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

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Abstract

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.

About the authors

O. Yu. Fomenko

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-9603-6988
Scopus Author ID: 16401538300

д.м.н., доц., рук. лаб.

Russian Federation, Moscow

S. V. Morozov

Federal Research Center of Nutrition and Biotechnology

Author for correspondence.
Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-6816-3058
Scopus Author ID: 19836606400

к.м.н., в.н.с. отд-ния

Russian Federation, Moscow

S. Mark Scott

Barts and the London School of Medicine and Dentistry, Queen Mary University of London

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-7997-1533

д.м.н., ст. науч. сотр., дир. отд. 

United Kingdom, London

H. Charles Knowles

Barts and the London School of Medicine and Dentistry, Queen Mary University of London

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-9854-6754

д.м.н, проф., зам. дир.

United Kingdom, London

D. A. Morozov

Sechenov First Moscow State Medical University (Sechenov University)

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-1940-1395

д.м.н., проф., зав. каф.

Russian Federation, Moscow

Yu. A. Shelygin

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-8480-9362

акад. РАН, д.м.н., проф., дир.

Russian Federation, Moscow

I. V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д.м.н, проф., зав. каф., засл. врач РФ, засл. деятель науки РФ

Russian Federation, Moscow

D. B. Nikityuk

Federal Research Center of Nutrition and Biotechnology; Sechenov First Moscow State Medical University (Sechenov University)

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-2259-1222

чл.-кор. РАН, д.м.н., проф., дир.

Russian Federation, Moscow

A. S. Shkoda

Vorokhobov City Clinical Hospital №67

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-9783-1796

д.м.н., проф., глав. врач

Russian Federation, Moscow

V. N. Kashnikov

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-5385-7898

д.м.н., зам. дир.

Russian Federation, Moscow

D. S. Bordin

Yevdokimov Moscow State University of Medicine and Dentistry; Loginov Moscow Clinical Research Center; Tver State Medical University

Email: morosoffsv@mail.ru
ORCID iD: 0000-0003-2815-3992

д.м.н., зав. отд., проф. каф. 

Russian Federation, Moscow; Tver

V. A. Isakov

Federal Research Center of Nutrition and Biotechnology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-4417-8076
Scopus Author ID: 7102480906

д.м.н., проф., зав. отд-нием

Russian Federation, Moscow

O. M. Biryukov

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-1081-1793

к.м.н., зав. отд-нием

Russian Federation, Moscow

S. V. Belousova

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0003-1475-2599

к.м.н., с.н.с.

Russian Federation, Moscow

E. S. Pimenova

Sechenov First Moscow State Medical University (Sechenov University)

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-7206-5987

к.м.н., доц. каф., врач – детский хирург

Russian Federation, Moscow

A. S. Rumiantsev

Vorokhobov City Clinical Hospital №67

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-1548-5456

травматолог-ортопед

Russian Federation, Moscow

E. D. Fedorov

Pirogov Russian National Research Medical University

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-5516-3155

д.м.н., проф., гл. науч. сотр., рук. отд.

Russian Federation, Moscow

M. Yu. Gvozdev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-8385-5500

д.м.н., проф. каф.

Russian Federation, Moscow

A. S. Trukhmanov

Sechenov First Moscow State Medical University (Sechenov University)

Email: morosoffsv@mail.ru
ORCID iD: 0000-0003-3362-2968

д.м.н., проф. каф.

Russian Federation, Moscow

O. A. Storonova

Sechenov First Moscow State Medical University (Sechenov University)

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-0960-1166

к.м.н., врач отд-ния

Russian Federation, Moscow

L. H. Indeykina

Loginov Moscow Clinical Research Center; Research Institute of Health Care Organization and Medical Management

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-3829-3211

зав. лаб., вед. специалист

Moscow

M. G. Biryukova

Federal Research Center of Nutrition and Biotechnology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-9392-4944

врач-гастроэнтеролог

Russian Federation, Moscow

D. N. Andreev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: morosoffsv@mail.ru
ORCID iD: 0000-0002-4007-7112

к.м.н., доц. каф.

Russian Federation, Moscow

Yu. A. Kucheryavyy

Yevdokimov Moscow State University of Medicine and Dentistry; Ilyinsky Hospital

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-7760-2091

к.м.н., доц. каф., зав. отд-нием 

Russian Federation, Moscow; Krasnogorsk

S. I. Achkasov

Ryzhikh National Medical Research Centre for Coloproctology

Email: morosoffsv@mail.ru
ORCID iD: 0000-0001-9294-5447

д.м.н., проф., рук. отд-ния

Russian Federation, Moscow

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Supplementary files

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2. Figure: 1. The layout of the probe for the AWP.

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3. Figure: 2. Scheme of the examination of the patient using functional methods for assessing the anorectal zone. Note. The given timelines differ from the original ones (the total duration of the survey in the original document is 12 minutes), since the sum of the time intervals required for the individual stages of the survey is greater than the one given by the authors of the international consensus.

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4. Figure: 3. London classification, part 1 (violation of RAIR) and part 2 (violation of tone and contractility of the anus muscles).

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5. Figure: 4. London classification, part 3 (rectal-anal coordination disorders) and part 4 (rectal sensation disorders).

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