The role of GSTM1 gene polymorphism in pathophysiology, evaluation, and management of constipation of anorectal outlet obstruction

Constipation of anorectal outlet obstruction may be caused by mechanical or functional causes. This complication is a debilitating disease that needs proper and timely treatment. Many studies have shown that there is a direct link between constipation and intestinal cancer. One of the most effective ways to prevent or diagnose intestinal cancer is through genetic studies. Evaluation of people's polymorphism shows how much they are at risk for cancer. Therefore, in this study, the GSTM1 gene polymorphism was evaluated in patients with constipation of anorectal outlet obstruction to assess better and manage this disease and investigate the possibility of anorectal cancer in these people. In this regard, 40 people with constipation of anorectal outlet obstruction were compared with 40 healthy people. In the case group (patients), in addition to demographic and clinical evaluations, the anorectal manometric test was used to diagnose the pathology of the disease. Results showed that out of 40 patients with constipation of anorectal outlet obstruction, 5 cases (12.5%) had megarectum, 7 cases (17.5%) had anismus, 10 cases (25%) had Hirschsprung's disease, 5 cases (12.5%) had descending perineum syndrome, 6 cases (15%) had rectal prolapse, 4 cases (10%) had enterocele, and 3 cases (7.5%) were with rectocele. Also, the results of GSTM1 gene deletion polymorphism showed that patients with constipation of anorectal outlet obstruction were almost two times more exposed to the null genotype than the control group (P <0.04). Therefore, in people with both constipation of anorectal outlet obstruction and null genotype (i.e., deletion in the GSTM1 gene), because they do not have glutathione-S transferase, they appear to be at higher risk for anorectal cancer than healthy people with the same genotype.

Methods for Mesh Implantation Efficacy Assessment in Rectocele

Aim. A methodological review on mesh implantation efficacy assessment in surgery for rectocele.Key points. Specialised quiz surveys are among the most appropriate methods to assess surgical intervention efficacy. The questionnaires that enable pre- and postsurgery rectocele grading include PFDI-20 (Pelvic Floor Distress Inventory), the colonic evacuation disorder scale and Cleveland Constipation Scoring System. These surveys determine the surgical intervention efficacy dynamically in conjunction with instrumental surgery assessment techniques.Conclusion. Clinical practice at the Ryzhikh National Medical Research Centre for Coloproctology combines the originally developed colonic evacuation disorder scale (2003) and PFDI-20. The combined scales allow for a comprehensive symptom assessment in patients with rectocele and other descending perineum syndrome manifestations prior to surgery, as well as symptom dynamics evaluation postoperatively, which, in link with defecography, enables a complete appraisal of the surgical effect.

Pathophysiology of the functional constipation in elderly

The aim of this study was to investigate the pathophysiology of functional constipation (FC) in the elderly. Material and methods: In the State Geriatric Center of Netanya (Israel), 37 patients at the age of 65-93 years with complaints of chronic constipation were examined. This main group did not include patients with tumors and cases after surgery on the rectum and colon. The results of a survey of 15 young people aged 11-17 years with no bowel disease were taken as a control group. A barium enema with a radiopaque marker near the anus was produced. A frontal radiography of the abdomen as well as an X-ray of the lateral projection of the anorectal zone were made after the administration of 100, 200 and 300 ml of barium. Results: In 6 (16%) cases, the width of the rectum was more than 5 cm - megarectum. The length of the anal canal was 2 times less than the minimum normal limit after the injection of 100 ml of barium. In 25 (68%) patients, the width of the rectum was normal and had a normal shape. The functioning anal canal length was shortened during the administration of barium. In 6 (16%) patients, the reason for constipation was high colonic tone. They had the anorectal parameters within the normal range. Conclusion: We found 3 types of FC in the elderly. In the structure of FC the cases of self-defined constipation (68%) are dominated, where there is no mechanical obstruction for defecation. The reason for the sense of constipation and incomplete emptying is due to the age-related weakness of the pelvic floor muscles. In 16% of patients, obstructive constipation with a megarectum and a fixed descending perineum syndrome was detected. This pathology originated in childhood or after anal fissures, and childbirth. In 16% of patients, the cause of constipation was a high tone of the colon, what can be the result of an irritable bowel syndrome, the formation of functional sphincters in the colon and diverticula of the sigmoid colon. An increase in the tone of the colon causes a slow transit constipation.