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.
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References
D’Hoore A, Penninckx F (2003) Obstructed defecation. Colorectal Dis Off J Assoc Coloproctology G B Irel 5(4):280–287
Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, Mott L, Rogers RG, Zinsmeister AR, Whitehead WE, Rao SSC, Hamilton FA (2015) Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol 110(1):127–136
Rao SSC (2010) Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 8(11):910–919
Benezech A, Bouvier M, Grimaud J-C, Baumstarck K, Vitton V (2014) Three-dimensional high-resolution anorectal manometry and diagnosis of excessive perineal descent: a comparative pilot study with defaecography. Colorectal Dis Off J Assoc Coloproctology G B Irel 16(5):O170–O175
Vitton V, Ben Hadj Amor W, Baumstarck K, Behr M, Bouvier M, Grimaud J-C (2013) Comparison of three-dimensional high-resolution manometry and endoanal ultrasound in the diagnosis of anal sphincter defects. Colorectal Dis Off J Assoc Coloproctology G B Irel 15(10):e607–e611
Benezech A, Cappiello M, Baumstarck K, Grimaud JC, Bouvier M, Vitton V (2017) Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography? Neurogastroenterol Motil 29(4)
Rao SSC, Mudipalli RS, Stessman M, Zimmerman B (2004) Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 16(5):589–596
Lee YY, Erdogan A, Rao SSC (2013) High resolution and high definition anorectal manometry and pressure topography: diagnostic advance or a new kid on the block? Curr Gastroenterol Rep 15(12):360
Woodward S, Norton C, Chiarelli P (2014). Biofeedback for treatment of chronic idiopathic constipation in adults. Cochrane Database Syst Rev;(3):CD008486
Shim LSE, Jones M, Prott GM, Morris LI, Kellow JE, Malcolm A (2011) Predictors of outcome of anorectal biofeedback therapy in patients with constipation. Aliment Pharmacol Ther 33(11):1245–1251
Gilliland R, Heymen S, Altomare DF, Park UC, Vickers D, Wexner SD (1997) Outcome and predictors of success of biofeedback for constipation. Br J Surg 84(8):1123–1126
Park DH, Myung S-J, Yoon I-J, Kwon O-R, Ko J-E, Chang H-S et al (2003) Clinical factors associated with response to biofeedback therapy for patients with chronic constipation. Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi 42(4):289–296
Chiarioni G, Salandini L, Whitehead WE (2005) Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 129:86–97
Byrne CM, Solomon MJ, Young JM, Rex J, Merlino CL (2007) Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 50(4):417–427
Shin JK, Cheon JH, Kim ES, Yoon JY, Lee JH, Jeon SM, Bok HJ, Park JJ, Moon CM, Hong SP, Lee YC, Kim WH (2010) Predictive capability of anorectal physiologic tests for unfavorable outcomes following biofeedback therapy in dyssynergic defecation. J Korean Med Sci 25(7):1060–1065
Fernández-Fraga X, Azpiroz F, Aparici A, Casaus M, Malagelada J-R (2003) Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 46(9):1218–1225
Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ (2002) Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Dis Colon Rectum 45(6):842–843
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97
Lee TH, Bharucha AE (2016) How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil 22(1):46–59
Raja S, Okeke FC, Stein EM, Dhalla S, Nandwani M, Lynch KL, Gyawali CP, Clarke JO (2017) Three-dimensional anorectal manometry enhances diagnostic gain by detecting sphincter defects and puborectalis pressure. Dig Dis Sci 62(12):3536–3541
Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH (2016) Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut 65(3):447–455
Pescatori M, Spyrou M, Pulvirenti d’Urso A (2007) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis Off J Assoc Coloproctology G B Irel 9(5):452–456
Leroi AM, Bernier C, Watier A, Hémond M, Goupil G, Black R, Denis P, Devroede G (1995) Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract. Int J Color Dis 10(4):200–206
Faried M, El Nakeeb A, Youssef M, Omar W, El Monem HA (2010) Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg Off J Soc Surg Aliment Tract 14(8):1235–1243
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis Off J Assoc Coloproctology G B Irel 10(1):84–88
Rao SSC, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P et al (2007) Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 5(3):331–338
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VV, CA, and MB have been consultants for Medtronic.
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Andrianjafy, C., Luciano, L., Loundou, A. et al. Three-dimensional high-resolution anorectal manometry can predict response to biofeedback therapy in defecation disorders. Int J Colorectal Dis 34, 1131–1140 (2019). https://doi.org/10.1007/s00384-019-03297-z
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DOI: https://doi.org/10.1007/s00384-019-03297-z