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Colorectal physiological tests: use or abuse of technology?
Eur J Surg. 1994 Mar; 160(3):167-74.EJ

Abstract

OBJECTIVE

To assess the value of colorectal physiological tests in patients with functional disorders of defecation.

DESIGN

Prospective study.

SETTING

Academic hospital.

SUBJECTS

308 consecutive patients.

INTERVENTIONS

Routine history and physical examination, followed by colonic transit study, and manometry, cinedefecography, electromyography of the anal sphincter, and assessment of terminal motor latency of the pudendal nerve.

MAIN OUTCOME MEASURES

Number of diagnoses made after physiological tests compared with routine history and examination alone.

RESULTS

Definitive diagnoses were made after history and physical examination alone in 15/180 (8%) with constipation, 9/80 (11%) with incontinence, and 11/48 (23%) with intractable rectal pain. The figures after physiological tests were 135/180 (75%), 53/80 (66%), and 20/48 (42%), respectively. Among the diagnoses made by physiological testing alone were: in patients with constipation, paradoxical puborectalis contraction (n = 59), colonic inertia (n = 31), rectocele (n = 19), and intussusception (n = 18); in those with incontinence, loss of muscle fiber (n = 21), neuropathy (n = 10), and both (n = 15); and in those with rectal pain, neuropathy (n = 6) and paradoxical puborectalis contraction (n = 3). The numbers of patients that remained undiagnosed in the three groups were 45 (25%), 27 (34%), and 28 (58%), respectively. Treatable conditions were diagnosed by physiological testing in 120/180 patients with constipation (67%) and 44 patients with incontinence (55%). Only 9 patients with rectal pain had treatable causes identified by physiologic testing.

CONCLUSION

The value of colorectal physiological tests is greatest in patients who present with constipation or incontinence; they are of little value in those with chronic intractable rectal pain.

Authors+Show Affiliations

Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8003569

Citation

Wexner, S D., and J M. Jorge. "Colorectal Physiological Tests: Use or Abuse of Technology?" The European Journal of Surgery = Acta Chirurgica, vol. 160, no. 3, 1994, pp. 167-74.
Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Eur J Surg. 1994;160(3):167-74.
Wexner, S. D., & Jorge, J. M. (1994). Colorectal physiological tests: use or abuse of technology? The European Journal of Surgery = Acta Chirurgica, 160(3), 167-74.
Wexner SD, Jorge JM. Colorectal Physiological Tests: Use or Abuse of Technology. Eur J Surg. 1994;160(3):167-74. PubMed PMID: 8003569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colorectal physiological tests: use or abuse of technology? AU - Wexner,S D, AU - Jorge,J M, PY - 1994/3/1/pubmed PY - 1994/3/1/medline PY - 1994/3/1/entrez SP - 167 EP - 74 JF - The European journal of surgery = Acta chirurgica JO - Eur J Surg VL - 160 IS - 3 N2 - OBJECTIVE: To assess the value of colorectal physiological tests in patients with functional disorders of defecation. DESIGN: Prospective study. SETTING: Academic hospital. SUBJECTS: 308 consecutive patients. INTERVENTIONS: Routine history and physical examination, followed by colonic transit study, and manometry, cinedefecography, electromyography of the anal sphincter, and assessment of terminal motor latency of the pudendal nerve. MAIN OUTCOME MEASURES: Number of diagnoses made after physiological tests compared with routine history and examination alone. RESULTS: Definitive diagnoses were made after history and physical examination alone in 15/180 (8%) with constipation, 9/80 (11%) with incontinence, and 11/48 (23%) with intractable rectal pain. The figures after physiological tests were 135/180 (75%), 53/80 (66%), and 20/48 (42%), respectively. Among the diagnoses made by physiological testing alone were: in patients with constipation, paradoxical puborectalis contraction (n = 59), colonic inertia (n = 31), rectocele (n = 19), and intussusception (n = 18); in those with incontinence, loss of muscle fiber (n = 21), neuropathy (n = 10), and both (n = 15); and in those with rectal pain, neuropathy (n = 6) and paradoxical puborectalis contraction (n = 3). The numbers of patients that remained undiagnosed in the three groups were 45 (25%), 27 (34%), and 28 (58%), respectively. Treatable conditions were diagnosed by physiological testing in 120/180 patients with constipation (67%) and 44 patients with incontinence (55%). Only 9 patients with rectal pain had treatable causes identified by physiologic testing. CONCLUSION: The value of colorectal physiological tests is greatest in patients who present with constipation or incontinence; they are of little value in those with chronic intractable rectal pain. SN - 1102-4151 UR - https://www.unboundmedicine.com/medline/citation/8003569/Colorectal_physiological_tests:_use_or_abuse_of_technology L2 - https://ClinicalTrials.gov/search/term=8003569 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -