1
|
Negosanti L, Balloni M, Landi S, Mercante E, Villa D, Sgarzani R. Complications in spinal cord injury persons with "traditional" colostomy: a case series. Spinal Cord Ser Cases 2024; 10:46. [PMID: 38997269 PMCID: PMC11245491 DOI: 10.1038/s41394-024-00660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
INTRODUCTION Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications. CASE PRESENTATION We present four cases of SCI/D persons treated with Hartmann's procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes. DISCUSSION Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann's, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients' characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.
Collapse
Affiliation(s)
| | | | | | | | - Davide Villa
- Montecatone Rehabilitation Institue, Imola, Italy
| | | |
Collapse
|
2
|
Hamilton C. Transanal irrigation. Br J Community Nurs 2024; 29:S29-S32. [PMID: 38728165 DOI: 10.12968/bjcn.2024.29.sup5.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Conor Hamilton examines the key components healthcare practitioners should consider when using transanal irrigation.
Collapse
Affiliation(s)
- Conor Hamilton
- Lecturer (Nursing), School of Nursing and Midwifery, Queen's University Belfast
| |
Collapse
|
3
|
Bolia R, Goel A, Thapar N. Transanal irrigation in children with functional constipation: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:1108-1115. [PMID: 38558090 DOI: 10.1002/jpn3.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/19/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Refractory functional constipation is a challenging condition to manage in children. The use of transanal irrigation (TAI) is well reported in children with neurological disorders as well as anorectal malformations but less so in children with functional disorders of defecation. The objective of our study was to evaluate the effectiveness, safety and outcomes of TAI in children with functional constipation. METHODS PubMed, Scopus and Google Scholar were searched for publications related to the use of TAI in functional constipation. Data regarding the study design, sample size, patient characteristics, investigator-reported response to TAI and adverse effects were extracted from studies that met the selection criteria. The inverse variance heterogeneity model was used for ascertaining the summary effect in this meta-analysis. RESULTS The search strategy yielded 279 articles of which five studies were included in the final review. The studies were from the United Kingdom (n = 2), Netherlands (n = 2) and Denmark (n = 1). These studies included 192 children with a median age ranging from 7 to 12.2 years old. The TAI systems used in these studies were: Peristeen (n = 2), Peristeen or Qufora (n = 1), Alterna (n = 1) and Navina (n = 1). The follow-up duration ranged from 5.5 months to 3 years. Eleven (5.7%) children did not tolerate TAI and withdrew from treatment soon after initiation. The pooled investigator-reported success of TAI was 62% (95% CI: 52%-71%). The most common adverse event was pain which was experienced by 21.7% of children. A total of 27 (14%) were successfully weaned off TAI at the last follow-up. CONCLUSIONS TAI is reported to be successful in 62% of children with refractory functional constipation. There is a need for well-designed prospective trials to evaluate this treatment option in children with refractory functional constipation.
Collapse
Affiliation(s)
- Rishi Bolia
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, South Brisbane, Australia
| | - Akhil Goel
- Departement of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, South Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
4
|
Bazzocchi G, Corazziari ES, Staiano A, Bassotti G, Bellini M, Chiarioni G, D'Alba L, Scarpato E. Position paper on transanal irrigation in chronic non-organic constipation. Dig Liver Dis 2024; 56:770-777. [PMID: 38461046 DOI: 10.1016/j.dld.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
The practice of recto-colonic water irrigation to treat constipation has been used since ancient times with different, uncontrolled, and variably performing methods which have been considered interchangeably all alike. The use of better-performing devices with a standardized methodology is relatively recent, and the term Trans Anal Irrigation (TAI) defines a methodology performed with devices able to control the timing, volume, and pressure of the water introduced into the rectum and colon utilizing a catheter or a cone through the anus. Such practice has been implemented with favorable responses in patients with refractory chronic constipation secondary to neurological diseases. However, since the role of Trans Anal Irrigation as a therapeutic aid in chronic functional constipation and functional evacuation disorders is not yet fully clarified and standardized, a group of clinical investigators with recognized expertise in these clinical conditions intends to clarify the elements that characterize a TAI procedure that can benefit patients with functional constipation and functional defecation disorders defined according to the lastly updated Rome Diagnostic Criteria. Finally, the paper deals with adherence and practical implementation of TAI.
Collapse
Affiliation(s)
- G Bazzocchi
- Montecatone Rehabilitation Institute, Imola - University of Bologna, Italy
| | - E S Corazziari
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.
| | - A Staiano
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
| | - G Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Chiarioni
- Il Centro Med Healthcare, Verona Center, Verona, Italy & UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L D'Alba
- Gastroenterology and Endoscopy Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - E Scarpato
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
| |
Collapse
|
5
|
Ethans K, Smith K, Khandelwal A, Nankar M, Shea J, Casey A. Transanal irrigation bowel routine for people with Cauda Equina Syndrome. J Spinal Cord Med 2024; 47:263-269. [PMID: 35108169 PMCID: PMC10885772 DOI: 10.1080/10790268.2021.2022371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES. DESIGN Clinical Trial. SETTING Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg. METHODS Twelve participants with a mean age of 46.2 years (range 34-72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks. OUTCOME MEASURES Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes: Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method. RESULTS Ten participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05). CONCLUSION Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail.
Collapse
Affiliation(s)
- Karen Ethans
- Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, Queens University, Kingston, Canada
| | | | | | | | - Alan Casey
- Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
6
|
Martellucci J, Annicchiarico A, Scheiterle M, Trompetto M, Prosperi P. Sacral Neuromodulation for defecation disorders after non oncologic pelvic surgery. Int J Colorectal Dis 2023; 39:2. [PMID: 38063973 PMCID: PMC10709257 DOI: 10.1007/s00384-023-04567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Defecation disorders (DD) can sometimes affect the outcomes of pelvic or colorectal surgery. The aim of the present study is to evaluate the role of sacral neuromodulation for the treatment of constipation and other evacuation disorders after surgery. METHODS A retrospective analysis in all the consecutive patients that underwent sacral nerve modulation (SNM) for DD arisen or worsened after pelvic or colorectal surgery was performed from January 2010 to December 2020. DD were defined starting from Rome IV Criteria, and according to manometric results, all patients were further divided into the two subgroups: inadequate defecatory propulsion and dyssynergic defecation. Cleveland Clinic Constipations Score (CCCS) and SF-36 have been evaluated in the time. RESULTS Thirty-seven patients have been included in the study. Twenty-seven out of thirty-seven (73.3%) patients had experienced sufficient benefits to implant the definitive device, and 22 patients (59.4% of tested and 81.5% of permanently implanted) still had the device functioning after a mean follow-up of 6.3 years. The most represented manometric pattern was inadequate propulsive function (59% of patients). CCCS at preoperative assessment for all patients was 17.5 with a reduction to 10.4 at the first year of follow-up (p < 0.001). CONCLUSION SNM appears to be a feasible, safe, and well-tolerated procedure with durable benefit in the long-term treatment of defecatory dysfunction after pelvic or colorectal surgery for benign diseases.
Collapse
Affiliation(s)
| | - Alfredo Annicchiarico
- Emergency Surgery, Careggi University Hospital, Florence, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Department of General Surgery, Vaio Hospital, Fidenza, Italy.
| | | | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - Paolo Prosperi
- Emergency Surgery, Careggi University Hospital, Florence, Italy
| |
Collapse
|
7
|
Magnuson FS, Christensen P, Krassioukov A, Rodriguez G, Emmanuel A, Kirshblum S, Krogh K. Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm. J Clin Med 2023; 12:6971. [PMID: 38002586 PMCID: PMC10672578 DOI: 10.3390/jcm12226971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Neurogenic bowel dysfunction (NBD) is a common condition in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). It usually entails constipation, difficult evacuation of the rectum, and fecal incontinence (FI); often in combination. It is highly burdensome for affected patients and is correlated with poor quality of life. The current treatment algorithm, or treatment pyramid, does not completely correspond to actual clinical practice, and the known and classical pyramid contains both treatments still in their experimental stage as well as several treatments which are not available at all treatment centers. Thus, an updated treatment algorithm is called upon, and the authors of this paper therefore propose a simplified version of the treatment pyramid, aiming to guide clinicians in treating NBD.
Collapse
Affiliation(s)
- Fredrika S. Magnuson
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Andrei Krassioukov
- International Collaboration of Repair Discoveries (ICORD), Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Gianna Rodriguez
- Physical Medicine and Rehabilitation, Spinal Cord Injury Medicine, University of Michigan Health, Ann Arbor, MI 48108, USA
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London WC1E 6DB, UK
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA;
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
| |
Collapse
|
8
|
Lawrence D. Transanal irrigation to treat chronic constipation in patients with spinal cord injury: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:944-947. [PMID: 37883310 DOI: 10.12968/bjon.2023.32.19.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient's suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse.
