Abstract
BackgroundA defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD—a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening.MethodsThis prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)].ResultsFrom 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening.ConclusionThe sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.
Highlights
A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams
DD may result from impaired anorectal function or rectal structural disturbances in patients with complaints of Chronic Constipation (CC) [1,2,3]
We found 3 potential “low-cost” tools—a DD clinical score, the balloon expulsion test (BET) and the digital rectal examination (DRE)
Summary
A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. This physiological evaluation can be cumbersome, inaccessible and costly. A defecation disorder (DD) is defined as a difficulty in evacuation or emptying the rectum. DD may result from impaired anorectal function or rectal structural disturbances in patients with complaints of Chronic Constipation (CC) [1,2,3]. The diagnosis of DD is established when a patient with functional chronic. Rome IV Diagnostica criteria (a) for functional defecation disorders. Impaired rectal evacuation by imaging (a) Criteria fulfilled for the last 3 months with symptoms onset at least 6 months before diagnosis
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