Rectal gas volume: Defining cut‐offs for screening for evacuation disorders in patients with constipation

Park, S.-Y.; Khemani, Disha; Acosta, Andrés; Eckert, Deborah J.; Camilleri, Michael

doi:10.1111/nmo.13044

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…Park et al . demonstrated that rectal gas volume was a marker of defecatory disorders; at a specificity of 90%, a rectal gas volume of 30 mL had a PPV of 77.3% for an evacuation disorder 50 , 51 .…”

Section: Normal and Abnormal Colonic And Anal Structure And Functionmentioning

confidence: 99%

Recent advances in understanding and managing chronic constipation

Prichard

Bharucha

2018

F1000Res

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Constipation, a condition characterized by heterogeneous symptoms, is common in Western society. It is associated with reduced physical health, mental health, and social functioning. Because constipation is rarely due to a life-threatening disease (for example, colon cancer), current guidelines recommend empiric therapy. Limited surveys suggest that fewer than half of treated individuals are satisfied with treatment, perhaps because the efficacy of drugs is limited, they are associated with undesirable side effects, or they may not target the underlying pathophysiology. For example, although a substantial proportion of constipated patients have a defecatory disorder that is more appropriately treated with pelvic floor biofeedback therapy than with laxatives, virtually no pharmacological trials formally assessed for anorectal dysfunction. Recent advances in investigational tools have improved our understanding of the physiology and pathophysiology of colonic and defecatory functions. In particular, colonic and anorectal high-resolution manometry are now available. High-resolution anorectal manometry, which is increasingly used in clinical practice, at least in the United States, provides a refined assessment of anorectal pressures and may uncover structural abnormalities. Advances in our understanding of colonic molecular physiology have led to the development of new therapeutic agents (such as secretagogues, pro-kinetics, inhibitors of bile acid transporters and ion exchangers). However, because clinical trials compare these newer agents with placebo, their efficacy relative to traditional laxatives is unknown. This article reviews these physiologic, diagnostic, and therapeutic advances and focuses particularly on newer therapeutic agents.

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Section: Normal and Abnormal Colonic And Anal Structure And Functionmentioning

confidence: 99%

Recent advances in understanding and managing chronic constipation

Prichard

Bharucha

2018

F1000Res

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“…The method for measuring the rectal area of gas on scout film (RASF) of an abdominal computed tomography (CT) scan has been previously published and validated relative to the estimated rectal gas volume measured by the same CT scan after 3-dimensional reconstruction. 15,23 From our previous studies, we used mean RASF >9 cm 2 (92.3% specificity and 68.8% positive predictive value) as the cut-off to diagnose RED. 23…”

Section: Methodsmentioning

confidence: 99%

“…15,23 From our previous studies, we used mean RASF >9 cm 2 (92.3% specificity and 68.8% positive predictive value) as the cut-off to diagnose RED. 23…”

Section: Methodsmentioning

confidence: 99%

“…We adopted a standardized approach to identify rectal gas, based on the bony landmarks (from the lower aspect of the sacroiliac joint to the lower aspect of the pubic symphysis) to define the margins of vertical extent of the rectal gas. 15,23 The surface area of rectal gas was outlined by using a manually operated region of interest (ROI) approach. The software, Quick Query Radiographs and Photographs, Electronic Analysis and Display Station (QREADs version 5.9.3.2, Mayo Clinic, Rochester, MN, USA), automatically calculated the area of rectal gas on the 2-dimensional abdominal film (RASF) in cm 2 .…”

Section: Methodsmentioning

confidence: 99%

“…RASF was measured by a single operator (V.C.) who was trained on how to identify and measure RASF, 15,23 and who was blinded to the information on DRE and HRM at the time when the RASF was being estimated.…”

Section: Methodsmentioning

confidence: 99%

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Audit of the diagnosis of rectal evacuation disorders in chronic constipation

Chedid

Vijayvargiya

Halawi

et al. 2018

Neurogastroenterology Motil

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Background: Balloon expulsion test (BET) and high resolution anorectal manometry (HRM) are used in diagnosis of rectal evacuation disorders (RED); their performance characteristics are suboptimal. Methods: We audited records of 449 consecutive patients with chronic constipation (CC). We documented: anal sphincter tone and contraction, puborectalis tenderness, and perineal descent on digital rectal exam (DRE); maximum resting and squeeze pressures, and rectoanal pressure gradient on HRM; weight or time to balloon expulsion; colonic transit, and area of rectal area on radiograph (RASF). We based the diagnosis of RED on ≥2 abnormalities on both DRE and HRM, excluding results of BET, since the performance of BET is being investigated. Results of RED vs. non-RED, and results obtained using tbBET vs. wbBET groups were compared. We used multivariate logistic regressions to identify predictors of RED using different diagnostic modalities. Key Results: Among 449 individuals, 276 were included (74 RED and 202 non-RED). Predominant exclusions were for no HRM (n=79) or use of low resolution anorectal manometry (n=77). Logistic regression models for abnormal tbBET showed time >60 seconds, RASF and age predicted RED. For tbBET, the current cut-off of 60 seconds had sensitivity of 39.0% and specificity 93.0% to diagnose RED; on the other hand, applying the cut-off at 22 seconds, the sensitivity was 77.8% and specificity 69.8%. Conclusions/Inferences: The clinical diagnosis of RED in patients with CC is achieved with combination of DRE, HRM and an optimized, time-based BET. Prospective studies are necessary to confirm the proposed 22 second cut-off for tbBET.

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Diagnosis and Treatment of Irritable Bowel Syndrome

Camilleri

2021

JAMA

207

135

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ImportanceThe prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.ObservationsValidation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.Conclusions and RelevanceAdvances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

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Rectal gas volume: Defining cut‐offs for screening for evacuation disorders in patients with constipation

Cited by 10 publications

References 15 publications

Recent advances in understanding and managing chronic constipation

Recent advances in understanding and managing chronic constipation

Audit of the diagnosis of rectal evacuation disorders in chronic constipation

Diagnosis and Treatment of Irritable Bowel Syndrome

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