Gastroenterology

Gastroenterology

Volume 126, Issue 1, January 2004, Pages 57-62
Gastroenterology

Clinical-alimentary tract
Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation

https://doi.org/10.1053/j.gastro.2003.10.044Get rights and content

Abstract

Background & Aims: The aim of this study was to establish a simple method to exclude the possibility of pelvic floor dyssynergia (PFD) in constipated patients and thus avoid unnecessary expensive physiologic studies. Methods: Patients with suspicion of functional constipation (FC) were studied prospectively between 1994 and 2002, excluding those with severe systemic, psychological, or symptomatic anorectal/colonic disorders or taking medications that might modify symptoms or results of studies. Diagnosis of PFD was established retrospectively by manometric plus defecographic findings according to Rome II criteria. Two groups of patients were identified: FC without PFD (FC group) and PFD group. A 30-day symptom diary and balloon expulsion test results were evaluated in all patients. Clinical differences and results of the expulsion test were statistically compared between groups. Results: Of 359 patients evaluated, 130 were included (FC group, 106; PFD group, 24). According to data from the diary, only anal pain was more frequent in the PFD group compared with the FC group (anal pain in >25% of defecations, 70.8% vs. 40.6%; P < 0.05, χ2 test). The expulsion test was pathologic in 21 of 24 patients with PFD and 12 of 106 without PFD. The specificity and negative predictive value of the test for excluding PFD were 89% and 97%, respectively. Conclusions: The balloon expulsion test is a simple and useful screening procedure to identify constipated patients who do not have PFD. Symptoms are not enough to differentiate between subtypes of constipation.

Section snippets

Patient population and selection criteria

Patients were recruited prospectively from the Digestive Motility Department of the Clinic University Hospital of Valencia between June 1994 and January 2002 and were examined to establish the diagnosis of FC according to the Rome I criteria (presence of 2 or more of the following for at least 12 weeks in the preceding 12 months and for at least one fourth of the time: 2 or fewer bowel movements per week, lumpy or hard stools, straining at defecation, or sensation of incomplete evacuation).6

Results

A total of 359 patients with suspicion of FC were referred to our department. Forty-three constipated patients did not satisfy the Rome I criteria. Sixty-four patients were excluded because of severe systemic/psychological disorders or medication use, which could influence constipation. Severe depression was detected in 18 patients, eating disorders in 8, other psychological disorders in 4, endocrine diseases in 17 (hypothyroidism in 11 and diabetes mellitus in 6), traumatic or neurologic

Discussion

The balloon expulsion test has been used to identify constipated patients with outlet dysfunction. The first study that compared its results between constipated patients and healthy volunteers showed an inability of most patients to expel the balloon, but subtypes of constipation were not differentiated.9 Another report established a pattern of pelvic floor outlet obstruction by defecography in 21 constipated patients, and 12 of the patients were unable to expel a water-filled balloon.3

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Supported in part by a grant from the Instituto de Salud Carlos III (C03/02).

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