‐metry and the percentage of time pH < 4 was calculated.
Results
Both alcoholic beverages increased reflux compared with water wine 23% (median), water 12%, P < 0.01; beer 25%, water 11%, P < 0.05. Between wine and beer, no difference in reflux induction was obtained. The reflux induction was seen in patients with (23%, P < 0.01) and without reflux oesophagitis (22%, P < 0.05) and in both sexes (women 23%, men 25%, P < 0.05 each).
Conclusions
Ingestion of commonly consumed alcoholic beverages such as wine and beer induces gastro‐oesophageal reflux in gastro‐oesophageal reflux disease patients. Therefore, these patients should be advised to avoid the intake of large amounts (≥300 mL) of these beverages.
Diabetes is frequently diagnosed in patients with cirrhosis and represents an important risk factor for morbidity and mortality. Pharmacological therapy is limited due to hepatotoxicity and the risk ...of hypoglycemia. Investigations on medical practice in this patient population, frequency of diabetes-associated complications and the impact of quality of metabolic control are rare.
A retrospective analysis was performed to compare the effects of hypoglycemic treatment, the achieved glycemic control under therapy, the prevalence of typical cirrhosis-related or microangiopathic complications, and cardiovascular comorbidities between a group of diabetic patients with cirrhosis (n = 87) and a nondiabetic cirrhotic population (n = 198).
The prevalence of diabetes in our cohort was 30.5%. Of all diabetic patients, 39.1% received therapy which might potentially result in serious side effects in patients with end-stage liver disease. The rate of ongoing alcohol abuse (28.7%) and noncompliance under medication (41.4%) was high. Only 28.7% of all diabetic subjects showed satisfactory (as defined by HbA1c ≤ 6.5%) glycemic control under therapy. Patients achieving satisfactory control experienced a lower rate of certain cirrhosis-related complications such as hepatic encephalopathy (HE) and hepatocellular carcinoma (HCC), arterial hypertension, and hypercholesterolemia. HE was significantly more frequent in diabetic than nondiabetic cirrhotic patients.
In functional constipation, three pathophysiological subgroups have been identified: slow‐transit constipation (STC); normal‐transit constipation (NTC) and outlet delay (OD). Extracolonic ...manifestations, especially disturbed small bowel motility, are well known to occur in STC, but have rarely been studied in NTC and OD. To perform 24‐h‐ambulatory jejunal manometry in a large prospective series of clinical patients with chronic constipation of all subtypes. A total of 61 consecutive patients, referred to our tertiary gastroenterologic centre for chronic constipation (48 female, 13 male; mean age 57 (range 20–87) years), underwent jejunal 24‐h‐ambulatory manometry (standardized meal) after a transit‐time study (radio‐opaque markers), anorectal manometry, defecography and colonoscopy. Computerized and visual analysis by two independent observers was compared with the normal range of manometric variables, defined by data previously obtained in 50 healthy subjects (Gut 1996;38:859). Five patients were excluded from the study because of coexistence of OD and STC. No patient with OD (n = 8), but all patients with STC (n = 32) and 94% of patients with NTC (n = 16) showed small bowel motor abnormalities; both in postprandial response and fasting motility. The abnormal findings ranged from severe disturbances with complete loss of MMC to subtle changes of contraction parameters that could only be assessed by computerized analysis. No significant differences between STC‐ and NTC‐patients were found. Most findings pointed to an underlying enteric neuropathy. Intestinal prolonged‐ambulatory manometry adds valuable information to the pathophysiologic understanding of functional chronic constipation of STC‐ and NTC‐type, however there are no distinct manometric features to differentiate between both.
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