Verma Abhai, Misra Asha, Ghoshal Uday C
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Indian J Gastroenterol. 2017 Mar;36(2):99-104. doi: 10.1007/s12664-017-0731-y. Epub 2017 Feb 18.
Though biofeedback therapy is often effective in patients with fecal evacuation disorder (FED), a common cause of chronic constipation (CC) in tertiary practice, data on anorectal physiological parameters following it are scanty.
Consecutive patients with FED with CC diagnosed by abnormalities in at least two of the three tests (anorectal manometry, defecography, and balloon expulsion test [BET]) undergoing biofeedback (two sessions per day, 30 min each, for 2 weeks) during a 3-year period were analyzed. Clinical evaluation, anorectal manometry (ARM), and BET were performed at the beginning and after biofeedback.
Incomplete evacuation 42/43 (98%), straining 40/43 (93%), and feeling of outlet obstruction 35/43 (81%) were the most common symptoms among these 43 patients (median age 44 years, range 18-76, 30 [71%] male). All the three tests (defecography, BET, and ARM) were abnormal in 17 (40%) patients and the others had two abnormal tests. Improvement in physiological parameters was noted following biofeedback (median residual anal pressure during defecation 99 mmHg (range 52-148) vs. 78 mmHg (37-182), p = 0.03; maximum intra-rectal pressure 60 mmHg (90-110) vs. 76 mmHg (31-178); p = 0.01; defecation index 1.1 (0.1-23.0) vs. 3.2 (0.5-29.0); p = 0.001). Dyssynergia on ARM and BET got corrected in 22/34 (65%) and 18/30 (60%) patients. At a 1-month follow up, 23/37 (62%) patients reported satisfactory symptomatic improvement.
Biofeedback not only improves symptoms but also anorectal physiological parameters in patients with FED.
尽管生物反馈疗法对排便障碍（FED）患者通常有效，而排便障碍是三级医疗机构中慢性便秘（CC）的常见原因，但关于生物反馈疗法后肛门直肠生理参数的数据却很少。
分析了连续3年期间因三项检查（肛门直肠测压、排粪造影和气囊排出试验[BET]）中至少两项异常而被诊断为FED伴CC的患者，这些患者接受了生物反馈治疗（每天两次，每次30分钟，共2周）。在生物反馈治疗开始时和治疗后进行了临床评估、肛门直肠测压（ARM）和BET。
在这43例患者（中位年龄44岁，范围18 - 76岁，30例[71%]为男性）中，排便不完全42/43（98%）、用力排便40/43（93%）和有排便出口梗阻感35/43（81%）是最常见的症状。17例（40%）患者的三项检查（排粪造影、BET和ARM）均异常，其他患者有两项检查异常。生物反馈治疗后生理参数有所改善（排便时肛门残余压力中位值99 mmHg（范围52 - 148）对78 mmHg（37 - 182），p = 0.03；直肠内最大压力60 mmHg（90 - 110）对76 mmHg（31 - 178）；p = 0.01；排便指数1.1（0.1 - 23.0）对3.2（0.5 - 29.0）；p = 0.001）。34例患者中有22例（65%）的ARM和BET不协调得到纠正，30例患者中有l8例（60%）得到纠正。在1个月的随访中，37例患者中有23例（62%）报告症状有满意改善。
生物反馈疗法不仅能改善FED患者的症状，还能改善其肛门直肠生理参数。