Collapse
Affiliation(s)
- Debbie Lawrence
- Community Clinical Nurse Specialist, Hollister Ltd, Wokingham
| |
Collapse
|
9
|
Lefèvre C, Le Roy C, Bessard A, Le Berre-Scoul C, Marchix J, Coron E, Le Rhun M, Brochard C, Perrouin-Verbe B, Neunlist M. Region-specific remodeling of the enteric nervous system and enteroendocrine cells in the colon of spinal cord injury patients. Sci Rep 2023; 13:16902. [PMID: 37803037 PMCID: PMC10558436 DOI: 10.1038/s41598-023-44057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023] Open
Abstract
Patients with spinal cord injury (SCI) suffer from major bowel dysfunction, whose exact pathophysiology, particularly the involvement of the enteric nervous system or epithelial dysfunction is poorly understood. Herein, we aimed to characterize the mucosal biopsies of the right and left colon in SCI patients vs controls (CT): (1) remodeling of key enteric neurotransmitters, (2) remodeling of enteroendocrine cells, and (3) mucosal inflammation compared to those in controls. In SCI, mucosal ACh concentration was lower in the right colon as compared to CT, but no change was observed in the left colon, and AChE expression was lower in both the right and left colons than in CT. While the VIP concentration was similar in the right and left colons, VIP mRNA expression was increased in the right colon and decreased in the left colon, in SCI patients as compared to CT. Interestingly, 5-HT concentration was reduced in the left colon but not in the right colon in SCI patients. Moreover, in SCI patients, as compared to CT, SERT mRNA expression was selectively increased in the left colon while TPH1 mRNA expression was increased in the right and left colons. Although mucosal TNFα and IL-1β mRNA expression did not significantly differ between SCI and CT groups, we identified a significant positive correlation between TNFα and IL-1β mRNA expression and left colon transit time in the SCI group. In conclusion, region-specific changes occur in the enteric neurotransmitter, serotonergic, and inflammatory pathways in the colon of SCI patients. The significant correlations between these pathways and clinical parameters in the left colon further set a scientific basis for designing therapeutic targets to improve colonic motor dysfunction in patients.Biobank information: Spinal cord injury patients: PHRC ConstiCAPE-clinical trial NCT02566746. Controls: Anosain-clinical trial NCT03054415 and biobank of the "Institut des Maladies de l'Appareil Digestif (IMAD)" registered under number DC-2008-402.
Collapse
Affiliation(s)
- Chloë Lefèvre
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
- Service de Médecine Physique et Réadaptation Neurologique, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Camille Le Roy
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
- Service de Médecine Physique et Réadaptation Neurologique, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Anne Bessard
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
| | - Catherine Le Berre-Scoul
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
| | - Justine Marchix
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
| | - Emmanuel Coron
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
- Service de Gastroentérologie, Nantes Université, CHU Nantes, IMAD, 44000, Nantes, France
| | - Marc Le Rhun
- Service de Gastroentérologie, Nantes Université, CHU Nantes, IMAD, 44000, Nantes, France
| | - Charlène Brochard
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
- CHU Rennes, Explorations Fonctionnelles Digestives, 35000, Rennes, France
| | - Brigitte Perrouin-Verbe
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France
- Service de Médecine Physique et Réadaptation Neurologique, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Michel Neunlist
- Nantes Université, INSERM, CHU Nantes, IMAD, "The Enteric Nervous System in Gut and Brain Disorders", 44000, Nantes, France.
| |
Collapse
|
10
|
Teixeira-Vaz A, Silva JC, Ribeiro da Cunha M. Inflammatory bowel disease-An enemy of neurogenic bowel management in patients with spinal cord injury. PM R 2023; 15:1318-1325. [PMID: 36580491 DOI: 10.1002/pmrj.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Ana Teixeira-Vaz
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Carlos Silva
- Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - Maria Ribeiro da Cunha
- Centro de Reabilitação do Norte, Centro Hospitalar Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
11
|
Valero Soriano M, Carrasco Prats MM, Perán Fernández C, Calero García P, López Morales P, Giménez Francés C, Jiménez Moreno IM, Albarracín Marín-Blázquez A. Transanal irrigation as a therapeutic option for patients with incontinence and severe chronic constipation refractory to first-line treatment. Cir Esp 2023; 101:587-593. [PMID: 36464105 DOI: 10.1016/j.cireng.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The aim is to evaluate the utility of transanal irrigation such as treatment of incontinence and severe chronic constipation which is refractory to first-line therapy, and to assess its impact into the symptomatology and quality of life. METHODS Observational retrospective study of patients with incontinence and chronic constipation that had initiated transanal irrigation in two hospitals of the region. We collect sociodemographic variables, comorbidity, previous treatments, tests, parameters and incidences during the irrigation, and punctuation in the Cleveland Clinic Incontinence and Constipation Scores and EuroQol-5D Quality Of Life Scale before and after the treatment. RESULTS 40 patients, 20 with incontinence and 20 with chronic constipation. After an average period of 9 months of treatment, in 14 patients with incontinence we have observed a mean clinical improvement of 7,45 points before-after treatment measured with Cleveland Clinic Incontinence Score, and a mean improvement of 23 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001); and in 16 patients with constipation a mean clinical improvement of 7,6 points before-after treatment measured with Cleveland Clinic Constipation Score, and a mean improvement of 31,5 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001). CONCLUSIONS Transanal irrigation is an effective therapy for patients with incontinence and chronic constipation that are refractory to first-line therapies. It's an easy, self-administered and safe procedure. When the patient learns how to use it, the symptomatology and quality of life are improved.
Collapse
Affiliation(s)
- María Valero Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain.
| | | | - Cristóbal Perán Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Purificación Calero García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Pedro López Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Clara Giménez Francés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Isabel María Jiménez Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | |
Collapse
|
12
|
Meurette G, Faucheron JL, Cotte E, Denost Q, Portier G, Loriau J, Hansen AW, Vicaut E, Lakkis Z. Low anterior resection syndrome after rectal resection management: multicentre randomized clinical trial of transanal irrigation with a dedicated device (cone catheter) versus conservative bowel management. Br J Surg 2023; 110:1092-1095. [PMID: 36977128 PMCID: PMC10416684 DOI: 10.1093/bjs/znad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/27/2023] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Guillaume Meurette
- Department of Visceral Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean-Luc Faucheron
- Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, CHU Grenoble Alpes, Grenoble, France
| | - Eddy Cotte
- Department of Digestive and Oncological Surgery, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Quentin Denost
- Department of Visceral Surgery, Hospital Pierre Bénite, CHU Lyon, Lyon, France
| | | | - Jerôme Loriau
- Department of Visceral Surgery, Groupe Hospitalier Saint Joseph, Paris, France
| | | | - Eric Vicaut
- Department of Biostatistics Hospital Saint-Louis, Paris, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| |
Collapse
|
13
|
Tamvakeras P, Horrobin C, Chang J, Chapman M. Long-Term Outcomes of Transanal Irrigation for Bowel Dysfunction. Cureus 2023; 15:e42507. [PMID: 37502470 PMCID: PMC10371390 DOI: 10.7759/cureus.42507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Transanal irrigation (TAI) improves bowel function and quality of life in patients with neurogenic bowel disease compared to conservative bowel care. Its use has been extended to a range of defecatory disorders. However, data on long-term benefits and compliance are lacking. We aim to evaluate the long-term efficacy of TAI by examining compliance and patient outcomes over a five-year period. METHODS This study is a five-year retrospective review of patients practising TAI in a district general hospital. Patient demographics, indications, long-term compliance, adverse events, and patient-reported Qufora bowel symptom bother scores were analysed. RESULTS A cohort of 18 patients had a median age of 61 (range 23-91) and were predominantly female (83.5%). The reasons for bowel dysfunction were diverse: low anterior resection syndrome, neurogenic bowel, congenital anorectal malformations, obstructed defecation, and functional disorders. Predominant symptoms were constipation (9), faecal incontinence (7), and mixed (2). Both high-volume (catheter and cone) and low-volume (mini cone) irrigation devices were used. Fourteen patients continued regular irrigation at a median follow-up of 27.7 months (range 5.1-72.3), while four had discontinued at a median follow-up of 4.8 months. The reasons for discontinuation were inadequate rectal evacuation and spontaneous improvement of symptoms. In the compliant group, there was a significant improvement in bowel symptom scores (p=0.003). No major adverse events, such as significant rectal bleeding or perforation, were noted. CONCLUSION In this small cohort, TAI was safe and effective for long-term use; however, a fifth of patients discontinued treatment. Further work needs to be done to identify those patients who will benefit from TAI.
Collapse
Affiliation(s)
- Panagiotis Tamvakeras
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Clare Horrobin
- Lower GI Physiology, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Jessica Chang
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Mark Chapman
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| |
Collapse
|
14
|
Falletto E, Martellucci J, Rossitti P, Bondurri A, Zaffaroni G, Ascanelli S, Chimisso L, Lauretta A, Mirafiori M, Clementi I, Ripetti V, Lufarelli P, Cestaro G, Bottini C, Bellini M, Lambiase C, Di Candido F, Zattoni D, Cornaglia S, Tonello P, Zucchi E. Transanal irrigation in functional bowel disorders and LARS: short-term results from an Italian national study. Tech Coloproctol 2023; 27:481-490. [PMID: 37160596 DOI: 10.1007/s10151-023-02800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). METHODS A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. RESULTS A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. CONCLUSION Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions.
