Fecal Incontinence Research Articles

Quality of life following complete clinical response to chemoradiotherapy for rectal cancer: Patient-reported outcomes.

120 Background: Complete clinical response (cCR) after neoadjuvant therapy (chemoradiotherapy/total neoadjuvant treatment) for rectal cancer may permit an organ-preserving approach with “watch and wait” (W&W) surveillance. This confers comparable survival, while avoiding the sequelae of pelvic surgery. Data on quality of life (QOL) for this cohort are lacking. Methods: Patient-reported outcomes were collated for patients on W&W following cCR in a single hospital network. Validated questionnaires evaluating surgical, radiation and chemotherapy-related QOL were completed, including Low Anterior Resection Syndrome (LARS) score, Functional Assessment of Chemotherapy: Colorectal (FACT-C), EORTC QLQ-CIPN20, EQ-5D-5L and a linear analogue and ordinal scale ranking self-perception of health. Results: From 2016-2023, 76 patients were enrolled on W&W. Median follow-up is 37 months (IQR20-63). 12 patients (15.8%) had local regrowth, of whom 11 (92%) had salvage surgery. Five patients (6.5%) developed metastases at median 8 months (IQR3-12) from W&W entry. Of 57 patients (75%) with sustained cCR on surveillance, 44 (77%) responded to structured questionnaires. Two with stomas were excluded from LARS. 74% of respondents had no LARS, 9% minor LARS and 17% major LARS. 43% reported faecal urgency and 33% faecal incontinence. 41% experienced functional impairment due to chronic chemotherapy-related side effects (Table). Median EORTC CIPN20 score was 23 (IQR20-28; possible range 19-76, high score = poor QOL). Median sensory score was 11 (IQR9-15.5, PR 9-36), median motor score 8 (IQR8-11, PR 8-32) and median autonomic score 4 (IQR3-6) for males (PR 3-12) and 2 (IQR2-2.5) for females (PR 2-8). 54% of men reported erectile dysfunction, of whom 62% experienced severe dysfunction (33% of all males). Median FACT-C score was 123.5 (IQR108-131; PR 0-136, high score = better QOL). Median overall health score was 80% (IQR70-95). 36% of patients reported difficulty with mobility, 27% with usual activities and 11% with self-care. 30% declared ongoing physical pain/discomfort, while 23% live with anxiety/depression related to their diagnosis. Overall, 86% of reported problems were mild/moderate and 14% severe/very severe. Conclusions: This study highlights self-reported QOL in patients on W&W pathway following neoadjuvant treatment of rectal cancer. It provides important insight to side-effects of treatment escalation in hope of organ preservation, and presents vital information for the counselling of future patients. Patients (n=41) Upper limb paraesthesia 12 (29%) Lower limb paraesthesia 17 (41%) Difficulty with: - Walking/standing (foot drop or impaired sensation) 10 (24%) - Stairs/sit-to-stand (leg weakness) 11 (27%) - Hot/cold differentiation 4 (10%) - Holding pen/manipulating small objects/opening jar/bottle 12 (29%) Hearing impairment 13 (32%) Blurred vision 4 (10%)

Risk Factors for Incontinence-Associated Dermatitis in Adults: A Systematic Review and Meta-Analysis.

