Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis
Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in pa...
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| Veröffentlicht in: | Canadian Journal of Gastroenterology and Hepatology 2021, Vol.2021, p.5685610-9 |
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| creator | Liu, Jie Lv, Chaolan Huang, Yizhou Wang, Ying Wu, Dandan Zhang, Cong Sun, Chenyu Wang, Wei Yu, Yue |
| description | Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P |
| doi_str_mv | 10.1155/2021/5685610 |
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Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P<0.001). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.</description><identifier>ISSN: 2291-2789</identifier><identifier>EISSN: 2291-2797</identifier><identifier>DOI: 10.1155/2021/5685610</identifier><identifier>PMID: 34746041</identifier><language>eng</language><publisher>Egypt: Hindawi</publisher><subject>Abdomen ; Anal Canal ; Ataxia ; Catheters ; Constipation ; Constipation - diagnosis ; Defecation ; Digital Rectal Examination ; Humans ; Manometry ; Meta-analysis ; Motility ; Patients ; Physiology ; Software ; Statistical analysis</subject><ispartof>Canadian Journal of Gastroenterology and Hepatology, 2021, Vol.2021, p.5685610-9</ispartof><rights>Copyright © 2021 Jie Liu et al.</rights><rights>Copyright © 2021 Jie Liu et al. This is an open access article distributed under the Creative Commons Attribution License (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. https://creativecommons.org/licenses/by/4.0</rights><rights>Copyright © 2021 Jie Liu et al. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-a198de011e386453401da42c0e976f27444cd8486ca2bb0910e9f135861b66ac3</citedby><cites>FETCH-LOGICAL-c514t-a198de011e386453401da42c0e976f27444cd8486ca2bb0910e9f135861b66ac3</cites><orcidid>0000-0001-6079-7566 ; 0000-0002-3617-2037 ; 0000-0003-3812-3164</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568520/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568520/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,873,881,4010,27900,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34746041$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Williams, Geoffrey</contributor><contributor>Geoffrey Williams</contributor><creatorcontrib>Liu, Jie</creatorcontrib><creatorcontrib>Lv, Chaolan</creatorcontrib><creatorcontrib>Huang, Yizhou</creatorcontrib><creatorcontrib>Wang, Ying</creatorcontrib><creatorcontrib>Wu, Dandan</creatorcontrib><creatorcontrib>Zhang, Cong</creatorcontrib><creatorcontrib>Sun, Chenyu</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><creatorcontrib>Yu, Yue</creatorcontrib><title>Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis</title><title>Canadian Journal of Gastroenterology and Hepatology</title><addtitle>Can J Gastroenterol Hepatol</addtitle><description>Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P<0.001). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.</description><subject>Abdomen</subject><subject>Anal Canal</subject><subject>Ataxia</subject><subject>Catheters</subject><subject>Constipation</subject><subject>Constipation - diagnosis</subject><subject>Defecation</subject><subject>Digital Rectal Examination</subject><subject>Humans</subject><subject>Manometry</subject><subject>Meta-analysis</subject><subject>Motility</subject><subject>Patients</subject><subject>Physiology</subject><subject>Software</subject><subject>Statistical