Is high‑resolution anorectal manometry superior to standard manometry for diagnosing dyssynergia in irritable pouch patients

What is known

- A pilot study established proposed normal high-resolution ano-pouch manometry values, balloon-expulsion times, barostat and MR defecography parameters in asymptomatic IPAA patients. ¹ - A systematic review concluded manometry alone is an imperfect assessment of pouch function in symptomatic patients and confirmatory dynamic imaging may be needed. ² - Guideline/review criteria diagnose pelvic dyssynergia via ano-pouch manometry plus balloon expulsion, with dynamic imaging (defecography, transperineal ultrasound) as adjuncts, no resolution comparison specified. ^3,4

What is unknown / caveats

- No head-to-head high-resolution vs standard manometry comparison in pouch patients was retrieved - Normative HR ano-pouch data come from a single small pilot (n=14) and may not generalize across manometry systems - The superiority question is unanswered, the evidence describes HR ano-pouch manometry's use and limitations, not a comparative diagnostic yield versus conventional manometry.

## References

1. Quinn KP, Busciglio IA, Burton DD, Inoue A, Lee YS, Heiken JP, Sheedy SP, Fletcher JG, Raffals LE. Defining normal pouch function in patients with ileal pouch-anal anastomosis: a pilot study. Aliment Pharmacol Ther. 2022;55(12):1560-1568. PMID: 35274320.

2. Luo Y, Schmidt N, Dubinsky MC, Jaffin B, Kayal M. Evaluating lleal Pouch Anal Anastomosis Function: Time to Expand Our ARM-amentarium. Inflamm Bowel Dis. 2023;29:1819-1825. PMID: 36351035.

3. Kayal M, Bislenghi G, Adamina M, Ardalan ZS, Avellaneda N, de Buck van Overstraeten A, Duijvestein M, Estevinho MM, Furfaro F, Hart AL, Holubar S, Lobaton T, Ollech J, Vavricka SR, Ferrante M. ECCO Topical Review on Pouch Disorders. J Crohns Colitis. 2025;19:ePub only. PMID: 40574702.

4. Kayal M, Boland B. Approach to Therapy for Chronic Pouchitis. Annu Rev Med. 2025;76(1):167-173. PMID: 39869428.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._