P0229 Evaluation of anorectal function and structure in patients with perianal Crohn's disease with a novel 3-D high-definition anorectal manometry technology
Authors: Lastiri E , Barber C , Serra J , Herrera C , Mayorga L , Robles V , Cespedes E , Serra X , Perez Z , Oller E , Borruel N 
Published: January 2025

Background

Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that can have perianal involvement with a fistulizing phenotype (PFCD) and could affect anal sphincter integrity, leading to morbidity and reduced quality of life (QoL) due to fecal incontinence (FI) and rectal pain. High-definition 3D anorectal manometry (HD-ARM) is a novel technique that allows volumetric imaging of the anal canal through 2D and 3D images, enabling visualization of morphology and identification of pressure defects caused by lesions in the sphincter complex. There are no studies in patients with IBD with this modality of manometry.

Our aim is to determine the functional and structural abnormalities of the sphincter complex using HD-ARM in patients with CD with and without PFCD and to correlate these findings with magnetic resonance imaging (MRI) results.

Methods

This is a prospective, longitudinal cohort study of anorectal function using HD-ARM and rectal sensitivity using rectal barostat in patients with CD from our IBD unit. Patients were recruited during follow-up visits regardless of whether or not they reported anorectal symptoms. Findings were correlated with clinical activity of CD (Harvey Bradshaw index), PFCD activity index (PDAI), FI severity index (Jorge-Wexner and St. Marks scores), QoL scores (IBDQ-9 for IBD and FIQLS for FI), and perineal MRI to confirm anatomical abnormalities.

Results

A total of 19 patients were recruited from December 2023 to September 2024, 68.4% of whom were female. Among patients with PFCD (68.4% of the total), 84.6% had undergone some form of anorectal surgery. Only two patients from the total cohort (10.5%) had normal HD-ARM results. The main manometric diagnoses were: rectal hypersensitivity (36.8%), rectal hyposensitivity (31.6%), internal anal sphincter insufficiency (weakness) (21.1%), incomplete evacuation maneuvers (21.1%), and dyssynergic defecation (15.8%), with no significant differences between the groups with and without PFCD. In 90% of patients with PFCD, MRI findings correlated with the presence or absence of pressure defects on the HD-ARM. Patients with pressure defects on the HD-ARM had higher FI scores on the Jorge-Wexner (7.5 vs. 3.3) and St. Marks (9 vs. 5) scores, although this difference did not reach statistical significance (p=0.07). No differences in quality of life or luminal/perianal disease activity index were found in association with manometric alterations.

Conclusion

Anorectal sphincter function abnormalities are common in patients with CD, with or without concomitant perianal disease. HD-ARM is a useful tool to correlate functional anorectal abnormalities with anatomic abnormalities on perineal MRI.

References

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Felt-Bersma, R.J.F., Vlietstra, M.S., Vollebregt, P.F. et al. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound. BMC Gastroenterol 18, 44 (2018)

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