Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Inflamm Bowel Dis. 2018 May 18;24(6):1280-1290. doi: 10.1093/ibd/izx109.
Understanding of the prevalence, pathophysiology, and management of fecal incontinence (FI) in inflammatory bowel disease (IBD) patients without an ileal pouch anal anastomosis (IPAA) is suboptimal. We conducted a systematic review and meta-analysis on the prevalence, pathophysiology, and management of primary FI in IBD patients without IPAA.
We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (1966 through March 2017) for studies on the prevalence, physiology, or management of FI in IBD patients without IPAA. A random effects model was used to calculate pooled prevalence rates and odds ratio (OR) with 95% confidence interval (CI). Heterogeneity was assessed with I2 statistics, Cochran Q statistic, and sensitivity analyses.
Seventeen studies were included. Six studies evaluated the prevalence of FI in 4671 IBD patients. There was significant heterogeneity among the studies, but the pooled prevalence of FI among case-control studies was homogeneous at 24% (95% CI 18%-30%, I2 = 50.6%, P = 0.16). FI was more common among IBD patients than non-IBD controls (OR = 7.73; 95% CI 6.26 to 9.84). Therapeutic options were poorly evaluated in uncontrolled studies. Surgery was effective in 70% of patients (7/10), sacral nerve stimulation was effective in 100% of patients (5/5), and 41.6% of patients (5/12) reported subjective improvement in FI with percutaneous tibial nerve stimulation.
FI is prevalent in IBD patients without IPAA, and more common than non-IBD controls. Additional controlled studies are warranted to further identify effective therapeutic interventions for FI in IBD. 10.1093/ibd/izx109_video1izx109_Video_15760611117001.
对没有回肠储袋肛管吻合术（IPAA）的炎症性肠病（IBD）患者粪便失禁（FI）的流行情况、病理生理学和管理的理解并不完善。我们对没有 IPAA 的 IBD 患者原发性 FI 的流行情况、病理生理学和管理进行了系统评价和荟萃分析。
我们检索了 MEDLINE、EMBASE 和 Cochrane 系统评价数据库（1966 年至 2017 年 3 月），以获取关于没有 IPAA 的 IBD 患者 FI 的流行情况、生理学或管理的研究。使用随机效应模型计算汇总患病率和比值比（OR）及其 95%置信区间（CI）。使用 I2 统计量、Cochran Q 统计量和敏感性分析评估异质性。
共纳入 17 项研究。6 项研究评估了 4671 例 IBD 患者 FI 的患病率。研究之间存在显著的异质性，但病例对照研究的 FI 汇总患病率是同质的，为 24%（95% CI 18%-30%，I2 = 50.6%，P = 0.16）。IBD 患者的 FI 发生率高于非 IBD 对照组（OR = 7.73；95% CI 6.26-9.84）。在未对照的研究中，治疗选择评估较差。手术对 70%的患者（7/10）有效，骶神经刺激对所有患者（5/5）有效，41.6%的患者（5/12）报告 FI 主观改善经皮胫神经刺激。
没有 IPAA 的 IBD 患者 FI 较为常见，且比非 IBD 对照组更为常见。需要进一步开展对照研究以确定 IBD 患者 FI 的有效治疗干预措施。
