Functional Anorectal Pain (FARP) is a chronic, functional, nonorganic disorder of the anorectal region, often misdiagnosed as various types of anorectal organic diseases in clinical practice. However, the pathogenesis and diagnostic markers of FARP remain poorly understood. In this study, we recruited 45 FARP patients and 35 healthy subjects to investigate the microbial and metabolomic profiles associated with FARP progression. Anorectal manometry was utilized to determine changes in anal pressure, revealing a significant decrease in FARP patients' anal resting pressure and maximum anal squeeze pressure. Through 16S rRNA gene sequencing and metabolomics analysis, we identified specific microbial genera, including Propionibacterium, Ruminococcus2, and Bilophila, and specific metabolite profiles, including Gentisic acid, 2-Naphthalenethiol, 2-Furancarboxaldehyde, Benzoic acid, Allose, and (S)-3-Amino-5-methylhexanoic acid, that were closely correlated with FARP. In-depth analysis revealed that the Phospholipase D (PLD) signaling pathway exhibited significant differences in FARP. Additionally, serum cortisol levels were found to be significantly elevated in FARP patients. These findings provide new insights into the anorectal manometry features, gut microbiota, and serum metabolome associated with FARP, potentially contributing to improved clinical diagnosis and therapeutic strategies for FARP.

目的 系统评价骶神经刺激(SNS)治疗功能性肛门痛的临床疗效.方法 计算机检索中国知网、万方、中国生物医学文献数据库、PubMed、Web of Science数据库,查找有关SNS治疗功能性肛门痛的临床研究.系统评价SNS对患者疼痛评分(VAS)及测压变化的影响,采用Revman5.3进行Meta分析.结果 共纳入5篇研究,共428例患者,其中SNS组339例,对照组89例.Meta分析结果显示:SNS可以降低VAS(SMD=-2.59,95％CI-4.81～-0.38,P=0.02),降低初始感觉阈值(SMD=-1.14,95％CI-1.41～-0.86,P=0.000),降低持续感觉阈值(SMD=-0.43,95％CI-0.69～-0.18,P=0.001),降低最大耐受量(SMD=-1.44,95％CI-1.72～-1.16,P=0.000),在静息压与收缩压的变化上,差异无统计学意义.敏感性分析显示静息压与收缩压的显著性均发生了较大改变,结果不稳定.结论 SNS可以减轻功能性肛门痛患者的疼痛与改善直肠感觉.但仍需更多高质量、大样本的随机对照试验进一步论证.

我国成人慢性便秘的发生率为5%左右，男女之比为1:6.8，其中围绝经期女性发生便秘尤为多见。一项针对女性患者的流行病学调查发现，围绝经期综合征合并功能性胃肠病的发病率为65.8% [1] 。更年期是女性必须经历的一个特殊生理时期，该时期的女性由于雌激素水平波动或下降，致植物神经紊乱，出现潮热、盗汗、胸闷、

功能性便秘是肛肠科常见疾病之一,严重影响患者的生活质量.直肠动力、感觉功能异常是其主要发病机制之一,而肛管直肠高分辨率测压作为一种非侵入性、客观的检测手段,能有效检测肛门直肠运动和感觉功能,是研究肛管直肠生理功能和指导肛肠疾病诊治的重要手段,特别是在功能性便秘的机制、诊断及治疗方面有着独特的优势.近10年来,肛管直肠高分辨率测压的研究不断涌现新的成果.本文就肛管直肠高分辨率测压在功能性便秘上的最新研究进展做一综述.

Neuromodulation refers to the method that plays an exciting, inhibitory or regulatory role on neurons or nerve signal transduction through various forms of stimulation, so as to strengthen neural connections and enhance neuroplasticity. Neuromodulation is widely used in colorectal anal diseases, including sacral nerve stimulation, tibial nerve stimulation, vagus nerve stimulation, pudendal nerve stimulation and other treatments. There are few studies on the pudendal nerve stimulation, and the understanding is still unclear. Therefore, this paper reviews application and research progress of pudendal nerve modulation.

Background/Aims: Functional anorectal pain (FARP) is a functional gastrointestinal disease, which belongs to chronic pelvic floor pain. The mechanisms of its development are not fully understood. We designed this experiment to evaluate the characteristics of rectal sensory evoked potential (RSEP) and anorectal manometry (ARM) in this population, so as to explore the pathophysiology of FARP. Methods: The rectal sensory evoked potentials (RSEP) and anorectal manometry (ARM) were performed in 23 patients with FARP and 23 healthy controls. The correlation between the two measurements was investigated. Results: The results of RSEP showed that (1) the median latency to the first positive peak was 69.2 ± 15.9 ms in patients, compared with 46.5 ± 5.8 ms in controls (P = 0.000). (2) The amplitude of evoked potential peaks in the FARP patients was significantly lower than the healthy controls (P1/N1: P = 0.049; N1/P2: P = 0.010). (3) Compared with the controls, the patients showed a lower maximum voluntary squeeze pressure (P = 0.009), lower rectum (P = 0.007), and anal sphincter pressures (P = 0.000) during strain; and increased maximum tolerance threshold to rectal distention (P = 0.000). (4) The resting pressure of the anal sphincter was correlated with the peak amplitude of the RSEP (P1/N1: r = 0.537, P = 0.039; N1/P2: r = 0.520, P = 0.047). Considering the different pathophysiological mechanisms of levator ani syndrome and proctalgia fugax, we analyzed data on unspecified functional anorectal pain and obtained similar results. Conclusions: The RSEP can be used to evaluate the state of afferent pathways in FARP patients; The longer latency and lower peak amplitude of RSEP indicate the functional defects of the anorectal afferent pathway. It can provide an objective evidence for the neuropathy of FARP. In addition, the pathophysiology of FARP is also associated with pelvic floor muscle motor and coordination dysfunction. The correlation between the peak amplitude of the RSEP and the resting pressure of the anal sphincter suggests that there seems to be a correlation between anal pressure and the afferent signaling pathway in patients with FARP.