Management of biliary complications after orthotopic liver transplantation:The role of endoscopy

Biliary complications are signifi cant causes of morbidity and mortality after orthotopic liver transplantation (OLT). The estimated incidence of biliary complications after OLT ranges between 10%-25%,however,these numbers continue to decline due to improvement in surgical techniques. The most common biliary complications are strictures (both anastomotic and non-anastomotic) and bile leaks. Most of these problems can be appropriately managed with endoscopic retrograde colangiography (ERC). Other complications such as bile duct stones,bile casts,sphincter of Oddi dysfunction,and hemobilia,are less frequent and also can be managed with ERC. This article will review the risk factors,diagnosis,and endoscopic management of the most common biliary complications after OLT.

Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation

AIM: To determine effect of irritable bowel syndrome(IBS) subtype on IBS-specific quality of life(QOL) questionnaire and its subscales.METHODS: We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States.IBS and IBS subtype were diagnosed using Rome-Ⅲ questionnaire.QOL was assessed using IBS-QOL questionnaire.IBSQOL assesses quality of life along eight subscales: dysphoria,interference with activities,body image,health worry,food avoidance,social reactions,sexual health,and effect on relationships.IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL.Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI.We compared mean IBS-QOL score and its subscales among various IBSsubtypes.Analysis of variance(ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender.A posthoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.RESULTS: Of 542 patients screened,243 had IBS as per Rome-Ⅲ criteria.IBS-mixed(IBS-M) was the most common IBS subtype(121 patients,49.8%) followed by IBS- diarrhea(IBS-D)(56 patients,23.1%),IBSconstipation(IBS-C)(54 patients,22.2%) and IBSunspecified(IBS-U)(12 patients,4.9%).Overall IBSQOL scores were significantly different among various IBS-subtypes(P = 0.01).IBS-QOL of patients with IBS-D(61.6,95%CI: 54.0-69.1) and IBS-M(63.0,95%CI: 58.1-68.0) was significantly lower than patients with IBS-C(74.5,95%CI: 66.9-82.1)(P = 0.03 and 0.02 respectively).IBS-D patients scored significantly lower than IBS-C on food avoidance(45.0,95%CI: 34.8-55.2 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and interference with activity(59.6,95%CI: 51.4-67.7 vs 82.3,95%CI: 74.1-90.6,P < 0.001).IBS-M patients had more interference in their activities(61.6,95%CI: 56.3-66.9 vs 82.3,95%CI: 74.1-90.6,P = 0.001) and greater impact on their relationships(73.3,95%CI: 68.4-78.2 vs 84.7,95%CI: 77.2-92.2,P = 0.02) than IBS-C patients.Patients with IBS-M also scored significantly lower than IBS-C on food avoidance(47.2,95%CI: 40.7-53.7 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and social reaction(66.1,95%CI: 61.1-71.1 vs 80.0,95%CI: 72.1-87.7,P = 0.005).CONCLUSION: IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients.Clinicians should recognize food avoidance,effects on daily activities and relationship problems in these patients.

Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease

AIM: To investigate the prevalence of proximal small bowel (SB) lesions detected by wireless capsule endoscopy (WCE) in Crohn's disease (CD). METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA) or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS). Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis. RESULTS: WCE detected proximal SB lesions in 16/32 (50%) patients (14 aphthoid ulcers, 2 deep ulcers, one stricture), which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidalanti-inflammatory drugs (NSAIDs), IDA]. Among patients with proximal SB lesions, 6 (37%) were smokers, 3 (19%) NSAID users, 3 (19%) had epigastric pain and 4 (25%) had IDA. SICUS detected proximal SB lesions in 3/32 patients (19%) also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (χ2 = 1.5, P = 0.2). CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum.

Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives

Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.

