Charlotte Andrianjafy1,2, Laure Luciano3, Anderson Loundou4, Michel Bouvier2,5, Veronique Vitton6,7. 1. Service de Gastroenterologie, CHU de Nancy, Vandoeuvre Lès Nancy, France. 2. Service de Gastroenterologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France. 3. Service de Gastroenterologie, Hopital d'Instruction des Armées Laveran, Marseille, France. 4. EA3279, Self-Perceived Health Assessment Research Unit, Aix Marseille Université, Marseille, France. 5. Plateforme d'Interface Clinique, CRN2M, CNRS UMR 7286, Aix Marseille Université, Marseille, France. 6. Service de Gastroenterologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France. vittonv@yahoo.com. 7. Plateforme d'Interface Clinique, CRN2M, CNRS UMR 7286, Aix Marseille Université, Marseille, France. vittonv@yahoo.com.
Abstract
PURPOSE: Biofeedback therapy (BT) is a simple and effective technique for managing outlet constipation and fecal incontinence. Several clinical factors are known to predict BT response, but a 50% failure rate persists. Better selection of BT responsive patients is required. We aimed to determine whether the defecation disorder type per high-resolution manometry (HRM) was predictive of BT response. METHODS: We analyzed clinical, manometric, and ultrasound endoscopic data from patients who underwent BT in our department between January 2015 and January 2016. Patients were classified into four groups per the following defecation disorder classification criteria: rectal pressure > 40 mmHg and anal paradoxical contraction (type I); rectal pressure < 40 mmHg and anal paradoxical contraction (type II); rectal pressure > 40 mmHg and incomplete anal relaxation (type III); and rectal pressure < 40 mmHg and incomplete anal relaxation (type IV). An experienced single operator conducted ten weekly 20-min sessions. Efficacy was evaluated with the visual analog scale. RESULTS: Of 92 patients, 47 (50.5%) responded to BT. Type IV and type II defecation disorders were predictive of success (p = 0.03) (OR = 5.03 [1.02; 24.92]) and failure (p = 0.05) (OR = 0.41 [0.17; 0.99]), respectively. The KESS score severity before BT (p = 0.03) (OR = 0.9 [0.81; 0.99]) was also predictive of failure. CONCLUSION: The manometry types identified according to the defecation disorder classification criteria were predictive of BT response. Our data confirm the role of three-dimensional HRM in the therapeutic management of anorectal functional disorders.
PURPOSE: Biofeedback therapy (BT) is a simple and effective technique for managing outlet constipation and fecal incontinence. Several clinical factors are known to predict BT response, but a 50% failure rate persists. Better selection of BT responsive patients is required. We aimed to determine whether the defecation disorder type per high-resolution manometry (HRM) was predictive of BT response. METHODS: We analyzed clinical, manometric, and ultrasound endoscopic data from patients who underwent BT in our department between January 2015 and January 2016. Patients were classified into four groups per the following defecation disorder classification criteria: rectal pressure > 40 mmHg and anal paradoxical contraction (type I); rectal pressure < 40 mmHg and anal paradoxical contraction (type II); rectal pressure > 40 mmHg and incomplete anal relaxation (type III); and rectal pressure < 40 mmHg and incomplete anal relaxation (type IV). An experienced single operator conducted ten weekly 20-min sessions. Efficacy was evaluated with the visual analog scale. RESULTS: Of 92 patients, 47 (50.5%) responded to BT. Type IV and type II defecation disorders were predictive of success (p = 0.03) (OR = 5.03 [1.02; 24.92]) and failure (p = 0.05) (OR = 0.41 [0.17; 0.99]), respectively. The KESS score severity before BT (p = 0.03) (OR = 0.9 [0.81; 0.99]) was also predictive of failure. CONCLUSION: The manometry types identified according to the defecation disorder classification criteria were predictive of BT response. Our data confirm the role of three-dimensional HRM in the therapeutic management of anorectal functional disorders.
Authors: Brototo Deb; Mayank Sharma; Joel G Fletcher; Sushmitha Grama Srinivasan; Alexandra Chronopoulou; Jun Chen; Kent R Bailey; Kelly J Feuerhak; Adil E Bharucha Journal: Gastroenterology Date: 2021-12-22 Impact factor: 22.682