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Wang M, Zhou W, Liu Y, Yu H. Experimental evaluation of an artificial anal sphincter based on biomechanical compatibility. Artif Organs 2024. [PMID: 39275859 DOI: 10.1111/aor.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND The artificial anal sphincter is a device used to treat patients with fecal incontinence who are unable to control their bowel movements on their own. Long-term morphological changes in the tissue surrounding the artificial anal sphincter can cause biomechanical compatibility problems, which seriously affect the clinical application of the artificial anal sphincter. METHODS In this paper, the superelasticity of shape memory alloys was utilized to design and fabricate a biomechanically compatible constant force clamping artificial anal sphincter. An in vitro simulation system was constructed to verify the effectiveness, safety, and constant force characteristics of the artificial anal sphincter. RESULTS The experimental results demonstrated that the artificial anal sphincter could be effectively closed with no leakage of the liquid-like intestinal contents, which are most likely to leak. The pressure of the artificial anal sphincter on the intestinal tube gradually increased and eventually became constant during closure, and the pressure value was always less than the intestinal blood supply pressure threshold. CONCLUSIONS In this paper, we designed an artificial anal sphincter based on biomechanical compatibility and the corresponding in vitro simulation experimental program and preliminarily verified the effectiveness, safety, and constant force characteristics of the artificial anal sphincter.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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Gielen AHC. Guideline for the assessment and management of gastrointestinal symptoms following colorectal surgery-A UEG/ESCP/EAES/ESPCG/ESPEN/ESNM/ESSO collaboration. Part II-Good practice guidance | sequelae to benign diseases. United European Gastroenterol J 2024. [PMID: 39276317 DOI: 10.1002/ueg2.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2024] Open
Affiliation(s)
- Anke H C Gielen
- Department of Surgery, Maastricht University (Maastricht University, including Maastricht UMC+), Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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Wespi N, Vavricka S, Brand S, Aepli P, Burri E, Misselwitz B, Seibold F, Hruz P, Peyrin-Biroulet L, Schoepfer A, Biedermann L, Sokollik C, Rogler G, Greuter T. Fecal urgency and incontinence in inflammatory bowel disease perceived by physician and patient: Results from the Swiss fecal urgency survey. United European Gastroenterol J 2024. [PMID: 39246002 DOI: 10.1002/ueg2.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024] Open
Abstract
INTRODUCTION Although increasingly appreciated, little is known about the prevalence of fecal urgency, fecal incontinence and differences between patients' and physicians' perception in inflammatory bowel disease (IBD). METHODS We performed an online patient and physician survey to evaluate the assessment, prevalence and impact of fecal urgency and incontinence in IBD. RESULTS A total of 593 patients (44.0% ulcerative colitis (UC), 53.5% Crohn's disease (CD), 2.2% indeterminate colitis, 2 not specified) completed the survey (65.8% females, mean age 47.1 years). Fecal urgency was often reported (UC: 98.5%, CD: 96.2%) and was prevalent even during remission (UC: 65.9%, CD: 68.5%). Fecal urgency considerably impacted daily activities (visual analog scale [VAS] 5, IQR 3-8). Yet, 22.8% of patients have never discussed fecal urgency with their physicians. Fecal incontinence was experienced by 44.7% of patients and 7.9% on a weekly basis. Diapers/pads were required at least once a month in 20.4% of patients. However, 29.7% of patients never talked with their physician about fecal incontinence. UC was an independent predictor for the presence of moderate-severe fecal urgency (OR 1.65, 95% CI 1.13-2.41) and fecal incontinence (OR 1.77, 95% CI 1.22-2.59). All physicians claimed to regularly inquire about fecal urgency and incontinence. However, the impact of these symptoms on daily activities was overestimated compared with the patient feedback (median VAS 8 vs. 5, p = 0.0113, and 9 vs. 5, p = 0.0187). CONCLUSIONS Fecal urgency and incontinence are burdensome symptoms in IBD, with a similar prevalence in UC and CD. A mismatch was found between the physician and patient perception. These symptoms should be addressed during outpatient visits.
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Affiliation(s)
- Nadia Wespi
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Brand
- Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Patrick Aepli
- Division of Gastroenterology and Hepatology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Emanuel Burri
- Division of Gastroenterology and Hepatology, University Medical Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Petr Hruz
- Division of Gastroenterology and Hepatology, Clarunis, University Hospital Basel, Basel, Switzerland
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, INFINY Institute, FHU-CURE, INSERM NGERE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD Center, Neuilly-sur-Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, CHUV University Hospital Lausanne and University of Lausanne UNIL, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christiane Sokollik
- Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Division of Gastroenterology and Hepatology, CHUV University Hospital Lausanne and University of Lausanne UNIL, Lausanne, Switzerland
- Division of Gastroenterology and Hepatology, GZO-Zurich Regional Health Center, Wetzikon, Switzerland
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Wu Q, Li T, Deng F, Yao X, Chen X, Jiang Q, Ding X. Assessing anorectal function in patients with recurrent ulcerative colitis. Int J Colorectal Dis 2024; 39:110. [PMID: 39009899 PMCID: PMC11249410 DOI: 10.1007/s00384-024-04680-1] [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] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Ulcerative colitis (UC) is an inflammatory bowel disease with an unclear etiology that can lead to irreversible changes in distal colonic function in chronic patients. This study investigated anorectal function in recurrent UC patients and identified influencing factors. METHODS This prospective study enrolled 33 recurrent UC patients and 40 newly diagnosed patients from January 2019 to December 2022. Data collection included clinical records, scores, and anorectal function assessments. Regression analyses were used to identify factors impacting anorectal function. RESULTS Recurrent UC patients had higher baseline CRP and fecal calprotectin levels, increased anxiety and depression, and more severe fecal incontinence. They also had lower BMIs, serum Hb and albumin (ALB) levels, and Inflammatory Bowel Disease Questionnaire scores than did initial-onset UC patients. Multivariate linear regression analysis revealed that long disease duration (coef. - 0.376, P < 0.001) and high fecal calprotectin level (coef. - 0.656, P < 0.001) independently influenced the initial sensation threshold in recurrent UC patients. Additionally, high fecal calprotectin (coef. - 0.073, P = 0.013) and high Zung Self-Rating Anxiety Scale score (coef. - 0.489, P = 0.001) were identified as two independent determinants of the defecation volume threshold. For the defecation urgency threshold, the independent factors included high disease duration (coef. - 0.358, P = 0.017) and high fecal calprotectin level (coef. - 0.499, P = 0.001). Similarly, the sole independent factor identified for the maximum capacity threshold was high fecal calprotectin (coef. - 0.691, P = 0.001). CONCLUSION Recurrent UC patients had increased rectal sensitivity and compromised anorectal function, which significantly impacted quality of life. Proactively managing the disease, reducing UC relapses, and addressing anxiety are effective measures for improving anorectal function in these patients.
