J Neurogastroenterol Motil  
Anorectal Manometry in Defecatory Disorder: A Comparative Analysis of High-resolution Pressure Topography and Waveform Manometry
Yeong Yeh Lee,1,2 Askin Erdogan,1 Siegfried Yu,1 Annie Dewitt,1 and Satish S C Rao1*
1Section of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia, USA; and 2School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
Correspondence to: Satish S C Rao, MD, PhD, FRCP, AGAF, FACG
Department of Medicine, Section of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, 1120 15th Street, BBR 2538, Augusta, GA 30912, USA
Tel: +1-706-721-2238, Fax: +1-706-721-0331, E-mail: srao@augusta.edu
Received: July 3, 2017; Revised: February 3, 2018; Accepted: March 26, 2018; Published online: June 7, 2018.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Whether high-resolution anorectal pressure topography (HRPT), having better fidelity and spatio-temporal resolution is comparable to waveform manometry (WM) in the diagnosis and characterization of defecatory disorders (DD) is not known.
Methods
Patients with chronic constipation (Rome III) were evaluated for DD with HRPT and WM during bearing-down “on-bed” without inflated rectal balloon and “on-commode (toilet)” with 60-mL inflated rectal balloon. Eleven healthy volunteers were also evaluated.
Results
Ninety-three of 117 screened participants (F/M = 77/16) were included. Balloon expulsion time was abnormal (> 60 seconds) in 56% (mean 214.4 seconds). A modest correlation between HRPT and WM was observed for sphincter length (R = 0.4) and likewise agreement between dyssynergic subtypes (κ = 0.4). During bearing down, 2 or more anal pressure-segments (distal and proximal) could be appreciated and their expansion measured with HRPT but not WM. In constipated vs healthy participants, the proximal segment was more expanded (2.0 cm vs 1.0 cm, P = 0.003) and of greater pressure (94.8 mmHg vs 54.0 mmHg, P = 0.010) during bearing down on-commode but not on-bed.
Conclusions
Because of its better resolution, HRPT may identify more structural and functional abnormalities including puborectal dysfunction (proximal expansion) than WM. Bearing down on-commode with an inflated rectal balloon may provide additional dimension in characterizing DD.
Keywords: Anal canal; Constipation; Defecation; Gastrointestinal motility; Manometry


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