Mesenteric adenitis caused by Yersinia pseudotubercolosis in a patient subsequently diagnosed with Crohn's disease of the terminal ileum

尽管在煽动性的肠疾病和胃肠的感染之间的协会被建议了，涉及 Crohn 的疾病(CD ) 的致病的机制仍然是未经决定的。我们报导以后与 Crohn 的疾病被诊断的一个人，开始由于 Yersinia pseudotubercolosis 感染与 mes 伤寒淋巴腺炎介绍了，的案例。这个案例遵守在建议那 CD 是在遗传上易受影响的个人连接到对伤寒细菌的反常有免疫力的回答的疾病的文学的最近的证据。

Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect

AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Services Division(ISD) Scotland and National Records of Scotland(NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records(SMR01) database which holds data on inpatient and daycase hospital discharges from non-obstetric and nonpsychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10(International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB,30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January,2000 and October,2009. There was no significant change in annual number of admissions over time,but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8%(P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category(P < 0.05),although case fatality was higher for the patients from the least deprived category(P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays(P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weekend when compared to weekdays,although only reached statistical significance for the last year of study 2009/10(P < 0.0005). CONCLUSION: Despite reduction in mortality for UGIB in Scotland during 2000-2010,weekend admissions show a consistently higher mortality and greater lengths of stay compared with weekdays.

Diagnosis and management of relapsing pancreatitis associated with cystic neoplasms of the pancreas

One of the most important causes of relapsing pancreatitis is a cystic neoplasm of the pancreas. These low grade malignancies may cause pancreatitis by obstructing or communicating with a pancreatic duct. Patients with relapsing pancreatitis and a focal fluid fluid collection should be investigated for the possibility of a mucinous cystic neoplasm. Cross sectional imaging can provide a diagnosis with the imaging findings of a low attenuation cystic lesion containing mural calcification (CT scanning) or a lobular T2 enhancing lesion (MRCP). Endoscopic ultrasound can provide more detailed imaging with the ability to guide fine needle aspiration of the cyst fluid. Cyst fluid analysis can provide a diagnosis of a mucinous cystic lesion with the combination of cytology (mucinous epithelium), elevated carcinoembryonic antigen (CEA), and the presence of DNA mutations. Management of these patients consists of surgical resection and monitoring in patients not able to withstand surgery.

Capsule endoscopy in suspected small bowel Crohn's disease:Economic impact of disease diagnosis and treatment

AIM: To model clinical and economic benef its of capsule endoscopy (CE) compared to ileo-colonoscopy and small bowel follow-through (SBFT) for evaluation of suspected Crohn’s disease (CD). METHODS: Using decision analytic modeling, total and yearly costs of diagnostic work-up for suspected CD were calculated, including procedure-related adverse events, hospitalizations, off ice visits, and medications. The model compared CE to SBFT following ileo-colonoscopy and secondarily compared CE to SBFT for initial evaluation. RESULTS: Aggregate charges for newly diagnosed, medically managed patients are approximately $8295. Patients requiring aggressive medical management costs are $29 508; requiring hospitalization, $49 074. At sensitivity > 98.7% and specifi city of > 86.4%, CE is less costly than SBFT. CONCLUSION: Costs of CE for diagnostic evaluationof suspected CD is comparable to SBFT and may be used immediately following ileo-colonoscopy.

Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment

Hepatitis B remains a significant global clinical problem,despite the implementation of safe and effective vaccination programs.The prevalence of hepatitis B virus(HBV)in patients with inflammatory bowel disease(IBD)largely follows the regional epidemiologic status.Serological screening with hepatitis B surface antigen(HBsAg),and antibodies to hepatitis B surface(anti-HBs)and core(anti-HBc)proteins is a key element in the management of IBD patients and,ideally,should be performed at IBD diagnosis.Stratification of individual cases should be done according to the serologic profile and the IBD-specific treatment,with particular emphasis in patients receiving immunosuppressive regimens.In patients who have not contracted HBV,vaccination is indicated to accomplish protective immunity.Vaccination in immunosuppressed patients,however,is a challenging issue and several strategies for primary and revaccination have been proposed.The risk of HBV reactivation in patients with IBD should be considered in both HBsAg-positive and HBsAg-negative/anti-HBc-positive patients,when immunosuppressive therapies are administered.HBV reactivation is preventable via the administration of prophylactic nucleot(s)ide analogues and should be the standard approach in HBsAg-positive patients.HBsAg-negative/anti-HBcpositive patients represent a non-homogeneous group and bear a significantly lower risk of HBV reactivation.Biochemical,serological and molecular monitoring is currently the recommended approach for anti-HBc patients.Acute HBV infection is rarely reported in IBD patients.In the present review,we outline the problems associated with HBV infection in patients with IBD and present updated evidence for their management.

Robotic-assisted cholecystectomy: Current status and future application

Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This review aims to provide an overview of the evidence for RC and to define its current and future role.A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022.The evidence obtained was summarised in a narrative style.Greater emphasis was placed on recent 10-year articles and studies of higher meth-odological quality.RC is noninferior to LC.The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot.LC remains appropriate for the majority of patients requiring cholecystectomy.The advantages of RC include inherent technical benefits,facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations(Mirizzi syndrome,complicated calculous disease,chronic liver disease and possibly malignancy).It also has increasing applicability to related biliary surgery.The limitations include cost,loss of tactile feedback and the learning curve associated with initial implementation.Future applications of robotic surgical systems include utilisation in difficult cholecystectomy,cases of biliary malignancy,telerobotic surgery and telementoring.

Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

Prevalence of gallstone disease in first-degree relatives of patients with cholelithiasis

AIM: To evaluate the influence of familiality on the prevalence of gallstone disease (GD) in Italy.METHODS: Families of 79 subjects with gallstones (cases) and of 79 subjects without gallstones (controls)were investigated for the presence of gallstones by ultrasonography. Index cases and index controls were matched for age, sex, and operative unit. Sixty-three and sixty-two husbands and wives of index cases and index controls, respectively, were also studied.RESULTS: Overall,the prevalence of GD was significantly higher (X2=14.52, P＜0.001) in the 202 first-degree relatives of subjects with gallstones than that in the 201 first-degree relatives of subjects without gallstones (28.6% vs 12.4%, relative risk (RR) 1.80, 95% confidence interval (CI) 1.29-2.63). In particular,prevalence of GD was significantly higher in mothers,fathers, and sisters of index cases than that in the respective family members of index controls. The highest RR was observed in mothers (RR=2.35, 95%CI 1.38-4.3).Prevalence of GD was not obviously different in brothers and also in husbands and wives of index cases and index controls. Family members of index cases did not differ from family members of control cases with respect to the most important risk factors for gallstones (age, diabetes,BMI, and number of pregnancies) with an exception of a higher prevalence of diabetes in fathers of index controls than in fathers of index cases.CONCLUSION: This study confirms that familiality plays a very important role in the pathogenesis of gallstones.

Sorghum germplasm from West and Gentral Africa maintained in the ICRISAT genebank: Status,gaps,and diversity

The genebank at ICRISAT maintains 8020 accessions of sorghum from 16 West and Central African countries. Geographical gaps and diversity were assessed in the collection. Using the passport data of 3991 accessions for which georeferenced data were available, a total of386 districts(gaps) located in 11 West and Central African countries were identified as geographical gaps. Burkina Faso with 140 and Nigeria with 118 districts were identified as countries with major geographical gaps. The collection of 43 accessions of wild species represented only three species belonging to Sorghum bicolor ssp. drummondii and ssp.verticilliflorum, S. hevisonii, and S. macrochaeta, highlighting the need for collection missions aimed exclusively at enriching the collection of wild relatives. Accessions having characterization data(7630) were used to assess diversity. The first three principal components contributed to >60% of variation. Maximum diversity was observed in the collection from Nigeria for both qualitative and quantitative traits. Mean values indicated significant differences between basic and intermediate races for the traits studied. Among the races, accessions of guinea-caudatum for qualitative traits and those of caudatum for quantitative traits were highly diverse. The low intensity of the sorghum collection and the many geographical gaps in the collection underline the importance of launching collection missions to fill the gaps, particularly in regions of predominantly guinea sorghums.Genotyping of possible duplicate accessions is needed to identify duplicates in the collection. It is suggested that all passport information including georeferenced data of collection sites should be collected when samples are collected in gaps.

