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Physiological and structural anorectal abnormalities in patients with systemic sclerosis and fecal incontinence
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
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2014 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 49, no 9, 1073-1083 p.Article in journal (Refereed) Published
Abstract [en]

Objective

Fecal incontinence is common in systemic sclerosis (SSc), but the underlying mechanisms are not fully understood. The objectives of this study were to characterize anorectal physiological and morphological defects in SSc patients and to correlate the results with incontinence symptoms.

Materials and methods

Twenty-five SSc patients underwent anorectal neurophysiological investigations, anal manometry, and ultrasound.

Results

Eleven patients (44%) reported incontinence to solid or liquid feces, but no patient reported diarrhea. Increased fiber density (FD) was recorded in 78% of patients with and in 86% of patients without fecal incontinence not significant (NS). Incontinent patients had lower squeeze pressure (SP; median 49.5 mm Hg) in the high-pressure zone (HPZ) than continent patients (median 72 mm Hg; p = 0.01). In two of the incontinent patients, sonographic abnormalities of the internal anal sphincter (IAS) and the external anal sphincter (EAS) were present, whereas in another two patients isolated IAS abnormalities were seen. These four individuals had lower resting pressure at 1 cm and in the HPZ, and lower SP at 2 cm than patients with normal anorectal sonographic findings (p < 0.05).

Conclusion

Lower voluntary SP in incontinent patients and EAS sonographic abnormalities only in patients with incontinence suggest that the EAS is more important in maintaining fecal continence in SSc patients than has previously been reported. The finding of increased FD in most patients further supports involvement of the EAS function in SSc and could indicate previous nerve injury with consequent incomplete reinnervation.

Place, publisher, year, edition, pages
2014. Vol. 49, no 9, 1073-1083 p.
National Category
Rheumatology and Autoimmunity Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-224114DOI: 10.3109/00365521.2014.913188ISI: 000340829900007PubMedID: 24786727OAI: oai:DiVA.org:uu-224114DiVA: diva2:715337
Available from: 2014-05-04 Created: 2014-05-04 Last updated: 2017-12-05Bibliographically approved

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Franck-Larsson, KarinGraf, WilhelmAxelson, Hans WRönnblom, Anders

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Franck-Larsson, KarinGraf, WilhelmAxelson, Hans WRönnblom, Anders
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Gastroenterology/HepatologyColorectal SurgeryDepartment of NeuroscienceClinical Neurophysiology
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Scandinavian Journal of Gastroenterology
Rheumatology and AutoimmunityMedical and Health Sciences

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