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Abnormal Balloon Expulsion Test in Patients with Fecal Incontinence
Leila Neshatian1, Chimi Fosso2, Eamonn Quigley3
1Department of Gastroenterology, Houston Methodist, Weill Cornell Medical College, Houston, USA. lneshati@stanford.edu.
Journal of Gastrointestinal and Liver Diseases : JGLD
|August 25, 2020
Summary
Patients with fecal incontinence (FI) and abnormal balloon expulsion test (BET) have lower rectal propulsive pressures and higher sensory thresholds. These factors can predict abnormal BET in FI patients.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- Functional defecatory dysfunction contributes to fecal incontinence (FI) in some patients.
- The balloon expulsion test (BET) assesses defecatory function.
- Distinct manometric characteristics may exist between FI patients with normal and abnormal BET.
Purpose of the Study:
- To compare the anorectal pressure profile in FI patients with and without abnormal BET.
- To identify risk factors associated with abnormal BET in FI patients.
Main Methods:
- Retrospective review of 77 consecutive ROME IV FI patients.
- Comparison using Wilcoxon rank sum test, t-test, and Fisher exact tests.
- Multivariable logistic regression to identify factors associated with abnormal BET.
Main Results:
- 32% of patients had abnormal BET.
- Rectal propulsive pressures during simulated defecation were significantly lower in patients with abnormal BET (p=0.02).
- Mean sensory threshold for first sensation was significantly higher in patients with abnormal BET (p=0.03).
- Rectal propulsive pressures and sensory threshold independently predicted abnormal BET.
Conclusions:
- Rectal sensory threshold and rectal propulsive pressures during simulated defecation can determine normal BET in FI patients.
- These parameters are valuable in differentiating FI patients with normal versus abnormal BET, even with similar clinical and anal pressure profiles.
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