Normal Values and Associated Factors in Highresolution Anorectal Manometry in Healthy Vietnamese Adults

Anh, Nguyen Ngoc; Tung, Le Dinh; Khoa, Ngo Xuan; Cuong, Le Manh; Hung, Nguyen Xuan; Hang, Nguyen Thi Thu; Khanh, Pham Phuc; Huy, Nguyen Van; Kien, Vu Duy

doi:10.1055/s-0041-1726078

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Journal of Coloproctology (Rio de Janeiro)

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Original Article • J. Coloproctol. (Rio J.) 41 (01) • Jan-Mar 2021 • https://doi.org/10.1055/s-0041-1726078 copy

Normal Values and Associated Factors in Highresolution Anorectal Manometry in Healthy Vietnamese Adults

Valores normais e fatores associados na manometria anorretal de alta resolução em adultos vietnamitas saudáveis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

The present study aims to identify normal high-resolution anorectal manometry (HRAM) values and related factors in healthy Vietnamese adults.

Methods

The present cross-sectional study was conducted at the Viet Duc hospital, Hanoi, Vietnam, during April and May 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values from the digestive tract, including pressure, were recorded.

Results

A total of 76 healthy volunteers were recruited. The mean functional anal canal length was 4.2 ± 0.5 cm, while the mean anal high-pressure zone length was 3.4 ± 0.5 cm. Themean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit the rectoanal inhibitory reflex (RAIR) was 18.1 mL. The mean rectal sensation values were 32.4mL, 81.6mL, and 159 mL for first sensation, desire to defecate, and urge to defecate, respectively. Dyssynergic patterns occurred in ~ 50% of the study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between male and female patients in terms of maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p<0.01).

Conclusions

The present study establishes normal HRAM values in healthy Vietnamese adults, particularly regarding normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted to further confirm the constants and their relationships.

Keywords:
high-resolution anorectal manometry; anorectal manometry; normal values; healthy people; Vietnam

	Total (n = 76)	Male (n = 38)	Female (n = 38)	p-value
	N (%) or mean (SD)			p-value
Age (years old)	41.5 (13.3)	40.5 (13.4)	42.6 (13.2)	0.49
Age group (years old)
≤ 40	45 (59.2)	20 (52.6)	25 (65.8)	0.24
≤ 40	31 (40.8)	18 (47.4)	13 (34.2)	0.24
BMI	22.4 (2.5)	23.2 (2.7)	21.7 (2.1)	< 0.01
BMI
< 25	65 (85.5)	30 (79.8)	35 (92.1)	0.19
≥ 25	11 (14.5)	8 (21.2)	3 (7.9)	0.19

	N (%) or mean (SD)	Min–Max
Functional anal canal length (cm)	4.2 (0.5)	3.2–4.8
HPZ length (cm)	3.4 (0.5)	2.4–4
Anal pressure
Maximum resting pressure (mm Hg)	71.5 (17.4)	31.3–115.9
Maximum squeeze pressure (mm Hg)	163.3 (59.1)	52.2–355.5
Maximum cough pressure (mm Hg)	99.5 (31.2)	38.4–191.5
Maximum strain pressure (mm Hg)	74.7 (28.9)	23.4–169.1
Rectal pressure
Maximum cough pressure (mm Hg)	89.8 (35.1)	36.1–197.3
Maximum strain pressure (mm Hg)	63.1 (26.3)	18.8–163.1
Defecation index	1.4 (0.8)	0.3–5
Threshold volume to elicit RAIR (ml)	18.1 (8.3)	10–50
Rectal sensation
First sensation (mL)	32.4 (10.9)	20–60
Desire to defecate (mL)	81.6 (19.3)	50–120
Urge to defecate (mL)	159.9 (31.5)	100–240
Dyssynergic pattern
Normal	38 (50.0)	NA
Type I	21 (27.6)	NA
Type II	3 (3.9)	NA
Type III	11 (14.6)	NA
Type IV	3 (3.9)	NA