A meta-analysis was conducted to comprehensively identify risk factors of incontinence-associated dermatitis (IAD) in adults and provide evidence-based support for healthcare professionals to formulate IAD preventive interventions and bundled interventions. Systematic review and meta-analysis of pooled findings. Two researchers independently searched databases PubMed, EBSCO, Cochrane Library, Embase, Medline, Web of Science and Scopus and 4 Chinese databases (CNKI, Wanfang Data, VIP and CBM) for relevant studies published from their inception to March 15, 2023. Two researchers independently extracted relevant data and literature characteristics and evaluated the quality of the included studies. Twenty-seven studies that collectively enrolled 4046 participants were included in our systematic review. Five were written in English, 1 was written in Spanish, and the other 21 were written in Chinese. The odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors for IAD were determined. Fecal incontinence, an etiologic factor (OR=5.79; 95% CI=[1.88-17.87]), stool characteristics (OR=5.28; 95% CI=[2.51-11.07]), and daily frequency of bowel movements (OR=5.76; 95% CI=[4.48-7.42]) were associated with an increased likelihood of IAD. The following risk factors: fever (OR=4.23; 95% CI=[1.89-9.46]), age (OR=1.04; 95% CI=[1.01-1.09]), hypoproteinemia (OR=3.30; 95% CI=[1.90-5.72]), impaired consciousness (OR=2.43; 95% CI=[1.66-3.54]), days of antibiotic use (OR=4.13; 95% CI=[3.11-5.49]), diabetes mellitus (OR=2.90; 95% CI=[1.73-4.86]), and a higher overall Perineal Assessment Tool (PAT) score (OR=2.56; 95% CI=[1.23-5.30]) emerged as independent risk factors for IAD in adult patients. In contrast, a higher serum albumin level (OR=0.88; 95% CI=[0.84-0.93]), a higher Braden Scale for Predicting Pressure Score Risk (Braden Scale) score (OR=0.66; 95% CI=[0.56-0.77]), and a higher Braden Scale mobility subscale score (OR=0.86; 95% CI=[0.74-1.00]) were protective factors that reduced the likelihood of IAD. Identification of risk factors for IAD may be used to identify patients at risk and in need of preventive interventions. Identification of modifiable risk factors may be used to design novel preventive interventions.

Evaluation of surgical strategy for low anterior resection syndrome using preoperative low anterior resection syndrome score in China.

Despite improved survival rates in rectal cancer treatment, many patients experience low anterior resection syndrome (LARS). The preoperative LARS score (POLARS) aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning. To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS. This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors. Patients were categorized into three groups according to their POLARS score: no LARS (score 0-20), minor LARS (score 21-29), and major LARS (score 30-42). The QLQ-C30/CR29 scores were compared among these groups, and the agreement between POLARS predictions and the actual LARS scores was analyzed. The study population was divided into three groups: major LARS (n = 51, 27.42%), minor LARS (n = 109, 58.6%), and no LARS (n = 26, 13.98%). Significant differences in the QLQ-C30 scales of social function, diarrhea, and financial impact were detected between the no LARS and major LARS groups (P < 0.05) and between the minor LARS and major LARS groups (P < 0.05). Similarly, significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool, fecal incontinence, and stool frequency between the no LARS and minor LARS groups (P < 0.05), as well as between the minor LARS and major LARS groups (P < 0.05). The predictive precision for major LARS using the POLARS score was 82.35% (42/51), with a recall of 35.89% (42/117). The mean absolute error (MAE) between the POLARS score and the actual LARS score was 8.92 ± 5.47. In contrast, the XGBoost (extreme gradient boosting) model achieved a lower MAE of 6.29 ± 4.77, with a precision of 84.39% and a recall of 74.05% for predicting major LARS. The POLARS score demonstrated effectiveness and precision in predicting major LARS, thereby providing valuable insights into postoperative symptoms and patient quality of life. However, the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.

The outcome of early perineal rehabilitation in obstetric anal sphincter injuries: a single-center experience.

The objective of this study is to evaluate the impact of pelvic floor physical therapy (PFPT) on symptoms and quality of life in women who experienced third- and fourth-degree perineal tears (Obstetric Anal Sphincter Injuries, OASIS) during childbirth. OASIS can lead to anal incontinence and dyspareunia, having important implications regarding the quality of life and health of women but, unfortunately, there is no standard practice for postpartum care following OASIS. In this retrospective observational study, patients diagnosed with OASIS between January 2016 and June 2023 were enrolled. Since 2016, all women with OASIS have been routinely referred for physiatric evaluation and pelvic floor rehabilitation. Validated questionnaires (Wexner score and Marinoff scale) were administered to enrolled women to assess anal incontinence and dyspareunia. The study included 148 women, of whom 88 responded to the questionnaires. Participants were divided into two groups: those who underwent PFPT (N = 68) and those who declined it (N = 20). The mean follow-up period was 1447.35days. The Wexner score was lower in the PFPT group compared to the no-PFPT group (p = 0.050). The Marinoff score did not show a statistically significant difference between the two groups (p = 0.381). PFPT was shown to be effective in reducing AI symptoms in women with OASIS, improving quality of life and maintaining its effects in the long term, but without providing benefits for dyspareunia. Strengths of this study include the use of validated questionnaires, the long follow-up period, and the involvement of a specialized team of physiatrists and physiotherapists.

