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Impaired Rectoanal Inhibitory Response in Scleroderma (Systemic Sclerosis): An Association with Fecal Incontinence

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Abstract

Gastrointestinal abnormalities in systemic sclerosis (SSc) involve both myogenic and neural mechanisms. The aims of this study were to evaluate the rectoanal inhibitory response (RAIR) in SSc patients and to correlate RAIR with duration and subtype of disease, antibody status, and lower gastrointestinal symptoms. Thirty-five patients with SSc completed a questionnaire and underwent anorectal manometry (ARM). Forty-five patients without SSc served as controls. In the 35 SSc patients, 62.3% reported diarrhea, 57.1% reported constipation, and 37.1% reported fecal incontinence. Twenty-five of the 35 scleroderma patients (71.4%) demonstrated an impaired or absent RAIR, compared with none of the 45 controls (P < 0:001). Eleven of 13 incontinent SSc patients (84%) had an impaired RAIR. No correlation was found between RAIR and duration or subtype of SSc, antibody status, or presence of diarrhea or constipation. Impaired RAIR was closely correlated with fecal incontinence, suggesting a possible neural mechanism for maintenance of continence.

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REFERENCES

  1. Cohen S: The gastrointestinal manifestations of scleroderma: patho-genesis and management. Gastroenterology 79:155–166, 1980

    Google Scholar 

  2. Rose S, Young MA, Reynolds JC: Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am 27:563–594, 1998

    Google Scholar 

  3. Treacy WL, Baggentoss AH, Slocumb CH: Scleroderma of the esophagus. Acorrelation of histologic and physiologic findings. Ann Intern Med 59:351, 1963

    Google Scholar 

  4. Engel AF, Kamm MA, Talbot IC: Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence. Gut 35:857–859, 1994

    Google Scholar 

  5. Malandrini A, Selvi E, Villanova M, Berti G, Sabadini L, Salvadori C, Gambelli S, De Stefano R, Vernillo R, Marcolongo R, Guazzi G: Autonomic nervous system and smooth muscle cell involvement in systemic sclerosis: Ultrastructural study of 3 cases. J Rheumatol 27:1203–1206, 2000

    Google Scholar 

  6. Trezza M, Krogh K, Egekvist H, Bjerring P, Laurberg S: Bowel problems in patients with systemic sclerosis. Scand J Gastroenterol 34:409–413, 1999

    Google Scholar 

  7. Lock G, Zeuner M, Lang B, Hein R, Scholmerich J, Holsteg A: Anorectal function in systemic sclerosis: Correlation with esophageal dysfunction? Dis Colon Rectum 40:1328–1335, 1997

    Google Scholar 

  8. Sonnex C, Paice E, White AG: Autonomic neuropathy in systemic sclerosis: A case report and evaluation of 6 patients. Ann Rheum Dis 45:957–960, 1986

    Google Scholar 

  9. Greydanus MP, Camilleri M: Abnormal postcibal antral and small bowel motility due to neuropathy and myopathy in systemic sclero-sis. Gastroenterology 96:110–115, 1989

    Google Scholar 

  10. Speakmann CT, Kamm MA: The internal anal sphincter-new in-sights into faecal incontinence. Gut 32:345–346, 1991

    Google Scholar 

  11. Duthie HL, Watts JM: Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 6:64–68, 1965

    Google Scholar 

  12. Tomita R, Tanjoh K, Fujisaki S, Fukuzawa M: The role of nitric oxide (NO) in the human internal anal sphincter. J Gastroenterol 36(6):386–391, 2001

    Google Scholar 

  13. Jaffin BW, Chang P, Spiera H: Fecal incontinence in scleroderma: Clinical features, anorectal manometric findings, and their therapeu-tic implications. J Clin Gastroenterol 25(3):513–517, 1997

    Google Scholar 

  14. Leighton JA, Valdovinos MA, Pemberton JH, Rath DM, Camilleri M: Anorectal dysfunction and rectal prolapse in progressive sys-temic sclerosis. Dis Colon Rectum 36:182–185, 1993

    Google Scholar 

  15. Chiou AW, Lin, JK, Wang FM: Anorectal abnormalities in progres-sive systemic sclerosis. Dis Colon Rectum 32:417–421, 1989

    Google Scholar 

  16. Anonymous: Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommitee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arth Rheum 23(5):581–590, 1980

  17. Katner IJ, Fry RD, Fleshman JW: Colon, rectum, and anus. In Principles of Surgery, Volume 2, 7th ed. SI Schwartz (ed). New York, McGraw-Hill, Health Professions Division, 1999, pp 1285–1287

    Google Scholar 

  18. Akesson A, Ekman R: Gastrointestinal regulatory peptides in sys-temic sclerosis. Arth Rheum 36:698–703, 1993

    Google Scholar 

  19. D'Angelo WA, Fries JF, Masi AT, Shulman LE: Pathologic obser-vations in systemic sclerosis (scleroderma): A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 46:428–439, 1969

    Google Scholar 

  20. deSouza NM, Williams AD, Wilson HJ, Gilderdale DJ, Coutts GA, Black CM: Fecal incontinence in scleroderma: Assessment of the anal sphincter with thin section endoanal MR imaging. Radiology 208(2):529–535, 1998

    Google Scholar 

  21. Herrick AL, Barlow JD, Bowden A, Williams N, Hobson AR, Irving M, Jayson MI: Investigation of anal function in patients with sys-temic sclerosis. Ann Rheum Dis 55:370–374, 1996

    Google Scholar 

  22. Kim KC, Park HJ, Lee SK, Chung JP, Lee KS, Chon CY, Park IS: Anorectal dysfunction in systemic sclerosis. J Korean Med Sci 11(3):244–249, 1996

    Google Scholar 

  23. Basilisco G, Barbera R, Vanoli M, Bianchi P: Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis. Dig Dis Sci 38:1525–1529, 1993

    Google Scholar 

  24. Hamel-Roy J, Devroede G, Arhan P, Tetreault L, Duranceau A, Menard HA: Comparative esophageal and anorectal motility in scle-roderma. Gastroenterology 88:1–7, 1985

    Google Scholar 

  25. Howard ER, Nixon HH: Internal anal sphincter: Observations on development and mechanism of inhibitory response in premature infants and children with Hirschsprung's Disease. Arch Dis Child 43(231):569–578, 1968

    Google Scholar 

  26. Frenckner B: Function of the anal sphincters in spinal man. Gut 16:638–644, 1975

    Google Scholar 

  27. Lubowski DZ, Nicholls RJ, Swash M, Jordan MJ: Neural control of internal anal sphincter function. Br J Surg 74:668–670, 1987

    Google Scholar 

  28. DiMarino AJ, Carlson G, Myers A, Schumaker HR, Cohen S: Duo-denal myoelectric activity in scleroderma. Abnormal responses to mechanical and hormonal stimuli. N Engl J Med 289(23):1220–1223, 1973

    Google Scholar 

  29. Goldblatt F, Gordon TP, Waterman SA: Antibody-mediated gastrointestinal dysmotility in scleroderma. Gastroenterology 123(4):1144–1150, 2002

    Google Scholar 

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Heyt, G.J., Oh, M.K., Alemzadeh, N. et al. Impaired Rectoanal Inhibitory Response in Scleroderma (Systemic Sclerosis): An Association with Fecal Incontinence. Dig Dis Sci 49, 1040–1045 (2004). https://doi.org/10.1023/B:DDAS.0000034569.85066.69

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  • DOI: https://doi.org/10.1023/B:DDAS.0000034569.85066.69

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