Ethnic Differences in Anorectal Manometry Findings in Patients With Fecal Incontinence:Results From a Multiethnic Cohort According to the London Classification

Background/Aims@#Clinical rates of fecal incontinence (FI) are known to vary based on race and ethnicity. It is unclear if anorectal manometry (ARM) findings in patients with FI differ based on ethnicity. @*Methods@#High-resolution ARM studies performed between 2014-2021 due to FI at 2 hospitals with multiethnic populations were retrospectively reviewed. @*Results@#Four hundred and seventy-nine subjects were included––87 (18.2%) Arab Israelis, 76 (15.9%) immigrants from the former Soviet Union, and 316 (66.0%) Jewish Israelis. Median age was 67 years old (76.0% women: 90.4% were parous). The Arab Israeli group had higher rates of smoking, diabetes, and obesity. Over 95% of ARM’s were abnormal per the London classification including 23% with “combined anal hypotension and hypocontractility,” 36% with “anal normotension with anal hypocontractility,” 67% with “dyssynergia,” and 65% with either “rectal hyposensation” or “borderline rectal hyposensation.” On univariate analyses, significant differences between the ethnic groups were noted in the rates of “anal hypotension with normal contractility,” “combined anal hypotension with anal hypocontractility,” and “dyssynergia.” In multivariate logistic regression analyses controlling for age, gender, parity, smoking, diabetes, and obesity, the Arab Israeli group remained several times more likely to have “combined anal hypotension and hypocontractibility” compared to the other groups. @*Conclusions@#Ethnicity impacts ARM findings in patients with FI. The reason for this is unclear and future studies on ethnically diverse populations evaluating the clinical relevance of these findings are warranted.

Achalasia During Pregnancy: Proposed Management Algorithm Based on a Thorough Literature Review

Fewer than 40 cases of achalasia occurring in pregnant woman have been reported in the literature. Given the rarity of achalasia during pregnancy, and the numerous treatment options that are available for achalasia in general, no guidelines exist for the management of achalasia during pregnancy. Diagnosis of new cases may be difficult as symptoms and physiological changes that occur during pregnancy may obscure the clinical presentation of achalasia. The management of achalasia in pregnancy is also challenging. Treatment decisions should be individualized for each case, considering both the welfare of the mother and the fetus.Since pregnant women suffering from achalasia represent a diagnostic and therapeutic challenge with complex maternal-fetal aspects to consider, we have reviewed the available literature on the subject and summarized current diagnostic and therapeutic options.Additionally, we present a management algorithm as a means to guide treatment of future cases. We recommend that a conservative approach should be adopted with bridging therapies performed until after delivery when definitive treatment of achalasia can be more safely performed.