{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:47:15Z","timestamp":1793159235374,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T00:00:00Z","timestamp":1565568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RO1 DK78924"],"award-info":[{"award-number":["RO1 DK78924"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U-01DK109191"],"award-info":[{"award-number":["U-01DK109191"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R21DK104127-02"],"award-info":[{"award-number":["5R21DK104127-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01DK115575"],"award-info":[{"award-number":["U01DK115575"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This 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\u2010resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010nine working group members (clinicians\/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face\u2010to\u2010face and three remote meetings to derive consensus between 2014 and 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key recommendations<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Inferences<\/jats:title>\n                    <jats:p>This 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\u2010needed standardization to these techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.13679","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T22:58:46Z","timestamp":1565650726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":309,"title":["The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9467-9223","authenticated-orcid":false,"given":"Emma V.","family":"Carrington","sequence":"first","affiliation":[{"name":"Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6355-0921","authenticated-orcid":false,"given":"Henriette","family":"Heinrich","sequence":"additional","affiliation":[{"name":"University of Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Knowles","sequence":"additional","affiliation":[{"name":"Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4394-5584","authenticated-orcid":false,"given":"Mark","family":"Fox","sequence":"additional","affiliation":[{"name":"University of Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4446-8452","authenticated-orcid":false,"given":"Satish","family":"Rao","sequence":"additional","affiliation":[{"name":"Medical College of Georgia Augusta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8980-2752","authenticated-orcid":false,"given":"Donato F.","family":"Altomare","sequence":"additional","affiliation":[{"name":"University Aldo Moro of Bari Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-0390","authenticated-orcid":false,"given":"Adil E.","family":"Bharucha","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Burgell","sequence":"additional","affiliation":[{"name":"Monash University and Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Chey","sequence":"additional","affiliation":[{"name":"Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiseppe","family":"Chiarioni","sequence":"additional","affiliation":[{"name":"AOUI Verona Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Dinning","sequence":"additional","affiliation":[{"name":"Flinders University Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Emmanuel","sequence":"additional","affiliation":[{"name":"University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ridzuan","family":"Farouk","sequence":"additional","affiliation":[{"name":"National University Hospital Singapore Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richelle J. F.","family":"Felt\u2010Bersma","sequence":"additional","affiliation":[{"name":"UMC Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-3691","authenticated-orcid":false,"given":"Kee Wook","family":"Jung","sequence":"additional","affiliation":[{"name":"Asan Medical Center Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4479-1188","authenticated-orcid":false,"given":"Anthony","family":"Lembo","sequence":"additional","affiliation":[{"name":"Harvard Medical School St, Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Malcolm","sequence":"additional","affiliation":[{"name":"University of Sydney and Royal North Shore Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0181-9697","authenticated-orcid":false,"given":"Ravinder K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"University of California Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u04abois","family":"Mion","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon et Hospices Civils de Lyon Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung\u2010Jae","family":"Myung","sequence":"additional","affiliation":[{"name":"Asan Medical Center Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Ronan","family":"O\u2019Connell","sequence":"additional","affiliation":[{"name":"University College Dublin Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Pehl","sequence":"additional","affiliation":[{"name":"Krankenhaus Vilsbiburg and Technical University Munich Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Mar\u00eda","family":"Remes\u2010Troche","sequence":"additional","affiliation":[{"name":"University of Veracruz Veracruz Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Matthew","family":"Reveille","sequence":"additional","affiliation":[{"name":"University of Colorado Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolynne J.","family":"Vaizey","sequence":"additional","affiliation":[{"name":"St Mark\u2019s Hospital and Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1314-7111","authenticated-orcid":false,"given":"Veronique","family":"Vitton","sequence":"additional","affiliation":[{"name":"AP\u2010HM \u2010 Aix\u2010Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6587-7602","authenticated-orcid":false,"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben K.","family":"Wong","sequence":"additional","affiliation":[{"name":"National University Hospital Singapore Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Mark","family":"Scott","sequence":"additional","affiliation":[{"name":"Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"All members of the International Anorectal Physiology Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.45.2008.ii55"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2018.27"},{"issue":"511","key":"e_1_2_12_4_1","first-page":"vii","article-title":"Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function","volume":"37","author":"Scott SM","year":"2008","journal-title":"Gastroenterol Clin North Am"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2002.00352.x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02554982"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.00950.x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-006-0549-7"},{"issue":"230","key":"e_1_2_12_9_1","first-page":"e163","article-title":"The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements","volume":"25","author":"Heinrich H","year":"2013","journal-title":"Neurogastroenterol Motil"},{"key":"e_1_2_12_10_1","first-page":"732","article-title":"American Gastroenterological Association medical position statement on anorectal testing techniques","volume":"116","author":"Barnett JL","year":"1999","journal-title":"American Gastroenterological Association. Gastroenterology"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.05450.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800760414"},{"key":"e_1_2_12_13_1","first-page":"n\/a\u2010n\/a","article-title":"Methods of anorectal manometry vary widely in clinical practice: Results from an international survey","author":"Carrington EV","year":"2017","journal-title":"Neurogastroenterol Motil"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31815ea291"},{"key":"e_1_2_12_15_1","unstructured":"https:\/\/www.nice.org.uk\/about\/what-we-do\/our-programmes\/nice-guidance\/nice-guidelines\/shared-decision-making. Accessed January 14 2019"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12632"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm15168"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800811143"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12858"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2000.00210.x"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.03.013"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13552"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12208"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12859"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_12_26_1","first-page":"842","article-title":"Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients","volume":"45","author":"Knowles CH","year":"2002","journal-title":"Dis Colon Rectum"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.159"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.009"},{"issue":"1915","key":"e_1_2_12_30_1","first-page":"e2","article-title":"Factors Associated With Efficacy of Percutaneous Tibial Nerve Stimulation for Fecal Incontinence, Based on Post\u2010Hoc Analysis of Data From a Randomized Trial","volume":"15","author":"Horrocks EJ","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.05.015"},{"issue":"1310","key":"e_1_2_12_32_1","first-page":"e1","article-title":"Assessment of Obstructive Defecation by High\u2010Resolution Anorectal Manometry Compared With Magnetic Resonance Defecography","volume":"13","author":"Heinrich H","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.09.154"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650090802"},{"key":"e_1_2_12_35_1","article-title":"High\u2010resolution Anorectal Manometry Measures Are More Accurate Than Conventional Measures in Detecting Anal Hypocontractility in Women With Fecal Incontinence","author":"Carrington EV","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12317"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-018-0662-5"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.127993"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.1"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-1-200301070-00012-w1"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8553(05)70169-2"},{"issue":"314","key":"e_1_2_12_42_1","first-page":"e2","article-title":"Phenotypic identification and classification of functional defecatory disorders using high\u2010resolution anorectal manometry","volume":"144","author":"Ratuapli SK","year":"2013","journal-title":"Gastroenterology"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2014-308835"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.13679","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.13679","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.13679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T15:06:05Z","timestamp":1694185565000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.13679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,12]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1111\/nmo.13679"],"URL":"https:\/\/doi.org\/10.1111\/nmo.13679","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,12]]},"assertion":[{"value":"2019-02-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13679"}}