Diagnostic testing for dyssynergic defecation in chronic constipation: meta‐analysis

Videlock, Elizabeth J.; Lembo, Anthony; Cremonini, Filippo

doi:10.1111/nmo.12096

Cited by 75 publications

(78 citation statements)

References 93 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prevalence of findings suggestive of abnormal defecation ranged from 14.9% for absent opening of the anorectal angle on defecography, to 47% for a dyssynergic pattern with manometry, and 52.9% for a dyssynergic pattern with ultrasonography. 46 Thus, not only manometry but combined abnormalities with other modalities (ie, balloon expulsion, manometry, and imaging) are required for making a diagnosis of this condition (see diagnostic criteria below). Anorectal manometry facilitates measurements of the defecation index, which is a ratio of the intrarectal pressure and anal sphincter residual pressure.…”

Section: Anorectal Manometrymentioning

confidence: 99%

“…51 However, methodological differences and poor interobserver agreement has limited its overall usefulness. 46 Magnetic resonance (MR) defecography or dynamic pelvic MRI can evaluate pelvic floor anatomy, dynamic motion, and rectal evacuation simultaneously. It provides an excellent resolution of anal sphincters, levator ani muscles and soft tissue surrounding the rectum without radiation exposure.…”

Section: Defecography and Magnetic Resonance Defecographymentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

195

149

View full text Add to dashboard Cite

Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

show abstract

Section: Anorectal Manometrymentioning

confidence: 99%

Section: Defecography and Magnetic Resonance Defecographymentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

195

149

View full text Add to dashboard Cite

show abstract

“…The prevalence of Dyssynergic defecation (DD) in patients with chronic constipation approaches 50% [1][2][3] . Thus far, most referral centers had been using the Konigsberg standard solid-state anorectal manometry (SARM) catheter for anorectal motility testing.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Soubra

Valestin

et al. 2014

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

AIM:To compare dyssynergic sub type patterns between SARM and HRM. METHODS: Patients with dyssynergic defecation diagnosed by ARM that had maintained the same stool patterns and frequency were re-evaluated with HRM while on waiting list for biofeedback training. Anorectal resting and squeezing pressure on the bed and commode were analyzed and compared between the two modalities. Paired t-test was used to compare the pressures and sensations. RESULTS: 25 dyssynergic patients diagnosed with SARM (F=21, age 41±12.9) underwent HRM. Twenty four patients had dyssynergia on HRM (96%). Twelve (48%) had similar patterns on≥one position, and five (20%) had similar patterns in both positions. When comparing between HRM and SARM, the maximum resting pressure (70 vs 55.6 mmHg p<0.01), anal straining on bed (73 vs 46.4 mHg, p<0.01), rectal straining on commode (107.4 vs 71.8 mmHg, p<0.01) and anal straining pressures on commode (76.3 vs 48.9 mmHg, p<0.01) significantly deferred between the exams respectively.

show abstract

“…In a recent meta-analysis of 7,591 patients with constipation, the prevalence of findings that suggested abnormal defaecation was varied -from 14.9% for absent opening of the anorectal angle on defaecography to 47.7% for a dyssynergic pattern on anorectal manometry and 52.9% on ultrasonography. (62) These findings highlight the considerable heterogeneity of DDs and their associated challenges. Thus, test results must be interpreted in the overall clinical context, taking into account local facilities and costs.…”

Section: Evaluation Of Colonic and Anorectal Functionmentioning

confidence: 99%

Current status of functional gastrointestinal evaluation in clinical practice

Ang

Fock²,

Law³

2015

smedj

View full text Add to dashboard Cite

Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient's care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients' persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools.

show abstract

Diagnostic testing for dyssynergic defecation in chronic constipation: meta‐analysis

Cited by 75 publications

References 93 publications

Diagnosis and Treatment of Dyssynergic Defecation

Diagnosis and Treatment of Dyssynergic Defecation

A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

Current status of functional gastrointestinal evaluation in clinical practice

Contact Info

Product

Resources

About