Rao Satish S C, Seaton Kara, Miller Megan, Brown Kice, Nygaard Ingrid, Stumbo Phyllis, Zimmerman Bridgette, Schulze Konrad
University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Clin Gastroenterol Hepatol. 2007 Mar;5(3):331-8. doi: 10.1016/j.cgh.2006.12.023.
BACKGROUND & AIMS: Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown.
In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction.
Subjects in the biofeedback group were more likely to correct dyssynergia (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group.
Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia.
便秘是一种常见疾病，目前的治疗方法总体上并不令人满意。生物反馈疗法可能对便秘和排便协同失调的患者有所帮助，但其疗效尚未得到证实，而且改善是由于操作性条件反射还是个人关注所致尚不清楚。
在一项前瞻性随机试验中，我们研究了生物反馈疗法（压力测定辅助肛门松弛、肌肉协调和模拟排便训练；生物反馈疗法）与假反馈疗法（假治疗）或标准疗法（饮食、运动、泻药；标准疗法）对77名（69名女性）慢性便秘和排便协同失调患者的疗效。在基线和治疗后（3个月），通过肛门直肠测压、气囊排出试验和结肠运输研究评估生理变化，通过视觉模拟量表和前瞻性大便日记评估症状变化和大便特征。主要结局指标（意向性分析）包括排便协同失调的存在、气囊排出时间、完全自主排便次数和总体肠道满意度。
与其他组相比，生物反馈疗法组的患者更有可能纠正排便协同失调（P < .0001）、改善排便指数（P < .0001）并缩短气囊排出时间（P = .02）。生物反馈疗法或标准疗法后结肠运输功能得到改善（P = .01），但假治疗后未改善。在生物反馈疗法组中，完全自主排便次数增加（P < .02）且高于其他组（P < .05），使用手法排便减少（P = .03）。生物反馈疗法组的总体肠道满意度高于假治疗组（P = .04）。
生物反馈疗法可改善排便协同失调患者的便秘及肠道功能的生理特征。这种效果是通过改变生理行为和结直肠功能来介导的。生物反馈疗法是便秘伴排便协同失调患者的首选治疗方法。
