TY - JOUR
T1 - The international anorectal physiology working group (IAPWG) recommendations
T2 - Standardized testing protocol and the London classification for disorders of anorectal function
AU - All members of the International Anorectal Physiology Working Group
AU - Carrington, Emma V.
AU - Heinrich, Henriette
AU - Knowles, Charles H.
AU - Fox, Mark
AU - Rao, Satish
AU - Altomare, Donato F.
AU - Bharucha, Adil E.
AU - Burgell, Rebecca
AU - Chey, William D.
AU - Chiarioni, Guiseppe
AU - Dinning, Philip
AU - Emmanuel, Anton
AU - Farouk, Ridzuan
AU - Felt-Bersma, Richelle J.F.
AU - Jung, Kee Wook
AU - Lembo, Anthony
AU - Malcolm, Allison
AU - Mittal, Ravinder K.
AU - Mion, Franҫois
AU - Myung, Seung Jae
AU - O’Connell, P. Ronan
AU - Pehl, Christian
AU - Remes-Troche, Jose María
AU - Reveille, R. Matthew
AU - Vaizey, Carolynne J.
AU - Vitton, Veronique
AU - Whitehead, William E.
AU - Wong, Reuben K.
AU - Scott, S. Mark
N1 - Publisher Copyright:
© 2019 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: 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. Methods: Twenty-nine working group members (clinicians/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face-to-face and three remote meetings to derive consensus between 2014 and 2018. Key recommendations: The IAPWG 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. Conclusions and Inferences: This framework introduces the IAPWG protocol and the London classification for disorders of anorectal function based on objective physiological measurement. The use of a common language to describe results of diagnostic tests, standard operating procedures, and a consensus classification system is designed to bring much-needed standardization to these techniques.
AB - Background: 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. Methods: Twenty-nine working group members (clinicians/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face-to-face and three remote meetings to derive consensus between 2014 and 2018. Key recommendations: The IAPWG 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. Conclusions and Inferences: This framework introduces the IAPWG protocol and the London classification for disorders of anorectal function based on objective physiological measurement. The use of a common language to describe results of diagnostic tests, standard operating procedures, and a consensus classification system is designed to bring much-needed standardization to these techniques.
KW - anorectal function testing
KW - anorectal manometry
KW - balloon expulsion test
KW - functional anorectal disorders
KW - rectal sensory test
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U2 - 10.1111/nmo.13679
DO - 10.1111/nmo.13679
M3 - Article
C2 - 31407463
AN - SCOPUS:85070752752
SN - 1350-1925
VL - 32
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 1
M1 - e13679
ER -