Results of Anorectal Physiological Testing in Patients with Limited English Proficiency

Jean C. Fox, Aoife M. Feighery, Jeffrey R. Fetzer, David O. Prichard

Research output: Contribution to journalArticlepeer-review


Background: Patients with limited English proficiency (LEP) experience barriers to healthcare. These include language barriers and difficulty accessing medical subspecialties. Consequently, patients with LEP may be underrepresented, and may be more likely to have abnormal results, among individuals referred for anorectal testing. Aims: To explore whether differences exist in the results of high-resolution anorectal manometry (HRM), rectal sensory testing (RST), and balloon expulsion testing (BET) between patients with LEP and English proficiency (EP). Methods: The electronic health records at Mayo Clinic, Rochester were used to identify constipated patients without organic anorectal disease who had undergone anorectal testing in 2018, 2019, and 2020. The language spoken by the patients was determined. HRM, RST, and BET results were compared. Nominal logistic regression explored the influence of age, gender, test operator, and LEP on the likelihood of abnormal findings. Key Results: Among 3298 patients (80% female, mean age ± standard deviation 46 ± 16 years), 67 (2%) had LEP. HRM measurements were similar in LEP and EP patients. However, LEP patients were more likely to have abnormal BET and RST. Logistic regression revealed that age (older than 50 years), gender, test operator, and LEP influenced the results of BET and RST, with LEP having the strongest influence. Conclusions: Results of anorectal testing in constipated patients differ between LEP and EP patients. This is likely to represent a difference in disease prevalence between these groups, for example, due to referral bias, rather than a difference in physiology or a language barrier.

Original languageEnglish (US)
Pages (from-to)750-760
Number of pages11
JournalDigestive diseases and sciences
Issue number3
StatePublished - Mar 2023


  • Constipation
  • Defecation/*physiology
  • High-resolution manometry (HRM)
  • Humans
  • Language
  • Manometry/*methods

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


Dive into the research topics of 'Results of Anorectal Physiological Testing in Patients with Limited English Proficiency'. Together they form a unique fingerprint.

Cite this