Collapse
Affiliation(s)
- E Falletto
- Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Torino, Turin, Italy.
| | - J Martellucci
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - P Rossitti
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - A Bondurri
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - G Zaffaroni
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - S Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - L Chimisso
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - A Lauretta
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - M Mirafiori
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - I Clementi
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy
| | - V Ripetti
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Lufarelli
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - G Cestaro
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - C Bottini
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - M Bellini
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - C Lambiase
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - F Di Candido
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - D Zattoni
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - S Cornaglia
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - P Tonello
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - E Zucchi
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| |
Collapse
|
15
|
Pieniowski EHA, Bergström CM, Nordenvall CAM, Westberg KS, Johar AM, Tumlin Ekelund SF, Larsson KR, Pekkari KJ, Jansson Palmer GC, Lagergren P, Abraham-Nordling M. A Randomized Controlled Clinical Trial of Transanal Irrigation Versus Conservative Treatment in Patients With Low Anterior Resection Syndrome After Rectal Cancer Surgery. Ann Surg 2023; 277:30-37. [PMID: 35797618 DOI: 10.1097/sla.0000000000005482] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate transanal irrigation (TAI) as a treatment for low anterior resection syndrome (LARS). BACKGROUND LARS is a bowel disorder that is common after sphincter preserving rectal cancer surgery. Despite symptomatic medical treatment of LARS many patients still experience bowel symptoms that may have a negative impact on quality of life (QoL). TAI is a treatment strategy, of which the clinical experience is promising but scientific evidence is limited. MATERIALS AND METHODS A multicenter randomized trial comparing TAI (intervention) with conservative treatment (control) was performed. Inclusion criteria were major LARS, age above 18 years, low anterior resection with anastomosis and a defunctioning stoma as primary surgery, >6 months since stoma reversal, anastomosis without signs of leakage or stricture, and no signs of recurrence at 1-year follow-up. The primary endpoint was differences in bowel function at 12-month follow-up measured by LARS score, Cleveland Clinic Florida Fecal Incontinence Score, and 4 study-specific questions. The secondary outcome was QoL. RESULTS A total of 45 patients were included, 22 in the TAI group and 23 in the control group. Follow-up was available for 16 and 22 patients, respectively. At 12 months, patients in the TAI group reported significantly lower LARS scores (22.9 vs 32.4; P =0.002) and Cleveland Clinic Florida Fecal Incontinence Score (6.4 vs 9.2; P =0.050). In addition, patients in the TAI group also scored significantly higher QoL [8 of 16 European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) QoL aspects] compared with the control group. CONCLUSIONS The results confirm our clinical experience that TAI reduces symptoms included in LARS and improves QoL.
Collapse
Affiliation(s)
- Emil H A Pieniowski
- Department of Surgery, South General Hospital (Södersjukhuset), Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Charlotta M Bergström
- Department of Surgery, Danderyd Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Caroline A M Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Colorectal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karin S Westberg
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Danderyd Hospital, Stockholm, Sweden
| | - Asif M Johar
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Susanne F Tumlin Ekelund
- Department of Surgery, South General Hospital (Södersjukhuset), Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Kristina R Larsson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Klas J Pekkari
- Department of Surgery, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Gabriella C Jansson Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Colorectal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mirna Abraham-Nordling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Colorectal Cancer, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Valero Soriano M, Carrasco Prats MM, Perán Fernández C, Calero García P, López Morales P, Giménez Francés C, Jiménez Moreno IM, Albarracín Marín-Blázquez A. La irrigación transanal como opción terapéutica para los pacientes con incontinencia y estreñimiento crónico severo refractarios a primera línea. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
17
|
Boman E, Nylander M, Oja J, Olofsson B. Transanal Irrigation for People With Neurogenic Bowel Dysfunction: An Integrative Literature Review. Gastroenterol Nurs 2022; 45:211-230. [PMID: 35833736 DOI: 10.1097/sga.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
Transanal irrigation has been introduced as a complement to standard bowel care for people with neurogenic bowel dysfunction. There is no contemporary integrative review of the effectiveness and feasibility of transanal irrigation from a holistic nursing perspective, only fragments of evidence to date. The aim was to investigate the effectiveness and feasibility of transanal irrigation for people with neurogenic bowel dysfunction. An integrative literature review was conducted. Nineteen studies were included. According to the results, transanal irrigation can reduce difficulties associated with defecation, episodes of incontinence, and the time needed for evacuation and bowel care. Transanal irrigation can increase general satisfaction with bowel habits and quality of life and decrease level of dependency. However, there are practical problems to overcome and adverse effects to manage. Discontinuation is relatively common. The results support the effectiveness of transanal irrigation, but feasibility is inconclusive. Users, including caregivers, report practical problems, and compliance was not always easy to achieve. It is important that users, including caregivers, are well informed and supported during transanal irrigation treatment, especially during introduction. The quality of the studies found was generally weak; therefore, high-quality quantitative and qualitative studies are needed on the topic.
Collapse
Affiliation(s)
- Erika Boman
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Malin Nylander
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Josefine Oja
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| |
Collapse
|
18
|
Ascanelli S, Bombardini C, Chimisso L, Carcoforo P, Turroni S, D’Amico F, Caniati ML, Baldi E, Tugnoli V, Morotti C, Valpiani G, Bazzocchi G. Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study. Mult Scler J Exp Transl Clin 2022; 8:20552173221109771. [PMID: 35832690 PMCID: PMC9272186 DOI: 10.1177/20552173221109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Constipation and faecal incontinence are not so uncommon in patients with multiple sclerosis, impairing quality of life. The gut microbiota is altered in multiple sclerosis patients and likely contributes to disease pathogenesis. Trans-anal irrigation has been proven to allow treatment of neurogenic bowel dysfunction and may affect gut microbiota. Objectives The primary outcome was trans-anal irrigation effectiveness on constipation and faecal incontinence. The secondary outcome was gut microbiota profiling compared to healthy subjects and during trans-anal irrigation adoption. Methods We conducted a prospective cohort study on multiple sclerosis patients, screened with Patient Assessment of Constipation Quality of Life questionnaire before undergoing constipation and faecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries and faecal sample collection for gut microbiota analysis before and after 4 weeks of trans-anal irrigation. Results and Conclusions Eighty patients were screened of which nearly half had intestinal symptoms. The included population (n = 37) was predominantly composed of women with significantly longer disease duration, higher mean age and disability than the excluded one ( p < 0.05). Twelve patients completed the trans-anal irrigation phase, which led to significant improvement of bowel dysfunction symptom-related quality of life, increase in gut microbiota diversity and reduction of the proportions of pro-inflammatory taxa ( p < 0.05). Trans-anal irrigation was safe, satisfactory and could help counteract multiple sclerosis-related dysbiosis.
Collapse
Affiliation(s)
| | | | | | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, Colorectal Unit, Section General Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Federica D’Amico
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Valeria Tugnoli
- Department of Neuroscience Rehabilitation, Multiple Sclerosis Center, Unit of Neurology, University Hospital of Ferrara, Ferrara, Italy
| | | | - Giorgia Valpiani
- Accreditation Office Quality Research Innovation, University Hospital of Ferrara, Ferrara, Italy
| | - Gabriele Bazzocchi
- Montecatone Rehabilitation Institute, University of Bologna, Imola, Italy
| |
Collapse
|
19
|
Harris G. An overview of transanal irrigation devices: an update. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:612-618. [PMID: 35736849 DOI: 10.12968/bjon.2022.31.12.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Transanal irrigation (TAI) is safe and effective treatment for constipation and faecal incontinence, but it should not be carried out before less invasive options have been tried. A thorough patient assessment and consideration of their preferences and tolerance should determine suitability and system choice. The range of available TAI equipment can be overwhelming. Therefore, to aid health professionals, this article presents a summary of the latest available devices on the market, as well as guidance on how to select a suitable device. TAI devices can be categorised into low-or high-volume; cones, catheters or balloon inflating devices; manual, electric pump or gravity-fed systems; and bed systems. Determining whether a low or high volume of water is required is a good starting point for device selection. Nurses should be aware of available devices and select one most suitable for a patient, as well as adequately train them in its usage and provide follow-up support. Nurses should communicate the potential improvement to quality of life TAI can offer and encourage adherence to avoid premature discontinuation.
Collapse
Affiliation(s)
- Gemma Harris
- Freelance Journalist and Health Writer, Birmingham
| |
Collapse
|
20
|
Teng M, Miget G, Moutounaïck M, Kervinio F, Charlanes A, Chesnel C, Breton FL, Amarenco G. Transanal Irrigation for Neurogenic Bowel Dysfunction in Multiple Sclerosis: A Retrospective Study. J Neurogastroenterol Motil 2022; 28:320-326. [PMID: 35362457 PMCID: PMC8978129 DOI: 10.5056/jnm19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 09/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Sixty-eight percent of multiple sclerosis (MS) patients suffer from neurogenic bowel dysfunction (NBD). Transanal irrigation (TAI) is part of the therapeutic strategy. This retrospective study aims to assess the efficacy of TAI in MS population. Methods Twenty-eight MS patients who underwent TAI after a learning period were included. We collected several demographic data: MS disease characteristics, treatments, urinary and bowel dysfunction characteristics, urodynamic parameters, results of the NBD score, the Urinary Symptom Profile (USP) score, and the Patient Global Impression of Severity score, completed by patients before the learning and during the follow-up consultation. We defined 4 specific groups depending on the NBD score severity: very minor, minor, moderate, and severe. Results Mean follow-up was 124 days, 85.0% were initially constipated and 36% had fecal incontinence. After TAI, improvement of NBD score was higher in initial Moderate NBD score group with 75.0% of patients decreasing their NBD score into lower severity categories. Few modifications were observed for baseline Very minor and Severe NBD score groups with 60.0% and 87.5% of patients staying in the same category. Statistical improvement of USP voiding dysfunction score was observed (95% CI, -6.13--1.19; P = 0.005) without improvement of overactive bladder USP sub-score. Conclusions TAI is effective in NBD, especially in MS patients with initial Moderate NBD score. Improvement of voiding dysfunction following TAI confirms the pelvic organ cross-talk and the need to systematically consider and treat bowel dysfunction in MS to also improve urinary symptoms.