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Affiliation(s)
- Qiaoyan Wu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Tongyu Li
- Department of Hematology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Fenglian Deng
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Xuejie Yao
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Xueqin Chen
- Hospital Quality Management Office, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Qi Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
| | - Xiaoyun Ding
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
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Ilsar T, Liebergall-Wischnitzer M, Solnica A, Zusman N, Rottenstreich M, Katz L. Prevalence of faecal incontinence in patients with inflammatory bowel disease: Severity and its relationship with quality of life. J Adv Nurs 2024. [PMID: 38877678 DOI: 10.1111/jan.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/06/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
AIMS To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method. DESIGN Correlational-descriptive study. METHODS Hebrew-speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale. RESULTS Ninety-six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty-five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self-perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self-embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group. CONCLUSION A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse. IMPACT There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Tal Ilsar
- Gastro-Intestinal Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Liebergall-Wischnitzer
- Henrietta Szold School of Nursing, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amy Solnica
- Henrietta Szold School of Nursing, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nurit Zusman
- Henrietta Szold School of Nursing, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe Rottenstreich
- Gastro-Intestinal Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lior Katz
- Gastro-Intestinal Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Simpson AN, Sutradhar R, Benchimol EI, Chan WC, Porter J, Moore S, Dossa F, Huang V, Maxwell C, Targownik L, Liu N, Baxter NN. Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102463. [PMID: 38631434 DOI: 10.1016/j.jogc.2024.102463] [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: 10/21/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. METHODS Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. RESULTS We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20-1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03; 95% CI 1-1.07). CONCLUSIONS The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Joan Porter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Sarah Moore
- Department of Surgery, MacKenzie Health, Vaughan, ON
| | - Fahima Dossa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian Huang
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Laura Targownik
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Rebmann E, Hamel JF, Helbert C, Lemasson F, Legendre G, Venara A. Anal incontinence after obstetrical anal sphincter injury significantly impacts quality of life for women: a cohort study. Langenbecks Arch Surg 2024; 409:67. [PMID: 38368278 DOI: 10.1007/s00423-024-03257-4] [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: 12/06/2023] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE To assess the prevalence of anal incontinence (AI) after obstetrical anal sphincter injuries (OASIS) and its severity, as well as the risk factors for AI and AI episodes ≥ 6 months. METHODS This prospective and observational monocentric cohort study included all the women who had an OASIS between 1 January 2005 and 31 December 2019. Information was collected by using a letter informing for the fecal incontinence quality of life (FIQL) questionnaire and by a phone interview. The main outcome measure was "1 passed or ongoing episode of AI". RESULTS Among the 227 patients included, 19.8% had ongoing AI, and 35.2% had AI passed or ongoing episodes. A total of 46.7% of women with AI reported a change in their quality of life in all fields of the FIQL. Excluding a history of inflammatory bowel disease, no factor was associated with the incidence of an AI episode. Post-obstetrical AI ≥ 6 months (POAI ≥ 6) represented 63.7% of AI cases. This incontinence began with significant incidence in the immediate postpartum period but increased over time, unlike AI < 6 months, which appeared primarily in the immediate postpartum period. Instrumental birth was a protective factor for POAI ≥ 6 (OR = 0.24; CI 95% [0.08-0.78]; p = 0.016), while an increase in parity and BMI were risk factors for POAI ≥ 6 (OR = 4.21; CI 95% [1.01-17.71]; p = 0.05 and OR = 1.15; CI 95% [1.03-1.30]; p = 0.016, respectively). CONCLUSION The prevalence of AI after OASIS is not underestimated. Despite the fact that women do not seek care, the impact of AI on the quality of life is significant. A case of AI that lasts for 6 months after giving birth risks becoming chronic. Therefore, specialist advice should be recommended in this case. CLINICAL TRIAL REGISTRY NCT04940494.
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Affiliation(s)
- Emeline Rebmann
- Faculty of Health, Angers, France
- Department of Visceral Surgery, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 09, France
| | - Jean-Francois Hamel
- Faculty of Health, Angers, France
- Department of Biostatistics, CHU Angers, Angers, France
- Ester | Irset Inserm UMR 1085, Angers, France
| | | | | | - Guillaume Legendre
- Faculty of Health, Angers, France
- Department of Gynaecology-Obstetrics, CHU Angers, 4 Rue Larrey, Angers, France
| | - Aurélien Venara
- Faculty of Health, Angers, France.
- Department of Visceral Surgery, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 09, France.
- Department of Gynaecology-Obstetrics, CHU Angers, 4 Rue Larrey, Angers, France.
- IHFIH, UPRES EA 3859, University of Angers, Angers, France.
- The Enteric Nervous System in Gut and Brain Disorders, Université de Nantes, INSERM, TENS, IMAD, Nantes, France.
