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High-resolution Anorectal Manometry in Parkinson Disease With Defecation Disorder

A Comparison With Functional Defecation Disorder

Yu, Ting PhD; Wang, Yun PhD; Wu, Gaojue MD; Xu, Qinrong MSc; Tang, Yurong MD; Lin, Lin MD, PhD

Journal of Clinical Gastroenterology: August 2016 - Volume 50 - Issue 7 - p 566–571
doi: 10.1097/MCG.0000000000000469
ALIMENTARY TRACT: Original Articles

Goal: To investigate the characteristics of high-resolution anorectal manometry (HR-ARM) in Parkinson disease (PD) patients with defecation disorder (DD) compared with patients with functional defecation disorder (FDD).

Background: DD is a common gastrointestinal symptom in PD. HR-ARM is a relatively new and reliable method for detecting DD.

Study: A cohort of PD patients with DD was matched with FDD patients. Defecatory symptoms were investigated by questionnaire. Anorectal motility and sensation were evaluated by HR-ARM. Differences in defecatory symptoms, sensorimotor parameters, and DD type were analyzed. Defecatory symptoms and manometric variables obtained in early-stage PD were compared with advanced stage, and relationships between manometric parameters and evacuatory symptoms explored.

Results: Straining and sensation of blockage was experienced significantly more in PD than FDD, and stool consistency more severely affected. Maximum squeeze and intrarectal pressure during defecation in PD was lower than in FDD. Anal resting and residual pressures, duration of sustained squeeze, threshold volumes for first sensation, urgency, and maximum discomfort were similar between groups. PD patients presented predominantly with inadequate propulsive forces, whereas FDD patients showed dyssynergic defecation. Defecatory symptoms and manometric parameters did not differ between stages of PD.

Conclusions: PD patients with DD experienced more straining and sensation of blockage than FDD patients, possibly related to inadequate anorectal motility and paradoxical anal contraction of pelvic floor. Impaired squeeze response and inadequate propulsive forces are specific to anorectal function of PD patients with DD, compared with FDD, with abnormalities unchanged between early and advanced PD.

Departments of *Gastroenterology

Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Y.T. and W.Y. contributed equally to this work.

The authors declare that they have nothing to disclose.

Address correspondence to: Lin Lin, MD, PhD, Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China (e-mail:

Received April 4, 2015

Accepted November 24, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.