Chiarioni Giuseppe, Whitehead William E
Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA.
Nat Clin Pract Gastroenterol Hepatol. 2008 Jul;5(7):371-82. doi: 10.1038/ncpgasthep1150. Epub 2008 Jun 3.
Biofeedback is a form of treatment that has no adverse effects and can be provided by physician extenders. The therapy relies on patients' ability to learn how to influence their bodily functions through dedicated machinery and teaching. This Review provides a comprehensive overview of all potential therapeutic applications of biofeedback for functional constipation, fecal incontinence, functional anorectal pain, IBS, functional dyspepsia, and aerophagia. Practical clinical applications of biofeedback therapy supported by randomized, controlled trials (RCTs) are limited to fecal incontinence and dyssynergic defecation. For fecal incontinence, RCTs suggest that biofeedback combining strength training and sensory discrimination training is effective in approximately 75% of patients and is more effective than placebo. However, verbal feedback provided by a therapist during extended digital examination may be equally effective, and children whose fecal incontinence is associated with constipation plus fecal impaction do no better with biofeedback than medical management. For dyssynergic defecation, RCTs show that biofeedback combining pelvic floor muscle relaxation training, practice in defecating a water-filled balloon, and instruction in effective straining is effective in approximately 70% of patients who have failed to respond to laxative treatment. For both incontinence and dyssynergic defecation, the benefits of biofeedback last at least 12 months.
生物反馈是一种无不良影响且可由非医师人员提供的治疗形式。该疗法依赖患者通过专用设备和指导来学习如何影响自身身体机能的能力。本综述全面概述了生物反馈在功能性便秘、大便失禁、功能性肛门直肠疼痛、肠易激综合征、功能性消化不良和气吞症等方面的所有潜在治疗应用。随机对照试验(RCT)支持的生物反馈疗法的实际临床应用仅限于大便失禁和排便协同失调。对于大便失禁,RCT表明,结合力量训练和感觉辨别训练的生物反馈对约75%的患者有效,且比安慰剂更有效。然而,在长时间指诊期间由治疗师提供的言语反馈可能同样有效,且大便失禁与便秘加粪嵌塞相关的儿童接受生物反馈治疗并不比药物治疗效果更好。对于排便协同失调,RCT显示,结合盆底肌肉放松训练、模拟排便充气球练习以及有效用力指导的生物反馈对约70%对泻药治疗无反应的患者有效。对于失禁和排便协同失调,生物反馈的益处至少可持续12个月。