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The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements

Authors

  • H. Heinrich,

    1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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  • H. Fruehauf,

    1. Division of Gastroenterology and Hepatology, Stadtspital Triemli, Zurich, Switzerland
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  • M. Sauter,

    1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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  • A. Steingötter,

    1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
    2. Institute of Biomedical Engineering and Medical Informatics, ETH and University Zurich, Zurich, Switzerland
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  • M. Fried,

    1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
    2. Zurich Centre for Integrated Human Physiology, University of Zurich, Institute of Physiology, Winterthurerstr, Zürich, Switzerland
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  • W. Schwizer,

    1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
    2. Zurich Centre for Integrated Human Physiology, University of Zurich, Institute of Physiology, Winterthurerstr, Zürich, Switzerland
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  • M. Fox

    1. Zurich Centre for Integrated Human Physiology, University of Zurich, Institute of Physiology, Winterthurerstr, Zürich, Switzerland
    2. Nottingham Digestive Diseases Centre and Biomedical Research Unit, Queen’s Medical Centre, Nottingham, UK
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  • This data was presented in abstract form during the following meetings: Neurogastroenterology & Motility, 2009. 21(s1): p. 15–98. Swiss Med Wkly 2009;139 (Suppl. 176)G4.

Address for Correspondence
Dr. med Henriette Heinrich, Clinical Research Fellow, Division of Gastroenterology and Hepatology, University Hospital Zürich Rämisstrasse 100, 8091 Zürich, Switzerland.
Tel: +41442551111; fax: +41442554503;
e-mail: henriette.heinrich@usz.ch

Abstract

Background  Guidelines recommend instruction and motivation during anorectal manometry; however, its impact on findings has not been reported. This study assessed the effects of standard versus enhanced instruction and verbal feedback on the results of anorectal manometry.

Methods  High-resolution manometry was performed by a solid-state catheter with 10 circumferential sensors at 6 mm separation across the anal canal and two rectal sensors. Measurements were acquired first with standard instruction and then with enhanced instruction and verbal feedback. On both occasions, squeeze pressure and duration during three voluntary contractions and intra-rectal pressure and recto-anal pressure gradient (RAPG) during three attempts at simulated defecation were assessed.

Key Results  A total of 70 consecutive patients (54 female; age 25–82 years) referred for investigation of fecal incontinence (n = 31), constipation, and related disorders of defecation (n = 39) were studied. Enhanced instruction and verbal feedback increased maximum squeeze pressure (Δ10 ± 28.5 mmHg; P < 0.0038) and duration of contraction (Δ3 ± 4 s; P < 0.0001). During simulated defecation, it increased intra-rectal pressure (Δ12 ± 14 mmHg; P < 0.003) and RAPG (Δ11 ± 20 mmHg; P < 0.0001). Using standard diagnostic criteria, the intervention changed manometric findings from locally validated ‘pathologic’ to ‘normal’ values in 14/31 patients with incontinence and 12/39 with disorders of defecation.

Conclusions & Inferences  Enhanced instruction and verbal feedback significantly improved voluntary anorectal functions and resulted in a clinically relevant change of manometric diagnosis in some patients. Effective explanation of procedures and motivation during manometry is required to ensure consistent results and to provide an accurate representation of patient ability to retain continence and evacuate stool.

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