Wang Jun, Luo Mao-Hong, Qi Qing-Hui, Dong Zuo-Liang
Department of Colorectal Surgery, Tianjin Binjiang Hospital, Tianjin 300022, China.
World J Gastroenterol. 2003 Sep;9(9):2109-13. doi: 10.3748/wjg.v9.i9.2109.
To determine the efficacy and long-term outcome of biofeedback treatment for chronic idiopathic constipation and to compare the efficacy of two modes of biofeedback (EMG-based and manometry-based biofeedback).
Fifty consecutive contactable patients included 8 cases of slow transit constipation, 36 cases of anorectic outlet obstruction and 6 cases of mixed constipation. Two modes of biofeedback were used for these 50 patients, 30 of whom had EMG-based biofeedback, and 20 had manometry-based biofeedback. Before treatment, a consultation and physical examination were done for all the patients, related information such as bowel function and gut transit time was documented, psychological test (symptom checklist 90, SCL90) and anorectic physiological test and defecography were applied. After biofeedback management, all the patients were followed up. The Student's t-test, chi-squared test and Logistic regression were used for statistical analysis.
The period of following up ranged from 12 to 24 months (Median 18 months). 70 % of patients felt that biofeedback was helpful, and 62.5 % of patients with constipation were improved. Clinical manifestations including straining, abdominal pain, bloating, were relieved, and less oral laxative was used. Spontaneous bowel frequency and psychological state were improved significantly after treatment. Patients with slow and normal transit, and those with and without paradoxical contraction of the anal sphincter on straining, benefited equally from the treatment. The psychological status rather than anorectal test could predict outcome. The efficacy of the two modes of biofeedback was similar without side effects.
This study suggests that biofeedback has a long-term effect with no side effects, for the majority of patients with chronic idiopathic constipation unresponsive to traditional treatment. Pelvic floor abnormalities and transit time should not be the selection criteria for treatment.
确定生物反馈疗法治疗慢性特发性便秘的疗效及长期预后，并比较两种生物反馈模式（肌电图引导型和测压引导型生物反馈）的疗效。
连续纳入50例可联系到的患者，其中包括8例慢传输型便秘、36例肛门直肠出口梗阻型便秘和6例混合型便秘。对这50例患者采用两种生物反馈模式，其中30例采用肌电图引导型生物反馈，20例采用测压引导型生物反馈。治疗前，对所有患者进行会诊和体格检查，记录肠道功能和肠道传输时间等相关信息，应用心理测试（症状自评量表90，SCL90）、肛门直肠生理测试和排粪造影。生物反馈治疗后，对所有患者进行随访。采用t检验、卡方检验和Logistic回归进行统计学分析。
随访时间为12至24个月（中位数18个月）。70%的患者认为生物反馈疗法有帮助，62.5%的便秘患者病情得到改善。包括用力排便、腹痛、腹胀等在内的临床表现得到缓解，口服泻药用量减少。治疗后，自发排便频率和心理状态显著改善。慢传输型和正常传输型患者，以及用力排便时肛门括约肌有无矛盾性收缩的患者，均从治疗中同等获益。心理状态而非肛门直肠测试能够预测治疗结果。两种生物反馈模式的疗效相似，且均无副作用。
本研究表明，对于大多数对传统治疗无反应的慢性特发性便秘患者，生物反馈疗法具有长期疗效且无副作用。盆底异常和传输时间不应作为治疗的选择标准。
