Referral for anorectal function evaluation: therapeutic implications and reassurance

Aim To determine the impact of anorectal function evaluation (AFE) on patie nts and referring specialists. Patients and methods In one year, 135 patients were referred for AFE, which consisted of proctoscopy, anal manometry, rectal compliance, anal sensitiv ity measurement and anal endosonography. Questionnaires were sent to the pa tients and referring specialists. Results In 70% of the 135 patients there was total agreement about the refe rring and final diagnosis. The response rate of the patients was 78% (n = 1 00) and that of the specialists was 91% (n = 117). The experience with rega rd to pain and embarrassment during AFE was good. Of the women, 13% preferr ed a female investigator. Fifty-nine patients answered that they had receiv ed one or more treatments after referral: surgery (n = 32), medication (n = 16), diet (n = 5), physiotherapy (n = 1) or a combination of the above (n = 5). Of the 41 patients who did not receive another treatment, 29 were rea ssured and 12 did not experience any benefit from the visit, thus bringing the total benefit of the referral to 88%. The anorectal complaints before A FE and at follow-up improved significantly in the treated group (P < 0.0001 ). The advice given was followed by the referring specialist in 98 cases (8 4%). The quality of the advice given was considered good in 98 (84%). The o pportunity of referral for AFE was considered useful in 108 cases (93%). In 71 patients, information from both the specialist and the patient was obta ined. Three patients had therapies that were not advised and 19 patients di d not follow the advice (mainly dietary). In the 135 patients, AFE changed the management in 34 patients (25%). In the other 101 patients, endosonogra phy was of value in determining the size of sphincter defects or the fistul a tracks. Conclusion AFE was well tolerated and changed the management in 25% of pati ents. Additional advice and reassurance were given in many patients; only 1 2% of patients claimed to have no benefit from the referral. Anal endosonog raphy seems the most valuable test. Eur J Gastroenterol Hepatol 11:289-294 (C) 1999 Lippincott Williams & Wilkins.