Abstract
Background Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P < 0.001). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.
Highlights
Dyssynergic defecation (DD) is an anorectal dysfunction characterized by impaired relaxation or improper contraction of pelvic floor muscles that occurs during attempted defecation [1] and has been implicated in persistent constipation. [2] According to previous studies, up to 17% of the global population suffer from chronic constipation, while more than 50% of patients referred to tertiary centers for chronic constipation treatment are diagnosed with DD [3, 4]
Lawrentschuk et al [11] reported that only 11% of students had palpated constipated patients, and up to 17% did not perform it during medical school. It is either not performed or inadequately used in clinical practice in evaluating patients with functional anorectal disorders. e purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with high-resolution anorectal manometry (HRAM) in diagnosing DD in patients with functional constipation
We explored the diagnostic yield of DRE, while highresolution anorectal manometry (HRAM) was considered as a reference standard for DD diagnosis. e paradoxical anal contraction was defined as an increase in anal pressure compared with the resting status when the patients were requested to defecate [15, 16]
Summary
Dyssynergic defecation (DD) is an anorectal dysfunction characterized by impaired relaxation or improper contraction of pelvic floor muscles that occurs during attempted defecation [1] and has been implicated in persistent constipation. [2] According to previous studies, up to 17% of the global population suffer from chronic constipation, while more than 50% of patients referred to tertiary centers for chronic constipation treatment are diagnosed with DD [3, 4]. In addition to Rome IV diagnostic criteria, diagnosing DD depends on physiological tests, including evidence of abnormal coordination pattern of defecation detected by anorectal manometry and/or electromyographic. DRE has been confirmed to be a reliable tool for detecting DD and facilitating selection of patients for additional physiological tests [7, 8]. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. e purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and highresolution anorectal manometry (HRAM) test were enrolled in this study. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. e sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%
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