The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry
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NEUROGASTROENTEROLOGY AND MOTILITY DISORDERS OF THE GASTROINTESTINAL TRACT (S RAO, SECTION EDITOR)
The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry S. Mark Scott 1 & Emma V. Carrington 1,2
# The Author(s) 2020
Abstract Purpose of Review Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice. Recent Findings This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. Summary The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice. Keywords Anorectal manometry . London Classification . IAPWG protocol . Constipation . Evacuation disorder . Faecal incontinence
Introduction In patients with refractory symptoms of faecal incontinence (FI) or constipation/evacuation disorder (ED), who have failed to respond to standard conservative or medical therapies, a number of complementary diagnostic investigations exist for the assessment of anorectal structure and of motor and sensory function [1, 2]. For those in whom advanced management strategies are being considered, such diagnostic testing should be considered a compulsory component of clinical evaluation,
This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract * S. Mark Scott [email protected] 1
Neurogastroenterology Group and GI Physiology Unit, Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University London, London, UK
2
Surgical Professorial Unit, St Vincent’s University Hospital, Dublin, Ireland
as it augments understanding of underlying pathoaetiology, which is often multifactorial, and establishes a physiological diagnosis to which treatments can be more optimally directed. Symptoms alone are poor predictors of response to treatment. Anorectal manometry (ARM), which provides a dynamic measure of intraluminal pressure, is the best established and most widely available investigative tool in the diagnostic armamentarium and enables an objective evaluation of parameters of both anal and rectal function, such as tone, contractility and relaxation, as well as rectoanal coordination and reflex activity and also rectal sensation [1••]. Anorecta
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