Department of Pediatric Gastroenterology, Hepatology, and Nutrition, APHP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France; Université de Paris, Faculté de Médecine, 2 rue de l'Ecole de Médecine, 75006, Paris, France.
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, APHP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.
Clin Res Hepatol Gastroenterol. 2021 May;45(3):101550. doi: 10.1016/j.clinre.2020.09.011. Epub 2020 Oct 22.
Fecal incontinence (FI) secondary to chronic retentive constipation is a frequent demand in pediatric gastroenterology clinics. The management of constipation in children includes laxatives (polyethylene glycol, PEG), enhanced toilet training, and dietary advice. Biofeedback is a possible treatment for children above the age of 7 years with resistant FI.
To analyze any changes in volume to trigger defecation (VTD) and envy score over the course of biofeedback sessions according to clinical response.
In this retrospective study, we reviewed the medical records of 23 children diagnosed with FI according to the Rome IV criteria and treated with biofeedback. For each biofeedback session, a mean VTD by subject was measured. At the end, therapy was considered a success if soiling disappeared and a failure if any persisted. The need to defecate expressed by the child was described as an envy score. A 0-10 visual analog scale was used to express the intensity of this sensation. Follow-up involved calling the parents 12 months after the biofeedback sessions had ended to assess symptoms remotely.
The study included 19 boys and 4 girls with a median age of 10 years. Patients' ages ranged between 7 and 17 years. None of them had any associated neurological disorders. All children had FI for >1 year. The median number of soiling episodes per week was 7. The average number of biofeedback sessions was 3 (range 1-5). At the end of the rehabilitation sessions, 12 children (52%) were in the "success" group. In the latter, median VTD decreased from 97 ml to 70 ml between the first and last session. In the "failure" group, VTD decreased from 120 ml to 100 ml. The between-group difference in the median VTD at the first session was not statistically significant. The last observation carried forward (LOCF) VTD was significantly lower in the "success" group compared to the "failure" group (70 ml versus 100 ml, p = 0.03). Median envy scores decreased during the biofeedback sessions with no statistical difference between the groups at the last session. Follow-up of children in the "success" group one year after the last biofeedback session revealed that 10 patients had no relapse (83%) and 2 were lost to follow-up.
Biofeedback might be an effective tool for the management of FI resistant to medical treatment in children.
慢性潴留性便秘引起的粪便失禁（FI）是儿科胃肠病学门诊的常见需求。儿童便秘的治疗包括泻药（聚乙二醇，PEG）、强化如厕训练和饮食建议。生物反馈是一种可能的治疗方法，适用于 7 岁以上有抵抗性 FI 的儿童。
根据临床反应，分析生物反馈治疗过程中触发排便量（VTD）和渴望评分的任何变化。
在这项回顾性研究中，我们回顾了 23 名根据罗马 IV 标准诊断为 FI 并接受生物反馈治疗的儿童的病历。对于每个生物反馈疗程，均以受试者的平均 VTD 进行测量。如果所有污染都消失，则认为治疗成功，如果仍有任何污染则认为治疗失败。孩子表达的排便需要被描述为渴望评分。使用 0-10 的视觉模拟量表来表达这种感觉的强度。治疗结束后，通过在生物反馈治疗结束后 12 个月打电话给家长来远程评估症状。
该研究包括 19 名男孩和 4 名女孩，中位年龄为 10 岁。患者年龄在 7 至 17 岁之间。他们均无任何相关的神经障碍。所有儿童的 FI 持续时间均超过 1 年。每周污染发作的中位数为 7 次。生物反馈疗程的平均次数为 3 次（范围 1-5 次）。在康复疗程结束时，12 名儿童（52%）属于“成功”组。在后者中，VTD 从第一疗程的 97ml 中位数降至最后一疗程的 70ml。在“失败”组中，VTD 从 120ml 中位数降至 100ml。在第一疗程时，两组间 VTD 的中位数差异无统计学意义。最后观察到的向前（LOCF）VTD 在“成功”组中明显低于“失败”组（70ml 与 100ml，p=0.03）。在生物反馈治疗过程中，渴望评分中位数下降，组间最后一次无统计学差异。在“成功”组中，在最后一次生物反馈治疗结束后一年对儿童进行随访，发现 10 名患者无复发（83%），2 名患者失访。
生物反馈可能是治疗对药物治疗有抵抗的儿童 FI 的有效工具。
