Referral for anorectal function evaluation: therapeutic implications and reassurance

Area of Science:

• Gastroenterology and Hepatology
• Colorectal Surgery
• Diagnostic Imaging

Background:

• Anorectal dysfunction significantly impacts patient quality of life.
• Accurate diagnosis is crucial for effective treatment of anorectal conditions.
• Referral for specialized anorectal function evaluation (AFE) is common practice.

Purpose of the Study:

• To assess the impact of anorectal function evaluation (AFE) on patient outcomes and specialist management.
• To evaluate patient and referring specialist satisfaction with the AFE process.
• To identify the most valuable diagnostic components within AFE.

Main Methods:

• A prospective study involving 135 patients undergoing AFE (proctoscopy, manometry, compliance, sensitivity, endosonography).
• Patient and referring specialist questionnaires were used to gather feedback.
• Analysis of diagnostic agreement, treatment changes, and patient-reported benefits.

Main Results:

• AFE was well-tolerated, with 88% of patients reporting benefit (treatment or reassurance).
• Management was altered in 25% of patients; anal endosonography proved valuable for sphincter defects and fistula tracks.
• Referring specialists found AFE useful (93%) and followed advice in 84% of cases.

Conclusions:

• Anorectal function evaluation (AFE) is a valuable, well-tolerated procedure.
• AFE leads to significant management changes and provides reassurance for a majority of patients.
• Anal endosonography is identified as a particularly impactful component of AFE.