Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Health, Lebanon, NH, USA.
Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI, USA.
Neurogastroenterol Motil. 2021 Nov;33(11):e14137. doi: 10.1111/nmo.14137. Epub 2021 Mar 27.
Chronic constipation is a common condition, and dyssynergic defecation underlies up to 40% of cases. Anorectal manometry is recommended to assess for dyssynergic defecation among chronically constipated patients but remains poorly standardized. We aimed to evaluate the diagnostic accuracy of anorectal manometry and determine optimal testing parameters.
We performed a systematic review with meta-analysis of diagnostic test accuracy including cohort studies of chronically constipated patients and case-control studies of patients with dyssynergic defecation or healthy controls. Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI).
A total of 15 studies comprising 2140 patients were included. Including all studies (estimating optimal diagnostic accuracy), the AUC was 0.78 [95% CI 0.72-0.82], summary sensitivity was 79% [61%-90%], and summary specificity was 64% [44%-79%] to diagnose dyssynergic defecation. In cohort studies only (estimating real-world diagnostic accuracy), the AUC was 0.72 [0.66-0.77], summary sensitivity was 86% [64%-95%], and summary specificity was 49% [30%-68%]. Employing three consecutive simulated defecation attempts improved sensitivity to 94%. A fourth simulated defecation maneuver with air insufflation may improve accuracy. Measuring anorectal pressures to identify complex dyssynergic patterns did not improve real-world diagnostic accuracy estimates over anal pressure measurement alone. Choice of manometry system did not impact diagnostic accuracy.
CONCLUSIONS & INFERENCES: Following the current iteration of the London consensus protocol (three simulated defecation attempts measuring anal relaxation), the role of anorectal manometry in evaluating dyssynergic defecation appears limited. Future iterations of this protocol may improve diagnostic accuracy.
慢性便秘是一种常见病症，其中多达 40%的病例是由协同失调性排便引起的。直肠测压法被推荐用于评估慢性便秘患者的协同失调性排便，但该方法的标准化程度仍然较差。我们旨在评估直肠测压法的诊断准确性，并确定最佳的测试参数。
我们进行了一项系统评价和荟萃分析，纳入了慢性便秘患者的队列研究和协同失调性排便患者或健康对照者的病例对照研究，评估了直肠测压法的诊断准确性。采用荟萃分析确定汇总敏感性、特异性和曲线下面积（AUC）及其 95%置信区间（CI）。
共纳入 15 项研究，包含 2140 例患者。包括所有研究（估计最佳诊断准确性），AUC 为 0.78（95%CI 0.72-0.82），汇总敏感性为 79%（61%-90%），汇总特异性为 64%（44%-79%），以诊断协同失调性排便。仅在队列研究中（估计实际诊断准确性），AUC 为 0.72（0.66-0.77），汇总敏感性为 86%（64%-95%），汇总特异性为 49%（30%-68%）。采用连续三次模拟排便尝试可将敏感性提高至 94%。第四次模拟排便时使用空气注入可能会提高准确性。测量直肠压力以识别复杂的协同失调模式并不能提高仅测量肛门压力的实际诊断准确性估计。测压系统的选择不会影响诊断准确性。
按照当前版伦敦共识协议（三次模拟排便尝试，测量肛门松弛），直肠测压法在评估协同失调性排便方面的作用似乎有限。该协议的未来迭代版本可能会提高诊断准确性。
