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A pharmacological challenge predicts reversible rectal sensorimotor dysfunctions in women with fecal incontinence
Author(s) -
Sharma M.,
Feuerhak K.,
Zinsmeister A. R.,
Bharucha A. E.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13383
Subject(s) - barostat , atropine , medicine , clonidine , anesthesia , placebo , randomization , fecal incontinence , randomized controlled trial , gastroenterology , irritable bowel syndrome , alternative medicine , pathology
Background In order to understand the pathophysiology of rectal sensorimotor dysfunctions in women with fecal incontinence ( FI ) and rectal urgency, we evaluated the effects of a muscarinic antagonist and an adrenergic α 2 agonist on these parameters. Methods Firstly, rectal distensibility and sensation were evaluated with a barostat and sinusoidal oscillation at baseline and after randomization to intravenous saline or atropine in 16 healthy controls and 44 FI patients. Thereafter, FI patients were randomized to placebo or clonidine for 4 wk; rectal compliance and sensation were revaluated thereafter. The effect of atropine and clonidine on rectal functions and the relationship between them were evaluated. Results At baseline, compared to controls, rectal capacity was lower ( P = .03) while the mean pressure ( P = .02) and elastance ( P = .01) during sinusoidal oscillation were greater, signifying reduced distensibility, in FI . Compared to placebo, atropine increased ( P ≤ .02) the heart rate in controls and FI and reduced ( P = .03) the variability in rectal pressures during sinusoidal oscillation in controls. Clonidine increased rectal compliance ( P = .04) and reduced rectal capacity ( P = .03) in FI . The effects of atropine and clonidine on compliance ( r = .44, P = .003), capacity ( r = .34, P = .02), pressures during sinusoidal oscillation ( r = .3, P = .057), pressure ( r = .6, P < .0001), and volume sensory thresholds ( r = .48, P = .003) were correlated. Conclusions The effects of atropine and clonidine on rectal distensibility and sensation were significantly correlated. A preserved response to atropine suggests that reduced rectal distensibility is partly reversible, mediated by cholinergic mechanisms, and may predict the response to clonidine, providing a pharmacological challenge.