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Ha C, Naegeli AN, Lukanova R, Shan M, Wild R, Hennessy F, Jyothi Kommoju U, Potts Bleakman A, Hunter Gibble T. Rectal Urgency Among Patients With Ulcerative Colitis or Crohn's Disease: Analyses from a Global Survey. CROHN'S & COLITIS 360 2023; 5:otad052. [PMID: 37928613 PMCID: PMC10622170 DOI: 10.1093/crocol/otad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background Rectal urgency is a common but under-reported inflammatory bowel disease (IBD) symptom. The present study assessed the prevalence of rectal urgency and its association with disease activity and patient-reported outcomes (PROs) among patients with ulcerative colitis (UC) or Crohn's disease (CD) in a real-world setting. Methods Data were drawn from the 2017-2018 Adelphi IBD Disease Specific Programme™, a multi-center, point-in-time survey of gastroenterologists and consulting adult patients with UC or CD in France, Germany, Italy, Spain, the United Kingdom, and the United States. Gastroenterologists completed patient record forms and patients completed self-reported forms. Analyses were conducted separately for patients with UC or CD. Patient demographics, clinical characteristics, disease activity, symptoms, and PROs were compared between patients with and without rectal urgency. Results In total, 1057 patients with UC and 1228 patients with CD were included. Rectal urgency was reported in 20.2% of patients with UC and 16.4% with CD. Patients with rectal urgency were more likely to have moderate or severe disease (UC or CD: P < .0001), higher mean Mayo score (UC: P < .0001), higher mean Crohn's Disease Activity Index score (CD: P < .0001), lower Short IBD Questionnaire scores (UC or CD: P < .0001), and higher work impairment (UC: P < .0001; CD: P = .0001) than patients without rectal urgency. Conclusions Rectal urgency is a common symptom associated with high disease activity, decreased work productivity, and worse quality of life. Further studies are needed to include rectal urgency assessment in routine clinical practice to better gauge disease activity in patients with UC or CD.
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Affiliation(s)
- Christina Ha
- The F. Widjaja Foundation Inflammatory Bowel Immunology Research Institute at Cedars-Sinai, Los Angeles, CA, USA
| | | | | | | | - Rosie Wild
- Adelphi Real World, Bollington, Cheshire, UK
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9
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Young S, Lee B, Smukalla S, Axelrad J, Chang S. Anorectal Manometry in Patients With Fecal Incontinence After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Cohort Study. CROHN'S & COLITIS 360 2023; 5:otad063. [PMID: 38077748 PMCID: PMC10708921 DOI: 10.1093/crocol/otad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 02/12/2024] Open
Abstract
Background Fecal incontinence commonly occurs in patients with ulcerative colitis and ileal pouch-anal anastomosis. There is a paucity of manometric data in pouch patients. We aimed to better define manometric parameters in pouch patients with fecal incontinence. Methods We compared clinical and manometric variables in ulcerative colitis patients with pouch and fecal incontinence to ulcerative colitis patients with pouch without fecal incontinence and to non-ulcerative colitis patients with fecal incontinence. Manometric data for the 3 cohorts were compared to established normative data. An independent-samples t-test was performed for continuous variables, and chi-square test was used for categorical variables. Logistic regression was performed to identify predictors of incontinence in pouch patients (P < .05). Results Among 26 pouch patients with fecal incontinence (73% female), 26 pouch patients without fecal incontinence (35% female), and 84 patients with fecal incontinence without ulcerative colitis (68% female), there were no differences in anorectal pressures between patients with fecal incontinence. Lower pressures were observed in pouch patients with fecal incontinence compared to those without fecal incontinence. Resting pressure was similar between pouch patients with fecal incontinence and healthy controls (60.9 ± 36.1 mmHg vs. 66.9 ± 3.2 mmHg, P = .40). Female sex (P = .019) and defecatory disorders (P = .033) each independently predicted fecal incontinence in pouch patients. Conclusions Pouch patients with fecal incontinence have lower anorectal pressures compared to pouch patients without incontinence, though have similar pressures to non-ulcerative colitis patients with fecal incontinence. Pouch patients with fecal incontinence have similar resting pressures as healthy controls. Distinct manometric normative values for pouch patients are needed.
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Affiliation(s)
- Sigrid Young
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Briton Lee
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Scott Smukalla
- Division of Gastroenterology, NYU Langone Health, New York, NY, USA
| | - Jordan Axelrad
- Division of Gastroenterology, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
| | - Shannon Chang
- Division of Gastroenterology, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
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de Codes LMG, de Jesus ACC, de Codes JJG, Ferreira RF, da Silva Beda Sacramento C, da Cruz IDM, de Castro Ribeiro Fidelis F, de Carvalho AL, Motta MP, de Oliveira Alves C, Netto EM, Santana GO. Anorectal Function and Clinical Characteristics Associated with Faecal Incontinence in Patients with Crohn's Disease. J Crohns Colitis 2023; 17:1252-1261. [PMID: 36951290 DOI: 10.1093/ecco-jcc/jjad048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND AIMS Faecal incontinence is an important complaint reported by patients with Crohn's disease [CD] and it is associated with several disease-related mechanisms, including anorectal functional disorders. This study aimed to assess the anorectal function and clinical characteristics to identify parameters associated with faecal incontinence in CD patients. METHODS This is a cross-sectional study of 104 patients with CD, aged 18 years or older, from a referral centre between August 2019 and May 2021. Patients responded to a specific questionnaire, and underwent medical record review, proctological examination and anorectal functional assessment with anorectal manometry. RESULTS Of the 104 patients, 49% were incontinent. Patients with incontinence had a lower mean resting pressure [43.5 vs 53.1 mmHg; p = 0.038], lower mean squeeze pressure [62.1 vs 94.1 mmHg; p = 0.036] and lower maximum rectal capacity [140 vs 180 mL; p < 0.001]. Faecal incontinence was also associated with disease activity [p < 0.001], loose stools [p = 0.02], perianal disease [p = 0.006], previous anoperineal surgery [p = 0.048] and number of anorectal surgeries [p = 0.036]. CONCLUSIONS This is the largest reported study describing manometric findings of Crohn's disease patients with and without faecal incontinence. Our results identified an association between faecal incontinence and functional disorders, in addition to clinical features in these patients. Functional assessment with anorectal manometry may help choose the best treatment for faecal incontinence in patients with CD.
