Ascanelli Simona, Bombardini Cristina, Chimisso Laura, Carcoforo Paolo, Turroni Silvia, D'Amico Federica, Caniati Maria Luisa, Baldi Eleonora, Tugnoli Valeria, Morotti Chiara, Valpiani Giorgia, Bazzocchi Gabriele
Department of Morphology, Surgery and Experimental Medicine, Colorectal Unit, Section General Surgery, University Hospital of Ferrara, Ferrara, Italy.
Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.
Mult Scler J Exp Transl Clin. 2022 Jul 6;8(3):20552173221109771. doi: 10.1177/20552173221109771. eCollection 2022 Jul-Sep.
Constipation and faecal incontinence are not so uncommon in patients with multiple sclerosis, impairing quality of life. The gut microbiota is altered in multiple sclerosis patients and likely contributes to disease pathogenesis. Trans-anal irrigation has been proven to allow treatment of neurogenic bowel dysfunction and may affect gut microbiota.
The primary outcome was trans-anal irrigation effectiveness on constipation and faecal incontinence. The secondary outcome was gut microbiota profiling compared to healthy subjects and during trans-anal irrigation adoption.
We conducted a prospective cohort study on multiple sclerosis patients, screened with Patient Assessment of Constipation Quality of Life questionnaire before undergoing constipation and faecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries and faecal sample collection for gut microbiota analysis before and after 4 weeks of trans-anal irrigation.
Eighty patients were screened of which nearly half had intestinal symptoms. The included population (n = 37) was predominantly composed of women with significantly longer disease duration, higher mean age and disability than the excluded one ( < 0.05). Twelve patients completed the trans-anal irrigation phase, which led to significant improvement of bowel dysfunction symptom-related quality of life, increase in gut microbiota diversity and reduction of the proportions of pro-inflammatory taxa ( < 0.05). Trans-anal irrigation was safe, satisfactory and could help counteract multiple sclerosis-related dysbiosis.
便秘和大便失禁在多发性硬化症患者中并不罕见，会损害生活质量。多发性硬化症患者的肠道微生物群会发生改变，可能与疾病发病机制有关。经肛门冲洗已被证明可用于治疗神经源性肠功能障碍，并且可能会影响肠道微生物群。
主要结局是经肛门冲洗对便秘和大便失禁的有效性。次要结局是与健康受试者相比以及在采用经肛门冲洗期间的肠道微生物群分析。
我们对多发性硬化症患者进行了一项前瞻性队列研究，在进行便秘和大便失禁评分、腹部X光检查肠道传输时间、编制食物和排便日记以及在经肛门冲洗4周前后收集粪便样本进行肠道微生物群分析之前，先用便秘生活质量患者评估问卷对患者进行筛查。
筛查了80名患者，其中近一半有肠道症状。纳入人群（n = 37）主要由女性组成，其病程明显更长，平均年龄和残疾程度均高于排除人群（<0.05）。12名患者完成了经肛门冲洗阶段，这导致肠道功能障碍症状相关生活质量显著改善、肠道微生物群多样性增加以及促炎类群比例降低（<0.05）。经肛门冲洗安全、令人满意，有助于对抗多发性硬化症相关的生态失调。
