Audit of the diagnosis of rectal evacuation disorders in chronic constipation.
constipation
dyssynergia
examination
pelvic floor
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
14
06
2018
revised:
08
10
2018
accepted:
16
10
2018
pubmed:
15
11
2018
medline:
21
1
2020
entrez:
15
11
2018
Statut:
ppublish
Résumé
Balloon expulsion test (BET) and high-resolution anorectal manometry (HRM) are used in diagnosis of rectal evacuation disorders (REDs); their performance characteristics are suboptimal. We audited records of 449 consecutive patients with chronic constipation (CC). We documented anal sphincter tone and contraction, puborectalis tenderness, and perineal descent on digital rectal exam (DRE); maximum resting and squeeze pressures, and rectoanal pressure gradient on HRM; weight or time to balloon expulsion; colonic transit, and area of rectal area on radiograph (RASF). We based the diagnosis of RED on ≥2 abnormalities on both DRE and HRM, excluding results of BET, as the performance of BET is being investigated. Results of RED vs non-RED and results obtained using tbBET vs wbBET groups were compared. We used multivariate logistic regressions to identify predictors of RED using different diagnostic modalities. Among 449 individuals, 276 were included (74 RED and 202 non-RED). Predominant exclusions were for no HRM (n = 79) or use of low resolution anorectal manometry (n = 77). Logistic regression models for abnormal tbBET showed time >60 seconds, RASF and age-predicted RED. For tbBET, the current cutoff of 60 seconds had sensitivity of 39.0% and specificity 93.0% to diagnose RED; on the other hand, applying the cutoff at 22 seconds, the sensitivity was 77.8% and specificity 69.8%. The clinical diagnosis of RED in patients with CC is achieved with combination of DRE, HRM and an optimized, time-based BET. Prospective studies are necessary to confirm the proposed 22 second cutoff for tbBET.
Sections du résumé
BACKGROUND
Balloon expulsion test (BET) and high-resolution anorectal manometry (HRM) are used in diagnosis of rectal evacuation disorders (REDs); their performance characteristics are suboptimal.
METHODS
We audited records of 449 consecutive patients with chronic constipation (CC). We documented anal sphincter tone and contraction, puborectalis tenderness, and perineal descent on digital rectal exam (DRE); maximum resting and squeeze pressures, and rectoanal pressure gradient on HRM; weight or time to balloon expulsion; colonic transit, and area of rectal area on radiograph (RASF). We based the diagnosis of RED on ≥2 abnormalities on both DRE and HRM, excluding results of BET, as the performance of BET is being investigated. Results of RED vs non-RED and results obtained using tbBET vs wbBET groups were compared. We used multivariate logistic regressions to identify predictors of RED using different diagnostic modalities.
KEY RESULTS
Among 449 individuals, 276 were included (74 RED and 202 non-RED). Predominant exclusions were for no HRM (n = 79) or use of low resolution anorectal manometry (n = 77). Logistic regression models for abnormal tbBET showed time >60 seconds, RASF and age-predicted RED. For tbBET, the current cutoff of 60 seconds had sensitivity of 39.0% and specificity 93.0% to diagnose RED; on the other hand, applying the cutoff at 22 seconds, the sensitivity was 77.8% and specificity 69.8%.
CONCLUSIONS & INFERENCES
The clinical diagnosis of RED in patients with CC is achieved with combination of DRE, HRM and an optimized, time-based BET. Prospective studies are necessary to confirm the proposed 22 second cutoff for tbBET.
Identifiants
pubmed: 30426597
doi: 10.1111/nmo.13510
pmc: PMC6296898
mid: NIHMS994345
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13510Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK067071
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK115950
Pays : United States
Organisme : NIH HHS
ID : R01-DK115950
Pays : United States
Organisme : NIH HHS
ID : R01-DK67071
Pays : United States
Informations de copyright
© 2018 John Wiley & Sons Ltd.
Références
Can J Gastroenterol Hepatol. 2016;2016:8654314
pubmed: 27847802
Nat Rev Gastroenterol Hepatol. 2018 May;15(5):309-323
pubmed: 29636555
Gastroenterology. 2004 Jan;126(1):57-62
pubmed: 14699488
Neurogastroenterol Motil. 2013 Jun;25(6):509-20
pubmed: 23421551
Am J Gastroenterol. 2012 Oct;107(10):1530-6
pubmed: 22986439
Gastroenterology. 2013 Feb;144(2):314-322.e2
pubmed: 23142135
N Engl J Med. 2003 Oct 2;349(14):1360-8
pubmed: 14523145
Gut. 1989 Dec;30(12):1737-49
pubmed: 2612988
Neurogastroenterol Motil. 2016 Nov;28(11):1690-1697
pubmed: 27254309
Neurogastroenterol Motil. 2017 Jul;29(7):
pubmed: 28261935
Am J Gastroenterol. 2014 Aug;109(8):1141-57; (Quiz) 1058
pubmed: 25022811
Aliment Pharmacol Ther. 2017 Aug;46(4):410-423
pubmed: 28660663
Am J Gastroenterol. 2015 Aug;110(8):1197-204
pubmed: 26032152
Gastroenterology. 2016 Feb 18;:
pubmed: 27144627
Neurogastroenterol Motil. 2018 Jul;30(7):e13314
pubmed: 29498141
Neurogastroenterol Motil. 2016 Oct;28(10):1589-98
pubmed: 27154577
Neurogastroenterol Motil. 2014 Jan;26(1):131-8
pubmed: 24118658
Colorectal Dis. 2012 Oct;14(10):1224-30
pubmed: 22251617
Clin Gastroenterol Hepatol. 2017 Mar;15(3):412-420
pubmed: 27720913
Nat Rev Dis Primers. 2017 Dec 14;3:17095
pubmed: 29239347
Ann Surg. 1991 Oct;214(4):403-11; discussion 411-3
pubmed: 1953096
Am J Gastroenterol. 2007 Apr;102(4):850-5
pubmed: 17397410
World J Gastroenterol. 2012 Dec 14;18(46):6836-42
pubmed: 23239922
Clin Gastroenterol Hepatol. 2010 Nov;8(11):955-60
pubmed: 20656061
Gut. 2012 Aug;61(8):1132-9
pubmed: 22180057
Gut. 2016 Mar;65(3):447-55
pubmed: 25765461
Dis Colon Rectum. 1996 Aug;39(8):899-905
pubmed: 8756846
Neurogastroenterol Motil. 2013 Jun;25(6):502-8
pubmed: 23406422
Gastroenterology. 2006 Apr;130(5):1510-8
pubmed: 16678564
Clin Gastroenterol Hepatol. 2017 Apr;15(4):543-552.e4
pubmed: 27856363
Neurogastroenterol Motil. 2010 Apr;22(4):415-23, e95
pubmed: 20025675
J Neurogastroenterol Motil. 2017 Jul 30;23(3):446-452
pubmed: 28578564
Neurogastroenterol Motil. 2013 Dec;25(12):e813-20
pubmed: 23952111