Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Am J Gastroenterol. 2019 Mar;114(3):519-523. doi: 10.14309/ajg.0000000000000149.
Plain film abdominal x-ray (AXR) is frequently used in the evaluation of constipation, but studies assessing the association between stool burden on AXR and colonic transit have been limited. We sought to investigate the relationship between colonic stool burden and slow transit constipation, as determined by a radiopaque marker (ROM) transit study.
A retrospective cohort population was assembled, consisting of adult patients with chronic constipation who underwent testing with both a ROM study and anorectal manometry at 2 tertiary care centers over 5 years. Stool burden was graded by 2 independent observers, with colonic transit being assessed by the Hinton method.
Of 361 patients, 145 (40.3%) had slow transit constipation, and women were more likely than men to have slow transit constipation (42.3% vs 26.5%, P = 0.04). The mean stool burden scores by observer 1 and observer 2 for patients with slow transit constipation were significantly higher than the mean stool burden scores for patients with normal transit constipation (8.1 ± 1.6 vs 6.9 ± 1.9, P < 0.0001; 8.5 ± 1.5 vs 5.8 ± 1.6, P < 0.0001). The Pearson correlation coefficient for the stool burden score and number of remaining ROMs was 0.31 (moderate) for observer 1 (P < 0.0001) and 0.62 (strong) for observer 2 (P < 0.0001), whereas the Pearson correlation coefficient for interrater reliability of the stool burden score was 0.58 (P < 0.0001), indicating a strong correlation. The ideal score cutoff for both observers was 7, with moderate agreement by Cohen's kappa (0.43, P < 0.0001).
Stool burden assessment on AXR may be a reliable alternative ROM study in the assessment of colonic transit.
腹部平片（AXR）常用于评估便秘，但评估粪便负荷与结肠传输之间关系的研究有限。我们旨在研究通过不透射线标志物（ROM）传输研究确定的结肠粪便负荷与慢传输性便秘之间的关系。
我们组建了一个回顾性队列人群，包括在 2 家三级保健中心进行 ROM 研究和肛肠测压的慢性便秘成年患者。由 2 名独立观察者对粪便负荷进行分级，采用 Hinton 法评估结肠传输。
在 361 例患者中，145 例（40.3%）患有慢传输性便秘，女性比男性更有可能患有慢传输性便秘（42.3%比 26.5%，P=0.04）。观察者 1 和观察者 2 对慢传输性便秘患者的粪便负荷评分明显高于对正常传输性便秘患者的评分（8.1±1.6 比 6.9±1.9，P<0.0001；8.5±1.5 比 5.8±1.6，P<0.0001）。观察者 1 的粪便负荷评分与剩余 ROM 数量的 Pearson 相关系数为 0.31（中等）（P<0.0001），观察者 2 的相关系数为 0.62（强）（P<0.0001），而粪便负荷评分的观察者间可靠性的 Pearson 相关系数为 0.58（P<0.0001），表明相关性较强。两位观察者的理想评分截点均为 7，Cohen's kappa 显示中等一致性（0.43，P<0.0001）。
AXR 上的粪便负荷评估可能是评估结肠传输的可靠替代 ROM 研究。
