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Diagnostic testing for dyssynergic defecation in chronic constipation: meta-analysis
E J Videlock1, A Lembo, F Cremonini
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. videlock@gmail.com
Neurogastroenterology and Motility
|February 21, 2013
Summary
Dyssynergic defecation (DD) is common in chronic constipation (CC) patients, affecting over a third. Manometry and balloon expulsion tests are recommended for initial evaluation over defecography.
Area of Science:
- Gastroenterology
- Pelvic Floor Disorders
- Colorectal Surgery
Background:
- Dyssynergic defecation (DD) involves impaired pelvic floor relaxation during defecation.
- The prevalence of DD in patients with chronic constipation (CC) requires clarification.
Purpose of the Study:
- To estimate the prevalence of abnormal findings associated with DD in CC patients undergoing physiological testing.
- To compare DD prevalence across different diagnostic modalities.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, and PubMed.
- Inclusion of studies reporting DD prevalence and specific diagnostic test findings in CC.
- Random effects models to calculate pooled prevalences with 95% confidence intervals.
Main Results:
- 79 studies including 7581 CC patients were analyzed.
- Median prevalence of any single abnormal DD finding was 37.2%.
- Prevalence varied by test: 14.9% (defecography) to 52.9% (ultrasound), with manometry at 47.7%.
Conclusions:
- Dyssynergic defecation is highly prevalent in chronic constipation patients.
- DD is detected consistently across various testing methods and patient populations.
- Defecography showed lower DD prevalence, suggesting manometry and balloon expulsion testing as preferred initial evaluations.
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