Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong.
School of Microelectronics and Communication Engineering, Chongqing University, Shapingba, China .
Clin Transl Gastroenterol. 2021 May 5;12(5):e00354. doi: 10.14309/ctg.0000000000000354.
Defecatory disorders including obstructed defecation (OD) are currently diagnosed using specialized investigations including anorectal manometry and the balloon expulsion test. Recently, we developed a simulated stool named Fecobionics that provides a novel type of pressure measurements and analysis. The aim was to study OD phenotypes compared with slow transit constipation (STC) patients and normal subjects (NS).
Fecobionics expulsion parameters were assessed in an interventional study design. The Fecobionics device contained pressure sensors at the front, rear, and inside a bag. All constipation patients had colon transit study, defecography, anorectal manometry, and balloon expulsion test performed. The Fecobionics bag was distended in the rectum until desire-to-defecate in 26 OD compared with 8 STC patients and 10 NS. Rear-front pressures (preload-afterload parameters) and defecation indices (DIs) were compared between groups.
The Wexner constipation scoring system score was 13.8 ± 0.9 and 14.6 ± 1.5 in the OD and STC patients (P > 0.5). The median desire-to-defecate volume was 80 (quartiles 56-80), 60 (54-80), and 45 (23-60) mL in OD, STC, and NS, respectively (P < 0.01). The median expulsion duration was 37 (quartiles 15-120), 6 (3-11), and 11 (8-11) seconds for the 3 groups (P < 0.03). Fecobionics rear-front pressure diagrams demonstrated clockwise loops with distinct phenotype differences between OD and the other groups. Most DIs differed between OD and the other groups, especially those based on the anal afterload reflecting the nature of OD constipation. Several OD subtypes were identified.
Fecobionics obtained novel pressure phenotypes in OD patients. DIs showed pronounced differences between groups. Larger studies are needed on OD subtyping.
排便障碍包括出口梗阻型便秘（OD）目前通过包括肛门直肠测压和球囊排出试验在内的专门检查进行诊断。最近，我们开发了一种名为 Fecobionics 的模拟粪便，它提供了一种新型的压力测量和分析方法。目的是研究 OD 表型与慢传输型便秘（STC）患者和正常受试者（NS）的比较。
采用介入性研究设计评估 Fecobionics 排出参数。Fecobionics 装置的前部、后部和袋子内部都装有压力传感器。所有便秘患者均进行结肠转运研究、排粪造影、肛门直肠测压和球囊排出试验。26 例 OD 患者和 8 例 STC 患者及 10 例 NS 将 Fecobionics 袋在直肠中膨胀至有便意，然后排空。比较各组之间的后-前压力（预载-后载参数）和排便指数（DI）。
OD 和 STC 患者的 Wexner 便秘评分系统评分分别为 13.8±0.9 和 14.6±1.5（P>0.5）。OD、STC 和 NS 患者的中位便意量分别为 80（四分位距 56-80）、60（54-80）和 45（23-60）mL（P<0.01）。3 组的中位排空时间分别为 37（四分位距 15-120）、6（3-11）和 11（8-11）秒（P<0.03）。Fecobionics 后-前压力图显示出顺时针环，OD 与其他组之间存在明显的表型差异。OD 与其他组之间的大多数 DI 差异显著，尤其是基于反映 OD 便秘性质的肛后负荷的那些 DI。确定了几种 OD 亚型。
Fecobionics 在 OD 患者中获得了新的压力表型。DI 显示组间差异显著。需要对 OD 亚型进行更大的研究。