Use of sacral neuromodulation in the treatment of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a prevalent condition characterized by urinary urgency, frequency, and incontinence, significantly impacting patients’ quality of life. Sacral neuromodulation (SNM) has emerged as an effective treatment, particularly for individuals unresponsive to conventional therapies. SNM operates by modulating sacral nerve activity to restore normal bladder function, offering both symptom relief and enhanced quality of life. Recent clinical studies demonstrate its long-term efficacy, with sustained improvements in urgency and frequency, and high patient satisfaction rates. Mechanisms underlying SNM involve the modulation of peripheral and central nervous pathways, normalizing overactive detrusor activity and rebalancing excitatory and inhibitory neural signals. Advances in device technology, including rechargeable systems and adaptive stimulation, have further optimized its clinical utility. Minimally invasive techniques and improved electrode designs have enhanced the safety and accessibility of SNM, reducing complications and recovery times. Emerging applications of SNM extend beyond OAB, showing potential in managing neurogenic bladder, fecal incontinence, and chronic pelvic pain. Integration with digital health technologies allows for remote monitoring and personalized adjustments, improving patient outcomes and adherence. Future directions include exploring combined therapies, expanding indications, and leveraging machine learning for tailored neuromodulation. As innovations continue to refine SNM, its role in treating complex pelvic disorders is set to expand, offering a durable, effective solution for patients with refractory conditions. This evolution highlights SNM’s transformative potential in both urological and multidisciplinary care.

Prevalence and breed predisposition for spinal diseases in pugs and French bulldogs.

Pugs and French bulldogs (FBDs) are commonly presented for spinal disease. The aim of this study was to define the most common spinal diseases in both breeds. This was a monocentric retrospective study including pugs and FBDs presenting with clinical signs consistent with spinal disease between 2010 and 2022. The information collected included signalment, onset of clinical signs, presence of spinal pain, progression of clinical signs, presence of urinary or faecal incontinence and neurological examination findings. A total of 439 FBDs with 448 diagnoses and 106 pugs with 125 diagnoses were included in the study. A total of 272 (62.0%) FBDs had an acute onset of clinical signs, and 79 pugs (74.5%) had a chronic onset. The most common disease in the FBD population was acute intervertebral disc extrusion, with 377 diagnoses (84.3%). The most common diagnoses among pugs were spinal arachnoid diverticula (SADs) (n = 30, 24.0%) and chronic intervertebral disc protrusion (n = 30, 24.0%). This study was limited by its retrospective nature, meaning that there was not a standardised diagnostic protocol. This study confirms that FBDs and pugs are affected by different spinal disorders. While FBDs are mostly affected by acute intervertebral disc extrusions, pugs are more often affected by SADs and chronic intervertebral disc protrusions.

The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis.