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Affiliation(s)
- Lina Maria Góes de Codes
- Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil; Department of Surgery, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
| | | | | | | | | | | | | | | | - Marina Pamponet Motta
- Department of Gastroenterology, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
| | | | - Eduardo Martins Netto
- Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil
| | - Genoile Oliveira Santana
- Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil; Department of Life Sciences, Universidade do Estado da Bahia, Salvador, Brazil
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Dibley L, Hart A, Duncan J, Knowles CH, Kerry S, Lanz D, Berdunov V, Madurasinghe VW, Wade T, Terry H, Verjee A, Fader M, Norton C. Supported Intervention Versus Intervention Alone for Management of Fecal Incontinence in Patients With Inflammatory Bowel Disease: A Multicenter Mixed-Methods Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2023; 50:235-244. [PMID: 37146115 DOI: 10.1097/won.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The aims of this study were to test a noninvasive self-management intervention supported by specialist nurses versus intervention alone in patients with inflammatory bowel disease (IBD) experiencing fecal incontinence and to conduct a qualitative evaluation of the trial. DESIGN Multicenter, parallel-group, open-label, mixed-methods randomized controlled trial (RCT). SUBJECTS AND SETTING The sample comprised patients from a preceding case-finding study who reported fecal incontinence and met study requirements; the RCT was delivered via IBD outpatient clinics in 6 hospitals (5 in major UK cities, 1 rural) between September 2015 and August 2017. Sixteen participants and 11 staff members were interviewed for qualitative evaluation. METHODS Adults with IBD completed the study activities over a 3-month period following randomization. Each participant received either four 30-minute structured sessions with an IBD clinical nurse specialist and a self-management booklet or the booklet alone. Low retention numbers precluded statistical analysis; individual face-to-face or telephone interviews, recorded digitally and transcribed professionally, were conducted to evaluate the RCT. Transcripts were analyzed thematically using an inductive method. RESULTS Sixty-seven participants (36%) of the targeted 186 participants were recruited. The groups comprised 32 participants (17% of targeted participants) allocated to the nurse + booklet intervention and 35 (18.8% of targeted participants) allocated to the booklet alone. Less than one-third (n = 21, 31.3%) completed the study. Given the low recruitment and high attrition, statistical analysis of quantitative data was considered futile. Participant interviews were conducted concerning study participation and 4 themes emerged that described experiences of patients and staff. These data provided insights into reasons for low recruitment and high attrition, as well as challenges of delivering resource-heavy studies in busy health service environments. CONCLUSIONS Alternative approaches to trials of nurse-led interventions in hospital settings are needed as many interfering factors may prevent successful completion.
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Affiliation(s)
- Lesley Dibley
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Ailsa Hart
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Julie Duncan
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Charles H Knowles
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Sally Kerry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Doris Lanz
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vladislav Berdunov
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vichithranie W Madurasinghe
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Tiffany Wade
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Helen Terry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Azmina Verjee
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Mandy Fader
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Christine Norton
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
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Glynn H, Knowles SR. A Phenomenological Investigation of Trauma in 18 Adults Living With Inflammatory Bowel Disease. Clin Nurs Res 2023; 32:159-170. [PMID: 35156407 DOI: 10.1177/10547738221075649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While trauma is recognized as being common in Inflammatory Bowel Disease (IBD) cohorts, limited research has explored how trauma impacts the lived experience of IBD. The aim of this study was to develop an understanding of how trauma impacts the experience of living with IBD and its subsequent management. An interpretative phenomenological analysis with thematic analysis was conducted. Eighteen adults with IBD participated in this qualitative research study. Key themes identified included: (1) Trauma was associated with the journey of IBD; (2) the impact of IBD and trauma, and (3) coping strategies. Pre-existing non-IBD trauma was prevalent, with several participants reporting links between traumatic events and their IBD diagnosis. Experiences of IBD trauma were described by participants across all stages of their illness journey. The study can assist healthcare professionals to better understand the experience of living with IBD and trauma and the factors that can contribute to traumatic responses.
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Affiliation(s)
- Heidi Glynn
- Swinburne University of Technology, Melbourne, Australia
| | - Simon R Knowles
- Swinburne University of Technology, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Australia
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13
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Kurt S, Caron B, Gouynou C, Netter P, Vaizey CJ, Wexner SD, Danese S, Baumann C, Peyrin-Biroulet L. Faecal incontinence in inflammatory bowel disease: The Nancy experience. Dig Liver Dis 2022; 54:1195-1201. [PMID: 35123908 DOI: 10.1016/j.dld.2022.01.125] [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: 10/03/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Faecal incontinence (FI) is a disabling condition in patients with inflammatory bowel disease (IBD). The diagnosis of FI is not easy as patients are reluctant to report this embarrassing symptom. The objectives of this study were to characterize the prevalence of FI in IBD patients using available scoring systems, and to identify associated risk factors. METHODS A FI clinic was implemented in routine practice between January 2020 and April 2021. FI was defined as a Wexner score ≥5. Factors associated with FI were analyzed. RESULTS A total of 319 consecutive patients with IBD were included. The prevalence of FI was 16.4% (53/319). Age >45 years at inclusion (Odd ratio (OR)=3.33, Confidence interval (CI) 95% 1.40-7.94), diarrhea (three stools at least per day) (OR=2.94, CI 95% 1.16-7.45), stool consistency according to the Bristol stool chart (OR=2.23, CI 95% 1.00-4.99), and abdominal pain (OR=2.24, CI 95% 1.10-4.53) were independently associated with FI in a multivariate model analysis. CONCLUSIONS Approximately one fifth of IBD patients reported FI in this real-world cohort, using an available scoring system. Increased age, diarrhea, stool consistency according to the Bristol stool chart, and abdominal pain were associated with FI. A systematic screening of FI would allow a better management of this disabling condition.
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Affiliation(s)
- Simon Kurt
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France
| | - Bénédicte Caron
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France; Nancy University Hospital, DRCI, F-54000 Nancy, France
| | - Celia Gouynou
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Carolynne J Vaizey
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France; Department of Surgery, St Mark's Hospital and Academic Institute, London, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States
| | - Silvio Danese
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States; Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele Milano Italy
| | - Cédric Baumann
- Unit of methodology, data management and statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France; University of Lorraine, Inserm, NGERE, F-54000 Nancy, France.
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14
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Bharucha AE, Knowles CH, Mack I, Malcolm A, Oblizajek N, Rao S, Scott SM, Shin A, Enck P. Faecal incontinence in adults. Nat Rev Dis Primers 2022; 8:53. [PMID: 35948559 DOI: 10.1038/s41572-022-00381-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Charles H Knowles
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Isabelle Mack
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany
| | - Allison Malcolm
- Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Satish Rao
- Department of Gastroenterology, University of Georgia, Augusta, GA, USA
| | - S Mark Scott
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Paul Enck
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany.