Collapse
Affiliation(s)
- Maëlys Teng
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Gabriel Miget
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Mirella Moutounaïck
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Florian Kervinio
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Audrey Charlanes
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Camille Chesnel
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Frédérique Le Breton
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| | - Gérard Amarenco
- GRC 01 GREEN (Groupe de RecherchE CliniquE en Neuro-Urologie), Sorbonne Université, Paris, France.,Service de Neuro-urologie, hôpital Tenon, APHP, Paris, France
| |
Collapse
|
21
|
Guideline for the management of neurogenic bowel dysfunction in spinal cord injury/disease. Spinal Cord 2022; 60:435-443. [PMID: 35332274 PMCID: PMC8948006 DOI: 10.1038/s41393-022-00786-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022]
Abstract
Introduction Almost all people with spinal cord injury/disease (SCI/D) suffer from neurogenic bowel dysfunction (NBD), with a considerable impact on quality of life. The Association of the Scientific Medical Societies in Germany (AWMF e.V.) guideline for NBD in SCI/D aims to provide practice-oriented support for the care of patients with NBD resulting from congenital or aquired SCI/D. The guideline describes the diagnosis and bowel management of NBD in people with SCI/D. Thus, treatment processes in acute medical care and rehabilitation as well as for lifelong aftercare are presented. Methods The present guideline was developed under the leadership of the German-speaking Medical Society for Paraplegiology in a multiprofessional interdisciplinary guideline team. To exceed the level of expert recommendations, consensus was reached within the framework of a structured nominal group process in defined steps under neutral moderation considering the criteria of the German guideline development instrument (DELBI). Results Individual bowel management must be developed on the basis of an adequate diagnosis and considering the different lesion types. Due to the multifactorial influenceability of the intestine and the individual neurological deficit, a simple to-do checklist is not effective. Various and complex bowel management programmes are the basis of the treatment of NBD. Conclusions Guidelines can only be successful in so far as they are applied in everyday life. Of course, the selection and application of the measures described must always take into consideration the individual situation of the person concerned, and the correct application is always a prerequisite for success.
Collapse
|
22
|
Hill B, Mitchell A. Transanal irrigation at a glance. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:308-314. [PMID: 35333548 DOI: 10.12968/bjon.2022.31.6.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article provides a brief overview of transanal irrigation (TAI). It covers the rationale behind the procedure, the contraindications, possible complications and considerations for patient education and support.
Collapse
Affiliation(s)
- Barry Hill
- Director of Nursing Midwifery and Health Employability, Northumbria University, Newcastle upon Tyne
| | - Aby Mitchell
- Professional Lead for Simulation and Immersive Technologies, University of West London, London
| |
Collapse
|
23
|
Koppen IJN, Benninga MA. Functional Constipation and Dyssynergic Defecation in Children. Front Pediatr 2022; 10:832877. [PMID: 35252068 PMCID: PMC8890489 DOI: 10.3389/fped.2022.832877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Defecation is a complex physiological process, which relies on intricate mechanisms involving the autonomic and somatic nervous system, the pelvic floor muscles, and the anal sphincter complex. Anorectal dysfunction may result in constipation, a bothersome defecation disorder that can severely affect daily lives of children and their families. In this review, we focus on different mechanisms underlying anorectal dysfunction and specific treatment options aimed at improving defecation dynamics in children with functional constipation.
Collapse
Affiliation(s)
- Ilan J N Koppen
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
24
|
Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence. CHILDREN 2021; 8:children8121174. [PMID: 34943370 PMCID: PMC8700212 DOI: 10.3390/children8121174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon. These adaptations were positively correlated with pre-treatment manometric and enema data. In each group, the improvement of score was statistically significant in all cases (p 0.000); the main factor influencing the efficacy was the rate of sphincter anomalies. The ARM group had slower improvement than other groups, whereas functional patients had the best response. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, thus improving the efficacy.
Collapse
|
25
|
Ng KS, Gladman MA. LARS: A review of therapeutic options and their efficacy. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
Evolving Evidence Supporting Use of Rectal Irrigation in the Management of Bowel Dysfunction: An Integrative Literature Review. J Wound Ostomy Continence Nurs 2021; 48:553-559. [PMID: 34781312 DOI: 10.1097/won.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Disorders of bowel function are prevalent, particularly among patients with spinal cord injuries and other neurological disorders. An individual's bowel control significantly impacts quality of life, as predictable bowel function is necessary to actively and independently participate in everyday activities. For many patients with bowel dysfunction, initial lifestyle adjustments and other conservative therapeutic interventions (eg, digital stimulation, oral laxatives, suppositories) are insufficient to reestablish regular bowel function. In addition to these options, rectal irrigation (RI) is a safe and effective method of standard bowel care that has been used for several decades in adults and children suffering from bowel dysfunction associated with neurogenic or functional bowel etiologies. Rectal irrigation is an appropriate option when conservative bowel treatments are inadequate. Unlike surgical options, RI can be initiated or discontinued at any time. This report summarizes the clinical, humanistic, and economic evidence supporting the use of RI in clinical practice, noting features (eg, practical considerations, patient education) that can improve patients' success with RI treatment.
Collapse
|
27
|
Corsetti M, Brown S, Chiarioni G, Dimidi E, Dudding T, Emmanuel A, Fox M, Ford AC, Giordano P, Grossi U, Henderson M, Knowles CH, O'Connell PR, Quigley EMM, Simren M, Spiller R, Whelan K, Whitehead WE, Williams AB, Scott SM. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment. Neurogastroenterol Motil 2021; 33:e14070. [PMID: 33522079 DOI: 10.1111/nmo.14070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/05/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic constipation is a prevalent disorder that affects quality of life of patients and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology and Motility journal supplement devoted to the investigation and management of constipation was published (Neurogastroenterol Motil 2009;21(Suppl 2):1). In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held. The faculty members of this symposium were invited to write two reviews to present a collective synthesis of talks presented and discussions held during this meeting. The first review addresses epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. PURPOSE The present is the second of these reviews, providing contemporary perspectives and clinical challenges regarding behavioral, conservative, medical, and surgical treatments for patients presenting with constipation. It includes a management algorithm to guide clinical practice.
Collapse
Affiliation(s)
- Maura Corsetti
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Medicine, University of Nottingham and Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Steven Brown
- Department of Surgery, University of Sheffield, Sheffield, UK
| | - Giuseppe Chiarioni
- Division of Gastroenterology, University of Verona, AOUI Verona, Verona, Italy.,Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eirini Dimidi
- Department of Nutritional Sciences, King's College London, London, UK
| | | | | | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Pasquale Giordano
- Department of Colorectal Surgery, Barts health NHS Trust, London, UK
| | - Ugo Grossi
- Tertiary Referral Pelvic Floor and Incontinence Centre, Regional Hospital Treviso, University of Padua, Padua, Italy
| | - Michelle Henderson
- Durham Bowel Dysfunction Service, Old Trust Headquarters, University Hospital of North Durham, Durham, UK
| | - Charles H Knowles
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - P Ronan O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Eamonn M M Quigley
- Lynda K and David M Center for Gastrointestinal Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA
| | - Magnus Simren
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robin Spiller
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Medicine, University of Nottingham and Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - William E Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - S Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
28
|
Chesnel C, Hentzen C, Haddad R, Charlanes A, Le Breton F, Turmel N, Amarenco G. Adherence to transanal irrigation in older adults: first-year assessment. Tech Coloproctol 2021; 25:1055-1063. [PMID: 34185193 DOI: 10.1007/s10151-021-02479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND While the prevalence of chronic constipation and fecal incontinence increases with age, few data on transanal irrigation in older adults are available. The aim of this study was to assess the adherence and predictive factors for adherence to transanal irrigation during the first year of use in older adults. METHODS This retrospective study included all patients over 65 years old, who had therapeutic education for transanal irrigation with the Peristeen® device between January 2010 and July 2019 in a neuro-urology department of a university hospital in France. The adherence rate was assessed at 1, 3, 6, and 12 months. Predictive factors for adherence were looked for by comparing persistent population and non-persistent population at 1, 3, 6, and 12 months. RESULTS Sixty-nine patients over 65 years old were included. The adherence rate was 73.9% at 1 month, 55.1% at 3 months, 46.4% at 6 months, and 40.1% at 1 year. No predictive factor for adherence to transanal irrigation was identified. CONCLUSIONS Adherence to transanal irrigation during the first year in older adults remains close to that in the adult general population. Predictive factors of adherence remain unclear.
Collapse
Affiliation(s)
- C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France. .,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France. .,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France.
