High Resolution and High Definition Anorectal Manometry

The book provides a comprehensive overview of high resolution and high definition anorectal manometry (HRAM/HDAM), showing the possible benefits of a wider use of these techniques in clinical practice, as well as their limitations. Although these techniques provide fresh insights into anorectal function and offer a new perspective on the pathophysiologic mechanisms of many defecation disturbances, there is a need to clarify whether their use has beneficial effects on clinical management compared to conventional manometry. There is still a considerable way to go to gain the clinical diffusion of esophageal HRM, which has become the gold standard in studying esophageal motility. Indeed, many gastroenterologists and surgeons are convinced that further studies are necessary in order to be able to recommend HRAM and HDAM over and above conventional anorectal manometry. The first part of the book presents anorectal anatomy and pathophysiology, highlighting the indications and limitations of conventional anorectal manometry. The second part then focuses on the general concepts of high resolution manometry and the difference between conventional anorectal manometry and HRAM/HDAM, including technical aspects and different equipment. The third part explains how to perform, analyze and interpret HRAM and HDAM recordings, and describes the parameters study protocol, normal values and how to formulate a particular diagnosis. Lastly, the fourth part includes a collection of normal and pathological images with a glossary of the most frequently terms. Written by experts in the field of anorectal manometry and defecation disorders, this book is of interest to specialists and residents dealing with these conditions.

Preface.- Anorectal Functional Anatomy.- Anorectal functional anatomy and pathophysiology.- Anorectal manometry: does it improve pathophysiology knowledge?.- Concept and development of HRM: the way it works,- Difference between Conventional Anorectal Manometry and HRAM/HDAM.- Technical aspects and equipments.-Performing, analyzing and interpreting HRAM and HDAM recordings.- Atlas  a)Normal pictures: normal anal sphincter, squeezing, straining; RAIR; rectal response to balloon distension; b)Functional defecation disorders; c) Fecal Incontinence; d)Hirschsprung’s Disease;  e) Artifacts.- Glossary.

Massimo Bellini is an Associate Professor of Medicine, and Head of the Digestive Physiopathology Section of the Gastroenterology Unit at the University of Pisa (Italy). He received his medical degree from the University of Pisa, where he also completed his training in gastroenterology prior to obtaining his doctoral degree in Clinic Physiopathology (University of Florence, Italy). His main research interests are digestive diseases, especially gastrointestinal motility disturbances and functional gastrointestinal disorders.  He has taken part in numerous pharmacological Phase II, Phase III and Phase IV studies regarding the efficacy and safety of new drugs acting on gastric acid secretion, gastrointestinal motility and functional digestive disorders. In particular, he has participated in controlled, multicenter studies on the effects of ranitidine, famotidine, rabeprazole, esomeprazole, fedotozine, alosetron and probiotics. He authored more than 100 original papers published in international journals. He was member of the National Board of GISMAD (Italian Group for the Study of Digestive Motility) and he is currently Head of the Scientific National Committee of the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO).