Ingemansson Anna, Walter Susanna A, Jones Michael P, Sjödahl Jenny
Department of Gastroenterology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Psychology Department, Macquarie University, North Ryde, NSW, Australia.
J Clin Gastroenterol. 2024 Jan 1;58(1):57-63. doi: 10.1097/MCG.0000000000001794.
To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC).
DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value.
Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed.
Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group ( P =0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group ( P =0.032). Hard stool was a discriminator for non-DP ( P =0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%.
The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.
评估一份为期2周的患者填写的排便习惯和症状日记作为直肠肛门协调障碍（DRC）筛查工具的实用性。
DRC是慢性便秘的一个重要亚组，可从生物反馈治疗中获益。DRC的诊断需要在高分辨率肛门直肠测压（HRAM）中出现排便尝试的不协调模式（DP），以及至少一项其他阳性标准化检查，如气囊排出试验或排粪造影。然而，HRAM通常仅限于三级胃肠病中心，寻找用于选择患者进行进一步检查的工具具有临床价值。
分析了99例慢性便秘患者的HRAM回顾性数据以及一份为期2周的患者填写的排便习惯和症状日记。
57%的患者在HRAM期间出现DP模式。在DP组中，76%的稀便或正常大便排便导致有排便不尽感，而非DP组为55%（P = 0.004）。DP组中，用力排便和稀便时的排便不尽感明显更常见（P = 0.032）。硬便是非DP的一个鉴别因素（P = 0.044）。包括排便不尽和正常大便的多因素逻辑回归预测DP的敏感度为82%，特异度为50%。
稀便或正常大便时的排便不尽感可能是慢性便秘患者中支持DP的一个潜在鉴别因素。排便习惯和症状日记可能是一种有用的工具，用于对便秘患者进行分层，以便对疑似DRC进行进一步调查。
