Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation

Ugo Grossi, Emma V. Carrington, Adil Eddie Bharucha, Emma J. Horrocks, S. Mark Scott, Charles H. Knowles

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective: The diagnostic accuracy of anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design: Derived line plots of anorectal pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these pressure profiles were characterised as normal (ie, increased rectal pressure coordinated with anal relaxation) or types I-IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I-IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia ('paradoxical' contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions: While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as 'abnormal' by AM. Hence, AM is of limited utility for distinguishing between FC and HV.

Original languageEnglish (US)
Pages (from-to)447-455
Number of pages9
JournalGut
Volume65
Issue number3
DOIs
StatePublished - Mar 1 2016

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Defecation
Manometry
Constipation
Healthy Volunteers
Ataxia
Pressure
Health Status

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Grossi, U., Carrington, E. V., Bharucha, A. E., Horrocks, E. J., Scott, S. M., & Knowles, C. H. (2016). Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut, 65(3), 447-455. https://doi.org/10.1136/gutjnl-2014-308835

Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. / Grossi, Ugo; Carrington, Emma V.; Bharucha, Adil Eddie; Horrocks, Emma J.; Scott, S. Mark; Knowles, Charles H.

In: Gut, Vol. 65, No. 3, 01.03.2016, p. 447-455.

Research output: Contribution to journalArticle

Grossi, U, Carrington, EV, Bharucha, AE, Horrocks, EJ, Scott, SM & Knowles, CH 2016, 'Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation', Gut, vol. 65, no. 3, pp. 447-455. https://doi.org/10.1136/gutjnl-2014-308835
Grossi, Ugo ; Carrington, Emma V. ; Bharucha, Adil Eddie ; Horrocks, Emma J. ; Scott, S. Mark ; Knowles, Charles H. / Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. In: Gut. 2016 ; Vol. 65, No. 3. pp. 447-455.
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AB - Objective: The diagnostic accuracy of anorectal manometry (AM), which is necessary to diagnose functional defecatory disorders (FDD), is unknown. Using blinded analysis and standardised reporting of diagnostic accuracy, we evaluated whether AM could discriminate between asymptomatic controls and patients with functional constipation (FC). Design: Derived line plots of anorectal pressure profiles during simulated defecation were independently analysed in random order by three expert observers blinded to health status in 85 women with FC and 85 age-matched asymptomatic healthy volunteers (HV). Using accepted criteria, these pressure profiles were characterised as normal (ie, increased rectal pressure coordinated with anal relaxation) or types I-IV dyssynergia. Interobserver agreement and diagnostic accuracy were determined. Results Blinded consensus-based assessment disclosed a normal pattern in 16/170 (9%) of all participants and only 11/85 (13%) HV. The combined frequency of dyssynergic patterns (I-IV) was very similar in FC (80/85 (94%)) and HV (74/85 (87%)). Type I dyssynergia ('paradoxical' contraction) was less prevalent in FC (17/85 (20%) than in HV (31/85 (36.5%), p=0.03). After statistical correction, only type IV dyssynergia was moderately useful for discriminating between FC (39/85 (46%)) and HV (17/85 (20%)) (p=0.001, positive predictive value=70.0%, positive likelihood ratio=2.3). Interobserver agreement was substantial or moderate for identifying a normal pattern, dyssynergia types I and IV, and FDD, and fair for types II and III. Conclusions: While the interpretation of AM patterns is reproducible, nearly 90% of HV have a pattern that is currently regarded as 'abnormal' by AM. Hence, AM is of limited utility for distinguishing between FC and HV.

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