Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

Grossi, Ugo; Tanna, Gian Luca Di; Heinrich, Henriette; Taylor, Stuart A.; Knowles, Charles H.; Scott, S. M.

doi:10.1111/apt.15039

Cited by 64 publications

(70 citation statements)

References 114 publications

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“…Normative data sets have provided evidence of truly pathologic findings (ie, those not seen in health), such as large rectoceles, high‐grade intussuscepta, and enteroceles (whole gut or oro‐anal) …”

Section: Resultsmentioning

confidence: 99%

European society of neurogastroenterology and motility guidelines on functional constipation in adults

Serra

Pohl

Azpiroz

et al. 2019

Neurogastroenterology Motil

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149

151

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Introduction: Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation.Design: After a thorough review of the literature by experts in relevant fields, including gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal motility testing from various European countries, a Delphi consensus process was used to produce statements and practical algorithms for the management of chronic constipation. 2 of 33 | SERRA Et Al. | INTRODUC TI ONChronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. 1,2 Its prevalence increases with age 3,4 and consequently is expected to rise over the next few years, 5 in parallel with the predicted increase in longevity of the European population. Constipation is a symptom that may have diverse etiologies, and for this reason, several diagnostic approaches and treatment options are available, ranging from simple lifestyle changes and general measures to sophisticated pharmacological treatments and surgical interventions. 6 In an attempt to unify the health care received by the population across Europe, the European Society of Neurogastroenterology and Motility (ESNM) decided to develop European guidelines to help physicians to take the best decisions to improve the quality of health in patients suffering from common functional and motor disorders. In this document, we present the ESNM guidelines for chronic constipation, which are intended to be a useful tool for the management of this condition in the general population in Europe. In order to produce comprehensive guidelines addressing the different aspects related with constipation, experts from European countries working in related fields developed relevant statements after a thorough review of the available literature, and final recommendations and management algorithms were produced following a Delphi consensus process. | ME THODS | ParticipantsA chair (Jordi Serra) and co-chair (Daniel Pohl) were commissioned by the ESNM Steering Committee to develop the guidelines. A panel of 12 experts from different European countries, constituted by gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal (GI) motility testing, was invited by the chairs to participate in the development of the guidelines. Each expert was assigned to develop a specific area of the document (see below) and to establish a team with one or two co-workers to complete the assigned task. The final ESNM guidelines working group was composed of 13 experts and 9 co-authors. | The Delphi consensusEach expert and co-worker conducted a thorough review of the literature in their specific field of expertise. The following areas were covered by the different subgrou...

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Section: Resultsmentioning

confidence: 99%

European society of neurogastroenterology and motility guidelines on functional constipation in adults

Serra

Pohl

Azpiroz

et al. 2019

Neurogastroenterology Motil

Self Cite

149

151

View full text Add to dashboard Cite

show abstract

“…We read with interest the systematic review and meta-analysis by Grossi et al on the rates of structural and functional abnormalities diagnosed by barium and magnetic resonance imaging defecography in patients with refractory constipation. 1 The prevalence of abnormalities detected by defecography was higher in patients than in healthy subjects, but varied considerably across studies.…”

Section: Editorsmentioning

confidence: 97%

“…Basilisco and Corsetti for their correspondence regarding our recent publication. 1,2 The issues they raised are important for clinical practice.…”

Section: Letter: Limitations Of Defecography Among Patients With Refrmentioning

confidence: 99%

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Letter: limitations of defecography among patients with refractory constipation

Basilisco

Corsetti

2019

Aliment Pharmacol Ther

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EDITORS,We read with interest the systematic review and meta-analysis by Grossi et al on the rates of structural and functional abnormalities diagnosed by barium and magnetic resonance imaging defecography in patients with refractory constipation. 1 The prevalence of abnormalities detected by defecography was higher in patients than in healthy subjects, but varied considerably across studies.As pointed out by the authors, the high level of heterogeneity reflected the poor standardisation of the technique. Based on these data, they proposed that defecography should be the first line diagnostic test in patients with refractory constipation. However, this seems premature according to the principles of evidencebased diagnostics. 2The first step in introducing a test into clinical practice is to establish the normal range in studies large enough to examine the potential influence of variables such as age and sex. Age, body mass index and parity are not only significantly associated with the frequency of pelvic floor disorders, 3 but they also affect anorectal motion in asymptomatic healthy women, 4 prompting the need for normal values adjusted for these variables.The second step should be to assess the association between the abnormal values of the test and the "disease" in terms of sensitivity, specificity and predictive values. In this context, it should be demonstrated that the anatomical abnormality is responsible for patients' symptoms. Chronic constipation is a multifactorial condition; diet, colonic motor, metabolic and absorptive functions, rectal sensitivity, behavioural responses and psychological factors play interacting roles and might influence studies assessing the diagnostic performance of the test.The third and most important step is to determine whether patients benefit from testing in comparison to those who are not tested. Only randomised clinical trials assessing beneficial and harmful effects of the two diagnostic strategies in the long term can address this. Meanwhile, it should be considered that perioperative complications and long-term adverse events of rectal suspension, rectovaginal reinforcement or rectal excision for constipation range from 6.1% to 21.5%. 5 These include urinary and sexual dysfunction for which prior rectal surgery represents the most important predictive factor. 6 Patients rate the severity of adverse functional outcomes of surgery for pelvic floor disorders similar to intensive care unit admission and death. 7To limit the number of patients with a perfect anatomical correction after surgery but with problems such as pain, urgency, or sexual dysfunction, the international community should standardise the technique and plan high quality studies to demonstrate the anatomical and functional alterations found at defecography that are related to patients' symptoms, and whether their correction improves symptoms in the long term. In the meantime, we should use the findings of this interesting study to be even more cautious in interpreting the results of a non-standardised techn...

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“…However, the differences between the two measures were greater when rectal evacuation was lower and the proportion of patients with a rectocele >2 cm was greater; these results suggest that at least in certain anatomical conditions the assessment of rectal area might not be representative of rectal volume. As defecography is often analyzed with qualitative methods, the present study prompts the application of software‐based techniques to allow a quick automatic calculation of rectal area and hopefully rectal volume in order to provide a precise definition of investigated variables. New research should also consider that dedicated software might automatically draw the region of interest used to calculate the areas of each sagittal image, further minimizing the qualitative part of the analytical process.…”

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confidence: 99%