Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders.
Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders.
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DOI：
10.1053/j.gastro.2022.08.034
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发表时间：
2022-12
期刊：
影响因子：
29.4
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中科院分区：
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高分辨率肛门直肠测压（HR-ARM）在诊断排便障碍（DD）方面的效用尚不清楚，因为健康人可能具有协同失调的特征。我们的目的是确定 DD 的客观诊断标准并确定 HR-ARM 在诊断 DD 中的效用。便秘患者接受 HR-ARM 和直肠球囊排出试验 (BET) 评估，部分患者接受排粪造影。正常值是通过评估 184 名性别匹配的健康人确定的。 Logistic 回归模型评估了异常 HR-ARM 结果与延长 BET 和减少直肠排便（通过排粪造影确定）的关联。 474 名便秘患者（420 名女性）接受了 HR-ARM 和 BET； 158 人接受了排粪造影。 152 名患者 (32%) 的 BET 时间延长，表明出现 DD。与正常 BET 患者相比，长期 BET 患者的直肠排空率较低。排空过程中较低的直肠肛门梯度、减少的肛门挤压增量和减少的直肠感觉与异常 BET 独立相关；直肠梯度对于延长 BET 的敏感性为 36%，特异性为 85%。较低的直肠肛门梯度和延长的 BET 与不完全排空独立相关。在便秘患者中，当梯度和 BET 均正常时，直肠排便减少的概率为 14%；当其中任一变量异常时，直肠排便减少的概率为 45%；当两个变量均异常时，直肠排便减少的概率为 75%。对于便秘患者，HR-ARM、BET 和排粪造影结果是一致的，直肠肛门梯度降低是 BET 延长或直肠排便减少的最佳 HR-ARM 预测因子。延长 BET、降低梯度和不完全排空均独立支持便秘患者 DD 的诊断。我们建议用“可能 DD”一词来描述有孤立的异常梯度或 BET 的患者，用“明确 DD”来描述两种测试结果均异常的患者。与年龄和性别匹配的无症状者相比，直肠肛门梯度降低是肛门直肠测压中预测球囊排出试验或排粪造影排便障碍的最重要参数，应被视为排便障碍的可能证据。
The utility of high-resolution anorectal manometry (HR-ARM) for diagnosing defecatory disorders (DDs) is unclear because healthy people may have features of dyssynergia. We aimed to identify objective diagnostic criteria for DD and to ascertain the utility of HR-ARM for diagnosing DD. Constipated patients were assessed with HR-ARM and rectal balloon expulsion test (BET), and a subset underwent defecography. Normal values were established by assessing 184 sex-matched healthy persons. Logistic regression models evaluated the association of abnormal HR-ARM findings with prolonged BET and reduced rectal evacuation (determined by defecography). Four hundred seventy-four constipated persons (420 women) underwent HR-ARM and BET; 158 underwent defecography. BET was prolonged, suggesting a DD, for 152 patients (32%). Rectal evacuation was lower for patients with prolonged vs normal BET. A lower rectoanal gradient during evacuation, reduced anal squeeze increment, and reduced rectal sensation were independently associated with abnormal BETs; the rectoanal gradient was 36% sensitive and 85% specific for prolonged BET. A lower rectoanal gradient and prolonged BET were independently associated with incomplete evacuation. Among constipated patients, the probability of reduced rectal evacuation was 14% when gradient and BET were both normal, 45% when either was abnormal, and 75% when both variables were abnormal. HR-ARM, BET, and defecography findings were concordant for constipated patients, and reduced rectoanal gradient was the best HR-ARM predictor of prolonged BET or reduced rectal evacuation. Prolonged BET, reduced gradient, and incomplete evacuation each independently supported a diagnosis of DD in constipated patients. We propose the terms probable DD for patients with an isolated abnormal gradient or BET and definite DD for patients with abnormal results from both tests. A reduced rectoanal gradient, as compared to age and sex-matched asymptomatic persons, was the most important parameter on anorectal manometry to predict impaired evacuation by either balloon expulsion test or defecography and should be considered probable evidence of a defecatory disorder.
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