Ethnic Differences in Anorectal Manometry Findings in Patients With Fecal Incontinence: Results From a Multiethnic Cohort According to the London Classification

Background/Aims Clinical rates of fecal incontinence (FI) are known to vary based on race and ethnicity. It is unclear if anorectal manometry (ARM) findings in patients with FI differ based on ethnicity.Methods High-resolution ARM studies performed between 2014-2021 due to FI at 2 hospitals with multiethnic populations were retrospectively reviewed.Results Four hundred and seventy-nine subjects were included--87 (18.2%) Arab Israelis, 76 (15.9%) immigrants from the former Soviet Union, and 316 (66.0%) Jewish Israelis. Median age was 67 years old (76.0% women: 90.4% were parous). The Arab Israeli group had higher rates of smoking, diabetes, and obesity. Over 95% of ARM's were abnormal per the London classification including 23% with combined anal hypotension and hypocontractility, 36% with anal normotension with anal hypocontractility, 67% with dyssynergia, and 65% with either rectal hyposensation or borderline rectal hyposensation. On univariate analyses, significant differences between the ethnic groups were noted in the rates of anal hypotension with normal contractility, combined anal hypotension with anal hypocontractility, and dyssynergia. In multivariate logistic regression analyses controlling for age, gender, parity, smoking, diabetes, and obesity, the Arab Israeli group remained several times more likely to have combined anal hypotension and hypocontractibility compared to the other groups.Conclusions Ethnicity impacts ARM findings in patients with FI. The reason for this is unclear and future studies on ethnically diverse populations evaluating the clinical relevance of these findings are warranted.

Automated summary

This study retrospectively reviewed high-resolution anorectal manometry (ARM) studies in a multiethnic population. The findings showed that there were differences in ARM results based on ethnicity, with higher rates of fecal incontinence and lower anal pressure and muscle contractility in the Arab Israeli group. Further research is needed to determine the clinical relevance of these findings in ethnically diverse populations.