科研之友
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摘要
OBJECTIVES: Supraconal spinal cord injury (SCI) and lower motor neurone spinal cord injury (LMN-SCI) cause bowel dysfunction; colorectal compliance may further define its pathophysiology. The aim of this study was to investigate rectal (RC) and sigmoid (SC) compliance and anorectal physiology parameters, in these subjects. METHODS: Twenty-four SCI subjects with gut symptoms (14 RC, 10 SC) and 13 LMN-SCI subjects (9 RC, 4 SC) were compared with 20 spinal intact controls (10 RC, 10 SC). Staircase distensions were performed using a barostat. Anorectal manometry, including rectoanal inhibitory reflex (RAIR) measurement, was performed in all. Data presented as mean +/- standard error (SCI/LMN-SCI vs. controls). RESULTS: SCI subjects had a higher RC (17.0 +/- 1.9 vs. 10.7 +/- 0.5 ml/mm Hg, P < 0.05) and SC (8.5 +/- 0.6 vs. 5.2 +/- 0.5 ml/mm Hg, P=0.002). LMN-SCI subjects had a lower RC (7.3 +/- 0.7 ml/mm Hg, P=0.0021) while SC was unchanged (8.3 +/- 2.2 ml/mm Hg, P>0.05). Anal resting pressure was decreased in SCI (55 +/- 5 vs. 79 +/- 7 cmH(2)O, P=0.0102). Anal squeeze pressure was decreased in LMN-SCI (76 +/- 13 vs. 154 +/- 21 cmH(2)O, P=0.0158). In SCI and LMN-SCI, the amplitude reduction of the RAIR was greater (62 +/- 4% and 70 +/- 6% vs. 44 +/- 3%, P=0.0007). CONCLUSIONS: Colorectal compliance abnormalities may explain gut symptoms: increased RC and SC contributing to constipation in SCI, reduced rectal compliance contributing to fecal incontinence (FI) in LMN-SCI. Reduced resting anal pressure in SCI and reduced anal squeeze pressure in LMN-SCI along with a greater RAIR amplitude reduction may be factors in FI. These co-existing abnormalities may explain symptom overlap, and represent future therapeutic targets to ameliorate neurogenic bowel dysfunction.
- 出版日期2016-4
