Wang Ximeng, Chen Jiande Dz
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21228, USA.
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor MI 48109, USA.
J Transl Int Med. 2023 Jul 5;11(2):115-127. doi: 10.2478/jtim-2023-0086. eCollection 2023 Jul.
The aim of this systemtic review is to introduce clinical applications (especially emerging) and potential mechanisms of sacral nerve stimulation (SNS) for treating various gastrointestinal diseases.
PubMed and Web of Science were searched for studies published on SNS and its clinical applications in fecal incontinence (limited to systematic review and meta-analysis of clinical studies), constipation (limited to reviews and randomized control clinical studies), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and upper gastrointestinal motility disorders. The relevant studies were pooled, and their findings were summarized and discussed.
SNS is an approved method for treating fecal incontinence. Systematic review and meta-analysis demonstrated high efficacy of the SNS therapy for fecal incontinence. Increased anal sphincter pressure and improvement in rectal sensation were reported as major mechanisms involved in the SNS therapy. SNS has also been proposed for treating constipation, but the therapy has been shown ineffective. There is a lack in SNS methodological optimization and mechanistic research. A few basic and clinical studies have reported the potential of SNS for treating visceral pain in IBS. SNS seemed capable of improving mucosal barrier functions. Several case reports are available in the literature on the treatment of IBD with SNS. Several laboratory studies suggested therapeutic potential of a special method of SNS for IBD. Cholinergic anti-inflammatory mechanisms were reported. Due to a recently reported spinal afferent and vagal efferent pathway of SNS, a few preclinical studies reported the potential of SNS for upper gastrointestinal motility disorders. However, no clinical studies have been performed.
SNS for fecal incontinence is a well-established clinical therapy. However, the current method of SNS is ineffective for treating constipation. Further methodological development and randomized clinical trials are needed to explore potential applications of SNS for IBS and IBD.
本系统评价旨在介绍骶神经刺激（SNS）治疗各种胃肠道疾病的临床应用（尤其是新兴应用）及其潜在机制。
检索PubMed和Web of Science数据库中关于SNS及其在大便失禁（限于临床研究的系统评价和荟萃分析）、便秘（限于综述和随机对照临床研究）、肠易激综合征（IBS）、炎症性肠病（IBD）和上消化道动力障碍方面临床应用的研究。汇总相关研究，并总结和讨论其结果。
SNS是一种已获批准的大便失禁治疗方法。系统评价和荟萃分析表明SNS治疗大便失禁疗效显著。肛门括约肌压力增加和直肠感觉改善被报道为SNS治疗的主要机制。SNS也被提议用于治疗便秘，但已证明该疗法无效。SNS在方法优化和机制研究方面存在不足。一些基础和临床研究报道了SNS治疗IBS内脏痛的潜力。SNS似乎能够改善黏膜屏障功能。文献中有几例关于SNS治疗IBD的病例报告。一些实验室研究提示一种特殊的SNS方法对IBD有治疗潜力。报道了胆碱能抗炎机制。由于最近报道了SNS的脊髓传入和迷走神经传出通路，一些临床前研究报道了SNS治疗上消化道动力障碍的潜力。然而，尚未进行临床研究。
SNS治疗大便失禁是一种成熟的临床疗法。然而，目前的SNS方法治疗便秘无效。需要进一步开展方法学研究和随机临床试验，以探索SNS在IBS和IBD中的潜在应用。
