A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Abstract

Aim: To compare dyssynergic sub type patterns between SARM and HRM. Methods: Patients with dyssynergic defecation diagnosed by ARM that had maintained the same stool patterns and frequency were re-evaluated with HRM while on waiting list for biofeedback training. Anorectal resting and squeezing pressure on the bed and commode were analyzed and compared between the two modalities. Paired t-test was used to compare the pressures and sensations. Results: 25 dyssynergic patients diagnosed with SARM (F=21, age 41±12.9) underwent HRM. Twenty four patients had dyssynergia on HRM (96%). Twelve (48%) had similar patterns on≥one position, and five (20%) had similar patterns in both positions. When comparing between HRM and SARM, the maximum resting pressure (70 vs 55.6 mmHg p<0.01), anal straining on bed (73 vs 46.4 mHg, p<0.01), rectal straining on commode (107.4 vs 71.8 mmHg, p<0.01) and anal straining pressures on commode (76.3 vs 48.9 mmHg, p<0.01) significantly deferred between the exams respectively. Conclusion: HRM pressures tend to be higher than SARM. Although there is high consensus regarding diagnosis of dyssynergia, there is low correlation regarding pattern types. New diagnostic pressure criteria should be adopted in centers converting to HRM.