Abe Tatsuya, Kunimoto Masao, Hachiro Yoshikazu, Ohara Kei, Inagaki Mitsuhiro, Murakami Masanori
Department of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan.
Department of Gastroenterology, Kunimoto Hospital, Akebono, Asahikawa, Japan.
J Neurogastroenterol Motil. 2021 Jul 30;27(3):419-425. doi: 10.5056/jnm20204.
BACKGROUND/AIMS: Defecation disorders (DD) are part of the spectrum of chronic constipation with outlet obstruction. Although anorectal physiologic tests are required for the diagnosis of DD, these tests are not available in many institutions. This study aims to investigate the predictivity of DD using rectosigmoid localization of radiopaque markers in a colonic transit study.
A total of 169 patients with refractory constipation with a mean age of 67 years were studied. All patients underwent anorectal manometry, a balloon expulsion test, and a colonic transit study. Barium defecography was performed if needed. The relationship between DD diagnosed by these anorectal tests and the rectosigmoid accumulation of markers was examined.
Seventy-nine (46.7%) patients were identified to have DD based on anorectal test combinations. Rectosigmoid accumulation of markers was observed in 39 (23.1%) patients. The sensitivity and positive predictive value of rectosigmoid accumulation for identifying DD were 31.6% and 64.1%, respectively. Rectosigmoid accumulation provided poor discrimination of DD from normal transit constipation, at a specificity of 82.1% but with a sensitivity of only 10.6%. In discriminating DD from slow transit constipation, rectosigmoid accumulation was found to be useful with a positive likelihood ratio of 5.3.
s Rectosigmoid accumulation of markers can differentiate DD from slow transit constipation. However, non-rectosigmoid accumulation does not exclude the presence of DD.
背景/目的：排便障碍（DD）是慢性便秘伴出口梗阻谱系的一部分。尽管DD的诊断需要进行肛门直肠生理检查，但许多机构无法进行这些检查。本研究旨在通过结肠运输试验中不透X线标志物的直肠乙状结肠定位来研究DD的预测性。
共研究了169例平均年龄为67岁的难治性便秘患者。所有患者均接受了肛门直肠测压、气囊排出试验和结肠运输试验。必要时进行钡剂排粪造影。检查了通过这些肛门直肠检查诊断的DD与标志物在直肠乙状结肠的积聚之间的关系。
根据肛门直肠检查组合，79例（46.7%）患者被确定患有DD。39例（23.1%）患者观察到标志物在直肠乙状结肠积聚。标志物在直肠乙状结肠积聚对DD的识别敏感性和阳性预测值分别为31.6%和64.1%。标志物在直肠乙状结肠积聚对DD与正常运输型便秘的鉴别能力较差，特异性为82.1%，但敏感性仅为10.6%。在鉴别DD与慢运输型便秘时，发现标志物在直肠乙状结肠积聚是有用的，阳性似然比为5.3。
标志物在直肠乙状结肠积聚可将DD与慢运输型便秘区分开来。然而，非直肠乙状结肠积聚并不能排除DD的存在。
