Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Anorectal Sphincter Function in Systemic Sclerosis (SSc)
Franck-Larsson1, Karin, Graf2, Wilhelm, Eeg-Olofsson2, Karin Edebol, Axelson2, Hans, Ronnblom2, Anders
In a previous population-based study, we have reported that 30% of the SSc patients suffer from fecal incontinence to varying extent (Franck-Larsson et al, Eur J Gastroenterol Hepatol 2009). The aim of the present study is to elucidate the underlying mechanisms.
A cohort of 25 SSc patients with and without fecal incontinence underwent clinical anorectal examination and investigations with proctoscopy, anorectal three-dimensional ultrasound, anorectal manometry, pudendal nerve terminal motor latency, standard EMG and single fiber EMG, and answered questionnaires on symptoms and quality of life (SF-36).
Forty-four % reported incontinence to solid and/or liquid feces. Rectocele was present in 30%, and peri-anal scleroderma skin changes in 30% of the patients.
Sonographic abnormalities, either as thin sphincters or sphincter defects, were present in 17%, all in patients with incontinence to solid and/or liquid feces. These morphologic changes were inversely associated to the resting pressure at 12 cm and to squeezing pressure at 2 cm (p=0,035 and 0,028 respectively, Mann-Whitney U), and were also associated to incontinence to solid feces and defecation problems (p=0,017 and 0,026 respectively, Pearson Chi Square).
Failure to increase anal pressure at attempted squeeze was seen in 28%. Increased fiber density was recorded bilaterally in 61% and unilaterally in another 22% of the patients. In patients with increased fiber density, maximum squeeze pressure was significantly lower at 2 and 3 cm (p=0,019 and 0,006 respectively Mann-Whitney U) in comparison with patients with normal fiber density; however, symptoms did not differ between the groups. Distal pudendal nerve latency was increased in 21%.
In patients who reported fecal incontinence, decreased squeeze pressure were recorded in the high pressure zone, and thin or defect sphincters. A majority of the SSc patients had increased fiber density, possibly indicating previous nerve injury with consequent reinnervation. We concluded, that both structural and neurogenic mechanisms are likely to influence the development of fecal incontinence in SSc patients.
To cite this abstract, please use the following information:
Franck-Larsson, Karin, Graf, Wilhelm, Eeg-Olofsson, Karin Edebol, Axelson, Hans, Ronnblom, Anders; Anorectal Sphincter Function in Systemic Sclerosis (SSc) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :461