The data were analyzed prospectively from registered patients at our motility center. This study recruited constipated patients (outpatients and inpatients) who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) at the Gastrointestinal Motility Center, the First Affiliated Hospital of University of Science and Technology of China, from November 2016 to January 2021. To further elucidate the pooled diagnostic accuracy of DRE in DD patients, we conducted a meta-analysis using data from previously published research, including our study. The purpose of this study is to evaluate the diagnostic yield of DRE compared with high-resolution anorectal manometry (HRAM) in diagnosing DD in patients with functional constipation. In other words, it is either not performed or inadequately used in clinical practice in evaluating patients with functional anorectal disorders. reported that only 11% of students had palpated constipated patients, and up to 17% did not perform it during medical school. However, there is a lack of emphasis on DRE use. DRE is a simple and inexpensive tool widely available for diagnosing anorectal disorders in clinics. The accurate DD diagnosis depends on anorectal physiological tests that are not readily available. However, one or more of these responses are absent in DD patients. When individuals were requested to push and bear down as if to defecate with a normal push maneuvre, the examiner could feel that external anal sphincter and/or puborectalis muscle of subjects were relaxed, together with perineal descent and tightening of abdominal muscles. Generally, the resting and squeeze anal sphincter tones are within a particular range. DRE can identify the presence of structural abnormalities, such as a stricture or spasm, tenderness, mass, or stool blockage. DRE has been confirmed to be a reliable tool for detecting DD and facilitating selection of patients for additional physiological tests. Physiological tests are critical in DD diagnosis and are considered the most important standard for DD. Notably, initial physical examination, particularly a thorough digital rectal examination (DRE), is critical in evaluating constipated patients. Moreover, DD diagnosis is also supported by prolonged balloon expulsion time, abnormal retention of radiopaque markers, and inability to evacuate barium from the rectum and physical examination. In addition to Rome IV diagnostic criteria, diagnosing DD depends on physiological tests, including evidence of abnormal coordination pattern of defecation detected by anorectal manometry and/or electromyographic. According to previous studies, up to 17% of the global population suffer from chronic constipation, while more than 50% of patients referred to tertiary centers for chronic constipation treatment are diagnosed with DD. Introductionĭyssynergic defecation (DD) is an anorectal dysfunction characterized by impaired relaxation or improper contraction of pelvic floor muscles that occurs during attempted defecation and has been implicated in persistent constipation. Meanwhile, our study highlights that DRE remains an important tool in clinical practice. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. DRE could be a valuable tool for screening DD. 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.
Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. There was a moderate agreement between DRE and HRAM for diagnosing DD ( κ-coefficient = 0.474, ). The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. 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.
The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. 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 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. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available.
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