Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn's disease

Br J Surg. 2002 Aug;89(8):1027-31. doi: 10.1046/j.1365-2168.2002.02173.x.


Background: Histological alterations in the enteric nervous system (ENS) have been described in patients suffering from Crohn's disease (CD). The aim of this study was to investigate whether patients with CD without rectal inflammation have abnormal anorectal function compared with healthy volunteers.

Methods: Fifty-four patients with CD and 26 healthy volunteers were examined by anorectal manometry and answered a standardized questionnaire. No patient had active CD in the rectum as determined by endoscopy.

Results: Maximum anal resting and squeeze pressures did not differ between patients and healthy volunteers. The rectoanal inhibitory reflex was absent in 24 of 54 patients and two of 26 healthy volunteers (P < 0.05). The first sensation to distension of the rectal balloon was reported at mean(s.e.m.) 57.9(4.4) ml by patients and 37.5(2.2) ml by healthy volunteers (P < 0.01). The standardized interview revealed additional disorders of anorectal function in patients with CD.

Conclusion: Anorectal function appears to be altered in many patients with CD even in the absence of macroscopic anorectal disease. This may be due to a disorder of the ENS.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Crohn Disease / complications*
  • Crohn Disease / pathology
  • Crohn Disease / physiopathology
  • Fecal Incontinence / etiology*
  • Fecal Incontinence / pathology
  • Fecal Incontinence / physiopathology
  • Female
  • Humans
  • Male
  • Manometry / methods
  • Middle Aged
  • Pressure
  • Proctitis / etiology