{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T22:39:17Z","timestamp":1792363157544,"version":"4.4.0"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82170556"],"award-info":[{"award-number":["82170556"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82000508"],"award-info":[{"award-number":["82000508"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The London Classification for anorectal physiological dysfunction specifically proposes rectoanal areflexia (RA), which means the absence of a rectoanal inhibitory reflex (RAIR) based on a manometric diagnosis. Although RA is not observed in healthy people, it can be found in adult patients with functional constipation (FC). This study describes the clinical manifestations of adult patients with FC and RA and their response to biofeedback therapy (BFT). Methods: This retrospective study reviewed the reports of high-resolution anorectal manometry (HR-ARM) and the efficacy of BFT in adult patients with FC. In addition, the Constipation Scoring System (CSS) scale, Patient Assessment of Constipation Symptoms (PAC-SYM) scale, Patient Assessment of Constipation Quality of Life (PAC-QOL) scale, Zung\u2019s Self-Rating Anxiety Scale (SAS), Zung\u2019s Self-Rating Depression Scale (SDS), balloon expulsion test (BET), and the use of laxatives were assessed. Results: A total of 257 adult patients diagnosed with FC were divided into the RA group (n = 89) and the RAIR group (n = 168). In the RA and RAIR groups, 60 (67.4%) and 117 (69.6%) patients, respectively, had dyssynergic defecation (DD) during simulated defecation. Type II pattern of dyssynergia was most frequently observed in both groups. Compared with the RA group, the RAIR group showed a higher CSS score, physical discomfort score, and prevalence of inadequate relaxation of the anal sphincter (p &lt; 0.001, p = 0.036, and p = 0.017, respectively). The anxiety and depression scores were not different between the two groups. The proportion of patients using volumetric and stimulant laxatives and their combination was significantly higher in FC patients with RA, whereas the efficacy of BFT was significantly lower (p\u00a0= 0.005, p &lt; 0.001, p = 0.045, and p = 0.010, respectively). Conclusion: Adult FC patients with RA may suffer more severe constipation and have a lower efficacy of BFT compared with those with RAIR.<\/jats:p>","DOI":"10.3390\/diagnostics13020255","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T01:30:47Z","timestamp":1673314247000},"page":"255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Characteristics of Adult Functional Constipation Patients with Rectoanal Areflexia and Their Response to Biofeedback Therapy"],"prefix":"10.3390","volume":"13","author":[{"given":"Fei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meifeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Hameed Ali","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4935-2528","authenticated-orcid":false,"given":"Yurong","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gu Lou District, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1053\/j.gastro.2020.04.014","article-title":"Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study","volume":"160","author":"Sperber","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1053\/j.gastro.2016.02.031","article-title":"Bowel Disorders","volume":"150","author":"Mearin","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5694\/mja18.00241","article-title":"Chronic idiopathic constipation in adults: Epidemiology, pathophysiology, diagnosis and clinical management","volume":"209","author":"Black","year":"2018","journal-title":"Med. 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