Excisional hemorrhoidectomy and stapled hemorrhoidopexy are 2 common procedures for treating symptomatic hemorrhoids. However, concerns persist regarding the risk of postoperative complications and their unclear prevalence in the literature. This systematic review aims to evaluate andcompare the prevalence of incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy. A systematic search of Medline, EMBASE, and CENTRAL identified studies published in the past 25years that reported incontinence after excisional treatments for hemorrhoids. Primary outcomes included early (<3months) and late (≥3months) fecal incontinence. Secondary outcomes included postoperative bleeding, urinary retention, and recurrence. Single-arm meta-analyses of proportions were performed using R with meta-regression. In total, 139 studies were included in the meta-analysis, including 68 randomized controlled trials with 8,445 participants and 71 observational studies with 22,687 participants. Early incontinence rates were 5.32% in randomized controlled trials (95% confidence interval, 2.74-8.51%) and 1.03% in nonrandomized controlled trials (95% confidence interval, 0.28-2.09%). Late incontinence rates were 2.48% in randomized controlled trials (95% confidence interval, 1.09-4.25%) and 1.44% in nonrandomized controlled trials (95% confidence interval, 0.71-2.37%). There was no significant difference in the risk of incontinence or other postoperative complications between stapled hemorrhoidopexy and excisional hemorrhoidectomy, both in randomized controlled trials and nonrandomized controlled trials. Incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy is uncommon, and there appears to be no significant difference in risk between the 2 procedures. However, considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies. Future research should standardize definitions and methods for assessing incontinence and include preoperative assessments to more accurately define the risks of complications associated with hemorrhoid surgery.

Outcomes after surgical repair of primary parastomal hernia

PurposeParastomal hernia is a frequent complication after stoma construction, with increasing incidence over time. Surgical repair is reported with a high recurrence rate and the evidence on the topic is limited. We conducted a retrospective study to evaluate the incidence of recurrence after parastomal hernia repair and assessed the risk factors and predictors for recurrence at the Regional Hernia Center at Horsens Regional Hospital, Denmark.Methods119 patients underwent primary parastomal hernia repair from January 2017 until April 2021. Mean follow-up period was 72 months. Information including demographic data, non-modifiable risk factors and modifiable risk factors were assessed and analyzed using LASSO to select relevant predictors and GLM was employed hereafter.ResultsMultivariate analysis showed that age, diabetes, IBD, constipation, and fecal incontinence were strong pre-operative predictors, with age, IBD, ileostomy, and colorectal cancer also reaching significance in univariate analyses. Post-operatively, EHS classification 1, and Clavien Dindo Grade 3b were identified as strong predictors in univariate analyses.ConclusionRecurrence after parastomal hernia repair was 17.64% during a follow-up period of minimum 3.5 years.

P0497 Faecal Incontinence and Urgency in IBD Patients on Biologic Therapy in Remission: Prevalence and Risk Factors

Abstract Background Despite being in clinical remission, patients with inflammatory bowel disease (IBD) on biologic therapy may experience faecal incontinence (FI) and urgency, significantly impacting their quality of life. This study aimed to determine the prevalence of FI and urgency in this population and to identify associated risk factors. Methods A cross-sectional study was conducted in a tertiary referral centre, including IBD patients in remission on biologic therapy (evaluated by partial Mayo score or Harvey-Bradshaw Index). Data on demographic and clinical characteristics were analysed, including age, sex, disease duration, previous biologic therapies, surgical history, and severity indices. FI was defined as a St. Mark’s Vaizey score ≥6, and urgency was assessed using a Visual Analog Scale (VAS) score ≥4. Statistical analysis included chi-squared, Fisher’s exact, and Wilcoxon rank sum tests. Results The study included 124 IBD patients (85 Crohn’s disease, 39 ulcerative colitis). FI was observed in 15% of patients, while urgency (VAS ≥4) was reported by 8%. Notably, 14.1% of Crohn’s disease patients in endoscopic remission (SES-CD ≤2) experienced significant FI. Risk factors significantly associated with FI included advanced age (median 49 years vs. 38 years, p=0.007), gender (male 33% vs. female 63%, p=0.014), and history of surgical interventions (58% vs. 26%, p=0.005). Urgency was more prevalent in patients requiring diapers or pads (30% vs. 5.7%, p&amp;lt;0.001) with no other significant factors identified. CRP and faecal calprotectin levels were not significantly associated with either FI or urgency in this cohort. Conclusion FI and urgency remain prevalent among IBD patients in clinical but also endoscopical remission on biologic therapy, underscoring the need for continued symptom monitoring and management strategies. Advanced age, gender and surgical history are key risk factors. Future studies should explore targeted interventions to mitigate these complications in this patient group.

Prevalence, clinical and anorectal function characterization of faecal incontinence and rectal urgency in ulcerative colitis patients (HOPE Study)

Abstract Background and aims Faecal incontinence (FI) and rectal urgency (RU) are underestimated and underdiagnosed in ulcerative colitis (UC) patients. Our primary aim is to evaluate the prevalence and severity of FI and/or RU in UC patients. Secondary aims include investigating the causes of FI and/or RU, identifying factors associated with FI and/or RU, and describing anorectal function in UC patients in remission who report these symptoms. Methods This is a prospective, multicentre study with two parts. The first part is an epidemiological analysis involving 667 UC patients, in whom the prevalence of FI and/or RU will be assessed. The second part focuses on characterizing anorectal function in patients who report FI and/or RU while in remission. As per clinical practice, an endoscopic study will rule out disease activity as a cause of symptoms in all patients reporting FI and/or RU in the first part. Those confirmed to be in remission will proceed to the second part, where anorectal function will be evaluated using high-resolution anorectal manometry. Therapeutic strategies for FI and RU will be proposed following clinical practice guidelines, and we will record responses to these treatments and their impact on symptom severity. Additionally, we will assess the impact of these therapeutic strategies on patients' quality of life. Anticipated impact To provide effective therapy for FI and/or RU in UC patients, it is essential to understand their prevalence during both active disease and remission, as well as the underlying mechanisms in remission. Our study aims to reveal the true prevalence of FI and RU in UC patients, expand knowledge of anorectal function in those in remission, and help identify therapeutic targets to alleviate these burdensome symptoms, ultimately improving quality of life for affected individuals.

P0386 Prevalence and Impact of Anorectal Disorders in IBD: Insights from a Romanian Tertiary Gastroenterology Center

Abstract Background Anorectal motility disorders profoundly affect the quality of life in patients with quiescent inflammatory bowel disease (IBD). Although faecal incontinence (FI) has a reported prevalence of up to 74%, its true extent is likely underestimated due to the stigma surrounding the condition. Fear of FI and challenges in accessing toilets remain significant concerns. This study evaluates the prevalence of these issues in Romanian tertiary care patients using the validated questionnaire International Consultation on Incontinence Questionnaire for Bowel Incontinence – IBD (ICIQ-IBD). Methods We surveyed 65 IBD patients aged over 18, admitted to our center, who were in remission but had previously experienced moderate to severe disease. Using the ICIQ-IBD questionnaire, we collected data on faecal incontinence, soiling, anal dyskinesia, their impact on quality of life, and demographic information. The analysis was conducted using Excel and Minitab. Results Of the 65 patients included in the study, 69% were male, with a median age of 40.82 ± 12.10 years. The majority were diagnosed with Crohn’s disease (65% CD, 35% UC). During remission, 22% of patients reported the need to rush to the toilet “always” or “most of the time,” compared to 40% during relapse, with a significant difference between disease phases (p = 0.02) but no differences based on gender or diagnosis. In relapse, 68% of patients had less than one minute to reach a toilet, compared to 32% in remission (p = 0.00). Soiling was reported by 49% of patients during active disease and 25% in remission (p = 0.004). Difficulty controlling liquid stools affected 62% of patients in relapse and 55% in remission, with no significant difference between disease states (p = 0.417). Emotional impact was reported by 72% of patients in relapse and 15% in remission, highlighting the psychosocial burden of bowel dysfunction in IBD. Conclusion Anorectal disorders significantly affect IBD patients’ quality of life, even during remission. Key symptoms, such as soiling and urgency, were more prevalent during relapse and strongly linked to emotional distress. These findings underscore the need for targeted management of anorectal symptoms in IBD care. References Norton, Christine et al. “Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life.” Journal of Crohn’s &amp; colitis vol. 7,8 (2013): e302-11. doi:10.1016/j.crohns.2012.11.004 Dibley, Lesley et al. “Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD.” European journal of gastroenterology &amp; hepatology vol. 28,2 (2016): 233-9. doi:10.1097/MEG.0000000000000513

