ABSTRACT
PURPOSE: The rectoanal inhibitory reflex (RAIR) aids the anal continence function by a sampling process. On the other hand, it might impair the anal continence function because the internal anal sphincter is relaxed during the reflex. We assessed the parameters of RAIR in incontinent patients with or without a sphincter defect and compared them with healthy control subjects to clarify the exact role of that reflex in the anal continence function. METHODS: The recovery time, slope, amplitude, and area under the reflex curve of the RAIR were measured for 31 normal controls without any history of anorectal surgery (group A), 32 incontinent patients with a sphincter defect (group B), and 49 incontinent patients without a sphincter defect (group C). Incontinence was defined as bowel accidents of more than 3 by the Cleveland Clinic Florida score. A sphincteric defect was defined endoanal sonographically. The mean ages of group A, B, and C were 57.9+/-14.3, 54.5+/-13.6, and 61.8+/-15.4 years, respectively. RESULTS: When group A and group B+C were compared, the recovery times (seconds) were 17.5+/-3.5 and 14.8+/-5.5 (P=.003), the slopes (mmHg/second) were 0.67+/-3.04 and 3.27+/-2.44 (P<.001), the amplitudes (%) were 7.0+/-16.5 and 53.3+/-19.4 (P=.352), and the area under the reflex curve (mmHg*seconds) were 230.2+/-102.15 and 173.0+/-140.8 (P=.020). When group B and group C were compared, the recovery times were 15.0+/-5.8 and 14.7+/-5.3 (P=.828), the slopes were 3.6+/-2.8 and 3.1+/-2.2 (P= .388), the amplitudes were 54.2+/-22.4 and 52.7+/-17.4 (P=.737), and the area under the reflex curve were 188.0+/-151.1 and 163.2+/-134.3 (P=.443). All parameters of the RAIR, except the amplitude were significantly diminished in incontinent patients whether they had a sphincter defect or not. CONSLUSIONS: Although the RAIR functions against continence in normal conditions by inhibiting sphincteric tone, it behaves suitably for keeping continence in the presence of incontinence, whatever the cause is, by attenuating the degree of inhibition.
Subject(s)
Humans , Anal Canal , Fecal Incontinence , Florida , Hand , ReflexABSTRACT
BACKGROUND/AIMS: It is difficult to clinically distinguish infants with Hirschsprung disease (HD) from those with other causes of intestinal obstruction. Therefore, reliable and safe diagnostic procedures are particularly necessary in infants with early onset symptoms. The purpose of this study was to assess the accuracy of anorectal manometry in the diagnosis of HD in infancy. METHODS: Forty five infants who were suspected of having HD, at Seoul National University Children's Hospital, from May 1999 to July 2002, were enrolled in this study. The diagnostic accuracy of recto-anal inhibitory reflex (RAIR) and transition zone was evaluated. RESULTS: Final diagnosis of HD was made in 18 cases. The presence of transition zone was proved to be very specific (100%), but sensitivity was very low (39%). The sensitivity and specificity of anorectal manometry were 100% and 93% in total 45 infants. However the sensitivity and specificity of this test were 100% in infants older than 3 months. CONCLUSIONS: It could be stated that the diagnostic accuracy of the RAIR is a highly valid diagnostic value for HD in young infancy. It is particularly helpful when clinical and radiological findings are inconclusive.