Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders

Blackett, John W.; Gautam, Misha; Mishra, Rahul; Oblizajek, Nicholas R.; Ramu, Shivabalan Kathavarayan; Bailey, Kent R.; Bharucha, Adil E.

doi:10.1053/j.gastro.2022.08.034

Cited by 19 publications

(30 citation statements)

References 33 publications

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“…The consequence of this difference depends on 1 if only one criterion is required, which variable (i.e., gradient or BET) is deemed more robust for diagnosing DD and 2 whether one or, as suggested by the Rome IV criteria, two abnormal tests are required to diagnose DD. [18][19][20] If one test is deemed sufficient and the BET is deemed more robust than the gradient, 4 then the different gradients between…”

Section: Discussionmentioning

confidence: 99%

“…In 19 constipated patients (36%), the rectoanal gradient during defecation, which is the most useful HR_ARM variable for diagnosing DD, 4 differed between HR_ARM1 and HR_ARM2. The consequence of this difference depends on 1 if only one criterion is required, which variable (i.e., gradient or BET) is deemed more robust for diagnosing DD and 2 whether one or, as suggested by the Rome IV criteria, two abnormal tests are required to diagnose DD 18‐20 …”

Section: Discussionmentioning

confidence: 99%

“…HR_ARM1 and HR_ARM2 arguably have relatively modest consequences on the clinical diagnosis because the BET was either normal or abnormal on both study days in 17 of 19 patients who had a different gradient (i.e., normal vs. abnormal) between HR_ARM1 and HR_ARM2. (However, a recent study suggests that a reduced rectoanal gradient and a prolonged BET have comparable diagnostic utility versus defecography for diagnosing DD 19. ) On the other hand, if two abnormal tests (i.e., gradient and BET) are deemed necessary to diagnose DD, then the differences between HR_ARM1 and HR_ARM2 have a considerable impact because the overall diagnosis based on a combined assessment of the gradient and the BET differed between HR_ARM1 and HR_ARM2 in all 23 patients.In conclusion, HR_ARM is a reproducible test.…”

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confidence: 99%

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Reproducibility of high‐resolution manometry among healthy and constipated persons

Mishra

Gautam

Oblizajek

et al. 2022

Neurogastroenterology Motil

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Background and Aims Although high‐resolution manometry (HR_ARM) is commonly used to diagnose defecatory disorders, its intraindividual day‐to‐day reproducibility is unknown. Since these measurements entail voluntary effort, this study aimed to evaluate the intraindividual day‐to‐day reproducibility of HR_ARM. Methods In 22 healthy women (35 years [14] mean [SD]) and 53 constipated patients (42 years [13], 46 women), the rectal balloon expulsion time (BET), and anorectal pressures were measured with HR_ARM on 2 days separated by a median (interquartile range) of 15 days (11–53) in healthy and 40 days (8–75) in constipated patients. Anorectal pressures were evaluated at rest (20 s), during squeeze, and during evacuation. Rectal sensation was also evaluated in constipated patients. The agreement between both measurements was evaluated with Lin's concordance correlation coefficient (CCC) and other tests. Results Among constipated patients, the anal resting (mean CCC [95%CI] 0.62 [0.43–0.76]) and squeeze pressures (CCC 0.65 [0.47–0.79]), rectoanal gradient during evacuation (CCC 0.42 [0.17–0.62]), and rectal sensory thresholds (CCC for urgency 0.72 [0.52–0.84]) were concordant. Between days 1 and 2, one or more outcomes, characterized as normal or abnormal, differed in 79% of constipated patients, i.e., anal resting and squeeze pressures, the gradient, and the rectal BET differed in, respectively, 25%, 19%, 36%, and 10% of constipated patients. The rectal BET was prolonged in three healthy persons (both days) and either on 1 day (six patients) or 2 days (33 patients) in constipated patients. Conclusions While HR_ARM variables and the BET are reproducible within healthy and constipated persons, the outcome on repeat testing differed in 79% of constipated patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Reproducibility of high‐resolution manometry among healthy and constipated persons

Mishra

Gautam

Oblizajek

et al. 2022

Neurogastroenterology Motil

Self Cite

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“…34 Although there are no published society guidelines, experts recommend conservative management of bowel symptoms before surgery. 35,36 Hard stools predispose to excessive straining and a defecatory disorder. 14,37 Hence, conservative management includes, as appropriate, measures to ensure soft stools that are generally easier to defecate and anorectal biofeedback therapy in patients with a defecatory disorder.…”

Section: Manag Ementmentioning

confidence: 99%

“…The management of a rectocele is guided by a detailed assessment of bowel symptoms, the characteristics of the rectocele, and anorectal functions with manometry 34 . Although there are no published society guidelines, experts recommend conservative management of bowel symptoms before surgery 35,36 . Hard stools predispose to excessive straining and a defecatory disorder 14,37 .…”

Section: Managementmentioning

confidence: 99%

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Bharucha

Knowles

2022

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Background More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2–4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. Purpose We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%–78%), symptoms of difficult defecation improved (30%–50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.

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Intestinale Transitstörungen

Frieling,

Pehl

2024

Gastroenterologie

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Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders

Cited by 19 publications

References 33 publications

Reproducibility of high‐resolution manometry among healthy and constipated persons

Reproducibility of high‐resolution manometry among healthy and constipated persons

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Intestinale Transitstörungen

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