Clinical utility of balloon expulsion test for functional defecation disorders

Abstract Purpose A Defecation Disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. 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. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET (standard and variable volume (vv)). Results From 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. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. 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 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. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

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Does sequential balloon expulsion test improve the screening of defecation disorders?

BMC Gastroenterology ◽

10.1186/s12876-020-01490-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

A. C. Caetano ◽

D. Costa ◽

R. Gonçalves ◽

J. Correia-Pinto ◽

C. Rolanda

Keyword(s):

Predictive Value ◽

Low Cost ◽

Digital Rectal Examination ◽

Tertiary Hospital ◽

Balloon Expulsion ◽

Defecation Disorders ◽

Physiological Evaluation ◽

Balloon Expulsion Test ◽

Physiological Tests ◽

Defecation Disorder

Abstract Background A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. 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. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)]. Results From 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. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. 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 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. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

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Epidemiology of Functional Abdominal Pain Disorders and Functional Defecation Disorders in Adolescents in Curacao

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0000000000002838 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Carlos Alberto Velasco-Benítez ◽

Laura Melissa Méndez-Guzmán ◽

Daniela Alejandra Velasco-Suárez

Keyword(s):

Abdominal Pain ◽

Functional Abdominal Pain ◽

Defecation Disorders ◽

Functional Defecation Disorders

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Anorectal physiology in health: A randomized trial to determine the optimum catheter for the balloon expulsion test

Neurogastroenterology & Motility ◽

10.1111/nmo.13552 ◽

2019 ◽

Vol 31 (4) ◽

pp. e13552 ◽

Cited By ~ 8

Author(s):

Yoav Mazor ◽

Gillian Prott ◽

Mike Jones ◽

John Kellow ◽

Anastasia Ejova ◽

...

Keyword(s):

Randomized Trial ◽

Anorectal Physiology ◽

Balloon Expulsion ◽

Balloon Expulsion Test

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Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/8798974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jie Liu ◽

Hulin Chen ◽

Dewei Wu ◽

Ruiling Wei ◽

Chaolan Lv ◽

...

Keyword(s):

Frequency Band ◽

Outlet Obstruction ◽

Low Frequency ◽

Biofeedback Training ◽

Before And After ◽

Balloon Expulsion ◽

Group A ◽

Functional Outlet Obstruction ◽

Group B ◽

Balloon Expulsion Test

Background. Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated. Aims. The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC. Methods. A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment. Results. Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p<0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p<0.001, respectively). Conclusions. TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.

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