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Z Gastroenterol 2007; 45(5): 397-417
DOI: 10.1055/s-2007-963099
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© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Empfehlungen zur Anorektalen Manometrie im Erwachsenenalter[1]

Anorectal Manometry[2] C. Pehl1 , P. Enck2 , A. Franke3 , T. Frieling4 , W. Heitland5 , A. Herold6 , H. Hinninghofen7 , M. Karaus8 , J. Keller9 , H.-J Krammer10 , M. Kreis11 , R. Kuhlbusch-Zicklam4 , H. Mönnikes12 , U. Münnich13 , T. Schiedeck14 , M. Schmidtmann12
  • 1Medizinische Klinik, Kreiskrankenhaus Vilsbiburg
  • 2Klinik für Innere Medizin VI - Psychosomatik, Universitätsklinikum Tübingen
  • 3II. Med. Klinik, Universitätsklinikum Mannheim
  • 4Medizin. Klinik II, Klinikum Krefeld
  • 5Chirurgische Klinik, Klinikum München-Bogenhausen
  • 6Enddarmzentrum Mannheim
  • 7Klinik für Innere Medizin VI, Psychosomatik, Universitätsklinikum Tübingen
  • 8Medizinische Klinik, Evangelisches Krankenhaus, Göttingen
  • 9Klinik für Innere Medizin, Israelitisches Krankenhaus, Hamburg
  • 10Praxis für Gastroenterologie und Ernährungsmedizin, Mannheim
  • 11Chirurgische Klinik, Ludwig-Maximilians-Universität (Klinikum Großhadern) München
  • 12Medizinische Klinik m.S. Hepatologie & Gastroenterologie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Berlin
  • 13Medtronic GmbH, Düsseldorf/Halle
  • 14Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg
Further Information

Publication History

Manuskript eingetroffen: 11.3.2007

Manuskript akzeptiert: 23.3.2007

Publication Date:
15 May 2007 (online)

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Zusammenfassung

Die Gesellschaft für Neurogastroenterologie hat in Zusammenarbeit mit den Deutschen Gesellschaften für Verdauungs- und Stoffwechselkrankheiten (Kommission Proktologie), für Viszeralchirurgie (Arbeitsgruppe Colo-Proktologie) und für Koloproktologie Empfehlungen zur anorektalen Manometrie beim Erwachsenen erarbeitet. Die Empfehlungen umfassen die Abschnitte „Technische Grundlagen”, „Vor- und Nachbereitung”, „Durchführung und Auswertung”, „Reproduzierbarkeit” sowie „Indikationen”. Bei jeder anorektalen Manometrie sind als Mindestanforderung zu bestimmen: der Ruhe- und maximale Kneifdruck im Analkanal, das Vorhandensein respektive Fehlen des rektoanalen Inhibitionsreflexes, die sensorischen Schwellenwerte für Rektumdehnung (Perzeptions- und Stuhldrangschwelle) sowie eine Compliancemessung des Rektums bei einer Ballonfüllung mit 100 mL. In Abhängigkeit von spezifischen Fragestellungen oder laborspezifischen Protokollen kann zusätzlich die Analkanallänge, die Dauerkontraktionsleistung, die Schmerzschwelle bei Rektumdehnung bestimmt sowie ein Husten- oder Defäkationstest durchgeführt werden. Die Durchführung einer anorektalen Manometrie ist im Rahmen eines strukturierten Programms zur Abklärung der Stuhlinkontinenz und Obstipation indiziert. Weiter kann eine anorektale Manometrie im Einzelfall präoperativ, vor Biofeedback-Therapie sowie bei Patienten mit idiopathischem Schmerzsyndrom oder Reizdarm sinnvoll sein.

Abstract

This document contains the guidelines of the German Societies of Neurogastroenterology and Motility, Gastroenterology (committee for proctology), Abdominal Surgery (coloproctology working group), and Coloproctology for anorectal manometry in adults. Recommendations are given about technical notes, study preparation (equipment; patient), technique for performing manometry and data analysis, reproducibility, and indications. Minimum standards for anorectal manometry are measurement of resting and squeeze pressure, testing of rectoanal inhibitory reflex, determination of rectal sensation (first perception and urge), and calculation of rectal compliance. Anorectal manometry is indicated in patients with fecal incontinence and constipation in the context of a structured programme.

Schlüsselwörter

Darm - Rektummanometrie - Empfehlungen

Key words

intestine - rectal manometry - recommendations

1 Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität, der Kommission Proktologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, der Deutschen Gesellschaft für Koloproktologie und der Chirurgischen Arbeitsgruppe Colo-Proktologie der Deutschen Gesellschaft für Viszeralchirurgie zur anorektalen Manometrie im Erwachsenenalter

2 Recommendations of the German Society for Neurogastroenterology and Motility, The Commission Proctology of the German Society for Digestive and Metabolic Diseases, the German Society for Coloprotology and the Surgical Working Group Coloproctology of the German Society for Visceral Surgery on Anorectal Manometry in Adults

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1 Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität, der Kommission Proktologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, der Deutschen Gesellschaft für Koloproktologie und der Chirurgischen Arbeitsgruppe Colo-Proktologie der Deutschen Gesellschaft für Viszeralchirurgie zur anorektalen Manometrie im Erwachsenenalter

2 Recommendations of the German Society for Neurogastroenterology and Motility, The Commission Proctology of the German Society for Digestive and Metabolic Diseases, the German Society for Coloprotology and the Surgical Working Group Coloproctology of the German Society for Visceral Surgery on Anorectal Manometry in Adults

Dr. Christian Pehl

Medizinische Klinik, Kreiskrankenhaus Vilsbiburg

Krankenhausstr. 2

84137 Vilsbiburg

Phone: ++49/87 41/60 31 53

Fax: ++49/87 41/60 32 04

Email: christian.pehl@kkh-vilsbiburg.de