ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2016 March;175(3):59-67

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Can the balloon expulsion test be used to exclude the diagnosis of “dyssynergic defecation”?

Angela INVIATI ¹, Gregorio SCERRINO ¹, Domenico SCHIFANO ¹, Silvia DI GIOVANNI ¹, Vito LO GRECO ², Sebastiano BONVENTRE ¹

¹ Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy; ² Service of Radiology, Department of Biopathology and Forensic Biotechnologies, University of Palermo, Palermo, Italy

BACKGROUND: Functional constipation (FC) is a common disorder, particularly frequent in women. The aim of our study was to compare the results of balloon expulsion test with the manometry and defecography findings to exclude dyssynergic defecation (DD) in patients with chronic constipation.
METHODS: From January 2005 to December 2011, 127 patients with the diagnosis of functional constipation were recruited retrospectively. They were divided into three groups: 24 with DD, 54 with descending perineum syndrome (PDS), 49 without DD/PDS. Diagnosis of DD was established by manometric and defecographic findings according to Rome III criteria.
RESULTS: The balloon expulsion test was abnormal in 11 out of 24 patients with DD, 19 out of 54 with PDS and 13 of 49 without both. The specificity and negative predictive value of the test for excluding dyssynergic defecation were 73% and 77%, respectively. There was no statistically significant association between the balloon expulsion test and findings in defecografy (P=0.31). There was a relevant association between mean resting pressure (MRP) and balloon expulsion test (P=0.002) on anorectal manometry.
CONCLUSIONS: The balloon expulsion test is a simple and useful screening procedure to identify constipated patients who do not have DD. However, the balloon expulsion test cannot be used alone as a golden standard for the diagnosis of “dyssynergic defecation” and should be integrated with other anorectal tests mainly with anorectal manometry and secondly defecography.