P1277 Cost-effectiveness of BOOST online intervention for supported self-management of pain, fatigue and bowel incontinence in Inflammatory Bowel Disease

Abstract Background People with IBD often experience symptoms of abdominal pain, fatigue and bowel incontinence that affect substantially their daily lives1. IBD-BOOST is the first randomised controlled trial (RCT) assessing the effectiveness of an online self-management intervention, BOOST, in managing these symptoms in IBD2. We report the cost-effectiveness of BOOST intervention compared to care as usual for people with IBD. Methods A cost-utility analysis was conducted alongside the pragmatic IBD-BOOST RCT of 780 patients requesting help for pain, fatigue or incontinence symptoms (mean age 49 years, 67% women, 55% with Crohn’s disease)3. The BOOST intervention costs and costs from patient-reported health service use, out-of-pocket expenses and time off work were calculated for each participant over the 12 months of follow-up. Quality-adjusted life-years (QALYs) over the 12 months were evaluated using the EQ-5D-5L questionnaires administered to participants at baseline, 6- and 12-months. Missing data (13% at 6 months and 38% at 12 months across the trial arms) was imputed using multiple imputation. Differences in total costs and QALYs between study arms were estimated using mixed effects models adjusting for pre-specified baseline factors. Incremental cost effectiveness ratios (ICERs) and net monetary benefit from UK healthcare and societal perspectives are reported. Results At recruitment, study participants reported quality of life (EQ-5D utility) of 0.73 (SD 0.22) and overall IBD-related costs of £2321 (SD 3170) over the previous 3 months with cost of biologics accounting for 47% of these costs, followed by hospital outpatient services (22%) and work productivity loss costs (14%) (Figure 1). After missing data imputation and controlling for covariates, the BOOST intervention (£151 per participant) was estimated to have led to health care cost savings of £746 (SE 356), other costs savings of £89 (SE 236) and incremental QALYs of 0.017 (SE 0.007) over the one-year follow-up per participant resulting in cost savings per QALY gained of £34,599 from the health services perspective and £39,745 from the societal perspective. The probability that the BOOST intervention was cost effective when compared with usual care was above 98% for willingness-to-pay thresholds of £20,000 to £30,000 from both health services and societal perspectives (Figure 2). Conclusion Our findings indicate that the BOOST intervention for supported self-management of symptoms of pain, fatigue and bowel incontinence in people with IBD is cost-effective.

P0229 Evaluation of anorectal function and structure in patients with perianal Crohn's disease with a novel 3-D high-definition anorectal manometry technology