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15
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Experiences and impact of living with incontinence associated stigma: A protocol for a systematic review and narrative synthesis of qualitative studies. PLoS One 2022; 17:e0270885. [PMID: 35802573 PMCID: PMC9269749 DOI: 10.1371/journal.pone.0270885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Incontinence is global health and social issue, with urinary incontinence alone affecting over 400 million people. Incontinence can lead to physical harms such as skin damage, but it also commonly causes social and psychological harms, including those associated with stigma. For many people, treatment to cure incontinence does not work or is not suitable and they live with the long-term consequences of incontinence. At the moment, no stigma reduction interventions (increasingly used with other conditions such as mental health problems and HIV) have been developed for people living with incontinence. As a starting point for developing such an intervention, this review will address the questions 1) What are the incontinence (urinary or faecal) associated experiences of stigma of people living with incontinence? 2) What is the impact of incontinence associated stigma on their lives? Methods The reviewers will search Embase, Medline, PsychINFO and the Cumulative Index to Nursing and Allied Health Literature using controlled vocabulary and relevant search terms. Articles assessed to meet inclusion criteria will be included. Once duplicates have been removed, titles and abstracts will be screened and full texts of selected research articles will be reviewed. An adapted Joanna Briggs Institute Data Extraction Form will be used to collect the data and quality will be assessed using the Joanna Briggs Institute checklist for qualitative research appraisal tool. A framework approach (using the Revised Framework for Understanding Non-communicable Disease Related Stigma) will be used to organise, integrate, interpret and summarise findings from included articles. The review will be reported in accordance with the Enhancing Transparency in reporting the synthesis of qualitative research statement. Prospero registration number CRD42021259065. Discussion The systematic review described in this protocol will provide the first in-depth, comprehensive understanding of people’s experiences of the stigma associated with incontinence and the impact that it has on their lives. It will identify broader influences of contextual variables such as age, sex, cause and type of incontinence, socio-economic culture and geographical location. The review aims to provide insights to support the development of incontinence associated stigma reduction interventions.
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16
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Khera AJ, Chase JW, Stillman BC, Salzberg M, Thompson AJV, Basnayake C, Wilson-O'Brien A, Kamm MA. Pelvic floor behavioral treatment for fecal incontinence and constipation in quiescent inflammatory bowel disease. Scand J Gastroenterol 2022; 57:807-813. [PMID: 35188055 DOI: 10.1080/00365521.2022.2039280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Refractory bowel symptoms in quiescent inflammatory bowel disease (IBD) are common but evidence for effective management is limited. We aimed to determine whether behavioral treatment, including pelvic floor muscle training, decreases the severity of functional bowel symptoms in patients with quiescent IBD. Secondary aims were to evaluate the treatment effect on quality of life, psychological well-being and pelvic floor muscle function. METHODS This prospective study included IBD patients in remission with persistent symptoms of fecal incontinence or constipation who received up to six sessions of behavioral treatment at monthly intervals. The primary outcome was patient-rated symptom improvement on a 7-point Likert scale (1 = substantially worse, 7 = substantially better). Secondary outcomes included validated symptom scores, quality-of-life, psychological measures, and transperineal ultrasound assessment of pelvic floor muscle activity. RESULTS Thirty-four patients (median age 38 years; 24 females; 18 ulcerative colitis, 13 Crohn's disease, 3 ileo-anal pouch) were included. Twenty-one of the 29 (72%) patients who completed treatment, or 21 of all 34 (62%) patients, reported moderate or substantial improvement (patient rating of 6 or 7). Symptom scores (p < .001), IBD-specific quality of life (p = .008) and illness perception scores (p = .003) significantly improved. General quality of life, and anxiety and depression scores, did not change significantly. Transperineal ultrasound pelvic floor measures did not correlate with patient-rating of symptom improvement. CONCLUSION Significant symptomatic improvement occurred in a majority of patients with quiescent IBD. Behavioral treatment should be considered for patients with quiescent IBD and ongoing functional bowel symptoms of fecal incontinence, fecal urgency, or constipation.
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Affiliation(s)
- Angela J Khera
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Janet W Chase
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Barry C Stillman
- School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Michael Salzberg
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Alexander J V Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Amy Wilson-O'Brien
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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17
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Le Berre C, Ricciuto A, Peyrin-Biroulet L, Turner D. Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last. Gastroenterology 2022; 162:1424-1438. [PMID: 34995529 DOI: 10.1053/j.gastro.2021.09.076] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022]
Abstract
Short- and long-term treatment targets in inflammatory bowel diseases (IBDs) evolved during the last decade, shifting from symptom control to endoscopic healing and patient-centered parameters. The STRIDE-II consensus placed these targets on a timeline from initiating treatment and introduced additional targets, normalization of serum and fecal biomarkers, restoration of quality of life, prevention of disability, and, in children, restoration of growth. Transmural healing in Crohn's disease and histologic healing in ulcerative colitis currently serve as adjunct measures to gauge remission depth. However, whether early treatment according to a treat-to-target paradigm affects the natural course of IBD remains unclear, leading to the need for prospective disease-modification trials. The SPIRIT consensus defined the targets for these trials to assess the long-term impact of early treatment on quality of life, disability, disease complications, risk of neoplastic lesions, and mortality. As further data emerge about the risk-benefit balance of aiming toward deeper healing, the targets in treating IBDs may continue to shift.
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Affiliation(s)
- Catherine Le Berre
- Department of Gastroenterology and Inserm TENS U1235, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France, and University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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18
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Inflammatory bowel diseases and the risk of adverse health outcomes: Umbrella review of meta-analyses of observational studies. Dig Liver Dis 2021; 53:809-816. [PMID: 33551353 DOI: 10.1016/j.dld.2021.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Accumulating evidence indicates a plausible association between inflammatory bowel diseases and the risk of adverse health outcomes. However, the conclusions are inconsistent. We aimed to perform an umbrella review of meta-analyses to appraise and grade the evidence of the association between inflammatory bowel diseases and the risk of adverse health outcomes. METHODS Meta-analyses of observational studies that examined the associations between inflammatory bowel disease and the risk of adverse health outcomes in PubMed, EMBASE, and Web of Science were screened. RESULTS This umbrella review identified 25 meta-analyses, which yielded 123 effect estimates for 60 unique putative health outcomes. Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes, including multiple cancers, cardiovascular disease, adverse pregnancy outcomes, adverse oral outcomes, and other adverse events. Moreover, inflammatory bowel diseases caused greater harm to health based on the presented evidence. However, none of the evidence was classified as "high" quality, only 15% was classified as "moderate," and 65% of outcomes were rated as "very low." CONCLUSION Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes and further studies should be conducted to draw firmer conclusions.
