Volumetric Rectal Perception Testing: Is It Clinically Relevant? Results From a Large Patient Cohort

Area of Science:

• Gastroenterology
• Physiology
• Clinical Diagnostics

Background:

• Rectal perception testing is a key part of anorectal physiology testing.
• Current guidelines for categorizing rectal sensitivity lack robust evidence.
• Data on the diagnostic capabilities and clinical utility of this testing are scarce.

Purpose of the Study:

• To investigate the associations between rectal perception thresholds and clinical/physiological variables.
• To improve the analysis and interpretation of real-world rectal perception test results.
• To assess the clinical relevance of categorizing rectal sensitivity into hypo- and hypersensitivity.

Main Methods:

• Analysis of prospectively collected data from 1,618 patients undergoing anorectal physiology testing.
• Evaluation of three rectal perception thresholds: first, urge, and maximal tolerated.
• Comparison of patient thresholds against normal values from healthy female subjects.

Main Results:

• Poor to moderate agreement was observed between the three rectal perception thresholds.
• Older age, male sex, and constipation correlated with higher thresholds.
• Irritable bowel syndrome, fecal incontinence, and pelvic radiation were linked to lower thresholds.

Conclusions:

• Rectal perception testing correlates with various disease states, indicating clinical relevance.
• Limited agreement between thresholds suggests they may reflect distinct pathophysiological pathways.
• Recommends measuring and reporting all three rectal perception thresholds separately in clinical practice.