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Anorectal abnormalities in progressive systemic sclerosis.

A W Chiou1, J K Lin, F M Wang

  • 1Department of Surgery, National Yang-Ming Medical College, Taipei, Taiwan, Republic of China.

Diseases of the Colon and Rectum
|May 1, 1989
PubMed
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Progressive systemic sclerosis (PSS) significantly impairs anorectal function, with reduced pressures and altered sensation. Surgical repair of anal incontinence in PSS patients yields satisfactory outcomes.

Area of Science:

  • Gastroenterology
  • Rheumatology
  • Physiology

Background:

  • Progressive systemic sclerosis (PSS) is a complex autoimmune disease affecting multiple organ systems.
  • Anorectal dysfunction is a potential complication of PSS, impacting quality of life.
  • Early identification and management of anorectal involvement in PSS are crucial.

Purpose of the Study:

  • To evaluate anorectal function in patients with PSS using manometry.
  • To compare anorectal manometric parameters between PSS patients and healthy controls.
  • To assess the efficacy of posterior anal repair for stool incontinence in PSS.

Main Methods:

  • Anorectal manometry was performed on 17 patients with PSS and 36 age-matched controls.
  • Key parameters measured included maximum basal pressure (MBP), functional length (FL), maximum squeeze pressure (MSP), and maximal tolerable capacity (Vmax).

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  • Rectoanal inhibitory reflex and response to rectal balloon inflation were also assessed. Surgical outcomes were evaluated post-procedure.

    • Main Results:

    • PSS patients exhibited significantly lower MBP (42.6 vs 71.2 mm Hg) and FL (2.4 vs 3.7 cm) compared to controls.
    • A significant difference was observed in the volume of first defecating sensation (66.3 vs 125.1 ml).
    • 71% of PSS patients lacked the rectoanal inhibitory reflex, and 10 had paradoxical contractions. Nine patients experienced anal incontinence, with abnormal manometry in most. Posterior anal repair improved MBP and FL, reducing incontinence symptoms.

    Conclusions:

    • Anorectal function is frequently and early affected in PSS, often subclinically.
    • Anorectal manometry is a valuable tool for diagnosing anorectal involvement in PSS.
    • Posterior anal repair offers a viable surgical option for managing stool incontinence in PSS patients with positive outcomes.