Parker Colleen H, Henry Stanley, Liu Louis W C
Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Can Assoc Gastroenterol. 2019 Aug;2(3):126-131. doi: 10.1093/jcag/gwy036. Epub 2018 Jul 14.
Chronic constipation (CC) and fecal incontinence (FI) are often secondary to pelvic floor neuromuscular sensory or motor dysfunction. Biofeedback therapy (BFT) uses visual and verbal feedback to improve anorectal coordination, strength and sensation. In clinical trials, BFT demonstrated response rates between 70% and 80%. The purpose of this study is to determine the effectiveness of BFT in clinical practice.
In this retrospective observational cohort study, the charts of all patients who completed BFT at our centre were reviewed. A positive response to BFT was defined as improvement in ARM profile from baseline or subjective symptom improvement or both. Descriptive statistics were used to analyze the data.
One hundred thirty patients with an average age of 57.5 ± 16.4 years and 79.2% female were included. Of all patients, 43.1% were referred for CC, 37.7% for FI, 16.9% for alternating CC and FI, and 2.3% for rectal pain. The overall response rate to BFT was 76.2% (n=99). Of those that responded, 64.6% (n=64) demonstrated both ARM and symptom improvement, 27.3% (n=27) had ARM improvement but no symptom improvement, and 8.1% (n=8) had symptom improvement but no ARM improvement. In patients with FI, the overall response rate was 79.6% (n=39) with symptom improvement in 67.3% (n=33). In those with CC with dyssynergic defecation (n=53), the overall response rate was 69.8% (n=37); however, only 45.3% (n=24) had symptomatic improvement.
In our clinical practice, although overall response rates to BFT are similar to published reports, patients with CC with dyssynergic defecation are less likely to have symptomatic response compared with those with FI.
慢性便秘（CC）和大便失禁（FI）通常继发于盆底神经肌肉感觉或运动功能障碍。生物反馈疗法（BFT）利用视觉和言语反馈来改善肛门直肠协调性、力量和感觉。在临床试验中，BFT的有效率在70%至80%之间。本研究的目的是确定BFT在临床实践中的有效性。
在这项回顾性观察性队列研究中，对在我们中心完成BFT的所有患者的病历进行了回顾。对BFT的阳性反应定义为与基线相比肛门直肠轮廓改善或主观症状改善或两者皆有。使用描述性统计分析数据。
纳入了130例患者，平均年龄为57.5±16.4岁，女性占79.2%。在所有患者中，43.1%因CC就诊，37.7%因FI就诊，16.9%因CC和FI交替出现就诊，2.3%因直肠疼痛就诊。对BFT的总体有效率为76.2%（n=99）。在有反应的患者中，64.6%（n=64）表现出肛门直肠和症状均改善，27.3%（n=27）有肛门直肠改善但无症状改善，8.1%（n=8）有症状改善但无肛门直肠改善。在FI患者中，总体有效率为79.6%（n=39），67.3%（n=33）有症状改善。在患有排便协同失调的CC患者（n=53）中，总体有效率为69.8%（n=37）；然而，只有45.3%（n=24）有症状改善。
在我们的临床实践中，尽管对BFT的总体有效率与已发表的报告相似，但与FI患者相比，患有排便协同失调的CC患者出现症状性反应的可能性较小。
