Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Clin Gastroenterol. 2013 Mar;47(3):252-5. doi: 10.1097/MCG.0b013e318266f43a.
Biofeedback therapy (BF) is a well-established treatment modality for patients with dyssynergic defecation and fecal incontinence (FI). Randomized controlled trials from highly specialized tertiary care centers report response rates of 70% to 80% for dyssynergic defecation and 55% to 75% for FI. Whether this therapy is as successful outside of clinical trials or specialized biofeedback referral centers remains unclear.
Our primary aim was to determine what percentage of patients referred for BF actually complete therapy and identify barriers to treatment. Our secondary aim was to determine the clinical response rate in a heterogeneous population of patients undergoing BF at our institution and a variety of regional locations.
We retrospectively reviewed patients who underwent high resolution anorectal manometry between 2007 and 2010 for symptoms of defecatory dysfunction. BF was recommended at the time of manometry analysis based on findings of dyssynergy, impaired or heightened rectal sensation, or poor augmentation of sphincter on squeeze maneuvers. Clinical response was recorded after a course of BF (≥ 5 sessions).
Two hundred three patients (78% female, 72% white; median age 52) underwent anorectal manometry for symptoms of constipation (130), FI (54), combination (12), and rectal pain (7). BF was recommended in 119 cases (58.6%): constipation (80), FI (27), combination (9), and rectal pain (3). Only 39 out of 80 (48%) patients with constipation ultimately underwent BF. Of the 27 FI cases, only 12 (44%) patients underwent BF. Barriers to BF included lack of insurance coverage, distance to local treatment facilities, and acute medical issues taking precedence. Of those who underwent at least 5 BF sessions, subjective short-term response rates based on patient opinion were 17/28 (60%) in the constipation group and 8/10 (80%) in the FI group. Age, sex, and race had no effect on whether the patients attended biofeedback or whether they responded to treatment. The location of BF also did not predict response to therapy.
In a heterogeneous patient population, less than half of patients recommended for BF ultimately underwent therapy. Despite this, the response rates in this small population undergoing BF in the "real world" are only slightly less than published randomized control trials. Prospective studies are warranted to further elucidate and eliminate barriers to BF, especially given that "real world" BF response rates may be comparable with those seen in clinical trials.
生物反馈疗法（BF）是治疗协同性排便障碍和粪便失禁（FI）患者的一种成熟的治疗方法。来自高度专业化的三级护理中心的随机对照试验报告，协同性排便障碍的反应率为 70%至 80%，FI 的反应率为 55%至 75%。这种治疗方法在临床试验或专门的生物反馈转介中心之外是否同样成功尚不清楚。
我们的主要目的是确定有多少接受 BF 治疗的患者实际上完成了治疗，并确定治疗的障碍。我们的次要目的是确定我们机构和各种地区位置接受 BF 治疗的异质患者群体的临床反应率。
我们回顾性地审查了 2007 年至 2010 年间因排便功能障碍症状而接受高分辨率肛门直肠测压的患者。根据协同障碍、直肠感觉受损或增强、或收缩时括约肌增压不良的发现，在测压分析时推荐进行 BF。在完成 BF 疗程（≥5 次）后记录临床反应。
203 名患者（78%为女性，72%为白人；中位年龄 52 岁）因便秘（130 例）、FI（54 例）、混合症状（12 例）和直肠痛（7 例）接受肛门直肠测压。119 例（58.6%）建议进行 BF：便秘（80 例）、FI（27 例）、混合症状（9 例）和直肠痛（3 例）。仅有 39 例（80%）便秘患者最终接受了 BF。27 例 FI 患者中，仅有 12 例（44%）患者接受了 BF。BF 的障碍包括缺乏保险覆盖、距离当地治疗设施的距离以及急性医疗问题优先考虑。在至少接受了 5 次 BF 治疗的患者中，根据患者意见得出的短期主观反应率在便秘组为 17/28（60%），在 FI 组为 8/10（80%）。年龄、性别和种族对患者是否接受 BF 或是否对治疗有反应没有影响。BF 的位置也不能预测治疗反应。
在异质患者群体中，不到一半建议接受 BF 的患者最终接受了治疗。尽管如此，在这个“现实世界”中接受 BF 治疗的小患者群体的反应率仅略低于随机对照试验。需要进行前瞻性研究来进一步阐明和消除 BF 的障碍，特别是考虑到“现实世界”的 BF 反应率可能与临床试验中观察到的相似。
