Service d'Explorations Fonctionnelles Digestives, CHRU Pontchaillou, Rennes, France.
The Enteric Nervous System in Gut and Brain Disorders INSERM, TENS, Université de Nantes, Nantes, France.
Colorectal Dis. 2023 Jun;25(6):1267-1276. doi: 10.1111/codi.16518. Epub 2023 Mar 11.
To compare transanal irrigation with conservative bowel management for the treatment of bowel dysfunction in Spina bifida (SB) patients.
Patients with SB and bowel dysfunction were randomly assigned to receive either transanal irrigation or conservative bowel management. The effectiveness of the treatment was defined as a decrease of 4 points in the neurogenic bowel dysfunction (NBD) score at week 10. Data on incontinence (Cleveland scores; Jorge-Wexner [JW]) and constipation (Knowles-Eccersley-Scott Symptom Constipation Score [KESS]) were recorded at 10 and 24 weeks after inclusion. Data were analysed on an intention-to-treat basis.
A total of 34 patients were randomised: 16 patients to conservative bowel management and 18 patients to transanal irrigation. A total of 19/31 (61%) patients improved at week 10, 13 (76%) in the transanal irrigation group versus six (43%) in the conservative group (p = 0.056). In the irrigation group, the decrease in NBD score was -6.9 (-9.9 to -4.02) versus -1.9 (-6.5 to -2.8) in the conservative group (p = 0.049 in univariate and p = 0.004 in multivariate analysis). The NBD, Cleveland (JW and KESS) and Rosenberg scores were significantly lower in the transanal irrigation group than in the conservative bowel management group at week 10.
This prospective, randomised, controlled, multicentre study in adult patients with SB suggests that transanal irrigation may be more effective than conservative bowel management.
比较经肛门灌洗与保守性肠道管理治疗脊髓脊膜膨出（SB）患者肠功能障碍的效果。
将患有 SB 和肠功能障碍的患者随机分为经肛门灌洗组或保守性肠道管理组。以第 10 周时神经源性肠功能障碍（NBD）评分降低 4 分为治疗有效的定义。分别在纳入后第 10 周和 24 周记录失禁（克利夫兰评分；Jorge-Wexner [JW]）和便秘（Knowles-Eccersley-Scott 症状便秘评分 [KESS]）的数据。采用意向治疗分析数据。
共 34 例患者随机分组：16 例接受保守性肠道管理，18 例接受经肛门灌洗。共有 19/31 例（61%）患者在第 10 周时改善，灌洗组 13 例（76%），保守组 6 例（43%）（p=0.056）。在灌洗组中，NBD 评分降低了-6.9（-9.9 至-4.02），而保守组为-1.9（-6.5 至-2.8）（单变量分析 p=0.049，多变量分析 p=0.004）。在第 10 周时，经肛门灌洗组的 NBD、克利夫兰（JW 和 KESS）和 Rosenberg 评分均显著低于保守性肠道管理组。
这项前瞻性、随机、对照、多中心研究纳入了成年 SB 患者，表明与保守性肠道管理相比，经肛门灌洗可能更有效。
