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BackgroundThis manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed.MethodsTwenty-nine working group members (clinicians/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face-to-face and three remote meetings to derive consensus between 2014 and 2018.Key recommendationsThe IAPWG protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.Conclusions and inferencesThis framework introduces the IAPWG protocol and the London classification for disorders of anorectal function based on objective physiological measurement. The use of a common language to describe results of diagnostic tests, standard operating procedures, and a consensus classification system is designed to bring much-needed standardization to these techniques.

Endoscopic sclerotherapy is an effective method for treating bleeding esophageal varices. However, a number of complications may limit its usefulness. A newly developed method for treating bleeding varices, endoscopic variceal ligation, that uses small rubber bands to occlude and eradicate the varices, may cause less damage to the esophagus. Twenty-eight patients (seven with no prior treatment, eight undergoing sclerotherapy, and 12 undergoing variceal ligation) were evaluated with a symptom questionnaire and esophageal manometry. The lower esophageal sphincter (LES) pressures in the three groups did not differ. The percent LES relaxation was significantly (p = 0.04) less in the sclerotherapy group than in the untreated group. Contraction waves in the esophageal body were not different in amplitude, duration, and propagation speed in the three groups. There was no increase in the amount of heartburn after either form of treatment. Eight of the nine sclerotherapy patients had a stricture after treatment that required dilatation, whereas none of the ligation patients had strictures. We conclude from this that early in the course of sclerotherapy, stricture formation is common, but any long-lasting adverse effect on esophageal function is minimal. We also conclude variceal ligation therapy causes less esophageal dysfunction and has fewer local complications. Thus, endoscopic variceal ligation may be a safer and more easily tolerated alternative to endoscopic sclerotherapy. [ABSTRACT FROM AUTHOR]