Use of Digital Rectal Exam Compared With High-Resolution Anorectal Manometry in the Diagnosis of Dyssynergic Defecation in Pediatrics.

Abstract

Background: Currently, high-resolution anorectal manometry (HRAM) is the only way to confirm the diagnosis of defecatory dyssynergia; however, it has limitations in pediatric patients. Digital rectal examination (DRE) may suggest the presence of defecatory dyssynergia based on clinical findings, but it is not a definitive diagnostic method. Its role in pediatric patients remains unexplored. The objective of this study was to determine the usefulness of DRE as a diagnostic test for dyssynergic defecation in pediatric patients compared with HRAM.

Methods: Patients aged 5-18 years who were referred for HRAM in a third-level hospital in Mexico City between March 2022 and September 2022 were included. Altered propulsion or impaired push effort was considered a suggestive diagnosis of dyssynergia by DRE. The results were compared with those obtained using HRAM.

Results: Forty-two patients were included, of whom 50% were male, with a median age of 10.68 years (standard deviation [SD] 3.23). Dyssynergia was diagnosed by DRE in 21 patients (50%) and by HRAM in 21 patients (50%). A sensitivity of 66% and a specificity of 66% were calculated for the alteration of rectal propulsion in DRE as suggestive of dyssynergia when compared to HRAM. A positive predictive value of 66% and a negative predictive value of 66% were calculated.

Conclusions and inferences: The sensitivity and specificity of DRE for the diagnosis of dyssynergic defecation were lower than those reported for adults (75% and 85%, respectively). In some cases, DRE would be useful, especially in low-resource scenarios where HRAM is not available, and we recommend DRE prior to HRAM as a complementary approach to dyssynergic defecation.