Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation

et al. 2016

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

Section: Statement: Anorectal Manometry Is Useful For Diagnosing Defementioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

et al. 2016

“…6 A study reported that a diagnosis of dyssynergic defecation with the BET showed a high negative predictive value (NPV) of 97%, suggesting that when BET results were normal, dyssynergic defecation could be excluded. 7 However, another study reported a contradictory finding which indicated that normal results of BET do not necessarily exclude dyssynergic defecation by demonstrating that some patients with dyssynergic defecation were able to expel the balloon within 1 minute. 8 Currently BET within 1 minute is regarded as normal, but there is still no consensus on the standard criteria among experts.…”

Section: Introductionmentioning

confidence: 99%

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

Hong

Kim

et al. 2017

Background/AimsBalloon expulsion test (BET) is regarded as a screening tool of dyssynergic defecation (DD). However, some patients with normal BET results may be treated effectively by biofeedback training. This study aims to validate BET as a single screening test. MethodsTwo hundred and thirty-two patients who were diagnosed with functional constipation or irritable bowel syndrome with constipation who underwent anorectal manometry (ARM) and BET at Seoul National University Hospital were enrolled. We evaluated the validity of BET based on ARM and electromyography (EMG) during biofeedback training. ResultsIf BET ≤ 1 minute was defined as normal, sensitivity and negative predictive value (NPV) of BET in predicting paradoxical contraction based on ARM findings were 71.4% and 13.9%. If BET ≤ 3 minutes was defined as normal, sensitivity and NPV were 35.2% and 6.6%. Specificity and positive predictive value (PPV) of BET ≤ 3 minutes criteria were 84.8% and 93.3%. Same analysis was conducted in 107 patients who underwent EMG during biofeedback training. With 1-minute criteria, sensitivity and NPV of BET were 70.3% and 14.3%. With 3 minutes criteria, sensitivity and NPV of BET was 38.6% and 8.8%. Specificity and positive predictive values were both 100.0%. ConclusionsBased on either ARM or EMG during biofeedback training, sensitivity was at most 71.4% and NPV was less than 15.0% irrespective of whether BET was within 1minute or within 3 minutes. BET seems to have a limitation as both a screening test for dyssynergic defecation and a simple assessment to rule out the necessity of biofeedback training.

“…While most laboratories inflate a rectal balloon by a standard volume, typically 50 mL, it has been reported that when rectal sensation is reduced, patients may not perceive the desire to defecate at a volume of 50 mL, limiting the ability to evacuate the balloon even though rectal evacuation is preserved. 5 That is, low volume insufficient to achieve a desire to defecate would result in overdiagnosis of a defecation disorder. Based on this observation, some recent studies suggested to inflate the balloon to the point at which the patients experience the desire to defecate.…”

Section: Filling Volume Of the Balloonmentioning

confidence: 99%

“…Based on this observation, some recent studies suggested to inflate the balloon to the point at which the patients experience the desire to defecate. 5 However, testers need to consider the possibility that it could be more difficult for patients with a defecatory disorder to expel a larger balloon. 6 And these 2 techniques (i.e., fixed versus variable balloon inflation) have not been yet compared.…”

Section: Filling Volume Of the Balloonmentioning

confidence: 99%

“…1 One study reported a sensitivity of 88%, a specificity of 89%, a positive predictive value of 67% and a negative predictive value of 97% for this test and suggested a normal BET might exclude a defecatory disorder. 5 However, Rao et al 10 found that many patients with dyssynergia could expel the balloon and they described a contradictory view that a normal test could not exclude the possibility of a defecatory disorder.…”

Section: How To Interpret the Balloon Expulsion Time And Its Clinicalmentioning

confidence: 99%

See 1 more Smart Citation

How to Perform and Interpret Balloon Expulsion Test

Kim

2014