Solitary rectal ulcer syndrome in 102 patients: Do different phenotypes make sense?

Background: Little is known about the pathophysiological mechanisms of solitary rectal ulcer syndrome (SRUS). Aims: We aim to identify the different phenotypes, taking into account complaints, anatomy and anorectal physiology. Methods: Complaints, endoscopy results, and physiology data of patients with histologically proven SRUS were collected and analysed. The associated anorectal diseases were faecal incontinence and obstructed defecation. The clinical aspects of SRUS were compared, and factors associated with anorectal diseases were identified. Results: Overall, 102 consecutive patients were included. The predominant lesion was a rectal ulcer (66%), and inflammation of the rectal wall was present in 42% of patients. Abnormal rectal capacities and/or rectal perception was observed in more than half. Nearly half (52%) of the patients met the criteria for obstructed defecation and they tended to more frequently have psychiatric disease (66.7% vs 33.3%; p=0.07). Patients with faecal incontinence (17%) reported more self-perception of anal procidentia (p=0.01) and were more likely to have inflammation of the rectal wall (p=0.02), high-grade internal rectal procidentia (p=0.06) and anal hypotonia (p=0.004); their maximum tolerable volume was lower (p=0.004). Conclusion: The characteristics of patients with SRUS suggest different phenotypes. This may be a way to develop a comprehensive treatment strategy. (C) 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study aimed to identify different phenotypes of solitary rectal ulcer syndrome (SRUS) by considering complaints, anatomy, and anorectal physiology. Results showed that the majority of patients had rectal ulcer as the predominant lesion, with inflammation of the rectal wall present in 42% of patients. Over half of the patients had abnormal rectal capacities and/or rectal perception, while nearly half met the criteria for obstructed defecation. Patients with faecal incontinence tended to have more self-perception of anal procidentia and were more likely to have inflammation of the rectal wall, high-grade internal rectal procidentia, and anal hypotonia.