S576 High Resolution Anorectal Manometry Findings in Men and Women With Parkinson’s Disease, Using London Classification

Introduction: Gastrointestinal dysfunction, particularly constipation, is among the most common non-motor manifestation in Parkinson’s Disease (PD). We aimed to identify high-resolution anorectal manometry (HR-ARM) abnormalities in patients with PD using the London Classification. Methods: We conducted a retrospective case series of all PD patients at our institution who underwent HR-ARM for evaluation of constipation between 2015-2021. Using age- and sex-specific normal values, HR-ARM recordings were re-analyzed and abnormalities were reported using the London Classification. A combination of Wilcoxon rank sum test and Fisher’s exact test were used to compare men and women. Results: Of 71 PD patients who underwent ARM, 36 with 2D HR-ARM were included. Median age at time of evaluation was 71 (69-74). Median BMI in men was 25.4; in women was 23.7, but 50% of women were overweight. Common comorbidities included depression/anxiety (61%), IBS (36%), and GERD (56%). Using the London classification, 7 (19%) of all patients had anal hypotension, 17 (47%) had anal hypocontractility, and only 3 women had combined disorders. Anal hypocontractility was significantly more common in females compared to males (Table). Recto-anal coordination with abnormal expulsion and dyssynergia were noted in 22 (61%) of patients (12 of whom (70%) were males vs 12 (52%) females, p=0.32) and were significantly higher than abnormal expulsion with poor propulsion in 2 (5%) or combined 2 (5%). Major rectal sensation abnormalities with rectal hyposensitivity and hypersensitivity were reported in 12 (33%) and 3 (8%) respectively and were similar in both males and females (Table). Max squeeze pressures were significantly higher in males. Residual anal pressures and paradoxical anal contraction during simulated defecation were also significantly higher in males, resulting in significantly more negative recto-anal pressure gradients. Balloon expulsion was similar in both groups. Conclusion: Our data affirms the high prevalence of functional anorectal disorders in PD. Using the London classification, disorders of rectoanal coordination with abnormal expulsion and dyssynergia, followed by abnormal anal hypocontractility were the most common minor and major abnormal findings in both men and women. Whether the higher prevalence of anal hypocontractility in females is directly related to PD or other confounding factors will require further research. Table 1. - London Classification of Manometric Parameters for Major and Minor Findings of Anorectal Disorders Variable All (n=36) Female (n=19) Male (n=17) p-value Disorders of anal tone and contractility (Major findings) Combined Hypotension and Hypocontractility 3 (8) 3 (16) 0 (0) 0.23 Anal Hypotension 7 (19) 4 (21) 3 (17) 1 Anal Hypocontractility 17 (47) 13 (68) 4 (23) 0.01 Disorders of rectoanal coordination (Minor findings) Abnormal Expulsion with poor propulsion 2 (5) 1 (5) 1(6) 1 Abnormal Expulsion with Dyssynergia 22 (61) 10 (52) 12 (70) 0.32 Abnormal Expulsion with Poor Propulsion with Dyssynergia 2 (5) 1 (5) 1(6) 1 Disorders of rectal sensation (Minor findings) Rectal Hyposensitivity 12 (33) 7 (37) 5 (29) 0.73 Rectal Hypersensitivity 3 (8) 2 (10) 1 (6) 1