Brochard C, Vénara A, Bodère A, Ropert A, Bouguen G, Siproudhis L
Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.
Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.
Neurogastroenterol Motil. 2017 Aug;29(8). doi: 10.1111/nmo.13051. Epub 2017 Feb 23.
Obesity is an emerging risk factor for fecal incontinence (FI). The aim of this study was to characterize pathophysiologic mechanisms of FI in obese patients compared with non-obese patients in a prospective case-matched study.
The general characteristics and data of the anorectal manometry and endosonography of patients who were evaluated for FI at a single institution from 2005 to 2015 were prospectively assessed. Fecal incontinence was defined by a Cleveland Clinic Incontinence Score (CCIS) >4. Obesity was defined by a body mass index ≥30 kg/m . Obese patients were case-matched with two age- and sex-matched non-obese patients.
A total of 201 patients were included (67 obese matched with 134 non-obese). The CCIS, Knowles-Eccersley-Scott Symptom Constipation Score and quality of life score were comparable between obese and non-obese patients with FI. Factors significantly associated with obesity in FI patients were cholecystectomy (odds ratio [OR]=3.45 [1.19-10.32], P=.0230), irritable bowel syndrome - diarrhea (OR=2.94 [1.22-7.19], P=.0158), upper part of the anal canal resting pressure ≥22 mm Hg (OR=3.45 [1.45-8.76], P=.0045), maximum rectal tolerable volume ≥240 mL (OR=3.14 [1.34-7.54], P=.0082), and abdominal pressure ≥28 mm Hg (OR=2.75 [1.13-7.33], P=.0248) by multivariate analysis.
CONCLUSIONS & INFERENCES: Obese patients with FI had a comparable severity of FI to that of non-obese patients with FI. Regarding obesity in patients with FI, physicians should focus on stool consistency.
肥胖是粪便失禁（FI）的一个新出现的风险因素。本研究的目的是在前瞻性病例匹配研究中，比较肥胖患者与非肥胖患者FI的病理生理机制。
对2005年至2015年在单一机构接受FI评估的患者的一般特征以及肛门直肠测压和腔内超声检查数据进行前瞻性评估。粪便失禁由克利夫兰诊所失禁评分（CCIS）>4定义。肥胖由体重指数≥30kg/m²定义。肥胖患者与两名年龄和性别匹配的非肥胖患者进行病例匹配。
共纳入201例患者（67例肥胖患者与134例非肥胖患者匹配）。肥胖和非肥胖FI患者的CCIS、诺尔斯-埃克斯利-斯科特症状便秘评分和生活质量评分相当。FI患者中与肥胖显著相关的因素经多因素分析为胆囊切除术（比值比[OR]=3.45[1.19 - 10.32]，P = 0.0230）、肠易激综合征-腹泻（OR = 2.94[1.22 - 7.19]，P = 0.0158）、肛管上部静息压≥22mmHg（OR = 3.45[1.45 - 8.76]，P = 0.0045）、最大直肠耐受容量≥240mL（OR = 3.14[1.34 - 7.54]，P = 0.0082）以及腹压≥28mmHg（OR = 2.75[1.