	Gender			Age group (years old)			BMI group
	Male(n = 38)	Female (n = 38)	p-value	≤ 40 (n = 45)	> 40 (n = 31)	p-value	BMI < 25 (n = 65)	BMI ≥ 25 (n = 11)	p -value
	N (%) or mean (SD)		p-value	N (%) or mean (SD)		p-value	N (%) or mean (SD)		p -value
Functional anal canal length (cm)	4.3 (0.5)	4.1 (0.5)	0.09	4.2 (0.5)	4.3 (0.5)	0.40	4.1 (0.5)	4.7 (0.3)	< 0.01
HPZ length (cm)	3.5 (0.5)	3.3 (0.5)	0.09	3.4 (0.5)	3.5 (0.5)	0.40	3.3 (0.5)	3.9 (0.3)	< 0.01
Anal pressure
Maximum resting pressure (mm Hg)	74.9 (16.3)	68.0 (18.0)	0.08	73.7 (17.9)	68.2 (16.4)	0.18	70.3 (18.4)	78.1 (7.8)	0.17
Maximum squeeze pressure (mm Hg)	183.3 (48.0)	143.3 (62.0)	<0.01	159.3 (60.1)	169.0 (58.1)	0.48	161.2 (58.5)	175.4 (64.6)	0.47
Maximum cough pressure (mm Hg)	112.2 (31.9)	86.7 (24.8)	<0.01	99.7 (29.4)	99.2 (34.0)	0.94	97.5 (30.1)	111.0 (36.2)	0.19
Maximum strain pressure (mm Hg)	84.1 (28.4)	65.4 (26.7)	<0.01	73.9 (28.9)	76.0 (29.4)	0.76	71.3 (28.9)	95.2 (20.3)	0.01
Rectal pressure
Maximum cough pressure (mm Hg)	101.7 (38.7)	78.0 (26.7)	<0.01	81.4 (34.2)	102.1 (33.2)	0.01	87.5 (34.2)	103.5 (39.3)	0.17
Maximum strain pressure (mm Hg)	75.1 (27.6)	51.0 (18.5)	<0.01	58.1 (24.4)	70.3 (27.7)	0.04	61.3 (25.3)	73.8 (31.1)	0.15
Defecation index	1.4 (0.7)	1.4 (0.8)	0.93	1.4 (0.8)	1.4 (0.7)	0.92	1.4 (0.8)	1.1 (0.5)	0.28
Threshold volume to elicit RAIR (mL)	18.7 (9.1)	17.5 (7.5)	0.53	16.3 (8.6)	20.6 (7.3)	0.02	18.1 (8.5)	18.2 (7.5)	0.97
Rectal sensation
First sensation (mL)	32.6 (10.6)	32.1 (11.4)	0.83	28.4 (7.1)	38.1 (13.0)	<0.01	31.2 (10.4)	39.1 (12.2)	0.03
Desire to defecate (mL)	79.2 (18.4)	83.9 (20.2)	0.29	76.7 (17.6)	88.7 (19.8)	<0.01	80.6 (18.9)	87.3 (21.5)	0.29
Urge to defecate (mL)	159.2 (30.6)	160.5 (32.7)	0.86	156.9 (32.6)	164.2 (29.8)	0.32	159.2 (30.6)	163.6 (35.6)	0.67
Dyssynergic pattern- N (%)
Normal	16 (42.1)	22 (57.9)	0.10	22 (48.9)	16 (51.6)	1.00	34 (52.3)	4 (36.4)	0.43
Type I	14 (36.8)	7 (18.4)		12 (26.7)	9 (29.0)		16 (24.6)	5 (45.4)
Type II	0 (0.0)	3 (7.9)		2 (4.4)	1 (3.2)		2 (3.1)	1 (9.1)
Type III	7 (18.5)	4 (10.5)		7 (15.6)	4 (12.9)		10 (15.4)	1 (9.1)
Type IV	1 (2.6)	2 (5.3)		2 (4.4)	1 (3.3)		3 (4.6)	0 (0.0)

	Model 1		Model 2		Model 3
	β (95%CI)	p-value	β (95%CI)	p-value	β (95%CI)	p-value
Functional anal canal length (cm)	0.20 (-0.02–0.42)	0.08	0.12 (-0.11,0.34)	0.31	0.12 (-0.10–0.36)	0.27
HPZ length (cm)	0.20 (-0.02–0.42)	0.08	0.12 (-0.11,0.34)	0.31	0.13 (-0.10–0.36)	0.27
Anal pressure
Maximum resting pressure (mm Hg)	6.44 (-1.35–14.24)	0.10	6.58 (-1.69–14.86)	0.12	5.43 (-2.84–13.70)	0.19
Maximum squeeze pressure (mm Hg)	40.56 (14.75–66,37)	< 0.01	40.32 (13.31–67.32)	<0.01	41.47 (13.98–68.96)	< 0.01
Maximum cough pressure (mm Hg)	24.82 (11.75–37.89)	< 0.01	24.94 (11.15–38.72)	<0.01	23.48 (9.59–37.38)	< 0.01
Maximum strain pressure (mm Hg)	18.66 (5.95–31.37)	< 0.01	15.81 (2.72–28.89)	0.02	15.15 (1.84–28.45)	0.03
Rectal pressure
Maximum cough pressure (mm Hg)	24.81 (9.79–39.84)	< 0.01	15.75 (0.96–30.54)	0.04	16.95 (1.97–31.93)	0.03
Maximum strain pressure (mm Hg)	24.68 (13.93–35.43)	< 0.01	20.70 (9.67–31.73)	<0.01	21.39 (10.19–32.60)	< 0.01
Defecation index	-0.01 (-0.36–0.34)	0.96	-0.04 (-0.40–0.33)	0.84	-0.03 (-0.40–0.35)	0.89
Threshold volume needed to elicit RAIR (mL)	1.39 (-2.40–5.19)	0.47	0.94 (-3.07–4.94)	0.64	1.36 (-2.68–5.40)	0.51
Rectal sensation
First sensation (mL)	1.38 (-3.05–5.81)	0.54	-1.16 (-6.30–3.99)	0.66	0.45 (-4.22–5.12)	0.85
Desire to defecate (mL)	-3.55 (-11.77–4.67)	0.39	-6.51 (-15.72–2.70)	0.16	-4.20 (-12.94–4.55)	0.34
Urge to defecate (mL)	-0.63 (-15.13–13.86)	0.93	-3.06 (-18.28–12.16)	0.69	-1.84 (-17.26–13.58)	0.81

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[1] Address for correspondence Nguyen Ngoc Anh, MD, MSc, Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Vietnam (e-mail: nngocanh@hmu.edu.vn).