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Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus).
Neurogastroenterol Motil. 2004 Oct; 16(5):589-96.NM

Abstract

Although 30-50% of constipated patients exhibit dyssynergia, an optimal method of diagnosis is unclear. Recently, consensus criteria have been proposed but their utility is unknown. To examine the diagnostic yield of colorectal tests, reproducibility of manometry and utility of Rome II criteria. A total of 100 patients with difficult defecation were prospectively evaluated with anorectal manometry, balloon expulsion, colonic transit and defecography. Fifty-three patients had repeat manometry. During attempted defecation, 30 showed normal and 70 one of three abnormal manometric patterns. Forty-six patients fulfilled Rome criteria and showed paradoxical anal contraction (type I) or impaired anal relaxation (type III) with adequate propulsion. However, 24 (34%) showed impaired propulsion (type II). Forty-five (64%) had slow transit, 42 (60%) impaired balloon expulsion and 26 (37%) abnormal defecography. Defecography provided no additional discriminant utility. Evidence of dyssynergia was reproducible in 51 of 53 patients. Symptoms alone could not differentiate dyssynergic subtypes or patients. Dyssynergic patients exhibited three patterns that were reproducible: paradoxical contraction, impaired propulsion and impaired relaxation. Although useful, Rome II criteria may be insufficient to identify or subclassify dyssynergic defecation. Symptoms together with abnormal manometry, abnormal balloon expulsion or colonic marker retention are necessary to optimally identify patients with difficult defecation.

Authors+Show Affiliations

Department of Internal Medicine and Clinical Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. satish-rao@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15500515

Citation

Rao, S S C., et al. "Investigation of the Utility of Colorectal Function Tests and Rome II Criteria in Dyssynergic Defecation (Anismus)." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 16, no. 5, 2004, pp. 589-96.
Rao SS, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil. 2004;16(5):589-96.
Rao, S. S., Mudipalli, R. S., Stessman, M., & Zimmerman, B. (2004). Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 16(5), 589-96.
Rao SS, et al. Investigation of the Utility of Colorectal Function Tests and Rome II Criteria in Dyssynergic Defecation (Anismus). Neurogastroenterol Motil. 2004;16(5):589-96. PubMed PMID: 15500515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). AU - Rao,S S C, AU - Mudipalli,R S, AU - Stessman,M, AU - Zimmerman,B, PY - 2004/10/27/pubmed PY - 2004/12/24/medline PY - 2004/10/27/entrez SP - 589 EP - 96 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 16 IS - 5 N2 - Although 30-50% of constipated patients exhibit dyssynergia, an optimal method of diagnosis is unclear. Recently, consensus criteria have been proposed but their utility is unknown. To examine the diagnostic yield of colorectal tests, reproducibility of manometry and utility of Rome II criteria. A total of 100 patients with difficult defecation were prospectively evaluated with anorectal manometry, balloon expulsion, colonic transit and defecography. Fifty-three patients had repeat manometry. During attempted defecation, 30 showed normal and 70 one of three abnormal manometric patterns. Forty-six patients fulfilled Rome criteria and showed paradoxical anal contraction (type I) or impaired anal relaxation (type III) with adequate propulsion. However, 24 (34%) showed impaired propulsion (type II). Forty-five (64%) had slow transit, 42 (60%) impaired balloon expulsion and 26 (37%) abnormal defecography. Defecography provided no additional discriminant utility. Evidence of dyssynergia was reproducible in 51 of 53 patients. Symptoms alone could not differentiate dyssynergic subtypes or patients. Dyssynergic patients exhibited three patterns that were reproducible: paradoxical contraction, impaired propulsion and impaired relaxation. Although useful, Rome II criteria may be insufficient to identify or subclassify dyssynergic defecation. Symptoms together with abnormal manometry, abnormal balloon expulsion or colonic marker retention are necessary to optimally identify patients with difficult defecation. SN - 1350-1925 UR - https://www.unboundmedicine.com/medline/citation/15500515/Investigation_of_the_utility_of_colorectal_function_tests_and_Rome_II_criteria_in_dyssynergic_defecation__Anismus__ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1350-1925&date=2004&volume=16&issue=5&spage=589 DB - PRIME DP - Unbound Medicine ER -