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Brochard C, Jezequel M, Blanchard-Dauphin A, Kerdraon J, Perrouin-Verbe B, Leroi AM, Reymann JM, Peyronnet B, Morçet J, Siproudhis L. Transanal irrigation is a better choice for bowel dysfunction in adults with Spina bifida: A randomised controlled trial. Colorectal Dis 2023. [PMID: 36799340 DOI: 10.1111/codi.16518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 02/18/2023]
Abstract
AIM To compare transanal irrigation with conservative bowel management for the treatment of bowel dysfunction in Spina bifida (SB) patients. METHODS Patients with SB and bowel dysfunction were randomly assigned to receive either transanal irrigation or conservative bowel management. The effectiveness of the treatment was defined as a decrease of 4 points in the neurogenic bowel dysfunction (NBD) score at week 10. Data on incontinence (Cleveland scores; Jorge-Wexner [JW]) and constipation (Knowles-Eccersley-Scott Symptom Constipation Score [KESS]) were recorded at 10 and 24 weeks after inclusion. Data were analysed on an intention-to-treat basis. RESULTS A total of 34 patients were randomised: 16 patients to conservative bowel management and 18 patients to transanal irrigation. A total of 19/31 (61%) patients improved at week 10, 13 (76%) in the transanal irrigation group versus six (43%) in the conservative group (p = 0.056). In the irrigation group, the decrease in NBD score was -6.9 (-9.9 to -4.02) versus -1.9 (-6.5 to -2.8) in the conservative group (p = 0.049 in univariate and p = 0.004 in multivariate analysis). The NBD, Cleveland (JW and KESS) and Rosenberg scores were significantly lower in the transanal irrigation group than in the conservative bowel management group at week 10. CONCLUSIONS This prospective, randomised, controlled, multicentre study in adult patients with SB suggests that transanal irrigation may be more effective than conservative bowel management.
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Affiliation(s)
- Charlène Brochard
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou, Rennes, France.,The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.,Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
| | - Magali Jezequel
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
| | | | | | - Brigitte Perrouin-Verbe
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.,Service universitaire de Médecine Physique et Réadaptation Neurologique, Nantes Université, Nantes, France
| | | | | | - Benoît Peyronnet
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France.,INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,Service d'Urologie, CHRU Pontchaillou, Rennes, France
| | - Jeff Morçet
- INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Laurent Siproudhis
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France.,INSERM CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,Service des Maladies de l'Appareil Digestif, CHRU Pontchaillou, Université de Rennes 1, Rennes, France
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[Analysis of anorectal manometry data in central and peripheral neurological deseases: Review of the literature]. Prog Urol 2022; 32:1505-1518. [PMID: 36030152 DOI: 10.1016/j.purol.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Peripheral or central neurological deseases are providers of anorectal disorders of variable clinical expression (constipation, dyschezia, faecal incontinence (FI)…). Anorectal manometry (ARM) participates in their exploration to determine the underlying mechanisms, guide and optimize treatments. The objective of this work was to determine if there is a pattern of ARM data in neurological populations. MATERIALS ET METHODS Literature review from PubMed, Cochrane and Google scholar databases, using the following keywords: parkinsonian disorders; parkinson's disease; multiple slcerosis; neurolog*; spinal cord injury; spina bifida occulta; stroke; pudendal; endometriosis; peripheral nervous system diseases. 196 articles were isolated and finally 45 retained after reading the title and the abstract. RESULTS Data comparison was difficult due to the heterogeneity of techniques and thresholds used. In central lesions, resting and squeeze anal pressures were often altered. The presence of FI or constipation, the sex and the lesion level were factors influencing these data (low if complete injury, women or EDSS>5.5). In case of peripheral lesion, it is the anal tone and the contraction that varied the symptomatology. The sensory thresholds were variable regardless of the impairment. CONCLUSION This review did not identify a data pattern of ARM in central and peripheral neurological deseases. Gradual standardization of techniques and protocols will allow better comparison of data.