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19
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Clinician Administered and Self-Report Survey Both Effective for Identifying Fecal Incontinence in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:2024-2031. [PMID: 32564207 DOI: 10.1007/s10620-020-06418-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To test two methods for reporting of fecal incontinence (FI) in people with inflammatory bowel disease. METHODS Consecutive patients from IBD clinics in six UK hospitals completed a short three-item case-finding survey about FI; they either completed the survey themselves or were asked the same questions face to face by a clinician. RESULTS Of 1336 eligible patients with complete data (48% male; mean 43 years; 55% Crohn's disease, 41% ulcerative colitis), 772 were asked about FI face to face, and 564 self-completed the survey: FI was reported in 63% and 56%, respectively (p = 0.012). In regression analyses, those aged 51-60, having Crohn's disease and higher disease activity, were more likely to report FI. Of all respondents, 38.7% were interested in receiving help for their incontinence. CONCLUSIONS Fecal incontinence affects the majority of people with IBD. Although more patients reported fecal incontinence when asked face to face than self-reported, routine screening by either method in clinical practice is recommended. Over one-third of patients with IBD want help for bowel control problems.
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20
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Rosso C, Aaron AA, Armandi A, Caviglia GP, Vernero M, Saracco GM, Astegiano M, Bugianesi E, Ribaldone DG. Inflammatory Bowel Disease Nurse-Practical Messages. NURSING REPORTS 2021; 11:229-241. [PMID: 34968201 PMCID: PMC8608068 DOI: 10.3390/nursrep11020023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Patients affected by inflammatory bowel diseases (IBDs) are complex patients with various problems from a clinical and psychological point of view. This complexity must be addressed by a multidisciplinary team, and an inflammatory bowel disease nurse can be the ideal professional figure to create a link between doctor and patient. The objective of this comprehensive review is to describe the figure of inflammatory bowel disease nurses and the various benefits that their introduction into a multidisciplinary team can bring, as well as a focus on how to become an inflammatory bowel disease nurse. Materials and Methods: A search on the PubMed database was performed by associating the terms "IBD" or "inflammatory bowel disease" with the Boolean term AND to the various issues addressed: "life impact", "communication", "fistulas", "ostomy", "diet", "incontinence", "sexuality", "parenthood", "fatigue", "pain management", and "follow up appointments". Regarding the analysis of the benefits that the IBD nurse brings, the terms "IBD", "inflammatory bowel diseases", "Crohn's disease", and "ulcerative colitis" were used, associating them with the terms "benefit", "costs", "team", and "patients". Finally, regarding the focus on how to become an IBD nurse, an IBD nurse was interviewed. Results: An IBD nurse is a valuable nursing figure within the multidisciplinary team that takes care of patients with IBD because this nurse performs important functions from both a clinical assistance point of view (management of fistulas, ostomies, infusion of biological drugs) and an information and therapeutic education point of view (communication with patients, direct contact with patients by telephone or email). Furthermore, this nurse performs the "filter" function between doctor and patient, saving time for doctors that will be used for more outpatient visits. Conclusions: The introduction of an inflammatory bowel disease nurse is therefore recommended for multidisciplinary organizations dealing with the clinical course of patients suffering from IBD.
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Affiliation(s)
- Chiara Rosso
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Alami Aroussi Aaron
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Angelo Armandi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Marta Vernero
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, 27100 Pavia, Italy;
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Marco Astegiano
- Unit of Gastroenterology, Città della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy;
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
| | - Davide Giuseppe Ribaldone
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (C.R.); (A.A.A.); (A.A.); (G.P.C.); (G.M.S.); (E.B.)
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21
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Clarke K. Addressing Fecal Incontinence in Inflammatory Bowel Disease Patients: A Messy Problem. CROHN'S & COLITIS 360 2021; 3:otab014. [PMID: 36778943 PMCID: PMC9802160 DOI: 10.1093/crocol/otab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kofi Clarke
- Penn State College of Medicine, Milton S Hershey Medical Center, Hershey, Pennsylvania, USA,Address correspondence to: Kofi Clarke, MD, FACP, FRCP (Lond), AGAF, Department of Medicine, Penn State College of Medicine, Milton S Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA ()
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22
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Kamal N, Motwani K, Wellington J, Wong U, Cross RK. Fecal Incontinence in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2021; 3:otab013. [PMID: 34226891 PMCID: PMC8248884 DOI: 10.1093/crocol/otab013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fecal incontinence (FI) is frequently reported in inflammatory bowel disease (IBD). METHODS We retrospectively reviewed data from the Study of a Prospective Adult Research Cohort with IBD registry. RESULTS Three hundred forty-seven patients had Crohn disease and 145 had ulcerative colitis. 14.2% of patients reported FI. FI was associated with active disease. FI was not associated with disease location, phenotype, or perianal involvement. Greater than 50 years of age or 15 years of disease increased the odds of FI and remission decreased the odds of FI. CONCLUSIONS Further research into the mechanism of FI in IBD is needed.
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Affiliation(s)
- Natasha Kamal
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kiran Motwani
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Uni Wong
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Address correspondence to: Raymond K. Cross, MD, MS, 685 W. Baltimore Street, Suite 8-00, Baltimore, MD 21201, USA ()
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23
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Abstract
Fecal incontinence can be a challenging and stigmatizing disease with a high prevalence in the elderly population. Despite effective treatment options, most patients do not receive care. Clues in the history and physical examination can assist the provider in establishing the diagnosis. Direct inquiry about the presence of incontinence is key. Bowel disturbances are common triggers for symptoms and represent some of the easiest treatment targets. We review the epidemiology and impact of the disease, delineate a diagnostic and treatment approach for primary care physicians to identify patients with suspected fecal incontinence and describe appropriate treatment options.
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Affiliation(s)
- Trisha Pasricha
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA.
