Alborzi Avanaki Foroogh, Rafiee Sara, Aldin Varpaei Hesam, Taher Mohammad, Aletaha Najmeh, Allameh Farshad
Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Middle East J Dig Dis. 2023 Jan;15(1):45-52. doi: 10.34172/mejdd.2023.319. Epub 2023 Jan 30.
Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients ( = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS ( < 0.001). Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.
慢性便秘是一个常见的健康问题。排便障碍被认为是慢性特发性便秘的机制之一。本研究旨在评估合并肠易激综合征（IBS）对慢性便秘和盆底失协调（PFD）患者生物反馈治疗成功率及反应的影响。这项前瞻性队列研究于2020年10月至2021年7月在德黑兰的伊玛目霍梅尼医院综合院区进行。纳入年龄在18 - 70岁、经临床检查、肛门直肠测压、气囊排出试验和/或排粪造影确诊为慢性便秘和PFD的患者。所有患者对生活方式调整和使用泻药治疗均无反应。IBS的诊断基于罗马IV标准。对所有患者进行生物反馈指导并推荐。我们使用三种不同指标评估患者对生物反馈的反应：1）便秘评分（问卷），2）生活方式评分（问卷），3）测压结果（胃肠病学家报告）。最终分析纳入40例患者，其中7例男性（17.5%）和21例（52.2%）患有IBS。研究人群的平均年龄为37.7±11.4。治疗后平均静息压力降低；然而，仅在非IBS患者中这种降低具有统计学意义（=0.007）。有和没有IBS的患者治疗后肛门括约肌松弛百分比均增加，但这种差异无统计学意义。尽管两组患者首次便意均降低，但这种降低无统计学意义。总体而言，IBS和非IBS患者的临床反应相同，但有和没有IBS的两组患者便秘和生活方式评分均显著降低（<0.001）。生物反馈治疗似乎可改善PFD患者的临床状况和生活质量。鉴于在IBS患者中已观察到生物反馈在纠正某些测压参数方面有更好效果，似乎关注这两种疾病之间的关联有助于治疗决策。
