Impaired rectoanal inhibitory response in scleroderma (systemic sclerosis): an association with fecal incontinence.
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.
Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jeffereson University Hospital, Philadelphia, Pennsylvania, USA.
Gregory J
GJ
Heyt
Mina K
MK
Oh
Nazanin
N
Alemzadeh
Susie
S
Rivera
Sergio A
SA
Jimenez
Satish
S
Rattan
Sidney
S
Cohen
Anthony J
AJ
Dimarino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology*; D001798:Blood Proteins; D003248:Constipation / Q000209:etiology; D004264:DNA Topoisomerases, Type I; D003967:Diarrhea / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D009687:Nuclear Proteins / Q000097:blood; D012021:Reflex, Abnormal; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications* / Q000503:physiopathology*
C468767:ACA protein, human; D001798:Blood Proteins; D008562:Membrane Glycoproteins; D009687:Nuclear Proteins; C048100:Scl 70 antigen, human; D004264:DNA Topoisomerases, Type I