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24
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Khera AJ, Chase JW, Salzberg M, Thompson AJV, Woods RJ, Wilson-O'Brien A, Kamm MA. Determinants of long-term function and general well-being in patients with an ileoanal pouch. JGH OPEN 2020; 5:91-98. [PMID: 33490618 PMCID: PMC7812478 DOI: 10.1002/jgh3.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022]
Abstract
Background and aim Fecal incontinence and/or evacuation difficulty are common after ileoanal pouch surgery. This study aimed to determine whether the development of these symptoms can be predicted so that preventive measures might be instituted. Methods A consecutive series of 46 patients with ulcerative colitis (median age at surgery, 41 years; 50% female) and a functioning pouch for a duration ≥12 months was included. Assessment utilized medical record review and questionnaires on pre‐ and postoperative bowel function, quality of life, and psychological well‐being. Pouch function was assessed by the Colorectal Functional Outcome score (0 = no impairment, 100 = worst impairment). Good pouch function was defined as a score ≤24. Results Fecal incontinence occurred in 67% preoperatively and 54% postoperatively; evacuation difficulty occurred in 65% and preoperatively and 85% postoperatively. The postoperative median Colorectal Functional Outcome score was 20 (range 2–74), with 44% of patients >24 (poor pouch function). Preoperative nocturnal fecal incontinence (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.2–19.4, P = 0.02) and pouchitis (OR 5.41, 95% CI 1.2–23.7, P = 0.02) were associated with poor pouch function after multivariable regression analysis. Postoperative satisfaction, psychological well‐being, and quality of life were significantly better in those with good pouch function, while poor sleep, impaired work, and sexual dysfunction were independently associated with poor pouch function. Conclusions Functional bowel symptoms are common before and after pouch surgery and are associated with the impairment of patient‐reported outcomes. Preoperative nocturnal fecal incontinence predicts poor pouch function. Therapeutic focus on continence, bowel evacuation, psychological well‐being, and quality of life should begin before surgery.
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Affiliation(s)
- Angela J Khera
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
| | - Janet W Chase
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Michael Salzberg
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
| | - Alexander J V Thompson
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
| | - Rodney J Woods
- Department of Colorectal Surgery St Vincent's Hospital Melbourne Victoria Australia
| | - Amy Wilson-O'Brien
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
| | - Michael A Kamm
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
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25
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D’Amico F, Wexner SD, Vaizey CJ, Gouynou C, Danese S, Peyrin-Biroulet L. Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review. United European Gastroenterol J 2020; 8:886-922. [PMID: 32677555 PMCID: PMC7707876 DOI: 10.1177/2050640620943699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fecal incontinence is a disabling condition affecting up to 20% of women. OBJECTIVE We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials. METHODS We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019. RESULTS In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies. CONCLUSION Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.
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Affiliation(s)
- Ferdinando D’Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston USA
| | | | - Célia Gouynou
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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Gu P, Patel D, Lakhoo K, Ko J, Liu X, Chang B, Pan D, Lentz G, Sonesen M, Estiandan R, Lin E, Pimentel M, Rezaie A. Breath Test Gas Patterns in Inflammatory Bowel Disease with Concomitant Irritable Bowel Syndrome-Like Symptoms: A Controlled Large-Scale Database Linkage Analysis. Dig Dis Sci 2020; 65:2388-2396. [PMID: 31754993 DOI: 10.1007/s10620-019-05967-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Breath testing (BT) has gained interest for diagnosing small intestinal bacterial overgrowth (SIBO) in IBD patients with irritable bowel syndrome (IBS) overlap. We aim to characterize the rate of SIBO and BT gas patterns in IBD patients with IBS-like symptoms compared to non-IBD patients. METHODS A database of 14,847 consecutive lactulose BTs was developed from patients with IBS-like symptoms between November 2005 and October 2013. BTs were classified as normal, H2 predominant, CH4 predominant, and flatline based on criteria established from the literature. BT data linkage with electronic health records and chart review identified IBD patients along with disease phenotype, location, severity, and antibiotic response. Poisson loglinear model evaluated differences in gas patterns between the two groups. RESULTS After excluding patients with repeat breath tests, we identified 486 IBD and 10,505 non-IBD patients with at least one BT. Positive BT was present in 57% (n = 264) of IBD patients. Crohn's disease (odds ratio (OR) 0.21, [95% confidence interval (CI) 0.11-0.38]) and ulcerative colitis (OR 0.39, [95% CI 0.22-0.70]) patients were less likely to produce excess CH4. IBD patients were more likely to have flatline BT (OR 1.82, [95% CI 1.20-2.77]). In IBD patients with SIBO, 57% improved symptomatically with antibiotics. CONCLUSION In a cohort of IBD patients with IBS-like symptoms, a high rate of patients had positive BT and symptomatic improvement with antibiotics. In IBD, methanogenesis is suppressed and flatline BT is more frequent, suggesting excess hydrogenotrophic bacteria. These findings suggest methanogenic and hydrogenotrophic microorganisms as potential targets for microbiome-driven biomarkers and therapies.
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Affiliation(s)
- Phillip Gu
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA.
| | - Devin Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Krutika Lakhoo
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey Ko
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xiaochen Liu
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bianca Chang
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| | - Dana Pan
- Division of Gastroenterology and Hepatology, University of California in Davis, Sacramento, CA, USA
| | - Greg Lentz
- Enterprise Information Services- Initiate Team, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew Sonesen
- Enterprise Information Services- Initiate Team, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Renier Estiandan
- Enterprise Information Services- Initiate Team, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eugenia Lin
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Pimentel
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ali Rezaie
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Cheng J, Shen H, Chowdhury R, Abdi T, Selaru F, Chen JDZ. Potential of Electrical Neuromodulation for Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:1119-1130. [PMID: 31782957 DOI: 10.1093/ibd/izz289] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD) is a common chronic inflammatory disease of the digestive tract that is often debilitating. It affects patients' quality of life and imposes a financial burden. Despite advances in treatment with medications such as biologics, a large proportion of patients do not respond to medical therapy or develop adverse events. Therefore, alternative treatment options such as electrical neuromodulation are currently being investigated. Electrical neuromodulation, also called bioelectronic medicine, is emerging as a potential new treatment for IBD. Over the past decade, advancements have been made in electrical neuromodulation. A number of electrical neuromodulation methods, such as vagus nerve stimulation, sacral nerve stimulation, and tibial nerve stimulation, have been tested to treat IBD. A series of animal and clinical trials have been performed to evaluate efficacy with promising results. Although the exact underlying mechanisms of action for electrical neuromodulation remain to be explored, this modality is promising. Further randomized controlled trials and basic experiments are needed to investigate efficacy and clarify intrinsic mechanisms.
