Richard Nicolas, Hudson Marie, Gyger Geneviève, Baron Murray, Sutton Evelyn, Khalidi Nader, Pope Janet E, Carrier Nathalie, Larché Maggie, Albert Alexandra, Fortin Paul R, Thorne Carter, Masetto Ariel
Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
Division of Rheumatology, Nova Scotia Rehabilitation Centre, Dalhousie University, Halifax, Nova Scotia.
Rheumatology (Oxford). 2017 Apr 1;56(4):581-588. doi: 10.1093/rheumatology/kew441.
The aim was to establish the prevalence and severity of faecal incontinence (FI) in SSc, its association with other intestinal manifestations and potential predictors of FI, and its impact on quality of life.
A multicentre, cross-sectional study of 298 SSc subjects followed in the Canadian Scleroderma Research Group cohort was performed using validated questionnaires: Jorge-Wexner score (an FI severity scale), Bristol stool scale (a visual scale of stool consistency) and FI Quality-of-Life scale. Constipation was defined by the Rome III criteria. Associations between the Jorge-Wexner score and other clinical variables were determined using multivariate regression analyses.
Eighty-one (27.2%) subjects had FI, which was mild in 37 (12.4%) and moderate to severe in 44 (14.8%). Most patients had well-formed stools, 111 (38.8%) reported constipation and 38 (13.4%) had been previously treated for small intestinal bacterial overgrowth (SIBO). Variables independently associated with FI were: loose vs well-formed stools [odds ratio (OR) = 7.01, 95% CI: 2.09, 23.51)], constipation (OR = 3.64, 95% CI: 1.61, 8.27, P = 0.002), history of SIBO (OR = 2.97, 95% CI: 1.06, 8.27) and urinary incontinence (OR = 2.45, 95% CI: 1.14, 5.27). Quality of life measured with the FI Quality-of-Life scale was inversely correlated with FI severity (correlation coefficients between -0.602 and -0.702, P < 0.001).
FI was common and often severe in SSc. Loose stools, SIBO, constipation and urinary incontinence were strongly associated with FI. Other than targeting anorectal dysfunction, concomitant treatment of clinical correlates could lead to improvement in FI and quality of life in SSc.
旨在确定系统性硬化症（SSc）患者粪便失禁（FI）的患病率及严重程度、其与其他肠道表现的关联以及FI的潜在预测因素，及其对生活质量的影响。
在加拿大硬皮病研究组队列中，对298例SSc患者进行了一项多中心横断面研究，使用经过验证的问卷：豪尔赫 - 韦克斯纳评分（一种FI严重程度量表）、布里斯托大便分类法（一种大便稠度视觉量表）和FI生活质量量表。便秘根据罗马III标准定义。使用多变量回归分析确定豪尔赫 - 韦克斯纳评分与其他临床变量之间的关联。
81例（27.2%）患者存在FI，其中37例（12.4%）为轻度，44例（14.8%）为中度至重度。大多数患者大便成形，111例（38.8%）报告有便秘，38例（13.4%）曾接受过小肠细菌过度生长（SIBO）治疗。与FI独立相关的变量有：稀便与成形大便[比值比（OR）= 7.01，95%置信区间：2.09，23.51]、便秘（OR = 3.64，95%置信区间：1.61，8.27，P = 0.002）、SIBO病史（OR = 2.97，95%置信区间：1.06，8.27）和尿失禁（OR = 2.45，95%置信区间：1.14，5.27）。用FI生活质量量表测量的生活质量与FI严重程度呈负相关（相关系数在 -0.602至 -0.702之间，P < 0.001）。
FI在SSc中很常见且往往较为严重。稀便、SIBO、便秘和尿失禁与FI密切相关。除了针对肛门直肠功能障碍外，同时治疗相关临床因素可能会改善SSc患者的FI及生活质量。
