Git j club anorectal disorders.


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GIT Journal club ano-rectal disorders for gastroenterologists.

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Git j club anorectal disorders.

  1. 1. Gastroenterology 2014;146:37–45 AN UPDATE ON ANO-RECTAL DISORDERS FOR GASTROENTEROLOGISTS ADIL E. BHARUCHA/ SATISH S. C. RAO Kurdistan Board GEH Journal club:
  2. 2. Introduction:  Gastroenterologists frequently encounter pelvic floor disorders.  It affect 10-15% of the population.  The ano-rectum is a complex organ that collaborates with the pelvic floor muscles to preserve fecal continence & enable defecation.  A careful clinical assessment is critical for the diagnosis& management of defecatory disorders & fecal incontinence.  Newer diagnostic tools (eg, high-resolution manometry& MR defecography) provide a refined understanding of anorectal dysfunctions&identify phenotypes in defecatory disorders& fecal incontinence.  Conservative approaches, including biofeedback, are the mainstay for manage.  New minimally invasive approaches may benefit a subset of patients with fecal incontinence, but more controlled studies are needed.
  3. 3. HRM in DD:
  4. 4. Anal SM inj of a “bulking agent” (dextranomer
  5. 5. Summary:  Significant advances in basic science & newer diagnostic techniques in humans have advanced our understanding of the multifaceted pelvic floor disorders.  DDs are a common cause of chronic constipation.  Symptoms &careful DRE are very useful for identifying DDs, but anorectal tests are necessary to confirm the diagnosis.  In most patients, anorectal manometry & rectal balloon expulsion test suffice.  In some patients, barium or MRI defecography is necessary to confirm or exclude the diagnosis.  Pelvic floor retraining by biofeedback therapy represents the mainstay
  6. 6. Summary:  FI is a common & often distressing symptom.  Bowel dysfunctions & ano-rectal sensorimotor dysfunctions are the key pathophysiological mechanisms.  Management:  Conservative measures.  Pelvic floor retraining by biofeedback therapy in patients who do not respond to conservative measures.  SNS or other surgical approaches for patients who are refractory to medical therapy.
  7. 7. A response to my question from the corresponding author:  <> wrote:  Congratulation for your excellent review in Gastroenterology. Isn't better to classify the defecatory disorders into the defecatory disorderinduced constipation & defecatory disorder-induced fecal incontinance ,rather than DD& FI. Thanks.  Thanks; To be honest I don't like the acronym DD for defecation disorders and prefer to use it for dyssynergic defecation. In this article I had to yield to my coauthor who insisted on this term. I usually prefer to use defecation disorder for non incontinence related conditions. Hope this helps and sets record clear. Satish Rao (Please forgive any typos)
  8. 8. THANKS