From the Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
J Pediatr Gastroenterol Nutr. 2022 Aug 1;75(2):166-172. doi: 10.1097/MPG.0000000000003515. Epub 2022 Jun 7.
To investigate the clinical effectiveness and patient experience of transanal irrigation (TAI) in children with constipation or fecal incontinence.
Combined retrospective and cross-sectional study including pediatric patients who used a Navina TAI system. We retrospectively collected baseline characteristics and data on treatment success at 1- and 6-month follow-up (FU). Treatment success was defined as defecating at least 3 times per week and having less than 1 episode of fecal incontinence per week. We cross-sectionally assessed health-related quality of life (HRQoL), treatment adherence, treatment satisfaction (Treatment Satisfaction Questionnaire for Medication [TSQM]), illness perceptions, medication beliefs, and patient empowerment with validated questionnaires.
Thirty-four patients were included (median age at start TAI: 11 years old [range, 6-18]), 32 in the retrospective review, and 26 in the cross-sectional survey (median of 3 years after initiation). Most patients were diagnosed with functional constipation (n = 26; 76%) or a neurogenic bowel disorder (n = 6; 18%). Treatment success rates significantly improved at each FU compared with baseline (baseline: 4/25 [16%]; 1-month FU: 12/16 [75%], P = 0.008; 6-month FU: 11/18 [61%], P = 0.016; cross-sectional FU: 13/26 [50%], P = 0.008). HRQoL scores were high (PedsQL median, 73 [IQR, 54-85]). Adherence (defined as Medication Adherence Report Scale [MARS] ≥ 23) was low (36%), whereas TSQM effectiveness scores were high (median, 69 [IQR, 47-86]). The majority of children (61%) reported an increase in independence since TAI treatment. Patient empowerment (GYPES) levels were similar to those reported in children with other chronic conditions.
TAI with a Navina system is an effective bowel management system for children with intractable constipation or fecal incontinence.
探讨经肛门灌洗（TAI）治疗儿童便秘或粪便失禁的临床疗效和患者体验。
本研究为回顾性与横断面研究相结合，纳入使用 Navina TAI 系统的儿科患者。我们回顾性收集基线特征及治疗 1 个月和 6 个月随访（FU）时的治疗成功数据。治疗成功定义为每周至少排便 3 次，每周至少发生 1 次粪便失禁。我们采用经过验证的问卷评估健康相关生活质量（HRQoL）、治疗依从性、治疗满意度（治疗药物满意度问卷 [TSQM]）、疾病认知、药物信念和患者授权。
共纳入 34 例患者（开始 TAI 时的中位年龄为 11 岁[范围，6-18 岁]），其中 32 例进行回顾性分析，26 例进行横断面调查（起始后中位时间为 3 年）。大多数患者诊断为功能性便秘（n = 26；76%）或神经源性肠病（n = 6；18%）。与基线相比，每次 FU 时治疗成功率均显著提高（基线：25 例中 4 例[16%]；1 个月 FU：16 例中 12 例[75%]，P = 0.008；6 个月 FU：18 例中 11 例[61%]，P = 0.016；横断面 FU：26 例中 13 例[50%]，P = 0.008）。HRQoL 评分较高（PedsQL 中位数，73[IQR，54-85]）。治疗依从性（定义为用药依从性报告量表[MARS]≥23）较低（36%），而 TSQM 效果评分较高（中位数，69[IQR，47-86]）。大多数患儿（61%）报告在接受 TAI 治疗后独立性增加。患者授权（GYPES）水平与其他慢性疾病患儿相似。
Navina 系统经肛门灌洗是治疗顽固性便秘或粪便失禁儿童的有效肠道管理系统。
