title: 3D High-definition anorectal manometry: Values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD).
abstract: BACKGROUND
  3D-high definition anorectal manometry (3DARM) may aid the diagnosis of functional anorectal disorders, but data comparing asymptomatic and symptomatic subjects are scarce. We aimed to describe 3DARM values in asymptomatic volunteers and those with fecal incontinence (FI) or chronic constipation (CC), and identify which variables differentiate best these groups.
  
  
  METHODS
  Asymptomatic subjects were stratified by sex, age, and parity. Those with FI or CC were included according to anorectal symptom questionnaires. Endoanal ultrasound examination and 3DARM were performed the same day. Anal pressures were analyzed at rest, during voluntary squeeze, and during push maneuver, and compared between the 3 groups. Anal pressure defects were defined and compared to ultrasound defects.
  
  
  RESULTS
  A total of 126 subjects (113 female, mean age 52 years, range 18-83) were included; 36 asymptomatic, 38 FI, 42 CC. Anal resting and squeeze pressures, and rectal sensitivity values were lower in FI women than in the other groups. Typical anal sphincter asymmetry during squeezing was less frequently observed in FI women. A dyssynergic pattern during push maneuver was found in 70% of asymptomatic subjects, and with a similar frequency in the 2 symptomatic groups. There was slight concordance between 3D-pressure defects and ultrasound defects.
  
  
  CONCLUSIONS
  3D anal pressures in asymptomatic women were significantly lower than in men, and in FI compared to asymptomatic women. The classical dyssynergic pattern during push maneuver was found as frequently in asymptomatic and symptomatic patients. Further studies should try to identify 3DARM variables that could reliably identify dyssynergic defecation.
authors.affiliation: Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-2908-1591
authors.initials: F
authors.lastname: Mion
authors.affiliation: Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Garros
authors.affiliation: Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France.
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-7354-6301
authors.initials: C
authors.lastname: Brochard
authors.affiliation: Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vitton
authors.affiliation: Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Ropert
authors.affiliation: Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Bouvier
authors.affiliation: Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: H
authors.initials: H
authors.lastname: Damon
authors.affiliation: Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France.
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
authors.affiliation: Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-7798-7638
authors.initials: S
authors.lastname: Roman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis* / Q000503:physiopathology; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology; D055815:Young Adult
keywords: 3D high-resolution anorectal manometry; chronic constipation; fecal incontinence; normal values