Intraparenchymal hepatic hematoma following endoscopic retrograde cholangiopancreatography: Risk factors and conservative approach in acute management

Endoscopic retrograde cholangiopancreatography(ERCP) is an invasive procedure with a complication rate ranging from 4% to 10% [1]. While post-procedure pancreatitis is the most common risk, bleeding also deserves attention. The most common symptoms of post-procedure bleeding were abdominal pain(91.7%), anemia(43.8%), hypotension(29.2%) and fever(20.8%) [2,3].

空间数据仓库的安全控制

安全在任何数据库访问和数据传输应用里都是一个重要的问题,尤其是在Internet环境下。基于Web的地理空间数据的安全问题和地理空间数据这个整体一样。

Spatial Analysis and Modelling of Wind Farm Site Suitability in Nasarawa State, North-Central Nigeria

There has been an increasing global and local interest in developing renewable, clean, and cheap energy towards achieving Goal number 7 of the Sustainable Development Goals (SDG). However, decisions involving suitable and sustainable locations for renewable energy projects remain an important task. This study employed Geographic Information System (GIS) and Multi-Criteria Decision Analysis (MCDA) to spatially analyze and model wind farm site suitability in Nasarawa State. The aim is to integrate the environmental, social, and economic aspects of decision-making for identifying sustainable wind farm sites. The study distinguished between two sets of decision criteria: decision constraints and decision factors. The former defined the exclusion zones while the latter were standardized based on fuzzy logic to depict varying degrees of suitability across the State. The MCDA applied the weighted linear combination method, with relative weights generated through pairwise comparisons of the analytic hierarchy process to analyze three policy scenarios: equal weights, environmental/social priority, and economic priority scenario. A combination of resulting composite maps from the constraints and the factors gave the final suitability maps. The resulting suitability index (SI) for the respective policy scenario describes the degrees of suitability: Ideal locations were denoted by one (1) and the not suitable locations by zero (0), with values in-between depicting varying degrees of wind farm site suitability. Based on the SI, priority locations indicating areas with good prospects, in addition to the most suitable parcels of land, were identified and delineated. The composite decision constraint revealed that wind farm projects would not be viable in more than half (57.58%) of the State. Wind speed was the major constraint and accounted for the exclusion of 46.25%, with a mean fuzzy membership value of 0.2008 indicating low suitability across the State. Also, the average acceptable wind farm location for the three-policy scenario was 33.33% of the entire study area. Lafia, Obi, Keana, Awe, Nasarawa-Eggon, Wamba and Kokona LGAs were the identified priority Local Government Areas (LGAs). However, only Lafia, Obi, and Nasarawa-Eggon were consistent with changes in the policy objectives. All the priority LGAs have one or more of the most suitable parcels within their administrative boundaries except for Wamba. Despite the severe limitations of wind speed, substantial parts of Nasarawa State still provide great development potentials for wind energy. The “most suitable” locations in Lafia, Nasarawa-Eggon, and Obi LGAs should have first consideration for the development of wind energy in the State.