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - A Charlanes
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| |
Collapse
|
29
|
Lin YM, Tang Y, Fu Y, Hegde S, Shi DW, Huang LYM, Shi XZ. An opioid receptor-independent mechanism underlies motility dysfunction and visceral hyperalgesia in opioid-induced bowel dysfunction. Am J Physiol Gastrointest Liver Physiol 2021; 320:G1093-G1104. [PMID: 33908261 PMCID: PMC8285582 DOI: 10.1152/ajpgi.00400.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Constipation and abdominal pain are commonly encountered in opioid-induced bowel dysfunction (OBD). The underlying mechanisms are incompletely understood, and treatments are not satisfactory. As patients with OBD often have fecal retention, we aimed to determine whether fecal retention plays a pathogenic role in the development of constipation and abdominal pain in OBD, and if so to investigate the mechanisms. A rodent model of OBD was established by daily morphine treatment at 10 mg/kg for 7 days. Bowel movements, colonic muscle contractility, visceromotor response to colorectal distention, and cell excitability of colon-projecting dorsal root ganglion neurons were determined in rats fed with normal pellet food, or with clear liquid diet. Morphine treatment (Mor) reduced fecal outputs starting on day 1, and caused fecal retention afterward. Compared with controls, Mor rats demonstrated suppressed muscle contractility, increased neuronal excitability, and visceral hypersensitivity. Expression of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) was upregulated in the smooth muscle of the distended colon in Mor rats. However, prevention of fecal retention by feeding rats with clear liquid diet blocked upregulation of COX-2 and NGF, restored muscle contractility, and attenuated visceral hypersensitivity in Mor rats. Moreover, inhibition of COX-2 improved smooth muscle function and fecal outputs, whereas anti-NGF antibody administration attenuated visceral hypersensitivity in Mor rats. Morphine-induced fecal retention is an independent pathogenic factor for motility dysfunction and visceral hypersensitivity in rats with OBD. Liquid diet may have therapeutic potential for OBD by preventing fecal retention-induced mechanotranscription of COX-2 and NGF.NEW & NOTEWORTHY Our preclinical study shows that fecal retention is a pathogenic factor in opioid-induced bowel dysfunction, as prevention of fecal retention with liquid diet improved motility and attenuated visceral hyperalgesia in morphine-treated animals by blocking expression of cyclooxygenase-2 and nerve growth factor in the colon.
Collapse
Affiliation(s)
- You-Min Lin
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas
| | - Yanbo Tang
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas,2Department of Gastroenterology, The First Affiliated Hospital, Guangxi University of Science and Technology, Guangxi, China
| | - Yu Fu
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas
| | - Shrilakshmi Hegde
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas
| | - Daniel W. Shi
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas,3College of Science, Texas A&M University, College Station, Texas
| | - Li-Yen M. Huang
- 4Department of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, Texas
| | - Xuan-Zheng Shi
- 1Department of Internal Medicine, The University of Texas
Medical Branch, Galveston, Texas
| |
Collapse
|
30
|
Caponcelli E, Meroni M, Brisighelli G, Rendeli C, Ausili E, Gamba P, Marte A, Iacobelli BD, Lombardi L, Leva E, Midrio P. Transanal irrigation (TAI) in the paediatric population: Literature review and consensus of an Italian multicentre working group. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 33960759 DOI: 10.4081/pmc.2021.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Constipation and fecal incontinence in pediatric patients are conditions due to either functional or organic bowel dysfunction and may represent a challenging situation both for parents, pediatricians, and pediatric surgeons. Different treatments have been proposed throughout the past decades with partial and alternant results and, among all proposed techniques, in the adult population the Transanal Irrigation (TAI) has become popular. However, little is known about its efficacy in children. Therefore, a group of Italian pediatric surgeons from different centers, all experts in bowel management, performed a literature review and discussed the best-practice for the use of TAI in the pediatric population. This article suggests some tips, such as the careful patients' selection, a structured training with expert in pediatric colorectal diseases, and a continuous follow-up, that are considered crucial for the full success of treatment.
Collapse
Affiliation(s)
| | - Milena Meroni
- Pediatric Surgery, Bambini Vittore Buzzi Hospital, Milan.
| | - Giulia Brisighelli
- Department Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg.
| | - Claudia Rendeli
- Department of Women's, children's and public health Studies, Foundation Policlinico Universitario Agostino Gemelli, IRCCS.
| | - Emanuele Ausili
- Department of Women's, children's and public health Studies, Foundation Policlinico Universitario Agostino Gemelli, IRCCS.
| | | | - Antonio Marte
- Pediatric Surgery, Luigi Vanvitelli, University o Campania Luigi Vanvitelli, Naples.
| | - Barbara Daniela Iacobelli
- Neuro-urology unit, spina bifida center and Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome.
| | - Laura Lombardi
- Pediatric Surgery, Nuovo Ospedale del bambino "P. Barilla", Maggiore Hospital, Parma.
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan.
| | - Paola Midrio
- Pediatric Surgery, Ca' Foncello Hospital, Treviso.
| |
Collapse
|
31
|
Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
| |
Collapse
|
32
|
Spinelli M, Sampogna G, Rizzato L, Spinelli A, Sammartano F, Cimbanassi S, Montanari E, Chiara O. The Malone antegrade continence enema adapting a transanal irrigation system in patients with neurogenic bowel dysfunction. Spinal Cord Ser Cases 2021; 7:34. [PMID: 33893272 DOI: 10.1038/s41394-021-00397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Patients with severe neurogenic bowel dysfunction (NBD) may undergo the Malone antegrade continence enema (MACE) surgery to perform antegrade bowel irrigation (ABI). The standard approach may be prevented by a previous appendectomy or complicated by appendicular stenoses and/or stomal leakages. We present the experience by our tertiary referral center for NBD, adopting a modified surgical technique, based on a neoappendix with the terminal ileum to preserve the natural anti-reflux mechanism of the ileocecal valve and avoid stool leakage, and a largely available transanal irrigation (TAI) system to catheterize the neoappendix and perform ABI. CASE PRESENTATION Three individuals with NBD successfully underwent our modified MACE program. Case 1 had cauda equina syndrome. He underwent surgery at 40. Case 2 was a man who suffered from spinal cord dysfunction due to acute disseminated encephalomyelitis, functionally T12 AIS B, at 57. Case 3 was a man with traumatic L1 AIS B paraplegia. At 60 he underwent surgery after 29 years since the injury. He needed a surgical revision due to a postoperative subcutaneous infection. After 121, 84 and 14 months from surgery, the three individuals performed ABI every 2 days, presented functional stomas, had no fecal incontinence, and reported an NBD score of 6, compared to 40, 33 and 35 pre-operatively. DISCUSSION To our knowledge, this is the first report of MACE combining a tapered terminal ileum conduit and an adapted TAI system. Our approach proved to be a safe and effective strategy for severe NBD avoiding a colostomy.
Collapse
Affiliation(s)
- Michele Spinelli
- Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Gianluca Sampogna
- Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Luigi Rizzato
- Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Antonella Spinelli
- Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabrizio Sammartano
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Università degli Studi di Milano, Milano, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Università degli Studi di Milano, Milano, Italy
| | - Emanuele Montanari
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
33
|
Stelzner S, Kupsch J, Mees ST. [Low anterior resection syndrome-Causes and treatment approaches]. Chirurg 2021; 92:612-620. [PMID: 33877394 DOI: 10.1007/s00104-021-01398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND With improvement of the oncological prognosis and more sphincter-preserving procedures for rectal cancer of the lower third, the functional sequelae of anterior rectal resection become more and more predominant and are summarized under the term low anterior resection syndrome (LARS). MATERIAL AND METHODS In this narrative review the causes, associated factors, prevalence, diagnostics and treatment strategies are presented based on an evaluation of the international literature. RESULTS The central role of the rectum in the physiology of defecation and continence explains the frequency of symptoms following anterior rectal resection. In an unselected patient population a major LARS is to be expected in approximately 40% and a minor LARS in approximately 20%. The most important factor is the length of the remaining rectal stump. The diagnosis of LARS is made clinically and can be quantified by scores, especially by the LARS score. Treatment options range from patient counselling to stoma construction and a symptom-related, stepwise approach is generally accepted. CONCLUSION While the evidence for the causes, the quantification and determination of associated factors of LARS is good, the treatment options are based either on experience or on only few studies.
Collapse
Affiliation(s)
- Sigmar Stelzner
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland.
| | - Juliane Kupsch
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland
| | - Sören Torge Mees
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland
| |
Collapse
|
34
|
Mosiello G, Safder S, Marshall D, Rolle U, Benninga MA. Neurogenic Bowel Dysfunction in Children and Adolescents. J Clin Med 2021; 10:1669. [PMID: 33924675 PMCID: PMC8069792 DOI: 10.3390/jcm10081669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023] Open
Abstract
Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.
Collapse
Affiliation(s)
- Giovanni Mosiello
- Department of Surgery, Division of Urology, Bambino Gesù Pediatric and Research Hospital, 00165 Rome, Italy
| | - Shaista Safder
- College of Medicine, Center for Digestive, Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL 32806, USA;
| | - David Marshall
- Department of Pediatric Surgery and Pediatric Urology, Royal Belfast Hospital for Sick Children, Belfast BT97AB, UK;
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, Goethe-University Frankfurt, 60596 Frankfurt, Germany;
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| |
Collapse
|
35
|
Validation of the Monitoring Efficacy of Neurogenic Bowel Treatment on Response (MENTOR) Tool in a Japanese Rehabilitation Setting. J Clin Med 2021; 10:jcm10050934. [PMID: 33804312 PMCID: PMC7957617 DOI: 10.3390/jcm10050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Study design: Prospective observational study. Objective: To validate the Monitoring Efficacy of NBD Treatment On Response (MENTOR) tool in individuals with a spinal cord injury (SCI) or spina bifida, suffering from neurogenic bowel dysfunction (NBD) in a rehabilitation center in Japan. Methods: First, the MENTOR tool was translated from English to Japanese using a validated translation process. Second, the MENTOR tool was validated in a rehabilitation clinic in Japan. Participants completed the MENTOR tool prior to a consultation with an expert physician. According to the results of the tool, each participant was allocated to one of three categories regarding change in treatment: “adequately treated,” “further discussion,” and “recommended change.” The results of the MENTOR tool were compared with the treatment decision made by an expert physician, who was blinded to the results of the MENTOR tool. Results: A total of 60 participants completed the MENTOR tool. There was an acceptable concordance between individuals allocated as respectively, being adequately treated (100%) and recommended change in treatment (61%) and the physicians’ decision on treatment. The concordance was lower for individuals allocated as requiring further discussion (48%). Conclusions: In this study the MENTOR tool was successfully validated in a Japanese rehab setting. The tool will help identify individuals with SCI that need further treatment of their NBD symptoms.
