Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
Proctos Kliniek, Bilthoven, The Netherlands.
Colorectal Dis. 2023 Aug;25(8):1658-1670. doi: 10.1111/codi.16628. Epub 2023 May 31.
The aim of this work was to determine the clinical efficacy of high-volume transanal irrigation (TAI) in patients with constipation and/or faecal incontinence using validated symptom and quality of life questionnaires.
This was a prospective cohort study of 114 consecutive patients with constipation and/or faecal incontinence (Rome IV defined) who started TAI. A comprehensive questionnaire was completed at baseline and 4, 12, 26 and 52 weeks' follow-up. The primary objective was significant symptom reduction [≥30%; Cleveland Clinic Constipation Score (CCCS) and St Marks Incontinence Score (SMIS)] in those who continued TAI at 52 weeks. Secondary objectives were (1) continuation rates of TAI, (2) effect on quality of life (QoL) and (3) identification of predictors for continuation.
A total of 59 (51.8%) patients with constipation, 26 (22.8%) with faecal incontinence and 29 (25.4%) with coexistent symptoms were included. At 52 weeks, 41 (36.0%) patients continued TAI, 63 (55.2%) stopped and 10 (8.8%) patients were lost to follow-up. In those who continued TAI at 52 weeks (n = 41), no reduction of constipation symptoms was observed. Median Patient Assessment of Constipation Quality of Life scores decreased on most domains, indicating QoL improvement. Reduction of faecal incontinence occurred in 5/9 (55.6%) patients with faecal incontinence and in 3/10 (30.0%) patients with coexistent symptoms. The median SMIS per-individual decreased in patients with coexistent symptoms (2; interquartile range 0-4; p = 0.023). Median Fecal Incontinence Quality of Life scores increased in most domains, indicating improved QoL. No clinical characteristics predicted continuation.
One-third (n = 41) of patients continued TAI at 52 weeks. In those who continued TAI at 52 weeks, symptoms of faecal incontinence (SMIS) were reduced but not constipation (CCCS). QoL related to both constipation and faecal incontinence improved. No clinical characteristics predicted continuation.
本研究旨在使用经过验证的症状和生活质量问卷，确定大容量经肛门灌洗（TAI）在便秘和/或粪便失禁患者中的临床疗效。
这是一项对 114 例连续便秘和/或粪便失禁（罗马 IV 标准）患者进行的前瞻性队列研究，他们开始接受 TAI。在基线和第 4、12、26 和 52 周的随访中完成了一份综合问卷。主要目标是在第 52 周继续接受 TAI 的患者中，症状显著缓解[≥30%；克利夫兰诊所便秘评分（CCCS）和圣马克斯失禁评分（SMIS）]。次要目标是（1）TAI 的继续率，（2）对生活质量（QoL）的影响，（3）确定继续治疗的预测因素。
共纳入 59 例便秘患者（51.8%）、26 例粪便失禁患者（22.8%）和 29 例同时存在症状的患者（25.4%）。在第 52 周时，41 例（36.0%）患者继续接受 TAI，63 例（55.2%）停止治疗，10 例（8.8%）患者失访。在第 52 周继续接受 TAI 的 41 例患者中，便秘症状未见缓解。大多数领域的患者便秘生活质量评估评分中位数下降，表明 QoL 改善。在 9 例粪便失禁患者中有 5 例（55.6%）和在 10 例同时存在症状的患者中有 3 例（30.0%）出现粪便失禁减少。同时存在症状的患者的个体 SMIS 中位数减少（2；四分位距 0-4；p=0.023）。在大多数领域，粪便失禁生活质量评分中位数增加，表明 QoL 改善。没有临床特征预测继续治疗。
三分之一（n=41）的患者在第 52 周继续接受 TAI。在第 52 周继续接受 TAI 的患者中，粪便失禁症状（SMIS）减少，但便秘症状（CCCS）未减少。与便秘和粪便失禁相关的 QoL 均有所改善。没有临床特征预测继续治疗。
