scholarly journals The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry

2020 ◽  
Vol 22 (11) ◽  
Author(s):  
S. Mark Scott ◽  
Emma V. Carrington
Keyword(s):  
Clinical Practice ◽  
Anorectal Manometry ◽  
Working Group ◽  
Anorectal Function ◽  
Sensory Function ◽  
Sensorimotor Function ◽  
Sensory Testing ◽  
Balloon Expulsion ◽  
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.

scholarly journals Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice

2020 ◽  
Vol 92 (12) ◽  
pp. 105-119
Author(s):  
O. Yu. Fomenko ◽  
S. V. Morozov ◽  
S. Mark Scott ◽  
H. Charles Knowles ◽  
D. A. Morozov ◽  
...  
Keyword(s):  
Real World ◽  
Working Group ◽  
Anorectal Function ◽  
Anorectal Physiology ◽  
Rectal Sensation ◽  
High Resolution Manometry ◽  
Additional Information ◽  
Wide Range ◽  
Balloon Expulsion ◽  
Function Testing

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

scholarly journals Evaluation of Anorectal Function in Perianal Crohn’s Disease: A Pilot Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5909
Author(s):  
Andreia Albuquerque ◽  
John Casey ◽  
Grace Fairlamb ◽  
Lesley A. Houghton ◽  
Christian Selinger
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anal Sphincter ◽  
Obstructed Defecation ◽  
Anorectal Function ◽  
Rectal Sensation ◽  
Perianal Crohn’S Disease ◽  
Balloon Expulsion ◽  
Balloon Expulsion Test ◽  
Perianal Crohn's Disease

Background: Perianal Crohn’s disease is a disabling condition, with little known about anorectal function in healed/inactive perianal Crohn’s disease; Aim: To evaluate anorectal function in a cohort of patients with treated/healed perianal Crohn’s disease; Methods: Prospective cohort study, including high-resolution anorectal manometry, balloon expulsion test, and 3D-endoanal ultrasound in all patients; Results: Of the 16 patients studied (mean age ± SD, 42 ± 13 years), 12 (75%) were men. A laceration of the internal anal sphincter and/or anal scarring was seen in nine (56%) patients; there was no laceration of the external anal sphincter. Five (56%) of these nine patients had never experienced faecal incontinence. All had normal anal resting and squeeze pressures. Manometry suggested dyssynergia in 11 (69%) patients, with only one (6%) fulfilling the criteria for obstructed defecation. Hyposensitivity for at least one sensory parameter was seen in 11 (69%) patients and hypersensitivity in five (31%) patients; Conclusions: This study detected sphincter abnormalities in more than half of patients, many of whom were asymptomatic. Alterations in rectal sensation were frequently seen, more commonly with rectal hyposensitivity. Trial registration: ClinicalTrials.gov (NCT03819257).

scholarly journals Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
◽  
Emma Kirk ◽  
Pim Ankum ◽  
Attila Jakab ◽  
Nathalie Le Clef ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ectopic Pregnancy ◽  
Working Group ◽  
Good Practice ◽  
Clear Definition ◽  
Different Types ◽  
Ectopic Pregnancies ◽  
Definition Of ◽  
Comprehensive Classification

Abstract STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN, SIZE, DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS, REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the working group were funded by ESHRE. T.T. declares speakers’ fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE’s GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE’s GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.

Sign in / Sign up

Export Citation Format

Share Document