Collapse
|
36
|
Mekhael M, Kristensen HØ, Larsen HM, Juul T, Emmanuel A, Krogh K, Christensen P. Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J Clin Med 2021; 10:jcm10040753. [PMID: 33668658 PMCID: PMC7918662 DOI: 10.3390/jcm10040753] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Transanal irrigation (TAI) has received increasing attention as a treatment option in patients with bowel dysfunction. This systematic review was conducted according to the PRISMA guidelines and evaluates the effect of TAI in neurogenic bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC). The primary outcome was the effect of TAI on bowel function. Secondary outcomes included details on TAI, quality of life (QoL), the discontinuation rate, adverse events, predictive factors for a successful outcome, and health economics. A systematic search for articles reporting original data on the effect of TAI on bowel function was performed, and 27 eligible studies including 1435 individuals were included. Three randomised controlled trials, one non-randomised trial, and 23 observational studies were included; 70% of the studies were assessed to be of excellent or good methodological quality. Results showed an improvement in bowel function among patients with NBD, LARS, FI, and CC with some studies showing improvement in QoL. However, discontinuation rates were high. Side effects were common, but equally prevalent among comparative treatments. No consistent predictive factors for a successful outcome were identified. Results from this review show that TAI improves bowel function and potentially QoL; however, evidence remains limited.
Collapse
Affiliation(s)
- Mira Mekhael
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
- Correspondence:
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
| | - Helene Mathilde Larsen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London NW1 2BU, UK;
| | - Klaus Krogh
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| |
Collapse
|
37
|
Christensen P, IM Baeten C, Espín‐Basany E, Martellucci J, Nugent KP, Zerbib F, Pellino G, Rosen H. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis 2021; 23:461-475. [PMID: 33411977 PMCID: PMC7986060 DOI: 10.1111/codi.15517] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
AIM Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS. METHOD The 'Management guidelines for low anterior resection syndrome' (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face-to-face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project. RESULTS The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts. CONCLUSIONS The MANUEL project provides an up-to-date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.
Collapse
Affiliation(s)
- Peter Christensen
- Department of SurgeryDanish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic OrgansAarhus University HospitalAarhusDenmark
| | - Coen IM Baeten
- Department of SurgeryGroene Hart ZiekenhuisGoudaThe Netherlands
| | | | | | | | - Frank Zerbib
- Gastroenterology DepartmentCHU de BordeauxCentre Medico‐Chirurgical MagellanHôpital Haut‐LévêqueUniversité de BordeauxBordeauxFrance
| | - Gianluca Pellino
- Colorectal SurgeryVall d'Hebron University HospitalBarcelonaSpain
- Department of Advanced Medical and Surgical SciencesUniversitá degli Studi della Campania ‘Luigi Vanvitelli’NaplesItaly
| | - Harald Rosen
- Department of Surgical OncologySigmund Freud UniversityViennaAustria
| | | |
Collapse
|
38
|
Emmanuel A, Kurze I, Krogh K, Ferreiro Velasco ME, Christensen P, Del Popolo G, Bazzocchi G, Hultling C, Perrouin Verbe B, Bothig R, Glott T, Gonzalez Viejo MA. An open prospective study on the efficacy of Navina Smart, an electronic system for transanal irrigation, in neurogenic bowel dysfunction. PLoS One 2021; 16:e0245453. [PMID: 33513187 PMCID: PMC7845961 DOI: 10.1371/journal.pone.0245453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Transanal irrigation (TAI) has emerged as a key option when more conservative bowel management does not help spinal cord injured (SCI) individuals with neurogenic bowel dysfunction (NBD). Aim To investigate the short-term efficacy and safety of an electronic TAI system (Navina Smart) in subjects with NBD. Design We present an open, prospective efficacy study on Navina Smart, in individuals with NBD secondary to SCI, studied at three months. Population Eighty-nine consecutive consenting established SCI individuals (61 male; mean age 48, range 18–77) naïve to TAI treatment were recruited from ten centres in seven countries. Subjects had confirmed NBD of at least moderate severity (NBD score ≥10). Methods Subjects were taught how to use the device at baseline assisted by the Navina Smart app, and treatment was tailored during phone calls until optimal TAI regime was achieved. The NBD score was measured at baseline and at three months follow up (mean 98 days). Safety analysis was performed on the complete population while per protocol (PP) analysis was performed on 52 subjects. Results PP analysis showed a significant decrease in mean NBD score (17.8 to 10, p<0.00001). In subjects with severe symptoms (defined as NBD score ≥14), mean NBD scores decreased (19.4 to 10.9, p<0.0001). The number of subjects with severe symptoms decreased from 41 (79%) subjects at baseline to 16 (31%) at three months follow-up. Device failure accounted for the commonest cause for loss of data. Side effects possibly related to the device developed in 11 subjects (12%). Discontinuation due to failure of therapy to relieve symptoms was reported by 5 subjects (6%). Conclusion Navina Smart is effective for individuals with NBD, even those with severe symptoms; long-term data will follow. Whilst there were some device problems (addressed by the later stages of subject recruitment) the treatment was generally safe. Clinical trial (ClinicalTrials.gov number NCT02979808)
Collapse
Affiliation(s)
- Anton Emmanuel
- GI Physiology Unit, UCH London, London, United Kingdom
- * E-mail:
| | - Ines Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Christensen
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Giuilio Del Popolo
- Neuro-Urology and Spinal Unit Dpt., Careggi University Hospital, Firenze, Italy
| | - Gabriele Bazzocchi
- Neurogastroenterology and G.I. Rehabilitation Unit, Montecatone Rehabilitation Institute, Imola, Bologna, Italy
| | | | | | - Ralf Bothig
- Dept. Neuro-Urology, BG Klinikum, Hamburg, Germany
| | | | | |
Collapse
|
39
|
Studsgaard Slot SD, Baunwall SMD, Emmanuel A, Christensen P, Krogh K. The Monitoring Efficacy of Neurogenic Bowel Dysfunction Treatment on Response (MENTOR) in a Non-Hospital Setting. J Clin Med 2021; 10:jcm10020263. [PMID: 33445668 PMCID: PMC7828108 DOI: 10.3390/jcm10020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most patients with a spinal cord injury (SCI) suffer from neurogenic bowel dysfunction (NBD). In spite of well-established treatment algorithms, NBD is often insufficiently managed. The Monitoring Efficacy of Neurogenic bowel dysfunction Treatment On Response (MENTOR) has been validated in a hospital setting as a tool to support clinical decision making in individual patients. The objective of the present study was to describe clinical decisions recommended by the MENTOR (either "monitor", "discuss" or "act") and the use of the tool to monitor NBD in a non-hospital setting. METHODS A questionnaire describing background data, the MENTOR, ability to work and participation in various social activities was sent by mail to all members of The Danish Paraplegic Association. RESULTS Among 1316 members, 716 (54%) responded, 429 men (61%) and 278 women (39%), aged 18 to 92 (median 61) years. Based on MENTOR, the recommended clinical decision is to monitor treatment of NBD in 281 (44%), discuss change in treatment in 175 (27%) and act/change treatment in 181 (28%). A recommendation to discuss or change treatment was associated with increasing age of the respondent (p = 0.016) and with impaired ability to work or participate in social activities (p < 0.0001). CONCLUSION A surprisingly high proportion of persons with SCI have an unmet need for improved bowel care. The MENTOR holds promise as a tool for evaluation of treatment of NBD in a non-hospital setting.
Collapse
Affiliation(s)
- Sofie Dagmar Studsgaard Slot
- Department of Hepatology and Gastroenterology, Aarhus University Hospital of Aarhus, DK8200 Aarhus N, Denmark; (S.D.S.S.); (S.M.D.B.)
| | - Simon Mark Dahl Baunwall
- Department of Hepatology and Gastroenterology, Aarhus University Hospital of Aarhus, DK8200 Aarhus N, Denmark; (S.D.S.S.); (S.M.D.B.)
| | - Anton Emmanuel
- GI Physiology Unit, University College Hospital, London NW1 2BU, UK;
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital of Aarhus, DK8200 Aarhus N, Denmark;
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital of Aarhus, DK8200 Aarhus N, Denmark; (S.D.S.S.); (S.M.D.B.)