analysis</subject><issn>2291-2789</issn><issn>2291-2797</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>RHX</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNp9ksFuFDEMhkcIRKvSG2cUiSMsjTNJZsIBaekWWKkICQrXyJNkplnNTkoySztXnpxsd1nRCydH9u_Pju2ieA70DYAQZ4wyOBOyFhLoo-KYMQUzVqnq8eFdq6PiNKUVpRSYEKpkT4ujkldcUg7Hxe-F7_yIPfnqzNZc3OHaDzj6MJBlIkh-YL_BpnfkvbPJW0euQuhJGyJZuDHn-KEjiymlaXCx8yZ7W2fu89-SOVl47IaQxhz4Nm7sRHCwGfrZjTibD9hPyadnxZMW--RO9_ak-P7h4ur80-zyy8fl-fxyZgTwcYagausogCtryUXJKVjkzFCnKtmyinNubM1raZA1DVWQAy2UopbQSImmPCmWO64NuNI30a8xTjqg1_eOEDuNMXfaOw0SQAosFTeOt61qeJ5xKyrVKCVatJn1bse62TRrZ40bxoj9A-jDyOCvdRd-6Xq7LEYz4OUeEMPPjUujXoVNzBNJmgnFSwn5f1n1eqcyMaQUXXuoAFRvD0BvD0DvDyDLX_zb1UH8d91Z8GonuPaDxVv_f9wfHL-3WA</recordid><startdate>2021</startdate><enddate>2021</enddate><creator>Liu, Jie</creator><creator>Lv, Chaolan</creator><creator>Huang, Yizhou</creator><creator>Wang, Ying</creator><creator>Wu, Dandan</creator><creator>Zhang, Cong</creator><creator>Sun, Chenyu</creator><creator>Wang, Wei</creator><creator>Yu, Yue</creator><general>Hindawi</general><general>Hindawi Limited</general><scope>RHU</scope><scope>RHW</scope><scope>RHX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-6079-7566</orcidid><orcidid>https://orcid.org/0000-0002-3617-2037</orcidid><orcidid>https://orcid.org/0000-0003-3812-3164</orcidid></search><sort><creationdate>2021</creationdate><title>Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis</title><author>Liu, Jie ; Lv, Chaolan ; Huang, Yizhou ; Wang, Ying ; Wu, Dandan ; Zhang, Cong ; Sun, Chenyu ; Wang, Wei ; Yu, Yue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c514t-a198de011e386453401da42c0e976f27444cd8486ca2bb0910e9f135861b66ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdomen</topic><topic>Anal Canal</topic><topic>Ataxia</topic><topic>Catheters</topic><topic>Constipation</topic><topic>Constipation - diagnosis</topic><topic>Defecation</topic><topic>Digital Rectal Examination</topic><topic>Humans</topic><topic>Manometry</topic><topic>Meta-analysis</topic><topic>Motility</topic><topic>Patients</topic><topic>Physiology</topic><topic>Software</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Jie</creatorcontrib><creatorcontrib>Lv, Chaolan</creatorcontrib><creatorcontrib>Huang, Yizhou</creatorcontrib><creatorcontrib>Wang, Ying</creatorcontrib><creatorcontrib>Wu, Dandan</creatorcontrib><creatorcontrib>Zhang, Cong</creatorcontrib><creatorcontrib>Sun, Chenyu</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><creatorcontrib>Yu, Yue</creatorcontrib><collection>Hindawi Publishing Complete</collection><collection>Hindawi Publishing Subscription Journals</collection><collection>Hindawi Publishing Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Canadian Journal of Gastroenterology and Hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Jie</au><au>Lv, Chaolan</au><au>Huang, Yizhou</au><au>Wang, Ying</au><au>Wu, Dandan</au><au>Zhang, Cong</au><au>Sun, Chenyu</au><au>Wang, Wei</au><au>Yu, Yue</au><au>Williams, Geoffrey</au><au>Geoffrey Williams</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis</atitle><jtitle>Canadian Journal of Gastroenterology and Hepatology</jtitle><addtitle>Can J Gastroenterol Hepatol</addtitle><date>2021</date><risdate>2021</risdate><volume>2021</volume><spage>5685610</spage><epage>9</epage><pages>5685610-9</pages><issn>2291-2789</issn><eissn>2291-2797</eissn><abstract>Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P<0.001). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.</abstract><cop>Egypt</cop><pub>Hindawi</pub><pmid>34746041</pmid><doi>10.1155/2021/5685610</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6079-7566</orcidid><orcidid>https://orcid.org/0000-0002-3617-2037</orcidid><orcidid>https://orcid.org/0000-0003-3812-3164</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Anal Canal Ataxia Catheters Constipation Constipation - diagnosis Defecation Digital Rectal Examination Humans Manometry Meta-analysis Motility Patients Physiology Software Statistical analysis |
| title | Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis |
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