title: Modulation of the rectoanal inhibitory reflex (RAIR): qualitative and quantitative evaluation in multiple sclerosis.
abstract: BACKGROUND
  Rectoanal inhibitory reflex (RAIR) is a physiological modulated reflex involved in anorectal continence and defined by a relaxation of internal anal sphincter following rectal distension. Its existence depends on intramural autonomic ganglions and its modulation on the integrity of the autonomic nervous system (ANS).
  
  
  OBJECTIVE
  The aim of this study was to analyse RAIR modulation in terms of amplitude and duration in multiple sclerosis (MS) patients.
  
  
  METHODS
  Twenty-one patients with MS and 40 control patients had anorectal manometry. Qualitative assessment (presence or absence) of RAIR was evaluated together with its modulation in amplitude and in duration.
  
  
  RESULTS
  All patients had present RAIR for each volume of rectal distension (10-50 ml). Seven patients (33.3%) in the MS group had abnormal RAIR modulation in amplitude (odds ratio (OR) = 2.78, compared to control group, p = 0.11). Nine patients (42.9%) in the MS group had abnormal RAIR modulation in duration (p = 0.14, OR = 2.54, compared to control group). Alteration of RAIR modulation was not correlated with Expanded Disability Status Scale, faecal incontinence and constipation (p > 0.05). Course of MS (relapsing-remitting MS or secondary progressive form) seems to be correlated to alteration of modulation in amplitude and in duration (OR = 1.31 and 1.07).
  
  
  CONCLUSIONS
  Even if our results do not have the required statistical significance (p > 0.05), they are interesting. If RAIR is always present in MS, its modulation seems to be altered. A hypothesis for this lack of RAIR modulation could be the alteration of ANS, often involved in MS besides somatic nervous system lesions.
authors.affiliation: Service de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP, 4, Rue de Chine, 75970, Paris Cedex 20, France. mandineguinet@yahoo.fr
authors.forename: Amandine
authors.initials: A
authors.lastname: Guinet
authors.forename: Marylène
authors.initials: M
authors.lastname: Jousse
authors.forename: Mireille
authors.initials: M
authors.lastname: Damphousse
authors.forename: Kathelyne
authors.initials: K
authors.lastname: Hubeaux
authors.forename: Frédérique
authors.initials: F
authors.lastname: Le Breton
authors.forename: Samer
authors.initials: S
authors.lastname: Sheikh Ismael
authors.forename: Gérard
authors.initials: G
authors.lastname: Amarenco
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D016022:Case-Control Studies; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D012007:Rectum / Q000503:physiopathology*; D012020:Reflex, Abdominal / Q000502:physiology*; D055815:Young Adult