{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:02:53Z","timestamp":1780549373730,"version":"3.54.1"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anorectal manometry (ARM) and balloon expulsion testing (BET) are often first\u2010line tests to diagnose dyssynergic defecation (DD), followed by either barium or MR defecography if results are equivocal for a defecatory disorder. However, real\u2010world outcomes for these patients are unclear. We aim to characterize patterns of patient treatment after equivocal results on ARM and BET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted of patients who obtained ARM and BET at a single referral motility center between January 2024 and February 2025. Demographic data, results of ARM, BET, and MR defecography if obtained were recorded along with the treatment plan at follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 409 charts reviewed, 97 patients with equivocal results were included in the study (81.4% female; mean age of 51.6\u2009\u00b1\u200918.0) and MR defecography was obtained by 30.9% of patients. Of these, 50.0% had findings consistent with DD and 56.7% had significant structural or anatomic abnormalities. Of the remaining 67 patients (69.1%) who did not obtain MR defecography, 31.3% opted for an empiric trial of biofeedback or pelvic physical therapy (PT), 26.9% continued with optimized medical management alone, whereas 14.4% were lost to follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fewer than one third of patients obtain MR defecography within 6\u2009months of equivocal ARM and BET; almost half of those had results corroborating a diagnosis of DD or significant structural abnormalities on MR defecography. Among patients who did not obtain MR defecography, most opted for an empiric trial of biofeedback\/pelvic PT or optimized medical management. More research is needed to identify which patients will substantively benefit from additional confirmatory testing when there are equivocal results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70348","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:49:01Z","timestamp":1778647741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["In the Gray Zone: Few Patients Proceed to Additional Testing After Equivocal Anorectal Manometry and Balloon Expulsion Testing"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-7408","authenticated-orcid":false,"given":"Madison R.","family":"Heath","sequence":"first","affiliation":[{"name":"Icahn School of Medicine Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Wade","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1738-0313","authenticated-orcid":false,"given":"Yuying","family":"Luo","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine Mount Sinai Hospital  New York New York USA"},{"name":"Mount Sinai Center of Gastrointestinal Physiology and Motility  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14524"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2022.2039282"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.70160"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-019-02142-9"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.10.029"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003267"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000003430"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001507"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2021.10.002"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14335"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.03.013"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.08.034"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-020-00793-z"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003667"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14633"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001242"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003532"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2013.07.004"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/28989463"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001070"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-023-04010-z"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14020548"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24665"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.09.154"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.247"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2025.04.013"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.21.26488"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.04.016"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001222"},{"issue":"3","key":"e_1_2_10_32_1","article-title":"Biofeedback for Treatment of Chronic Idiopathic Constipation in Adults","volume":"2014","author":"Woodward S.","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.07.023"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.10.027"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.03.022"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14948"}],"container-title":["Neurogastroenterology &amp; 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