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Brochard C, Bouguen G, Olivier R, Durand T, Henno S, Peyronnet B, Pagenault M, Lefèvre C, Boudry G, Croyal M, Fautrel A, Esvan M, Ropert A, Dariel A, Siproudhis L, Neunlist M. Altered epithelial barrier functions in the colon of patients with spina bifida. Sci Rep 2022; 12:7196. [PMID: 35505001 PMCID: PMC9065040 DOI: 10.1038/s41598-022-11289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
Our objectives were to better characterize the colorectal function of patients with Spina Bifida (SB). Patients with SB and healthy volunteers (HVs) completed prospectively a standardized questionnaire, clinical evaluation, rectal barostat, colonoscopy with biopsies and faecal collection. The data from 36 adults with SB (age: 38.8 [34.1-47.2]) were compared with those of 16 HVs (age: 39.0 [31.0-46.5]). Compared to HVs, rectal compliance was lower in patients with SB (p = 0.01), whereas rectal tone was higher (p = 0.0015). Ex vivo paracellular permeability was increased in patients with SB (p = 0.0008) and inversely correlated with rectal compliance (r = - 0.563, p = 0.002). The expression of key tight junction proteins and inflammatory markers was comparable between SB and HVs, except for an increase in Claudin-1 immunoreactivity (p = 0.04) in SB compared to HVs. TGFβ1 and GDNF mRNAs were expressed at higher levels in patients with SB (p = 0.02 and p = 0.008). The levels of acetate, propionate and butyrate in faecal samples were reduced (p = 0.04, p = 0.01, and p = 0.02, respectively). Our findings provide evidence that anorectal and epithelial functions are altered in patients with SB. The alterations in these key functions might represent new therapeutic targets, in particular using microbiota-derived approaches.Clinical Trials: NCT02440984 and NCT03054415.
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Affiliation(s)
- Charlène Brochard
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France.
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU Rennes, 35000, Rennes, France.
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France.
| | - Guillaume Bouguen
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU Rennes, 35000, Rennes, France
- Service des Maladies de l'Appareil Digestif, CHRU Pontchaillou, Université de Rennes 1, Rennes, France
- Institut Numecan, INSERM, INRAE, Univ Rennes, Rennes, France
| | - Raphael Olivier
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France
| | - Tony Durand
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France
| | - Sébastien Henno
- Service d'Anatomopathologie, CHRU Pontchaillou, Rennes, France
| | - Benoît Peyronnet
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU Rennes, 35000, Rennes, France
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
- Service d'Urologie, CHRU Pontchaillou, Rennes, France
| | - Mael Pagenault
- Service des Maladies de l'Appareil Digestif, CHRU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Chloé Lefèvre
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France
| | - Gaëlle Boudry
- Institut Numecan, INSERM, INRAE, Univ Rennes, Rennes, France
| | - Mikael Croyal
- Université de Nantes, CHU Nantes, INSERM, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, 44000, Nantes, France
- CRNH-Ouest Mass Spectrometry Core Facility, 44000, Nantes, France
| | - Alain Fautrel
- Plateforme H2P2, Université de Rennes, Rennes, France
| | - Maxime Esvan
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU Rennes, 35000, Rennes, France
| | - Alain Ropert
- Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France
| | - Anne Dariel
- Service de Chirurgie Pédiatrique, CHU Marseille, Marseille, France
| | - Laurent Siproudhis
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU Rennes, 35000, Rennes, France
- Centre Référence Maladies Rares Spina Bifida, CHRU Pontchaillou, Rennes, France
- Service des Maladies de l'Appareil Digestif, CHRU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Michel Neunlist
- The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France
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Wincentak J, Xu Y, Rudden L, Kassam-Lallani D, Mullin A, Truong C, Krog K, Kingsnorth S. Current State of Knowledge on Digital Rectal Stimulation in Individuals With Traumatic and Nontraumatic Spinal Cord Injury: A Scoping Review. Arch Phys Med Rehabil 2021; 102:1816-1825. [PMID: 33529613 DOI: 10.1016/j.apmr.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To map and characterize the nature of the evidence on the use of digital rectal stimulation for bowel management in individuals with spinal cord injury (SCI). DATA SOURCES Five electronic databases were searched (ie, MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and Cochrane Incontinence Group) from 1990 to November 2019. STUDY SELECTION Articles that provided information on the use of digital rectal stimulation either alone or in combination with treatments were included. Title and abstract screening was split between 2 reviewers after reaching consensus on the first 100 studies screened. Full-texts were reviewed independently by 2 reviewers. Discrepancies were resolved by a third reviewer. DATA EXTRACTION The data extraction form was developed by 2 reviewers and piloted. Data were extracted by one reviewer and checked for accuracy by a second reviewer. DATA SYNTHESIS A total of 4841 studies were screened, including 425 full text articles; 33 articles were identified. Thirty-two studies focused solely on individuals with SCI and 1 study explored the experiences of caregivers of individuals with SCI. The majority of participants were aged between 30 and 59 years old. Most studies used quantitative methods (n=30, 91%). Fourteen of the studies (42%) were cross-sectional. Within experimental or quasiexperimental designs, digital rectal stimulation was commonly studied as an adjunct to other methods such as suppositories or enemas. Incontinence and defecation time were the most commonly examined outcomes. CONCLUSION There were few studies found that focus on digital rectal stimulation. Further studies examining experience, effectiveness, complications, and long-term outcomes are warranted.
