Evidence map›Paper›PMID 36564719›Full record

ArticleBMC gastroenterology2022

Anorectal manometry for the diagnosis of pelvic floor disorders in patients with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome.

Wendy Zhou, Thomas A Zikos, Houssam Halawi, Vipul R Sheth, Brooke Gurland, Linda A Nguyen, Leila Neshatian

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.7field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Wendy ZhouDepartment of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 430 Broadway St. Pav C 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.
Thomas A ZikosDepartment of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 430 Broadway St. Pav C 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.
Houssam HalawiDepartment of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 430 Broadway St. Pav C 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.
Vipul R ShethDepartment of Radiology, Stanford University, Redwood City, USA.
Brooke GurlandDepartment of Surgery, Stanford Universtiy, Redwood City, USA.
Linda A NguyenDepartment of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 430 Broadway St. Pav C 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.
Leila NeshatianDepartment of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 430 Broadway St. Pav C 3rd Floor, GI Suite, Redwood City, CA, 94063, USA. lneshati@stanford.edu.
Stanford University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionFunctional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls.

methodsWe conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2 minutes. Wilcoxon rank sum test and Fisher's exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation.

resultsA total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p < 0.001) and nulliparous. Concurrent psychiatric disorders; depression, and anxiety (p < 0.05), and somatic syndromes; fibromyalgia, migraine and sleep disorders (p < 0.001) were more common in these patients. Rate of abnormal BET were comparable among the groups. HDS/hEDS patients had significantly less anal relaxation and higher residual anal pressures during simulated defecation, resulting in significantly more negative rectoanal pressure gradient. The remaining anorectal pressure profile and sensory levels were comparable between the groups. While diminished rectoanal pressure gradient was the determinant of abnormal balloon evacuation in non HSD/hEDS patients, increased anal resting tone and maximum volume tolerated were independent factors associated with an abnormal BET in HSD/hEDS patients. Review of defecography data from a subset of patients showed no significant differences in structural pathologies between HSD/hEDS and non HSD/hEDS patients.

conclusionsThese results suggest anorectal pressure profile is not compromised by connective tissue pathologies in HSD patients. Whether concurrent psychosomatic disorders or musculoskeletal involvement impact the pelvic floor function in these patients needs further investigation.

Indexed as

Ehlers-Danlos SyndromePelvic Floor DisordersAnal CanalFemaleHumansManometryRectumAnorectal manometryEhlersDanlos syndrome (EDS)Pelvic floor disordersPsychosomatic disorders

Identifiers

PMID36564719
PMCPMC9784268
OpenAlexW4312117584

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.