一种基于四种症状的简单BEDS评分，用于预测慢性便秘患者的排便协同失调。
A simple four symptom-based BEDS score to predict dyssynergic defecation in patients with chronic constipation.
作者信息
Jain Mayank, Agrawal Vinodini
机构信息
Department of Gastroenterology, Arihant Hospital and Research Centre, 283-A Gumasta Nagar, Indore, 452 009, India.
出版信息
Indian J Gastroenterol. 2024 Oct 21. doi: 10.1007/s12664-024-01697-w.
BACKGROUND AND AIMS
Dyssynergic defecation (DD) is a disorder of anorectal function characterized by impaired relaxation or inappropriate contraction of pelvic floor muscles on attempted defecation. Based on previous Indian studies, we devised a symptom score (bleeding per rectum, excessive straining for stools, digitation, sense of incomplete evacuation/blockage-BEDS) and tried to determine if it can identify which patients with chronic constipation are more likely to have DD.
METHODS
This is a prospective observational cohort study in which consecutive adult patients (> 18 years) with chronic constipation who were referred to our centre for anorectal manometry (ARM) between 2019 and 2023 were included. Prior to tests, patients were asked in detail regarding their symptoms and scoring was done. ARM was done by a single observer. Diagnosis of DD was based on standard criteria. Statistical tests used were median, range and percentages, Chi-square test and Mann-Whitney U-test. The data was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Agreement of symptom-based scoring and DD diagnosis as per criteria was calculated using Cohen's κ coefficient. A p value of < 0.05 was considered statistically significant.
RESULTS
As many as 244 patients (males 140, median age 42 years) formed the study cohort. Of these, 104 (42.6%) have DD. Sense of incomplete evacuation/sense of blockage (72.1% vs. 40%, p < 0.0001), excessive straining (73.1% vs. 22.1%, p < 0.0001) and digitation (28.8% vs. 13.5%, p 0.003) were more commonly reported in patients with DD. Taking a cut-off score of > / = 2, sensitivity of 69.2%, specificity 81.4% and positive likelihood ratio of 3.73 were noted. Similarly, if the score of > / = 3 was considered, the likelihood ratio increased to 4.71 with an increase in specificity (94.29%) and fall in sensitivity (26.92%).
CONCLUSION
Symptom-based BEDS score of > / = 2 is useful in identifying patients with DD.
背景与目的
排便协同失调（DD）是一种肛门直肠功能障碍，其特征是在试图排便时盆底肌肉松弛受损或出现不适当收缩。基于此前印度的研究，我们设计了一种症状评分（直肠出血、过度用力排便、手指辅助排便、排便不尽感/阻塞感——BEDS），并试图确定它能否识别出哪些慢性便秘患者更有可能患有DD。
方法
这是一项前瞻性观察性队列研究，纳入了2019年至2023年间因肛门直肠测压（ARM）被转诊至我们中心的连续成年慢性便秘患者（年龄>18岁）。在进行检查前，详细询问患者症状并进行评分。ARM由一名观察者完成。DD的诊断基于标准标准。所使用的统计检验包括中位数、范围和百分比、卡方检验和曼-惠特尼U检验。对数据进行敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分析。使用科恩κ系数计算基于症状的评分与根据标准进行的DD诊断之间的一致性。p值<0.05被认为具有统计学意义。
结果
多达244名患者（男性140名，中位年龄42岁）构成了研究队列。其中，104名（42.6%）患有DD。排便不尽感/阻塞感（72.1%对40%，p<0.0001）、过度用力（73.1%对22.1%，p<0.0001）和手指辅助排便（28.8%对13.5%，p=0.003）在DD患者中报告更为常见。取截断分数≥2时，敏感性为69.2%，特异性为81.4%，阳性似然比为3.73。同样，如果考虑分数≥3，似然比增加到4.71，特异性增加（94.29%），敏感性下降（26.92%）。
结论
基于症状的BEDS评分≥2有助于识别患有DD 的患者。
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