Протокол функционального обследования аноректальной зоны и классификация нарушений: международный консенсус и Российские рекомендации
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Fomenko O.Yu., Morozov S.V., Scott S.M., et al. Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice. Therapeutic Archive. 2020; 92 (12): 105–119. DOI: 10.26442/00403660.2020.12.200472
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Ключевые слова: аноректальная манометрия, аноректальная манометрия высокого разрешения, тест на выталкивание баллона, эвакуаторная проба, функциональные расстройства аноректальной зоны, тест на чувствительность прямой кишки, консенсус.
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This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim – to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists – general practitioners, therapists, gastroenterologists, coloproctologists – all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.
Keywords: anorectal manometry, high-resolution anorectal manometry, balloon expulsion test, push test, functional defecatory disorders, rectal sensatory test, consensus.
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71. Carrington EV, Knowles CH, Grossi U, Scott SM. High-resolution Anorectal Manometry Measures Are More Accurate Than Conventional Measures in Detecting Anal Hypocontractility in Women With Fecal Incontinence. Clin Gastroenterol Hepatol. 2019;17(3):477-85.e9. doi: 10.1016/j.cgh.2018.06.037
72. Sauter M, Heinrich H, Fox M, et al. Toward more accurate measurements of anorectal motor and sensory function in routine clinical practice: validation of high-resolution anorectal manometry and Rapid Barostat Bag measurements of rectal function. Neurogastroenterol Motil. 2014;26(5):685-95. doi: 10.1111/nmo.12317
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75. Roman S, Huot L, Zerbib F, et al. High-Resolution Manometry Improves the Diagnosis of Esophageal Motility Disorders in Patients With Dysphagia: A Randomized Multicenter Study. Am J Gastroenterol 2016;111(3):372-80. doi: 10.1038/ajg.2016.1
76. Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138(1):W1-W12. doi: 10.7326/0003-4819-138-1-200301070-00012-w1
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73. Seo M, Joo S, Jung KW, et al. New Metrics in High-Resolution and High-Definition Anorectal Manometry. Curr Gastroenterol Rep. 2018;20(12):57. doi: 10.1007/s11894-018-0662-5
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77. Rao SS. Dyssynergic defecation. Gastroenterol Clin North Am. 2001;30(1):97-114. doi: 10.1016/s0889-8553(05)70169-2
78. Ratuapli SK, Bharucha AE, Noelting J, et al. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology. 2013;144(2):314-322.e2. doi: 10.1053/j.gastro.2012.10.049
1 ФГБУ «Национальный медицинский исследовательский центр колопроктологии им. А.Н. Рыжих» Минздрава России, Москва, Россия;
2 ФГБУН «Федеральный исследовательский центр питания, биотехнологии и безопасности пищи», Москва, Россия;
3 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Лондон, Великобритания;
4 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России
(Сеченовский Университет), Москва, Россия;
5 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России,
Москва, Россия;
6 ГБУЗ «Государственная клиническая больница №67 им. Л.А. Ворохобова» Департамента здравоохранения г. Москвы, Москва, Россия;
7 ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
8 ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия;
9 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
10 ГБУЗ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента»
Департамента здравоохранения г. Москвы, Москва, Россия;
11 АО «Ильинская больница», Красногорск, Московская область, Россия
________________________________________________
O.Yu. Fomenko 1, S.V. Morozov 2, S.M. Scott 3, C.H. Knowles 3, D.A. Morozov 4, Yu.A. Shelygin 1, I.V. Maev 5, D.B. Nikityuk 2,4, A.S. Shkoda 6, V.N. Kashnikov 1, D.S. Bordin 5,7,8, V.A. Isakov 2, O.M. Biryukov 1, S.V. Belousova 1, E.S. Pimenova 4, A.S. Rumiantsev 6, E.D. Fedorov 9, M.Yu. Gvozdev 5, A.S. Trukhmanov 4, O.A. Storonova 4, L.H. Indeykina 7,10, M.G. Biryukova 2, D.N. Andreev 5, Yu.A. Kucheryavyy 5,11, S.I. Achkasov 1
1 Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia;
2 Federal Research Center of Nutrition and Biotechnology, Moscow, Russia;
3 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK;
4 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
5 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
6 Vorokhobov City Clinical Hospital №67, Moscow, Russia;
7 Loginov Moscow Clinical Research Center, Moscow, Russia;
8 Tver State Medical University, Tver, Russia;
9 Pirogov Russian National Research Medical University, Moscow, Russia;
10 Research Institute of Health Care Organization and Medical Management, Moscow, Russia;
11 Ilyinsky Hospital, Krasnogorsk, Moscow region, Russia