Obesity Is Associated with Altered Rectal Sensitivity in Chronic Constipation - PubMed (original) (raw)

Obesity Is Associated with Altered Rectal Sensitivity in Chronic Constipation

Nayna A Lodhia et al. Dig Dis Sci. 2024 Mar.

Abstract

Background: Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between obesity and anorectal function on physiologic testing in patients presenting with CC.

Methods: This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m2) vs non-obese (BMI < 30 kg/m2) groups at the time of HRAM. Fisher-exact/student t-test for univariate analyses and general linear regression for multivariable analysis were performed.

Results: 383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg, p = 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg, p = 0.043). No significant differences in dyssynergia (61% vs 53%, p = 0.294) and failed balloon expulsion (18% vs 25%, p = 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL, p = 0.042) and urge sensation (113.9 vs 103.7 mL, p = 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (β-coefficient 13.7, p = 0.049).

Conclusion: Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.

Keywords: Anorectal manometry; Constipation; Obesity; Rectal hyposensitivity.

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest WWC served on scientific advisory boards for Phathom Pharmaceuticals, Regeneron Pharmceuticals, and Sanofi Pharmaceuticals. CCT had the following disclosures: Apollo Endosurgery—Consultant/Research Support (Consulting fees/Institutional Research Grants); Aspire Bariatrics—Research Support (Institutional Research Grant); BlueFlame Healthcare Venture Fund—General Partner; Boston Scientific—Consultant (Consulting fees)/Research Support (Institutional Research Grant); Medtronic—Consultant (Consulting Fees); Endoquest Robotics—Consultant, Institutional Research Grant; Enterasense Ltd—Founder, Consultant, Board Member; EnVision Endoscopy—Founder, Board Member, Consultant; ERBE—Institutional Research Grant; Fractyl—Consultant/Advisory Board Member (Consulting Fees); FujiFilm—Consultant/Institutional Research Grant; GI Dynamics—Consultant (Consulting Fees)/ Research Support (Institutional Research Grant); GI Windows—Founder, Board Member, Ownership interest; Lumendi—Consultant/Institutional Research Grant; Olympus/Spiration—Consultant (Consulting Fees)/Research Support (Equipment Loans); USGI Medical—Consultant (Consulting Fees)/Advisory Board Member (Consulting fees)/Research Support (Institutional Research Grant); Xenter—Consultant/SAB. No other disclosures by the remaining authors.

References

    1. Stewart WF, Liberman JN, Sandler RS et al. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol. Dec 1999;94:3530–3540. 10.1111/j.1572-0241.1999.01642.x. -DOI -PubMed
    1. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. Apr2004;99:750–759. 10.1111/j.1572-0241.2004.04114.x. -DOI -PubMed
    1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. Mar2009;136:741–754. 10.1053/j.gastro.2009.01.015. -DOI -PubMed
    1. Faigel DO. A clinical approach to constipation. Clin Cornerstone. 2002;4:11–21. 10.1016/s1098-3597(02)90002-5. -DOI -PubMed
    1. Nellesen D, Yee K, Chawla A, Lewis BE, Carson RT. A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. J Manag Care Pharm. Nov-Dec 2013;19:755–764. 10.18553/jmcp.2013.19.9.755. -DOI -PMC -PubMed

MeSH terms

LinkOut - more resources