- Correspondence:
| |
Collapse
|
40
|
Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
| |
Collapse
|
41
|
Randomized Pilot Trial of Percutaneous Posterior Tibial Nerve Stimulation Versus Medical Therapy for the Treatment of Low Anterior Resection Syndrome: One-Year Follow-up. Dis Colon Rectum 2020; 63:1602-1609. [PMID: 33149022 DOI: 10.1097/dcr.0000000000001614] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Low anterior resection syndrome is significantly associated with a deterioration in the quality of life, and its medical treatment is usually ineffective. OBJECTIVE The aim of the present study was to establish the efficacy of percutaneous tibial nerve stimulation in treating this syndrome. DESIGN This is a randomized pilot trial with 1-year follow-up. SETTINGS The study was conducted in a specialized colorectal unit of a tertiary hospital. PATIENTS Patients who underwent neoadjuvant chemoradiotherapy and low anterior rectal resection for cancer with low anterior resection syndrome score ≥21 and ileostomy closed at least 18 months earlier were included. INTERVENTIONS Patients were randomly assigned to receive either percutaneous tibial nerve stimulation plus medical treatment (arm A, n = 6) or medical treatment (arm B, n = 6). Low anterior resection syndrome was assessed using symptom severity and disease-specific quality-of-life scores at baseline, at the end of treatment, and at 1-year follow-up. MAIN OUTCOME MEASURES The primary outcome was a clinical response, defined as a reduction of the low anterior resection syndrome score. RESULTS Only in group A low anterior resection syndrome score, fecal incontinence severity index, and obstructed defecation syndrome score improved significantly with treatment (35.8 ± 2.5 vs 29.0 ± 3.8 (p = 0.03); 36.8 ± 4.3 vs 18.5 ± 8.0 (p = 0.02); 10.3 ± 3.9 vs 8.0 ± 4.9 (p = 0.009)) and changes were observed in all domains of quality-of-life instruments. In both groups the symptom severity and quality-of-life scores at 1-year follow-up did not differ significantly from those recorded at the end of treatment. LIMITATIONS The study had a small number of patients and it was underpowered to detect the within-group effect. CONCLUSIONS Percutaneous tibial nerve stimulation could be an effective treatment for low anterior resection syndrome. Additional studies are warranted to investigate clinical effectiveness in low anterior resection syndrome. See Video Abstract at http://links.lww.com/DCR/B371. ESTUDIO PILOTO ALEATORIO DE ESTIMULACIÓN PERCUTÁNEA DEL NERVIO TIBIAL POSTERIOR VERSUS TERAPIA MÉDICA PARA EL TRATAMIENTO DEL SÍNDROME DE RESECCIÓN ANTERIOR BAJA: UN AÑO DE SEGUIMIENTO: El síndrome de resección anterior baja se asocia con un deterioro significativo en la calidad de vida y su tratamiento médico generalmente es ineficaz.El objetivo del presente estudio fue establecer la eficacia de la estimulación percutánea del nervio tibial en el tratamiento de este síndrome.Este es un estudio piloto aleatorio con 1 año de seguimiento.El estudio se realizó en una unidad colorrectal especializada de un hospital terciario.Se incluyeron pacientes que se sometieron a quimiorradioterapia neoadyuvante y resección rectal anterior baja por cáncer con puntaje de síndrome de resección anterior baja ≥ 21 e ileostomía cerrada al menos 18 meses antes.Los pacientes fueron asignados aleatoriamente para recibir estimulación percutánea del nervio tibial + tratamiento médico (brazo A, n = 6) o tratamiento médico (brazo B, n = 6). El síndrome de resección anterior baja se evaluó utilizando puntajes de la gravedad de los síntomas y de calidad de vida específicos de la enfermedad al inicio, al final del tratamiento y al año de seguimiento.El resultado primario fue una respuesta clínica, definida como una reducción de la puntuación del síndrome de resección anterior baja.Solo en el grupo A, el puntaje del síndrome de resección anterior baja, el índice de severidad de incontinencia fecal y el puntaje del síndrome de defecación obstruida mejoraron significativamente con el tratamiento (35.8 ± 2.5 vs 29 ± 3.8, p = 0.03; 36.8 ± 4.3 vs 18.5 ± 8.0, p = 0.02; 10.3 ± 3.9 vs 8.0 ± 4.9, p = 0.009, respectivamente) y se observaron cambios en todos los dominios de los instrumentos de calidad de vida. En ambos grupos, los puntajes de severidad de los síntomas y de calidad de vida al año de seguimiento no difirieron significativamente de los registrados al final del tratamiento.El estudio tuvo un pequeño número de pacientes y no logró suficiente poder para detectar el efecto dentro de grupo.La estimulación percutánea del nervio tibial podría ser un tratamiento efectivo para el síndrome de resección anterior baja. Se requieren estudios adicionales para investigar la efectividad clínica en el síndrome de resección anterior baja. Consulte Video Resumen http://links.lww.com/DCR/B371.
Collapse
|
42
|
Musco S, Bazzocchi G, Martellucci J, Amato MP, Manassero A, Putignano D, Lopatriello S, Cafiero D, Paoloni F, Del Popolo G. Treatments in neurogenic bowel dysfunctions: evidence reviews and clinical recommendations in adults. Eur J Phys Rehabil Med 2020; 56:741-755. [PMID: 32935955 DOI: 10.23736/s1973-9087.20.06412-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Neurogenic bowel dysfunction (NBD) is an impairment of defecation control due to any nervous system lesion negatively affecting physical health status and quality of life. We aimed at systematically assessing all available evidence on NBD treatment in adults and providing clinical management guidance and recommendations. EVIDENCE ACQUISITION PICOs and questions (N.=7) were identified by an expert panel. We searched for and retrieved evidence from the PUBMED and EMBASE databases, limited to the English language and the Western countries context, related to any type of setting and published from 2009 to 2019. Health effects, patient values, preferences and resource use were assessed. Of all, only RCTs, observational studies and systematic reviews on adult population (≥18 years) were analyzed. The study was conducted according to PRISMA guidelines and Cochrane recommendations. The effect size, if possible, was calculated for the interpretation of the outcomes, and evidence was assessed through the GRADE method. EVIDENCE SYNTHESIS Thirty-one studies were included in our qualitative synthesis. Evidence is generally scarce. Most of the outcomes are narratively described and therefore defined by imprecision. Besides, most of the included studies are affected by risk of bias. Digital stimulation was found to be effective in short term follow-up. The pharmacological treatment choice, combined or alone, needs to be balanced case by case considering clinical history, setting of use and bowel management protocol. According to only one RCT supporting evidence mainly in persons affected by spinal cord injury (SCI), trans-anal irrigation (TAI) improves QoL and patient independency with a significant reduction of time spent for defecation and daily bowel program. History of urinary infections predicts the choice of using TAI. Patient-reported efficacy of colostomy alone or in combination with other surgeries appears evident in terms of patient's satisfaction and QoL over time. Nonetheless, perioperative and late complications can occur and may result in reduced acceptability over time. CONCLUSIONS Evidence is somehow weak and mainly reported in SCI. The systematic use of assistive interventions does not reduce the need of conservative or invasive approaches. Studies are needed on the role of bowel management in protecting patients from complications secondary to NBD in long term follow-ups.
Collapse
Affiliation(s)
- Stefania Musco
- SOD of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Gabriele Bazzocchi
- Technical and Scientific Committee, Montecatone Rehabilitation Institute S.p.A, Imola, Bologna, Italy
| | | | - Maria P Amato
- Department of Neurology, Careggi University Hospital, Florence, Italy
| | - Alberto Manassero
- Unit of Neuro-Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Die Leitlinie (AWMF-Register-Nr.: 179-004) „Neurogene Darmfunktionsstörung bei Querschnittlähmung“ der Deutschsprachigen Medizinischen Gesellschaft für Paraplegiologie ist an alle Personen adressiert, die Menschen mit kongenitalen oder erworbenen Querschnittlähmungen mit neurogenen Darmfunktionsstörungen (NDFS) betreuen. Insbesondere werden Ärzte, Pflegende und Therapeuten angesprochen. Die multiprofessionell erstellte Leitlinie (beteiligt waren Neuro-Urologen, Viszeralchirurgen, Gastroenterologen sowie Gesundheits- und Krankenpflegekräfte und Ernährungsberater sowie assoziierte Fachgesellschaften im Review-Verfahren) stellt eine praxisorientierte Unterstützung für die Versorgung von Patienten mit NDFS dar. Es werden Definitionen und aktuelles Wissen zur Diagnostik von NDFS sowie zu dem notwendigen konservativen Darmmanagement vermittelt, um eine kompetente Behandlung von Patienten mit NDFS zu gewährleisten. Dabei wird das Konzept der neurogenen Darmfunktionsstörung sowie deren klinische Auswirkungen beschrieben. Medikamentöse Interventionen und operative Eingriffe werden in Kurzform erläutert und Empfehlungen abgegeben. Das Hauptziel der vorliegenden Leitlinie besteht darin, Komplikationen inklusive der Stuhlinkontinenz und der Obstipation zu verhindern und so die Lebensqualität der Betroffenen positiv zu beeinflussen. Hilfreiche Anhänge, die im Alltag genutzt werden können, runden die Leitlinie ab.
Collapse
|
44
|
Negosanti L, Sgarzani R, Linguerri R, Vetrone G, Liotta S, Bazzocchi G, Balloni M. "Imola-Montecatone" subtotal colectomy to improve bowel management in spinal cord injury patients. Retrospective analysis in 19 cases. Spinal Cord Ser Cases 2020; 6:59. [PMID: 32636361 PMCID: PMC7341834 DOI: 10.1038/s41394-020-0311-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVES Persons with spinal cord injury live with neurogenic bowel dysfunction. Difficulties with management of neurogenic bowel can increase over time with age and time post injury, with a negative impact on autonomy and quality of life. Many conservative treatments are available to improve bowel management; however, in case of failure, a colostomy may be considered. SETTING Specialized Care Unit, Montecatone Rehabilitation Institute and General Surgery Division, Imola Hospital, Imola, Italy. METHODS From 2016 to 2019, selected patients affected by SCI and bowel dysfunction failing conservative care were treated with subtotal colectomy associated with placement of a bioabsorbable prosthesis, to prevent parastomal hernia. The surgical procedure is presented along with results. RESULTS Overall, 19 individuals underwent the described procedure; after 1 year of follow-up, we observed four minor complications: two cases of dehiscence of the abdominal incision, easily treated during hospital stay, and two cases of leakage of mucorrhoea. CONCLUSION Our results demonstrate the efficacy of the procedure to improve bowel management in persons with spinal cord injury.
