{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:04:57Z","timestamp":1790053497560,"version":"4.0.1"},"reference-count":124,"publisher":"Wiley","issue":"11-12","license":[{"start":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T00:00:00Z","timestamp":1541894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Defecography is considered the reference standard for the assessment of pelvic floor anatomy and function in patients with a refractory evacuation disorder. However, the overlap of radiologically significant findings seen in patients with chronic constipation (CC) and healthy volunteers is poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To systematically review rates of structural and functional abnormalities diagnosed by barium defecography and\/or magnetic resonance imaging defecography (MRID) in patients with symptoms of CC and in healthy volunteers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Electronic searches of major databases were performed without date restrictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From a total of 1760 records identified, 175 full\u2010text articles were assessed for eligibility. 63 studies were included providing data on outcomes of 7519 barium defecographies and 668 MRIDs in patients with CC, and 225 barium defecographies and 50 MRIDs in healthy volunteers. Pathological high\u2010grade (Oxford III and IV) intussuscepta and large (&gt;4\u00a0cm) rectoceles were diagnosed in 23.7% (95% CI: 16.8\u201031.4) and 15.9% (10.4\u201022.2) of patients, respectively. Enterocele and perineal descent were observed in 16.8% (12.7\u201021.4) and 44.4% (36.2\u201052.7) of patients, respectively. Barium defecography detected more intussuscepta than MRID (OR: 1.52 [1.12\u20102.14];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.009]). Normative data for both barium defecography and MRID structural and functional parameters were limited, particularly for MRID (only one eligible study).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pathological structural abnormalities, as well as functional abnormalities, are common in patients with chronic constipation. Since structural abnormalities cannot be evaluated using nonimaging test modalities (balloon expulsion and anorectal manometry), defecography should be considered the first\u2010line diagnostic test if resources allow.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.15039","type":"journal-article","created":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T20:24:08Z","timestamp":1541967848000},"page":"1186-1201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Systematic review with meta\u2010analysis: defecography should be a first\u2010line diagnostic modality in patients with refractory constipation"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"Ugo","family":"Grossi","sequence":"first","affiliation":[{"name":"Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK"},{"name":"Proctology Unit Fondazione Policlinico Universitario A. Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Luca","family":"Di Tanna","sequence":"additional","affiliation":[{"name":"Department of Econometrics, Statistics and Applied Economics Riskcenter \u2013 IREA Universitat de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henriette","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Centre for Medical Imaging University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Knowles","sequence":"additional","affiliation":[{"name":"Centre for Trauma and Surgery, and GI Physiology Unit, Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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