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CC BY-NC-ND 4.0 · Journal of Coloproctology 2023; 43(03): e159-e165
DOI: 10.1055/s-0043-1773800
Original Article

Sampling Reflex as a New Manometric Marker in the Diagnosis of Defecation Disorders - Systematic Review

Henrique Perobelli Schlenstein
1   Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil
,
Gabriel Thiago da Silva
2   University Center São Camilo, São Paulo, SP, Brazil
,
Gabriella Catharino Caliman
2   University Center São Camilo, São Paulo, SP, Brazil
,
Izabella Dias Muniz de Andrade
2   University Center São Camilo, São Paulo, SP, Brazil
,
Marina Silva Rodrigues
2   University Center São Camilo, São Paulo, SP, Brazil
,
Matheus Vitoretti
2   University Center São Camilo, São Paulo, SP, Brazil
,
Renato Migliore
,
João Kleber de Almeida Gentile 
3   Department of Surgery of the Digestive System and Coloproctology, Megastro Cirurgia, Hospital São Camilo, Pompeia Unity, São Paulo, SP, Brazil
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Abstract

Introduction Distension of the rectum wall and subsequent momentary relaxation of the internal anal sphincter (IAS) trigger a reflex called the rectoanal inhibitory reflex (RAIR). This same rectal distension causes a reflex contraction of the external anal sphincter (EAS), responsible for conscious continence called rectoanal excitatory reflex (RAER). This set of reflexes are named sampling reflex.

Objectives The sampling reflex is necessary to initiate defecation or flatulence. The objective of this study is to evaluate the sampling reflex and its practical applicability as a manometric marker of the main defecation disorders.

Methodology This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) items. The development method consisted of searching for articles in the research platforms BVS, PubMed, Cochrane Library, SciELO and ScienceDirect and for the selection of articles the Rayyan Platform was used. The articles resulting from the search strategies were added to the platform and five collaborators were invited for the blind selection. Finally, 6 articles were included in the final review.

Results An intact sampling reflex allows the individual to facilitate discrimination between flatus and stool and to choose whether to discharge or retain rectal contents. On the other hand, an impaired sampling reflex can predispose an individual to incontinence.

Therefore, it was observed that patients with defecation disorders had an impaired sampling reflex, since it was found that constipated patients have incomplete opening of the IAS, lower amplitude of RAIR and increase of RAER. Most incontinent patients present a failure in the recruitment of the EAS, a decrease in the RAER and an increase in the RAIR, in duration and amplitude.

Conclusion The improvement of high-resolution anorectal manometric techniques was essential for understanding the pathophysiology of defecation disorders, as well as the physiological understanding and importance of RAIR and RAER.

Keywords

manometry - digestive System physiological phenomena - reflex - fecal incontinence - constipation


Publikationsverlauf

Eingereicht: 20. Februar 2023

Angenommen: 09. Mai 2023

Artikel online veröffentlicht:
21. September 2023

© 2023. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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