ABSTRACT
【Objective】 To study the diagnostic value of balloon expulsion test, anorectal manometry, and colonic transit test for detecting constipation with defecation disorders. 【Methods】 Outpatients with functional constipation were retrospectively analyzed and classified into dyssynergic defecation constipation and non-dyssynergic defecation constipation according to the Rome Ⅳ diagnostic criteria. We studied the differences in symptomatological characteristics and results of the three testing methods between the two groups of patients. 【Results】 Among the 48 patients with functional constipation included, there were 13 males (27.1%) and 35 females (72.9%) with an age of (44.8±12.3) years, including 32 patients (66.7%) with defecation disorder and 16 patients (33.3%) with non-defecation disorder. The percentage of anal distension was significantly higher in patients with dyssynergic defecation constipation than in those with non-dyssynergic defecation constipation (34.4% vs. 0.0%, P=0.021). All the three tests had diagnostic value for dyssynergic defecation constipation, but with low diagnostic agreement between the results of each test. The diagnostic sensitivity of anorectal manometry was 100%, but the specificity (56.3%) was low, and both the positive predictive value (82.1%) and the negative predictive value (100%) were higher; the diagnostic sensitivity (75.0%) and specificity (81.3%) of the balloon expulsion test were both higher. The Youden index of colonic transit test was the smallest. The anal resting pressure and maximum systolic pressure of dyssynergic defecation constipation were lower than those of non-dyssynergic defecation constipation (75.2 mmHg vs. 97.1 mmHg, 168.7 mmHg vs. 251.6 mmHg). The two types of constipation did not significantly differ in anorectal pressure gradients during simulated defecation or rectal sensory function. 【Conclusion】 The balloon expulsion test can be used as a primary screening test for constipation with defecation disorders, and anorectal manometry has the highest comprehensive diagnostic value, but there is a certain false positive rate, and the colonic transit test has the lowest diagnostic efficacy. Thus a comprehensive analysis of the patient’s symptoms and the results of different tests is needed in clinical practice.
ABSTRACT
Objective To investigate the differences of anorectal manometry (ARM) parameters in different position (left lateral position and seated position) in patients with functional constipation (FC),and the value of rectoanal pressure gradient (RAPG) was assessed in seated position in the evaluation of anorectal motility disorder in patients with FC.Methods From March 2015 to July 2016,at Clinical Gastrointestinal Motility Center of Ningbo Yinzhou People's Hospital,66 consecutive patients with FC aged 18 to 75 who met Rome Ⅲ criteria were recruited.The questionnaires of patient assessment of constipation symptom (PAC-SYM)and patient assessment of constipation quality of life (PAC-QoL) were recorded.Patients randomly underwent ARM examination in left lateral or seated positions,and then followed by a balloon expulsion test (BET) in seated position.The differences of ARM parameters in different positions were compared.The correlation between ARM parameters and BET results,constipation symptoms and quality of life scores were analyzed.T-test,Spearman correlation analysis and Kappa coefficient were performed for statistical analysis.Results ARM parameters including rectal resting pressure,rectal defecation pressure and RAPG in seated position were both higher than those of left lateral position ((30.83 ±7.89) mmHg (1 mmHg =0.133 kPa) vs.(10.53 ± 3.94) mmHg,(78.86±22.25) mmHg vs.(54.92±21.26) mmHg,(17.53 ±27.40) mmHg vs.(-7.80 ±26.88) mmHg),and the differences were statistically significant (t =-21.10,-12.35 and-8.84,all P ＜ 0.01).However,there was no significant difference in anal-related pressure parameters (P ＞ 0.05).The RAPG in seated position was highly consistent with BET,with a maximum Kappa-value of 0.643,which was higher than the maxium Kappa-value of 0.349 in left lateral position.The optimal RAPG threshold of seated position was 10 mmHg,the sensitivity of RAPG in the prediction of BET was 85.71％ and the specificity was 79.17％.According to the optimal RAPG threshold in seated position,the patients were divided into high RAPG group and low RAPG group.The frequency of weekly spontaneous defecation of high RAPG group was higher than that of low RAPG group (2.88 ±2.16 vs.1.66 ±0.96),and the difference was statistically significant (t=2.65,P=0.01).The satisfaction score of PAC-QoL questionnaire of high RAPG group was lower than that of low RAPG group (2.05 ±0.55 vs.2.83 ±0.78),and the difference was statistically significant (t =-4.72,P ＜0.01).Conclusion It may be more reasonable to perform ARM in the seated position in FC patients,especially for the RAPG in seated position is better correlated with BET results,constipation symptoms and quality of life scores which may have more clinical value in the evaluation of anorectal motility disorder in FC patients.
ABSTRACT
The purpose of this study is to evaluate the predictive capability of anorectal physiologic tests for unfavorable outcomes prior to the initiation of biofeedback therapy in patients with dyssynergic defecation. We analyzed a total of 80 consecutive patients who received biofeedback therapy for chronic idiopathic functional constipation with dyssynergic defecation. After classifying the patients into two groups (responders and non-responders), univariate and multivariate analyses were performed to determine the predictors associated with the responsiveness to biofeedback therapy. Of the 80 patients, 63 (78.7%) responded to biofeedback therapy and 17 (21.3%) did not. On univariate analysis, the inability to evacuate an intrarectal balloon (P=0.028), higher rectal volume for first, urgent, and maximal sensation (P=0.023, P=0.008, P=0.007, respectively), and increased anorectal angle during squeeze (P=0.020) were associated with poor outcomes. On multivariate analysis, the inability to evacuate an intrarectal balloon (P=0.018) and increased anorectal angle during squeeze (P=0.029) were both found to be independently associated with a lack of response to biofeedback therapy. Our data show that the two anorectal physiologic test factors are associated with poor response to biofeedback therapy for patients with dyssynergic defecation. These findings may assist physicians in predicting the responsiveness to therapy for this patient population.