Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn's disease

  title={Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn's disease},
  author={M. H. Mueller and Martin E Kreis and Matthew Gross and Horst Dieter Becker and T. T. Zittel and Ekkehard C. Jehle},
  journal={British Journal of Surgery},
Histological alterations in the enteric nervous system (ENS) have been described in patients suffering from Crohn's disease (CD). The aim of this study was to investigate whether patients with CD without rectal inflammation have abnormal anorectal function compared with healthy volunteers. 
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Evidence in the literature reports motility abnormalities in patients with inflammatory bowel disorders, and different factors, either direct or indirect, of muscles and nerves can produce alteration of gut functions through the involvement of endocrine and neural networks.
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This review article considers putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD.
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After 14 years, 54 % of the IBD patients with perianal lesions still have mild complaints, and the quality of life remained moderate over a long period, which is concerning.
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The quality of life score was lower in ulcerative colitis patients than in Crohn’s patients and significantly lower in fecal incontinent patients, suggesting anorectal function is impaired in IBD patients with perianal disease.
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  • P. Petryszyn, L. Paradowski
  • Medicine
    Advances in clinical and experimental medicine : official organ Wroclaw Medical University
  • 2018
Assessing stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs) found a majority of patients with IBD complain of urgency.
Evaluation of Anorectal Function in Perianal Crohn’s Disease: A Pilot Study
This study detected sphincter abnormalities in more than half of patients, many of whom were asymptomatic, and Alterations in rectal sensation were frequently seen, more commonly with rectal hyposensitivity.
Increased anal resting pressure and rectal sensitivity in crohn’s disease
This study demonstrates how patients with Crohn’s disease without macroscopic proctitis have increased anal pressures in conjunction with increased rectal sensitivity, which may contribute to later development of anal pathology.
Dyssynergic Defecation: A Treatable Cause of Persistent Symptoms When Inflammatory Bowel Disease Is in Remission
Despite remission, some inflammatory bowel disease patients have persistent defecatory symptoms, and anorectal manometric testing and biofeedback therapy for patients with a diagnosis of dyssynergia may be a useful therapy.
Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment
The prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD are described.
Biofeedback Therapy Improves Continence in Quiescent Inflammatory Bowel Disease Patients with Ano-Rectal Dysfunction
BFT appears to be just as effective for FI in IBD patients as it is in non-IBD populations and may have a role in restoring continence and QoL and highlights the importance of anorectal physiology studies in symptomatic patients once active inflammation is excluded.


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