Three is not a crowd: improving the study of chronic constipation.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Diagnostic Imaging

Background:

• Chronic constipation affects a significant patient population, necessitating accurate diagnostic tools.
• High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET), and magnetic resonance defecography (MR defecography) are key investigations for defecation disorders.
• Evaluating the prevalence of functional defecation disorders and structural anorectal alterations is crucial for effective management.

Purpose of the Study:

• To assess the prevalence of functional defecation disorders and structural anorectal alterations in chronic constipation patients.
• To compare the diagnostic capabilities of HD-ARM and BET with MR defecography in evaluating constipation.
• To identify correlations between manometric findings, functional tests, and imaging results.

Main Methods:

• Retrospective cohort study of patients with refractory functional constipation or IBS-C.
• Patients underwent HD-ARM, BET, and MR defecography.
• Groupings based on HD-ARM and BET findings: normal/normal, abnormal/abnormal, and mixed results.

Main Results:

• Out of 64 patients, 49 had functional constipation (76.6%) and 15 had IBS-C (23.4%).
• MR defecography revealed structural alterations in 73.4% and dyssynergia in 23.4% of patients.
• Dyssynergic defecation was diagnosed in 29.7% of patients overall, with MR defecography diagnosing it in 24.2% of a subset.

Conclusions:

• One-third of patients with functional constipation and IBS-C present with dyssynergic defecation.
• Approximately three-quarters of these patients exhibit relevant structural anorectal alterations.
• Combining MR defecography with HD-ARM and BET provides a comprehensive evaluation for constipation management.