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Manometric Evaluation of Evacuatory Difficulty (Dyschezia) in Ileal Pouch Patients

Khanna, Reena MD; Li, Yue MD; Schroeder, Thomas MD; Brzezinski, Aaron MD; Lashner, Bret A. MD, MPH; Kiran, Ravi P. MD, MS; Remzi, Reza H. MD; Shen, Bo MD

doi: 10.1097/MIB.0b013e31827e78d6
Original Clinical Articles

Background: Dyschezia occurs in patients with ileal pouch-anal anastomosis. There are limited data on the mechanisms of this condition. We hypothesized that paradoxical contractions may contribute to dyschezia in those patients with mechanical or inflammatory pouch conditions. This study was aimed to evaluate the underlying manometric abnormalities in this population.

Methods: In this retrospective analysis, we screened our Pouchitis Registry for patients with dyschezia and underlying inflammatory bowel disease. Patients having undergone anopouch manometry were considered eligible and included. Patients without inflammatory or structural diseases of the pouch (the functional pouch disorder [FPD] group) were compared with those with inflammatory or structural diseases (the inflammatory/structural pouch disorder [ISPD] group). Demographic, clinical, manometric, and laboratory variables were analyzed.

Results: A total of 45 patients were included; of which, 21 (46.7%) were female. The median age of patients in the FPD group (n = 10) and ISPD group (n = 35) were 41 (interquartile range =32.5–56) years and 40 (interquartile range = 28–49) years, respectively (P = 0.469). There were no differences in the demographic, clinical, and laboratory variables between the 2 groups, with the exception of the modified Pouch Disease Activity Index. For manometric evaluations, paradoxical contractions and failure of balloon expulsion occurred in 50.0% and 60.0%, respectively, of the FPD group and in 17.1% and 20.0%, respectively, of the ISPD group (P = 0.048 and 0.043, respectively).

Conclusions: In this cohort, manometric evaluation demonstrated that paradoxical contractions occurred more frequently in patients with FPD than in those with inflammatory/structural conditions. This suggests that the underlying physiologic mechanisms of dyschezia in these patients differ.

Article first published online 1 February 2013

Departments of Gastroenterology/Hepatology and Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Reprints: Bo Shen, MD, Department of Gastroenterology/A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (e-mail:

The authors declared no financial or conflicts of interest to disclose.

Received May 31, 2012

Accepted June 11, 2012

© Crohn's & Colitis Foundation of America, Inc.
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