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Affiliation(s)
- Joanne Wincentak
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
| | - Ying Xu
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Louise Rudden
- Specialized Orthopedic Developmental Rehabilitation Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Dilshad Kassam-Lallani
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Spina Bifida & Spinal Cord Injury Clinic, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Young Adult Spina Bifida Transition Program, Vibrant Healthcare Alliance, Toronto, Ontario, Canada
| | - Amy Mullin
- Spina Bifida & Spinal Cord Injury Clinic, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Cindy Truong
- Nursing, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kim Krog
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Collaborative Practice, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Brochard C, Peyronnet B, Hascoet J, Olivier R, Manunta A, Jezequel M, Alimi Q, Ropert A, Neunlist M, Bouguen G, Siproudhis L. Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches. Neurourol Urodyn 2018; 38:719-725. [PMID: 30575995 DOI: 10.1002/nau.23904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 01/06/2023]
Abstract
AIMS Spina Bifida (SB) is a rare congenital condition that frequently impairs the neurological control of both fecal continence and defecation. Several therapeutic strategies have been proposed but impact assessment is lacking. Our objectives were to quantify the symptomatic improvement and to determine the optimal strategy in this rare condition where randomized controlled trials are difficult to conduct. METHODS Data were extracted from a prospective database. The present analysis focused on patients having undergone at least two gastroenterological assessments. A standardized therapeutic approach was used from the first visit. Improvement was quantified by the variation of quantified symptomatic scores. RESULTS The data of of 57 adults with SB (gender F/M: 30/27 [52.6/47.4%]; mean age: 33.8 [18.5] years) were extracted. After a mean follow-up of 46 months, 23/57 patients (40.4%) had at least improvement of one point of the Cleveland Clinic Incontinence score (CCIS); 13/57 (22.8%) reported a significant improvement of continence (delta score >50%). Five of the twelve patients (41.6%) with CCIS < 5 at baseline became incontinent over time. The neurological level was not associated with a worse continence outcome. Work on stool consistency and transanal irrigation were the most useful strategies in those with significant improvement of continence. CONCLUSIONS Using conventional strategies, a benefit on fecal continence occurs in only one out of five patients suffering from Spina Bifida and continent patients at baseline can develop fecal incontinence over time. A strategy targeting improved control of defecation (transanal irrigation) and a standardization of follow-up protocol might be beneficial.
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Affiliation(s)
- Charlène Brochard
- CHU Rennes, Service d'Explorations Fonctionnelles Digestives, Université Rennes, Rennes, France
| | - Benoît Peyronnet
- CHU Rennes, Service d'Urologie, Université Rennes, Rennes, France
| | - Juliette Hascoet
- CHU Rennes, Service d'Urologie, Université Rennes, Rennes, France
| | | | - Andréa Manunta
- CHU Rennes, Service d'Urologie, Centre Référence National Maladies Rares Spina Bifida-dysraphismes, Rennes, France
| | - Magali Jezequel
- CHU Rennes, Centre Référence National Maladies Rares Spina Bifida-dysraphismes, Rennes, France
| | - Quentin Alimi
- CHU Rennes, Service d'Urologie, Centre Référence National Maladies Rares Spina Bifida-dysraphismes, Rennes, France
| | - Alain Ropert
- CHU Rennes, Service d'Explorations Fonctionnelles Digestives, Université Rennes, Rennes, France
| | | | - Guillaume Bouguen
- CHU Rennes, Service des Maladies de l'Appareil Digestif, Université Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| | - Laurent Siproudhis
- CHU Rennes, Service des Maladies de l'Appareil Digestif, Université Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
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Peyronnet B, Brochard C, Jezequel M, Hascoet J, Alimi Q, Senal N, Carsin-Nicole B, Riffaud L, Le Reste PJ, Bonan I, Olivari-Philiponnet C, Siproudhis L, Kerdraon J, Game X, Manunta A. Comparison of neurogenic lower urinary tract dysfunctions in open versus closed spinal dysraphism: A prospective cross-sectional study of 318 patients. Neurourol Urodyn 2018; 37:2818-2826. [DOI: 10.1002/nau.23782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Benoit Peyronnet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Charlène Brochard
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | | | - Juliette Hascoet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Quentin Alimi
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Nelly Senal
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Béatrice Carsin-Nicole
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neuro-Radiologie; CHU Rennes; Rennes France
| | - Laurent Riffaud
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Pierre-Jean Le Reste
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Isabelle Bonan
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Camille Olivari-Philiponnet
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Laurent Siproudhis
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | - Jacques Kerdraon
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Centre de rééducation de Kerpape; Ploemeur France
| | - Xavier Game
- Département d'Urologie; Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Andrea Manunta
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
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