Soh Jae Seung, Lee Hyo Jeong, Jung Kee Wook, Yoon In Ja, Koo Hyun Sook, Seo So Young, Lee Seohyun, Bae Jung Ho, Lee Ho-Su, Park Sang Hyoung, Yang Dong-Hoon, Kim Kyung-Jo, Ye Byong Duk, Byeon Jeong-Sik, Yang Suk-Kyun, Kim Jin-Ho, Myung Seung-Jae
Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
1] Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea [2] Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Am J Gastroenterol. 2015 Aug;110(8):1197-204. doi: 10.1038/ajg.2015.153. Epub 2015 Jun 2.
Digital rectal examination (DRE) is a simple clinical method to diagnose anorectal disorders. High-resolution antorectal manometry (HRAM) based on a spatiotemporal plot is expected to promote improved diagnostic accuracy. However, there are no reports comparing the effectiveness of DRE and HRAM. The aim of our study was therefore to evaluate the diagnostic value of DRE compared with HRAM.
A total of 309 consecutive patients with chronic constipation (n=268) or fecal incontinence (n=41) who underwent a standardized DRE, HRAM, and balloon expulsion test were enrolled in this study. The diagnostic yield of DRE compared with HRAM was determined, and agreement between DRE and HRAM data was evaluated.
Of the constipated patients, 207 (77.2%) were diagnosed with dyssynergia using HRAM. The sensitivity, specificity, and positive predictive value of DRE in the diagnosis of dyssynergia were 93.2%, 58.7%, and 91.0%, respectively, and moderate agreement was seen between the two modalities (κ-coefficient =0.542, P<0.001). In patients with fecal incontinence, there was moderate agreement in terms of anal squeeze pressure between the two modalities (κ-coefficient =0.418, P=0.006); however, there was poor agreement for anal resting tone (κ-coefficient =0.079, P=0.368).
DRE shows high sensitivity and positive predictive value in detecting dyssynergia compared with HRAM, and could therefore be used as a bedside screening test for the diagnosis of this disorder. Further studies are warranted to evaluate the correlation between DRE and HRAM in assessing anal sphincter pressure.
直肠指检（DRE）是诊断肛肠疾病的一种简单临床方法。基于时空图的高分辨率肛肠测压法（HRAM）有望提高诊断准确性。然而，尚无比较DRE和HRAM有效性的报告。因此，我们研究的目的是评估DRE与HRAM相比的诊断价值。
本研究纳入了309例连续的慢性便秘患者（n = 268）或大便失禁患者（n = 41），这些患者均接受了标准化的DRE、HRAM和气囊排出试验。确定了DRE与HRAM相比的诊断率，并评估了DRE和HRAM数据之间的一致性。
在便秘患者中，207例（77.2%）经HRAM诊断为协同失调。DRE诊断协同失调的敏感性、特异性和阳性预测值分别为93.2%、58.7%和91.0%，两种方法之间存在中度一致性（κ系数 = 0.542，P < 0.001）。在大便失禁患者中，两种方法在肛门收缩压方面存在中度一致性（κ系数 = 0.418，P = 0.006）；然而，在肛门静息张力方面一致性较差（κ系数 = 0.079，P = 0.368）。
与HRAM相比，DRE在检测协同失调方面显示出高敏感性和阳性预测值，因此可作为该疾病诊断的床边筛查试验。有必要进一步研究评估DRE与HRAM在评估肛门括约肌压力方面的相关性。
