![]() We found 3 potential “low-cost” tools-a DD clinical score, the BET and the digital rectal examination (DRE). Applying the creative concept of “low-cost” tools, we run an extensive review of the subject. A cheaper but satisfactory screening approach of DD that promotes an adequate selection of complementary tests and an earlier and adequate treatment seems ideal. However, with the nowadays cost-effectiveness constraints, it may be impossible to perform the recommended physiological evaluation to all patients seeking a medical consultation for CC or IBS-C. Thus, there is a subgroup of constipated patients-with DD-that can benefit from specific treatment behind laxatives, and we do not want them to miss proper treatment in consequence of the DD underdiagnosis. American studies report costs of healthcare utilization for CC as high as 500 dollars-patient-year while the exact impact of CC diagnostic assessment and treatment in Western Europe healthcare systems is unknown. This physiological evaluation is not always easily accessible, moreover it can be long and costly. Therefore, the diagnosis of DD is established when a patient with functional chronic constipation (CC) or irritable bowel syndrome with constipation (IBS-C) has impaired evacuation as demonstrated by 2 of 3 types of tests-balloon expulsion test (BET) imaging (conventional defecography, dynamic ultrasound or dynamic magnetic resonance) anorectal manometry (ARM) or electromiography (EMG). ĭD was recently defined by the Rome IV criteria, based on symptoms and objective physiological criteria-Table 1. ![]() DD may result from impaired anorectal function or rectal structural disturbances in patients with complaints of Chronic Constipation (CC). The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.Ī defecation disorder (DD) is defined as a difficulty in evacuation or emptying the rectum. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. Resultsįrom 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. ![]() Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET. This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Three “low-cost” tools to evaluate DD-a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. However, this physiological evaluation can be cumbersome, inaccessible and costly. A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams.
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