Minguez Miguel, Herreros Belen, Sanchiz Vicente, Hernandez Vicent, Almela Pedro, Añon Ramon, Mora Francisco, Benages Adolfo
Department of Gastroenterology, University Clinic Hospital, University of Valencia, Valencia, Spain.
Gastroenterology. 2004 Jan;126(1):57-62. doi: 10.1053/j.gastro.2003.10.044.
The aim of this study was to establish a simple method to exclude the possibility of pelvic floor dyssynergia (PFD) in constipated patients and thus avoid unnecessary expensive physiologic studies.
Patients with suspicion of functional constipation (FC) were studied prospectively between 1994 and 2002, excluding those with severe systemic, psychological, or symptomatic anorectal/colonic disorders or taking medications that might modify symptoms or results of studies. Diagnosis of PFD was established retrospectively by manometric plus defecographic findings according to Rome II criteria. Two groups of patients were identified: FC without PFD (FC group) and PFD group. A 30-day symptom diary and balloon expulsion test results were evaluated in all patients. Clinical differences and results of the expulsion test were statistically compared between groups.
Of 359 patients evaluated, 130 were included (FC group, 106; PFD group, 24). According to data from the diary, only anal pain was more frequent in the PFD group compared with the FC group (anal pain in >25% of defecations, 70.8% vs. 40.6%; P < 0.05, chi(2) test). The expulsion test was pathologic in 21 of 24 patients with PFD and 12 of 106 without PFD. The specificity and negative predictive value of the test for excluding PFD were 89% and 97%, respectively.
The balloon expulsion test is a simple and useful screening procedure to identify constipated patients who do not have PFD. Symptoms are not enough to differentiate between subtypes of constipation.
本研究旨在建立一种简单的方法，以排除便秘患者盆底失协调（PFD）的可能性，从而避免不必要的昂贵生理检查。
1994年至2002年对疑似功能性便秘（FC）的患者进行前瞻性研究，排除患有严重全身、心理或有症状的肛肠/结肠疾病的患者，或正在服用可能改变症状或研究结果的药物的患者。根据罗马II标准，通过测压加排粪造影结果对PFD进行回顾性诊断。确定了两组患者：无PFD的FC（FC组）和PFD组。对所有患者评估了30天症状日记和气囊排出试验结果。对两组之间的临床差异和排出试验结果进行统计学比较。
在评估的359例患者中，130例被纳入（FC组106例；PFD组24例）。根据日记数据，与FC组相比，PFD组仅肛门疼痛更为常见（排便时肛门疼痛>25%，70.8%对40.6%；P<0.05，卡方检验）。24例PFD患者中有21例排出试验为病理性，106例无PFD患者中有12例为病理性。该试验排除PFD的特异性和阴性预测值分别为89%和97%。
气囊排出试验是一种简单且有用的筛查方法，可用于识别无PFD的便秘患者。症状不足以区分便秘的亚型。
