Can Digital Rectal Examination Identify the Subtype of Dyssynergic Disorders as Well as High Resolution Anorectal Manometry?

Abstract

BACKGROUND AND OBJECTIVES: The diagnosis of dyssynergic disorders (DD) often necessitates high-definition anorectal manometry (3D-HRAM), introducing concerns related to cost, availability, and delayed referral. Digital rectal examination (DRE) has demonstrated reliable performance in diagnosing DD, offering a cost-effective and readily available alternative. This study aimed to assess DRE's capability to accurately classify patients with DD into the four subtypes outlined in Rao's classification. METHODS: We conducted a retrospective monocentric study involving patients diagnosed with DD through 3D-HRAM. The same senior clinician performed all DREs, while another senior clinician conducted the 3D-HRAM. Statistical tests were employed to gauge the correlation between DRE and HRAM in classifying the four DD subtypes. RESULTS: The study included 200 patients, revealing a commendable overall agreement between DRE and HRAM (Kappa= 0.658). Specific to subtype diagnosis, the correlation was substantial for subtypes I, II, and IV (0.679, 0.741, 0.649, respectively) and moderate for subtype III (Kappa = 0.325). CONCLUSION: DRE yields satisfactory results in diagnosing the four subtypes of DD, enabling prompt referral for rehabilitation without awaiting confirmation from 3D-HRAM. Enhanced training in DRE, emphasizing functional information, has the potential to reduce reliance on additional tests, thereby mitigating economic and organizational impacts.