title: Accuracy and Reproducibility of High-definition Anorectal Manometry and Pressure Topography Analyses in Healthy Subjects.
abstract: OBJECTIVE
  High-definition anorectal manometry (HDAM-3D) provides a topographic and 3-dimensional profile of anorectal pressure. We assessed anorectal sensorimotor function and the reproducibility of measurements made with HDAM-3D in healthy adults, and the accuracy of data analysis by its software.
  
  
  METHODS
  Anal sphincter pressures and rectal sensory thresholds were measured in 78 healthy subjects via placement of a 10-mm rigid probe, with 256 circumferentially arrayed pressure sensors, and a balloon in the rectum. The bearing down maneuver was assessed in a subset of 18 subjects. We compared data analyzed by an expert with findings from automated software analysis. Measurements made in a subset of 16 subjects, 2 weeks apart, were compared to determine reproducibility.
  
  
  RESULTS
  Resting, squeezing, and sustained squeezing pressures were significantly higher in men than in women (P < .05); other parameters were similar. Desire and urgency to defecate were similar between men and women, but the maximal tolerable volume was significantly lower in women (P < .05). Older women (>50 years) had significantly lower resting (P < .01) and sustained squeeze pressures (P < .04). Dyssynergic patterns of defecation were observed in 12 of 18 subjects (67%) who attempted to defecate without the 60-mL rectal balloon distention and in 6 of 18 subjects (33%) with the 60-mL rectal balloon distention. Test-retest values correlated (r = 0.81), as did analyses made by an expert vs software analyses of data (r = 0.99).
  
  
  CONCLUSIONS
  On the basis of HDAM-3D measurements in healthy adults, anal sphincter pressures are higher in men than in women, but sensory and other parameters are similar; older subjects have weaker sphincters. Many people were found to have dyssynergic patterns of defecation, which could be related to the probe or other technical issues, so this technique may not be suitable for assessing defecation patterns. Measurements made by HDAM-3D are reproducible, and data can be accurately analyzed by its software.
authors.affiliation: Digestive Health Center, Georgia Regents University, Augusta, Georgia.
authors.forename: Enrique
authors.initials: E
authors.lastname: Coss-Adame
authors.affiliation: Digestive Health Center, Georgia Regents University, Augusta, Georgia; University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: srao@gru.edu.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Jessica
authors.initials: J
authors.lastname: Valestin
authors.affiliation: Biological and Medical Research Institute, University of Veracruz, Veracruz, Mexico.
authors.forename: Amyra
authors.initials: A
authors.lastname: Ali-Azamar
authors.affiliation: Biological and Medical Research Institute, University of Veracruz, Veracruz, Mexico.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Remes-Troche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology*; D003627:Data Interpretation, Statistical; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011312:Pressure; D015203:Reproducibility of Results; D012984:Software; D055815:Young Adult
keywords: Anorectal Disorder; Balloon Expulsion; Neuromuscular; Rectal Motor Function