The following article is a part of conference coverage from the American College of Gastroenterology 2021 Annual Meeting , held from October 22 to 27, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from ACG 2021.


Obesity, especially class II and III, is independently correlated with worse fecal incontinence, rectal hyposensitivity, and health-related quality of life (HRQOL), according to research presented at the American College of Gastroenterology (ACG) 2021 Annual Meeting, held from October 22 to 27, 2021, in Las Vegas, Nevada and virtually.

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Investigators sought to evaluate the relationship between obesity and measures from high-resolution anorectal manometry (HRAM) and hindgut symptoms in consecutive adults referred for HRAM at a tertiary center.

The study authors prospectively collected validated surveys at the time of HRAM, including the Patient-Reported Outcomes Measurement Information System (PROMIS) symptom scales for incontinence, constipation, and diarrhea and the 12-item Short-Form Health Survey (SF-12) for HRQOL. Patients were grouped according to body mass index (BMI) — normal (<25 kg/m2), overweight (25-29.9 kg/m2), class I obesity (30-34.9 kg/m2), and class II and III obesity (>35 kg/m2).

A total of 220 patients (mean age, 52.2 years; 83% women) were included — 25% had a BMI considered overweight, 9.6% met criteria for class I obesity, and 9.1% met criteria for class II and III obesity. BMI was correlated with increased PROMIS incontinence (r = 0.31; P =.0002) and diarrhea (r = 0.19; P =.027) scores, but not constipation or lower physical component score (PCS) on the SF-12 (r = –0.27; P =.004).

HRAM showed that BMI was correlated with higher first rectal sensation (r = 0.20; P =.014), urge (r = 0.19; P =.021), and maximal tolerated (r = 0.18; P =.03) volumes, but not other measures. Participants with class II and III obesity had worse PROMIS incontinence scores and PCS, as well as greater rectal hyposensitivity on HRAM according to London classification (≥2 elevated sensory volumes), compared with the other groups.

Separate multivariable models that adjusted for age, sex, thyroid dysfunction, irritable bowel syndrome, and diabetes demonstrated that BMI remained correlated with more severe incontinence (β = 0.109; P =.0065) and rectal hyposensitivity (odds ratio [OR], 1.067; P =.01). Class II and III obesity independently predicted worse incontinence (β = 1.82; P =.049), PCS (β = –13.6; P =.0023), and rectal hyposensitivity (OR, 2.81; P =.038).

“Changes in anorectal physiology and sensory function may contribute to bothersome hindgut symptoms among patients with obesity,” stated the study authors. “Anorectal physiology testing should be considered to help guide management,” they concluded.

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Wang C, Lodhia N, Chan WH. Obesity is an independent risk factor for fecal incontinence, rectal hyposensitivity, and worse health-related quality of life. Presented at: ACG 2021 Annual Meeting; October 22-27, 2021; Las Vegas, NV and virtual. Abstract P0866.