TY - JOUR
T1 - Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders
AU - Blackett, John W.
AU - Gautam, Misha
AU - Mishra, Rahul
AU - Oblizajek, Nicholas R.
AU - Kathavarayan Ramu, Shivabalan
AU - Bailey, Kent R.
AU - Bharucha, Adil E.
N1 - Funding Information:
Funding This study was supported by United States Public Health Service National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases , United States, grant R01DK078924.
Funding Information:
Funding This study was supported by United States Public Health Service National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases, United States, grant R01DK078924.June Oshiro, PhD, ELS, Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff at Mayo Clinic provided proofreading, administrative, and clerical support. John W. Blackett, MD, MS (Formal analysis: Lead; Investigation: Lead; Writing – original draft: Lead; Writing – review & editing: Equal). Shivabalan Kathavarayan Ramu, MBBS (Formal analysis: Supporting; Investigation: Equal). Misha Gautam, MBBS (Formal analysis: Supporting; Investigation: Supporting). Rahul Mishra, MBBS (Formal analysis: Supporting; Investigation: Supporting). Nicholas R. Oblizajek, MD (Formal analysis: Supporting; Investigation: Supporting). Kent R. Bailey, PhD (Formal analysis: Equal; Investigation: Supporting; Writing – review & editing: Supporting). Adil E. Bharucha, MD (Conceptualization: Lead; Funding acquisition: Lead; Investigation: Equal; Methodology: Lead; Project administration: Lead; Supervision: Lead; Writing – original draft: Equal; Writing – review & editing: Lead).
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/12
Y1 - 2022/12
N2 - Background & Aims: The utility of high-resolution anorectal manometry (HR-ARM) for diagnosing defecatory disorders (DDs) is unclear because healthy people may have features of dyssynergia. We aimed to identify objective diagnostic criteria for DD and to ascertain the utility of HR-ARM for diagnosing DD. Methods: Constipated patients were assessed with HR-ARM and rectal balloon expulsion time (BET), and a subset underwent defecography. Normal values were established by assessing 184 sex-matched healthy individuals. Logistic regression models evaluated the association of abnormal HR-ARM findings with prolonged BET and reduced rectal evacuation (determined by defecography). Results: A total of 474 constipated individuals (420 women) underwent HR-ARM and BET, and 158 underwent defecography. BET was prolonged, suggesting a DD, for 152 patients (32%). Rectal evacuation was lower for patients with prolonged vs normal BET. A lower rectoanal gradient during evacuation, reduced anal squeeze increment, and reduced rectal sensation were independently associated with abnormal BETs; the rectoanal gradient was 36% sensitive and 85% specific for prolonged BET. A lower rectoanal gradient and prolonged BET were independently associated with reduced evacuation. Among constipated patients, the probability of reduced rectal evacuation was 14% when the gradient and BET were both normal, 45% when either was abnormal, and 75% when both variables were abnormal. Conclusions: HR-ARM, BET, and defecography findings were concordant for constipated patients, and reduced rectoanal gradient was the best HR-ARM predictor of prolonged BET or reduced rectal evacuation. Prolonged BET, reduced gradient, and reduced evacuation each independently supported a diagnosis of DD in constipated patients. We propose the terms probable DD for patients with an isolated abnormal gradient or BET and definite DD for patients with abnormal results from both tests.
AB - Background & Aims: The utility of high-resolution anorectal manometry (HR-ARM) for diagnosing defecatory disorders (DDs) is unclear because healthy people may have features of dyssynergia. We aimed to identify objective diagnostic criteria for DD and to ascertain the utility of HR-ARM for diagnosing DD. Methods: Constipated patients were assessed with HR-ARM and rectal balloon expulsion time (BET), and a subset underwent defecography. Normal values were established by assessing 184 sex-matched healthy individuals. Logistic regression models evaluated the association of abnormal HR-ARM findings with prolonged BET and reduced rectal evacuation (determined by defecography). Results: A total of 474 constipated individuals (420 women) underwent HR-ARM and BET, and 158 underwent defecography. BET was prolonged, suggesting a DD, for 152 patients (32%). Rectal evacuation was lower for patients with prolonged vs normal BET. A lower rectoanal gradient during evacuation, reduced anal squeeze increment, and reduced rectal sensation were independently associated with abnormal BETs; the rectoanal gradient was 36% sensitive and 85% specific for prolonged BET. A lower rectoanal gradient and prolonged BET were independently associated with reduced evacuation. Among constipated patients, the probability of reduced rectal evacuation was 14% when the gradient and BET were both normal, 45% when either was abnormal, and 75% when both variables were abnormal. Conclusions: HR-ARM, BET, and defecography findings were concordant for constipated patients, and reduced rectoanal gradient was the best HR-ARM predictor of prolonged BET or reduced rectal evacuation. Prolonged BET, reduced gradient, and reduced evacuation each independently supported a diagnosis of DD in constipated patients. We propose the terms probable DD for patients with an isolated abnormal gradient or BET and definite DD for patients with abnormal results from both tests.
KW - Defecography
KW - Dyssynergic Defecation
KW - Pelvic Floor Dysfunction
KW - Rome Criteria
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U2 - 10.1053/j.gastro.2022.08.034
DO - 10.1053/j.gastro.2022.08.034
M3 - Article
C2 - 35995074
AN - SCOPUS:85137090439
SN - 0016-5085
VL - 163
SP - 1582-1592.e2
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -