Technique, Interpretation and Clinical Application of Anorectal Manometry and Balloon Expulsion Test

Abstract Purpose of Review Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice. Recent Findings This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. Summary The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice.

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Relationships Between Anal Pressure Profiles Derived from High-Definition Anorectal Manometry and Results of Balloon Expulsion test in Patients with Chronic Constipation

Gastroenterology ◽

10.1016/s0016-5085(17)30430-4 ◽

2017 ◽

Vol 152 (5) ◽

pp. S17

Author(s):

Anusha Shirwaikar Thomas ◽

Chimi Fosso ◽

Gulchin Ergun ◽

Eamonn Quigley ◽

Leila Neshatian

Keyword(s):

Chronic Constipation ◽

Anorectal Manometry ◽

Anal Pressure ◽

High Definition ◽

Pressure Profiles ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Su1618 - Weight-Based vs. Time-Based Balloon Expulsion Test and High-Resolution Anorectal Manometry for Diagnosis of Rectal Evacuation Disorders

Gastroenterology ◽

10.1016/s0016-5085(18)32040-7 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-550

Author(s):

Victor Chedid ◽

Priya Vijayvargiya ◽

Houssam Halawi ◽

Michael Camilleri

Keyword(s):

High Resolution ◽

Anorectal Manometry ◽

Balloon Expulsion ◽

Rectal Evacuation ◽

Balloon Expulsion Test

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Clinical utility of balloon expulsion test for functional defecation disorders

Annals of Surgical Treatment and Research ◽

10.4174/astr.2016.90.2.89 ◽

2016 ◽

Vol 90 (2) ◽

pp. 89 ◽

Cited By ~ 4

Author(s):

Moo-Kyung Seong

Keyword(s):

Clinical Utility ◽

Balloon Expulsion ◽

Defecation Disorders ◽

Balloon Expulsion Test ◽

Functional Defecation Disorders

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Anorectal physiology in health: A randomized trial to determine the optimum catheter for the balloon expulsion test

Neurogastroenterology & Motility ◽

10.1111/nmo.13552 ◽

2019 ◽

Vol 31 (4) ◽

pp. e13552 ◽

Cited By ~ 8

Author(s):

Yoav Mazor ◽

Gillian Prott ◽

Mike Jones ◽

John Kellow ◽

Anastasia Ejova ◽

...

Keyword(s):

Randomized Trial ◽

Anorectal Physiology ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/8798974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jie Liu ◽

Hulin Chen ◽

Dewei Wu ◽

Ruiling Wei ◽

Chaolan Lv ◽

...

Keyword(s):

Frequency Band ◽

Outlet Obstruction ◽

Low Frequency ◽

Biofeedback Training ◽

Before And After ◽

Balloon Expulsion ◽

Group A ◽

Functional Outlet Obstruction ◽

Group B ◽

Balloon Expulsion Test

Background. Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Aims. The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC. Methods. A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment. Results. Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p<0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p<0.001, respectively). Conclusions. TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.

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