{"title":"A simple four symptom-based BEDS score to predict dyssynergic defecation in patients with chronic constipation.","authors":"Mayank Jain, Vinodini Agrawal","doi":"10.1007/s12664-024-01697-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Dyssynergic defecation (DD) is a disorder of anorectal function characterized by impaired relaxation or inappropriate contraction of pelvic floor muscles on attempted defecation. Based on previous Indian studies, we devised a symptom score (bleeding per rectum, excessive straining for stools, digitation, sense of incomplete evacuation/blockage-BEDS) and tried to determine if it can identify which patients with chronic constipation are more likely to have DD.</p><p><strong>Methods: </strong>This is a prospective observational cohort study in which consecutive adult patients (> 18 years) with chronic constipation who were referred to our centre for anorectal manometry (ARM) between 2019 and 2023 were included. Prior to tests, patients were asked in detail regarding their symptoms and scoring was done. ARM was done by a single observer. Diagnosis of DD was based on standard criteria. Statistical tests used were median, range and percentages, Chi-square test and Mann-Whitney U-test. The data was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Agreement of symptom-based scoring and DD diagnosis as per criteria was calculated using Cohen's κ coefficient. A p value of < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>As many as 244 patients (males 140, median age 42 years) formed the study cohort. Of these, 104 (42.6%) have DD. Sense of incomplete evacuation/sense of blockage (72.1% vs. 40%, p < 0.0001), excessive straining (73.1% vs. 22.1%, p < 0.0001) and digitation (28.8% vs. 13.5%, p 0.003) were more commonly reported in patients with DD. Taking a cut-off score of > / = 2, sensitivity of 69.2%, specificity 81.4% and positive likelihood ratio of 3.73 were noted. Similarly, if the score of > / = 3 was considered, the likelihood ratio increased to 4.71 with an increase in specificity (94.29%) and fall in sensitivity (26.92%).</p><p><strong>Conclusion: </strong>Symptom-based BEDS score of > / = 2 is useful in identifying patients with DD.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12664-024-01697-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: Dyssynergic defecation (DD) is a disorder of anorectal function characterized by impaired relaxation or inappropriate contraction of pelvic floor muscles on attempted defecation. Based on previous Indian studies, we devised a symptom score (bleeding per rectum, excessive straining for stools, digitation, sense of incomplete evacuation/blockage-BEDS) and tried to determine if it can identify which patients with chronic constipation are more likely to have DD.
Methods: This is a prospective observational cohort study in which consecutive adult patients (> 18 years) with chronic constipation who were referred to our centre for anorectal manometry (ARM) between 2019 and 2023 were included. Prior to tests, patients were asked in detail regarding their symptoms and scoring was done. ARM was done by a single observer. Diagnosis of DD was based on standard criteria. Statistical tests used were median, range and percentages, Chi-square test and Mann-Whitney U-test. The data was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Agreement of symptom-based scoring and DD diagnosis as per criteria was calculated using Cohen's κ coefficient. A p value of < 0.05 was considered statistically significant.
Results: As many as 244 patients (males 140, median age 42 years) formed the study cohort. Of these, 104 (42.6%) have DD. Sense of incomplete evacuation/sense of blockage (72.1% vs. 40%, p < 0.0001), excessive straining (73.1% vs. 22.1%, p < 0.0001) and digitation (28.8% vs. 13.5%, p 0.003) were more commonly reported in patients with DD. Taking a cut-off score of > / = 2, sensitivity of 69.2%, specificity 81.4% and positive likelihood ratio of 3.73 were noted. Similarly, if the score of > / = 3 was considered, the likelihood ratio increased to 4.71 with an increase in specificity (94.29%) and fall in sensitivity (26.92%).
Conclusion: Symptom-based BEDS score of > / = 2 is useful in identifying patients with DD.
期刊介绍：
The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.
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