Defecatory disorders are a common cause of chronic constipation in Parkinson disease.

Autor: Ramu SK; Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA., Oblizajek NR; Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Savica R; Division of Movement Disorders, Mayo Clinic, Rochester, Minnesota, USA., Chunawala ZS; Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA., Deb B; Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA., Bharucha AE; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2024 May; Vol. 36 (5), pp. e14767. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1111/nmo.14767
Abstrakt: Background and Aims: Up to 50% of patients with Parkinson disease have constipation (PD-C), but the prevalence of defecatory disorders caused by rectoanal dyscoordination in PD-C is unknown. We aimed to compare anorectal function of patients with PD-C versus idiopathic chronic constipation (CC).
Methods: Anorectal pressures, rectal sensation, and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry (HR-ARM) in patients with PD-C and control patients with CC, matched for age and sex.
Results: We identified 97 patients with PD-C and 173 control patients. Eighty-six patients with PD-C (89%) had early PD, and 39 (40%) had a defecatory disorder, manifest by a prolonged rectal balloon expulsion time (37 patients) or a lower rectoanal pressure difference during evacuation (2 patients). PD-C patients with a prolonged BET had a greater anal resting pressure (p = 0.02), a lower rectal pressure increment (p = 0.005), greater anal pressure (p = 0.047), and a lower rectoanal pressure difference during evacuation (p < 0.001). Rectal sensory thresholds were greater in patients with abnormal BET. In the multivariate model comparing CC and PD-C (AUROC = 0.76), PD-C was associated with a lower anal squeeze increment (odds ratio [OR] for PD-C, 0.93 [95% CI, 0.91-0.95]), longer squeeze duration (OR, 1.05 [95% CI, 1.03-1.08]), lower rectal pressure increment (OR per 10 mm Hg, 0.72 [95% CI, 0.66-0.79]), and negative rectoanal gradient during evacuation (OR per 10 mm Hg, 1.16 [95% CI, 1.08-1.26]).
Conclusions: Compared with CC, PD-C was characterized by impaired squeeze pressure, longer squeeze duration, lower increase in rectal pressure, and a more negative rectoanal gradient during evacuation.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: