PDF(Pubmed)
Abstract：
Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely utilized for reasons that remain unclear. The aim of this roundtable discussion was to critically examine the current clinical practices of ARM and biofeedback therapy by physicians and surgeons in both academic and community settings.
Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic challenges with these technologies, review the literature, and generate consensus-based recommendations.
ARM identifies key pathophysiological abnormalities such as dyssynergic defecation, anal sphincter weakness, or rectal sensory dysfunction, and is a critical component of biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence. Additionally, ARM has the potential to enhance health-related quality of life and reduce healthcare costs. However, it has significant barriers that include a lack of education and training of healthcare providers regarding the utility and availability of ARM and biofeedback procedures, as well as challenges with condition-specific testing protocols and interpretation. Additional barriers include understanding when to perform, where to refer, and how to use these technologies, and confusion over billing practices.
Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders.
Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic challenges with these technologies, review the literature, and generate consensus-based recommendations.
ARM identifies key pathophysiological abnormalities such as dyssynergic defecation, anal sphincter weakness, or rectal sensory dysfunction, and is a critical component of biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence. Additionally, ARM has the potential to enhance health-related quality of life and reduce healthcare costs. However, it has significant barriers that include a lack of education and training of healthcare providers regarding the utility and availability of ARM and biofeedback procedures, as well as challenges with condition-specific testing protocols and interpretation. Additional barriers include understanding when to perform, where to refer, and how to use these technologies, and confusion over billing practices.
Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders.
摘要：
目的：肛门直肠测压（ARM）是评估便秘患者的综合诊断工具，大便失禁,或肛门直肠疼痛;然而，它没有被广泛使用，原因尚不清楚。这次圆桌讨论的目的是批判性地检查学术和社区环境中医生和外科医生的ARM和生物反馈治疗的当前临床实践。
方法：对对肛肠疾病感兴趣的内科和外科胃肠病学和物理疗法的领导者进行了调查，了解这些技术的实践模式和利用情况。随后，举行了一次圆桌会议，讨论调查结果，探索这些技术当前的诊断和治疗挑战，回顾文献，并产生基于共识的建议。
结果：ARM确定了关键的病理生理异常，如协同排便，肛门括约肌无力,或者直肠感觉功能障碍,是生物反馈治疗的重要组成部分，一种基于证据的排便失调和大便失禁患者治疗方法。此外,ARM有潜力提高与健康相关的生活质量并降低医疗保健成本。然而,它存在重大障碍，包括缺乏有关ARM和生物反馈程序的实用性和可用性的医疗保健提供者的教育和培训，以及针对特定条件的测试协议和解释的挑战。其他障碍包括了解何时执行，在哪里引用，以及如何使用这些技术，以及对计费做法的困惑。
结论：通过适当的教育克服这些挑战，培训,合作研究,基于证据的ARM测试和生物反馈治疗指南可以显著提高肛肠疾病患者的护理。
方法：对对肛肠疾病感兴趣的内科和外科胃肠病学和物理疗法的领导者进行了调查，了解这些技术的实践模式和利用情况。随后，举行了一次圆桌会议，讨论调查结果，探索这些技术当前的诊断和治疗挑战，回顾文献，并产生基于共识的建议。
结果：ARM确定了关键的病理生理异常，如协同排便，肛门括约肌无力,或者直肠感觉功能障碍,是生物反馈治疗的重要组成部分，一种基于证据的排便失调和大便失禁患者治疗方法。此外,ARM有潜力提高与健康相关的生活质量并降低医疗保健成本。然而,它存在重大障碍，包括缺乏有关ARM和生物反馈程序的实用性和可用性的医疗保健提供者的教育和培训，以及针对特定条件的测试协议和解释的挑战。其他障碍包括了解何时执行，在哪里引用，以及如何使用这些技术，以及对计费做法的困惑。
结论：通过适当的教育克服这些挑战，培训,合作研究,基于证据的ARM测试和生物反馈治疗指南可以显著提高肛肠疾病患者的护理。
