P0539 - Characterization of Clinical and Manometric Features in Constipated Patients With Concordant vs Discordant Findings on Anorectal Function Testing

Raguraj Chandradevan, MD¹, Anam Herekar, MD¹, Dhanush Shimoga, MBBS¹, Arsh Momin, MD², Amanda Tyra, PA-C¹, Yun Yan, PhD¹, Amol Sharma, MD, MS, FACG^1
1Medical College of Georgia at Augusta University, Augusta, GA; ²Penn State Milton S Hershey Medical Center, Hershey, PA

Introduction: Dyssynergic defecation (DD) is diagnosed if 2 of 3 anorectal function tests (ArFT) are abnormal: anorectal manometry (ARM), balloon expulsion test (BET), and defecography. ARM and BET are performed in the same appointment and there is frequently discrepancy between them. We aim to examine clinical and manometric features of concordant and discordant groups.

Methods: A retrospective review of adult patient charts with constipation undergoing ArFT at MCG between 2022-2023 was performed (IRB#1828783). Patients completing a symptom survey, referred for the indication of constipation, and having manometric dyssynergia, defined as presence of dyssynergia pattern on ARM in both the left lateral and seated positions, were included for analysis. Dyssynergia on BET was defined as expulsion time >60 sec. Patients were divided into two groups. Concordant group had both manometric dyssynergia and dyssynergia on BET. Discordant group did not have either manometric dyssynergia or dyssynergia on BET. Descriptive statistics were performed and if large group differences were suspected, chi-square test and two-sample t-test assuming unequal variance were performed for qualitative and quantitative data, respectively.

Results: Charts of 83 refractory constipated patients (age 53.8±17.7, F/ M 69/14, BMI 28.5±7.0) were reviewed and 28 were excluded for FI as a primary or concurrent indication or incomplete surveys. Both groups had >55% with moderate-severe dyssynergic symptoms (straining, feeling of incomplete emptying, and abdominal pain). More than 25% had use of digits and enemas and > 30% had self-reported FI. The group difference in moderate-severe abdominal pain approached significance (p=0.06). The discordant group had a lower resting anal sphincter pressure (65.2 ± 4.6 vs 76.9 ± 5.2 mmHg, p< 0.05) than the concordant group. The two groups did not differ in maximum squeeze pressure, sustained squeeze pressure, and defecation index in the left lateral or seated positions.

Discussion: One quarter of all constipated patients referred for ArFT have coexisting FI. Lower resting anal pressures are present in patients with discordant findings on ARM and BET compared to those with concordance. Low resting anal tone may explain false-negative BETs and a minimal resting anal pressure should be considered for expulsion testing. Higher rates of moderate-severe abdominal pain in the discordant group implies abnormal visceral sensation also impacts symptomatology.



Disclosures:


Raguraj Chandradevan, MD¹, Anam Herekar, MD¹, Dhanush Shimoga, MBBS¹, Arsh Momin, MD², Amanda Tyra, PA-C¹, Yun Yan, PhD¹, Amol Sharma, MD, MS, FACG¹. P0539 - Characterization of Clinical and Manometric Features in Constipated Patients With Concordant vs Discordant Findings on Anorectal Function Testing, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.