The State of Anorectal Zone as a Marker of Functional and Organic Gastrointestinal Disorders

Abstract

Aims: This research was aimed at investigating both sensory and motor function of the rectum and anal canal in the patients with irritable bowel syndrome (IBS) and organic bowel disease. Methodology: There were examined 45 children with age of 11-13 years suffering from IBS and organic bowel disease. 20 healthy children of same age were examined as a control. All patients were examined with the use of general clinical blood and urine tests, biochemical blood tests including direct and indirect bilirubin, alanin aminotransferase, aspartame aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, urea, creatinine. Coprogram and fecal dysbiosis were also analysed. Digital rectal examination, ultrasonography of the abdomen, multiphase duodenal intubation, colonoscopy or sigmoidoscopy or irigography (by the indications) was also performed. Results: The average basal pressure was 6.5±0.6 mm Hg in the rectum and 44.5±1.5 mm Hg in the anal canal (mean ± s.e.m.). These indices were not dependent on the general health conditions and the clinical manifestations of IBS. However the threshold of reflective sensitivity was significantly greater (28.4±2.2 ml) in patients with chronic constipation associated with organic bowel disease compared with patients suffering from IBS with functional constipation (20.5±2.8 ml) and diarrhea (22.5 + 2.8 ml). Conclusion: Anorectal manometry is a sensitive and specific method to differentiate IBS from organic bowel disease. The most informative test is anorectal manometry using rectal balloon slowly filled with water.