Grossi, U;
Heinrich, H;
Di Tanna, GL;
Taylor, SA;
Vollebregt, PF;
Knowles, CH;
Scott, SM;
(2021)
Systematic Characterization of Defecographic Abnormalities in a Consecutive Series of 827 Patients with Chronic Constipation.
Diseases of the Colon & Rectum
, 64
(11)
pp. 1385-1397.
10.1097/DCR.0000000000001923.
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Abstract
BACKGROUND: Barium defecography can assess structural and functional abnormalities in patients with chronic constipation. OBJECTIVE: To determine the prevalence of individual and overlapping defecographic findings in this setting. DESIGN: Cross-sectional. SETTING: University Hospital: tertiary gastrointestinal physiology department. PATIENTS: Consecutive examinations of 827 consecutive patients presenting over a 30-month period with well-defined symptom severity (≥12 points on the Cleveland Clinic Constipation score): systematic evaluation of images with results stratified by sex. MAIN OUTCOME MEASURES: Six individual functional or anatomical (intussusception, rectocele, enterocele, megarectum, excessive dynamic perineal descent) defecographic observations were defined a priori thus permitting 26 possible combinations of findings (i.e. 63 abnormal types + 1 normal). RESULTS: Patients with constipation (mean symptom score, 19) were predominantly female (88%) with median age 49 (17-98) years. All 6 individual radiological findings were identified with a total of 43 combinations found in the cohort; the 14 most prevalent of these accounted for >85% of patients. Only 136 (16.4%) patients had a normal defecography (34.3% males vs. 13.9% females; P<0.0001). Overall, 612 (74.0%) patients had structural (n=508 [61.4%]) or functional (n=104 [12.6%]) abnormalities in isolation, with 79 (9.6%) others exhibiting combinations of both. Functional abnormalities in isolation were more common in males compared to females (22.5% vs.11.2%,P=0.025) as opposed to structural abnormalities (57.8% vs. 85.7%, P<0.0001). Expulsion time was longer in females compared to males (110 [60-120] vs. 90 [60-120] sec; P=0.049). LIMITATIONS: Lack of multiorgan opacification. CONCLUSIONS: These results provide a contemporary atlas of defecographic findings in constipation. Several individual structural and functional features have been systematically classified, with overlap greater than previously acknowledged and profound differences among sexes that carry implications for tailoring management. See Video Abstract at http://links.lww.com/DCR/B552.
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