儿科肝移植术前的血管影像学检查

Background/Purpose: There is a considerable variation in the use of vascular imaging techniques in the preoperative assessment of children scheduled for liver transplantation. Duplex Doppler ultrasound scan (US), magnetic resonance angiography (MRA), and conventional angiography are used to varying extents. The authors compared the results of preoperative vascular imaging studies with operative findings to determine their accuracy and usefulness. Methods: Results of preoperative vascular imaging in 37 consecutive children undergoing cadaveric liver transplantation were compared with operative findings. Those undergoing relatively elective transplantations were investigated by US and MRA (group 1), whereas those requiring urgent transplants were assessed only by US (group 2). Results: The median age of the cohort (15 boys; 22 girls) was 4 years (19 days to 16 years) and the median weight was 17 kg (2.9 to 82 kg). In group 1 (n = 26), 20 children had a normalcaliber, patent portal vein at transplant and 6 had a narrow but patent portal vein requiring venous reconstruction in 4. The sensitivity and specificity of MRA in the detection of an abnormally narrow portal vein were 100% (6/6) and 95% (19/20), respectively. If reversed or absent flow in the portal vein on US was taken as an indication of a potentially abnormal vein, the sensitivity and specificity of Doppler US were 83% (5/6) and 95% (19/20), respectively. Magnetic resonance angiography revealed arterial anomalies in 4 children but failed to detect small accessory hepatic arteries in 5. The single patient with an aberrant vena cava was identified by MRA. In group 2 (n = 11), venous findings at operation and on US were concordant in 10 (91% ) cases; one infant with reversed flow in the portal vein on US had a thrombosed vein at surgery. Magnetic resonance angiography was useful in 2 patient groups: those with reversed flow on Doppler US or suspected portal vein thrombosis in whom an abnormal portal vein was present in 86% (6/7) and infants with the biliary atresia splenic malformation syndrome who had multiple venous and arterial anomalies. Conclusions: A detailed Doppler examination of the hepatic vasculature by an experienced sonographer/radiologist provides sufficient vascular imaging for most children scheduled for cadaveric liver transplantation. Routine MRA is recommended in children with the biliary atresia splenic malformation syndrome and in those with abnormal duplex Doppler US findings. Although there are limited data in this study, MRA is also valuable in children with Budd-Chiari syndrome, liver tumors, or a previous portosystemic shunt.

在英国谢菲尔德所做的关于户外空气污染与卒中关系的一项小范围的地域性研究

Background and Purpose:Current evidence suggests that stroke mortality and hospital admissions should be higher in areas with elevat ed levels of outdoor air pollution because of the combined acute and chronic exp osure effects of air pollution.We examined this hypothesis using a small-area l evel ecological correlation study. Methods:We used 1030 census enumeration dist ricts as the unit of analysis and examined stroke deaths and hospital admissions from 1994 to 1998, with census denominator counts for people ≥45 years. Modele d air pollution data for particulate matter (PM10), nitrogen oxides (NOx), and c arbonmonoxide (CO) were interpolated to census enumeration districts. We adjuste d for age, sex, socioeconomic deprivation,and smoking prevalence. Results:The a nalysis was based on 2979 deaths, 5122 admissions, and a population of 199 682.A fter adjustment for potential confounders, stroke mortality was 37%(95%CI, 19 to 57), 33%(95%CI, 14 to 56), and 26%(95%CI, 10 to 46) higher in the highest , relative to the lowest, NOx, PM10, and CO quintile categories, respectively.Co rresponding increases in risk for admissions were 13%(95%CI, 1 to 27), 13%(95 %CI, -1 to 29), and 11%(95%CI, -1 to25). Conclusion:The results are consis tent with an excess risk of stroke mortality and, to a lesser extent, hospital a dmissionsin are as with high outdoor air pollution levels. If causality were ass umed, 11%of stroke deaths would have been attributable to outdoor air pollution . Targeting policy interventions at high pollution areas may be a feasible optio n for stroke prevention.

急性大便失禁患者直肠感觉运动障碍:来自延长测压研究的证据

Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence- namely, those with rectal hypersensitivity who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensve assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.