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Affiliation(s)
- Jiafei Cheng
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hong Shen
- Division of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Reezwana Chowdhury
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tsion Abdi
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Florin Selaru
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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28
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Vasant DH, Ford AC. Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift? World J Gastroenterol 2020; 26:3712-3719. [PMID: 32774052 PMCID: PMC7383849 DOI: 10.3748/wjg.v26.i26.3712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/23/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory “functional” gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies.
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Affiliation(s)
- Dipesh H Vasant
- Gastroenterology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester M23 9LT, United Kingdom
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds LS9 7TF, United Kingdom
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
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29
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Khera AJ, Chase JW, Salzberg M, Thompson AJV, Kamm MA. Systematic review: Pelvic floor muscle training for functional bowel symptoms in inflammatory bowel disease. JGH Open 2019; 3:494-507. [PMID: 31832550 PMCID: PMC6891014 DOI: 10.1002/jgh3.12207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Large bowel functional symptoms are common in patients with inflammatory bowel disease (IBD) who are in disease remission. The efficacy of pelvic floor muscle training for symptoms of evacuation difficulty or fecal incontinence is well established in patients without organic bowel disease but is unknown in these patients. This study aimed to systematically evaluate the published evidence in this group of patients. METHODS A systematic review was conducted of articles evaluating pelvic floor muscle training, with or without biofeedback, to improve bowel function in patients with quiescent IBD, including those with an ileoanal pouch. The outcome of interest was improved bowel function measured by bowel diary, patient report, or validated questionnaire in randomized controlled studies, cohort studies, or case series. RESULTS Two randomized controlled trials, four retrospective case series, and one prospective study met eligibility criteria. Pelvic floor muscle training for patients with quiescent IBD improved symptoms in 51 of 76 (68%) patients with evacuation difficulty and 20 of 25 (80%) patients with fecal incontinence. Pelvic floor muscle training for patients with an ileoanal pouch, prior to stoma closure, did not appear to reduce the risk or severity of fecal incontinence following stoma closure. Studies were limited by small numbers, study design, methodological quality, and lack of long-term follow-up. CONCLUSION Pelvic floor muscle training appears to be of therapeutic value in some patients with quiescent IBD and evacuation difficulty or fecal incontinence. The effectiveness of this approach warrants further investigation.
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Affiliation(s)
- Angela J Khera
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
| | - Janet W Chase
- Department of GastroenterologySt Vincent's HospitalAustralia
| | | | - Alexander J V Thompson
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
| | - Michael A Kamm
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
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30
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Barros LL, Farias AQ, Rezaie A. Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment. World J Gastroenterol 2019; 25:4414-4426. [PMID: 31496621 PMCID: PMC6710178 DOI: 10.3748/wjg.v25.i31.4414] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.
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Affiliation(s)
- Luísa Leite Barros
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Alberto Queiroz Farias
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Ali Rezaie
- Division of Gastroenterology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
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31
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Beyond pregnancy, women's health in inflammatory bowel disease. Curr Opin Gastroenterol 2019; 35:288-295. [PMID: 33216483 DOI: 10.1097/mog.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Women's health includes comprehensive physical, mental and preventive care. This section will provide an overview of some of the most common disorders that can impact the health and quality of life (QOL) of women with inflammatory bowel diseases (IBDs). RECENT FINDINGS Women with IBD are at higher risk for cervical dysplasia compared to healthy controls with most cases preventable with vaccination. Current rates of cervical cancer screening and human papilloma virus vaccination remain low. Irritable bowel syndrome is highly prevalent among women with IBD and may present with similar symptoms. In addition, gastrointestinal symptoms may worsen during the menstrual cycle. Evaluation for active inflammation and infection should be undertaken prior to changing IBD medications. Fecal incontinence is prevalent but highly underreported in women with IBD. Further, sexual dysfunction is ubiquitous in women with IBD. Many aspects of IBD impact sexual function, including side-effects of medications, changes in body image and surgical interventions. SUMMARY Understanding other disorders that may cause symptoms in women with IBD is important for providers to obtain a clear history, provide the appropriate treatment and improve QOL. Caring for women with IBD involves more comprehensive care beyond the treatment of active luminal inflammation.
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Cavalcante ART, Lima RPD, Souza VSBD, Pinto FCM, Campos Júnior O, Silva JGMD, Albuquerque AVD, Aguiar JLDA. Effects of bacterial cellulose gel on the anorectal resting pressures in rats submitted to anal sphincter injury. Heliyon 2018; 4:e01058. [PMID: 30603694 PMCID: PMC6310775 DOI: 10.1016/j.heliyon.2018.e01058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to evaluate if a gel of bacterial cellulose gel can revert the loss of anal resting pressure after anorectum sphincter injury in rat model, elected as a model to simulate fecal incontinence. Thirty-nine animals were equally divided into three groups: Control (CG), Sphincter injury plus Saline injection (SG) and Sphincter injury plus Bacterial Cellulose Gel injection (BCG). Anal pressure at rest was assessed for all animal in the three groups using anorectum manometry. Saline and Gel groups were subject to anorectum sphincter injury to reduce the anal pressure at rest. Fifteen days later Saline or Gel was injected into the anorectum, according to their groups. Sixty days later first manometry, the anorectum of all animals were removed and processed histologically. The CG group showed maintenance of their mean anorectal resting pressure levels; SG presented a fall in their mean anorectal resting pressure. The BCG presented a significant elevation of the mean anorectal resting pressure levels, surpassing the pressure of CG. The gel of bacterial cellulose remained at the injection site and was neovascularized, colonized by fibroblasts and dense conjunctive tissue. Those data suggest that BC can be used as a future filling agent treatment for fecal incontinence in clinical trial protocols.
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33
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Nigam GB, Limdi JK, Vasant DH. Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease. Therap Adv Gastroenterol 2018; 11:1756284818816956. [PMID: 30574193 PMCID: PMC6295686 DOI: 10.1177/1756284818816956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023] Open
Abstract
Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment 'escalation' and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.
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Affiliation(s)
| | - Jimmy K. Limdi
- Pennine Acute Hospitals NHS Trust, Greater Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Dipesh H. Vasant
- Honorary Senior Lecturer, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester University NHS Foundation Trust, Neurogastroenterology Unit, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK
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