Collapse
Affiliation(s)
| | | | | | | | - Sigrid Liotta
- Division of General Surgery, Imola Hospital, Imola, Italy
| | | | | |
Collapse
|
45
|
Use of a new transanal irrigation device for bowel disorder management by patients familiar with the irrigation technique: a prospective, interventional, multicenter pilot study. Tech Coloproctol 2020; 24:731-740. [PMID: 32318989 PMCID: PMC7297826 DOI: 10.1007/s10151-020-02212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/06/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of transanal irrigation (TAI) with a new medical device incorporating an electric pump, the IryPump®R Set. METHODS An interventional, prospective, open-label, non-comparative, multicenter pilot study on TAI was conducted at three French university hospitals. Patients with experience of TAI were enrolled for a 1-month period during which 5 consecutive TAIs were performed using the IryPump®R Set (B.Braun Melsungen AG Melsungen, Germany). The study's primary efficacy criterion was successful TAI, defined as (i) use of the patient's usual irrigation volume of water, (ii) stool evacuation, and (iii) the absence of leakage between TAIs. The first two TAIs were not taken into account in the main analysis. The secondary outcome measures were device acceptability, bowel dysfunction scores, tolerability, and safety. RESULTS Fifteen patients were included between November 2016 and May 2017, and 14 were assessed in the main analysis. The TAI success rate was 72.4% (21 out of 29 procedures). The bowel dysfunction scores at the end of the study did not differ significantly from those recorded on inclusion. A high proportion of patients (> 70%) reported that TAI was feasible with the new medical device. There were no serious adverse events or device-related adverse events. At the end of the study, 50% of the participants were willing to consider further use of the new device. CONCLUSIONS In patients familiar with TAI, using a new medical device incorporating an electric pump was feasible. Levels of patient satisfaction were high, especially with regard to comfort of use and a feeling of security during TAI.
Collapse
|
46
|
Yates A. Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:393-398. [PMID: 32279546 DOI: 10.12968/bjon.2020.29.7.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Historically, the use of colonic irrigation or transanal irrigation (TAI) has been viewed as an alternative therapy for the treatment of a wide variety of conditions not relating to bowel dysfunction, including nausea, fatigue, depression, headache, anxiety and rheumatism. However, these days it is viewed as an effective treatment in individuals who may present with bowel dysfunction and related symptoms of constipation and faecal incontinence. Such individuals would include people with neuropathic bowel disorders, conditions that affect sphincter control or bowel motility disorders. injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor, and chronic faecal incontinence. TAI may be performed by the person with bowel dysfunction, or by a carer or health professional. An individual's ability to use a device to undertake the procedure will be influenced by a range of factors, which are explored in this article.
Collapse
Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board, Cardiff
| |
Collapse
|
47
|
Serra J, Pohl D, Azpiroz F, Chiarioni G, Ducrotté P, Gourcerol G, Hungin APS, Layer P, Mendive JM, Pfeifer J, Rogler G, Scott SM, Simrén M, Whorwell P. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil 2020; 32:e13762. [PMID: 31756783 DOI: 10.1111/nmo.13762] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation. DESIGN After a thorough review of the literature by experts in relevant fields, including gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal motility testing from various European countries, a Delphi consensus process was used to produce statements and practical algorithms for the management of chronic constipation. KEY RESULTS Seventy-three final statements were agreed upon after the Delphi process. The level of evidence for most statements was low or very low. A high level of evidence was agreed only for anorectal manometry as a comprehensive evaluation of anorectal function and for treatment with osmotic laxatives, especially polyethylene glycol, the prokinetic drug prucalopride, secretagogues, such as linaclotide and lubiprostone and PAMORAs for the treatment of opioid-induced constipation. However, the level of agreement between the authors was good for most statements (80% or more of the authors). The greatest disagreement was related to the surgical management of constipation. CONCLUSIONS AND INFERENCES European guidelines on chronic constipation, with recommendations and algorithms, were developed by experts. Despite the high level of agreement between the different experts, the level of scientific evidence for most recommendations was low, highlighting the need for future research to increase the evidence and improve treatment outcomes in these patients.
Collapse
Affiliation(s)
- Jordi Serra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.,Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Badalona, Spain
| | - Daniel Pohl
- Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.,Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Fernando Azpiroz
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.,Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Giuseppe Chiarioni
- Division of Gastroenterology B, AOUI Verona, Verona, Italy.,UNC Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - Philippe Ducrotté
- Department of Gastroenterology, UMR INSERM 1073, Rouen University Hospital, Rouen, France
| | - Guillaume Gourcerol
- Department of Physiology, UMR INSERM 1073 & CIC INSERM 1404, Rouen University Hospital, Rouen, France
| | - A Pali S Hungin
- General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Peter Layer
- Department of Medicine, Israelitic Hospital, Hamburg, Germany
| | - Juan-Manuel Mendive
- Sant Adrià de Besòs (Barcelona) Catalan Institut of Health (ICS), La Mina Primary Health Care Centre, Badalona, Spain
| | - Johann Pfeifer
- Department of Surgery, Division of General Surgery, Medical University of Graz, Graz, Austria
| | - Gerhard Rogler
- Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.,Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - S Mark Scott
- Neurogastroenterology Group, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts, UK.,The London School of Medicine & Dentistry, Queen Mary University London, London, UK
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Whorwell
- Division of Diabetes, Endocrinology & Gastroenterology, Neurogastroenterology Unit, Wythenshawe Hospital, University of Manchester, Manchester, UK
| | | |
Collapse
|
48
|
Emmanuel A, Krogh K, Kirshblum S, Christensen P, Spinelli M, van Kuppevelt D, Abel R, Leder D, Santacruz BG, Bain K, Passananti V. Creation and validation of a new tool for the monitoring efficacy of neurogenic bowel dysfunction treatment on response: the MENTOR tool. Spinal Cord 2020; 58:795-802. [PMID: 31988365 PMCID: PMC7340621 DOI: 10.1038/s41393-020-0424-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVES A tool to help decision-making tool for Neurogenic Bowel Dysfunction (NBD) in individuals with SCI is needed. We present a project to create and validate a new tool, the Monitoring Efficacy of NBD Treatment On Response (MENTOR), and to determine its level of concordance with decisions made by experienced clinicians in the field. SETTING UK, Denmark, USA, Italy, The Netherlands, Germany. METHODS The first phase was creation of the tool through a modified Delphi process. The second phase was the validation, wherein individuals with spinal cord injury with NBD were asked to complete the MENTOR tool immediately prior to clinic consultation. From the responses to the questionnaire of the tool, each participant was allocated into one of three categories reflecting the possible therapeutic recommendations ("recommend change", "further discussion" and "monitoring"). An expert clinician then assessed the participant, blinded to MENTOR results, and made an independent treatment decision. RESULTS A total of 248 MENTOR forms were completed. Strong agreement was found when the MENTOR tool recommended monitoring (92%) or treatment change (83%); the lowest concordance when the decision was for the "further discussion" option (59%). Patient acceptability was reported by 97% of individuals. CONCLUSIONS MENTOR is an easy to use tool to monitor the treatment of NBD and determinate progression through the clinical pathway. This validation study shows good correspondence between expert clinician opinion and MENTOR result. The tool has potential to be used in other patient groups, following further studies.
Collapse
Affiliation(s)
- Anton Emmanuel
- GI Physiology Unit, University College Hospital, London, UK.
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, New Jersey, USA
| | | | | | | | - Rainer Abel
- Department of Orthopedic Surgery, Kinikum Bayreuth, Bayreuth, Germany
| | - Dietrich Leder
- Department Of Proctology and Endoscopy, Viszera Chirugie Zentrum, Munich, Germany
| | | | - Kimberly Bain
- Certified Facilitator, BaingGroup Consulting, Ontario, Canada
| | | |
Collapse
|
49
|
Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020; 17:21-39. [PMID: 31690829 DOI: 10.1038/s41575-019-0222-y] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.
Collapse
Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Michael Camilleri
- C.E.N.T.E.R. Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
50
|
Abstract
The symptoms of neurogenic bowel dysfunction (NBD) comprise constipation and fecal incontinence. These have a major impact on quality of life and dignity. Bowel symptoms occur in the majority of patients with chronic neurological diseases like multiple sclerosis, spinal cord injury, and Parkinson’s disease. Management relies on obtaining a careful bowel history, including assessment of bowel function prior to the onset of neurological symptoms. Objective measures of NBD are available and important in terms of monitoring response for what are often intensely personal and difficult-to-elicit symptoms. Conservative management begins by establishing an effective and regular bowel regime by optimizing diet and laxative use. If this is insufficient, as seen in about half of patients, transanal irrigation has been shown to reduce NBD symptoms and improve quality of life. Failing that, there are more invasive surgical options available. This review aims to provide practical guidance for the clinician who encounters these patients, focusing on a stepwise approach to assessment, interventions, and monitoring.
Collapse
Affiliation(s)
- Anton Emmanuel
- GI Physiology Unit, University College London Hospital, Euston Road, London, WC1E 6DB, UK
| |
Collapse
|