Abstract Background Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that can have perianal involvement with a fistulizing phenotype (PFCD) and could affect anal sphincter integrity, leading to morbidity and reduced quality of life (QoL) due to fecal incontinence (FI) and rectal pain. High-definition 3D anorectal manometry (HD-ARM) is a novel technique that allows volumetric imaging of the anal canal through 2D and 3D images, enabling visualization of morphology and identification of pressure defects caused by lesions in the sphincter complex. There are no studies in patients with IBD with this modality of manometry. Our aim is to determine the functional and structural abnormalities of the sphincter complex using HD-ARM in patients with CD with and without PFCD and to correlate these findings with magnetic resonance imaging (MRI) results. Methods This is a prospective, longitudinal cohort study of anorectal function using HD-ARM and rectal sensitivity using rectal barostat in patients with CD from our IBD unit. Patients were recruited during follow-up visits regardless of whether or not they reported anorectal symptoms. Findings were correlated with clinical activity of CD (Harvey Bradshaw index), PFCD activity index (PDAI), FI severity index (Jorge-Wexner and St. Marks scores), QoL scores (IBDQ-9 for IBD and FIQLS for FI), and perineal MRI to confirm anatomical abnormalities. Results A total of 19 patients were recruited from December 2023 to September 2024, 68.4% of whom were female. Among patients with PFCD (68.4% of the total), 84.6% had undergone some form of anorectal surgery. Only two patients from the total cohort (10.5%) had normal HD-ARM results. The main manometric diagnoses were: rectal hypersensitivity (36.8%), rectal hyposensitivity (31.6%), internal anal sphincter insufficiency (weakness) (21.1%), incomplete evacuation maneuvers (21.1%), and dyssynergic defecation (15.8%), with no significant differences between the groups with and without PFCD. In 90% of patients with PFCD, MRI findings correlated with the presence or absence of pressure defects on the HD-ARM. Patients with pressure defects on the HD-ARM had higher FI scores on the Jorge-Wexner (7.5 vs. 3.3) and St. Marks (9 vs. 5) scores, although this difference did not reach statistical significance (p=0.07). No differences in quality of life or luminal/perianal disease activity index were found in association with manometric alterations. Conclusion Anorectal sphincter function abnormalities are common in patients with CD, with or without concomitant perianal disease. HD-ARM is a useful tool to correlate functional anorectal abnormalities with anatomic abnormalities on perineal MRI. References Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn’s disease in apopulation-based cohort. Dis Colon Rectum 2012;55:773–7. Felt-Bersma, R.J.F., Vlietstra, M.S., Vollebregt, P.F. et al. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound. BMC Gastroenterol 18, 44 (2018) R Costache, A Dimitriu, A Les, C Gheorghe, P027 Anorectal Motility Disorders in Inflammatory Bowel Disease patients, Journal of Crohn's and Colitis, Volume 17, Issue Supplement_1, February 2023, Page i197 De Codes LMG, de Jesus ACC, de Codes JJG, Ferreira RF, da Silva Beda Sacramento C, da Cruz IDM, de Castro Ribeiro Fidelis F, de Carvalho AL, Motta MP, de Oliveira Alves C, Netto EM, Santana GO. Anorectal function and clinical characteristics associated with fecal incontinence in patients with Crohn's disease. J Crohns Colitis. 2023 Mar 23:jjad048

P0518 Study of the prevalence of defecatory disorders in patients with quiescent ulcerative colitis using high resolution anorectal manometry

Abstract Background Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. Initially, it affects the rectum, and it may progress in a proximal and continuous manner to encompass other sections of the colon. Anorectal manometry quantifies and evaluates various aspects of the intricate and multifactorial mechanisms that regulate defecation and continence. Methods This study was carried out on 50 ulcerative colitis patients aged from 19 to 76 years old, both sexes, patients who have documented disease remission or mild activity clinically and by colonoscopy for the last six months and had persistent defecatory disorder symptoms. All patients were subjected to detailed history taking, systemic physical examination, laboratory investigations, colonoscopy showing remission or mild activity for the last six months based on Mayo score, and high-resolution anorectal manometry. Results There were statistically significant differences regarding relation between fecal incontinence and duration of the disease (P=0.008), while no significant differences were observed with the ulcerative colitis extension, and the treatment used. Regarding constipation, urgency, incomplete evacuation and proctalgia; there was no statistically significant differences with the duration of the disease, the ulcerative colitis extension, and the treatment used. Conclusion Many ulcerative colitis patients still experience defecatory disorders even at the quiescent stage, and this could be explained by the long-term neuromuscular effect of prolonged inflammation. High resolution anorectal manometry is the most important test to assess anal tone and contractility, recto-anal coordination and rectal sensation. Fecal incontinence in quiescent ulcerative colitis patients is significantly associated with the duration of the disease. References Gajendran M, Loganathan P, Jimenez G, Catinella AP, Ng N, Umapathy C, et al. A comprehensive review and update on ulcerative colitis. Dis Mon. 2019; 65:100-51. Kang HR, Lee JE, Lee JS, Lee TH, Hong SJ, Kim JO, et al. Comparison of high-resolution anorectal manometry with water-perfused anorectal manometry. J Neurogastroenterol Motil. 2015; 21:126-32. Torresan F, Mandolesi D, Bonventre S, Usai P. Differences between conventional anorectal manometry and high resolution\high-definition anorectal manometry. In: Bellini M, editor. High resolution and high-definition anorectal manometry. 5. Cham: Springer; 2020. p.49-68.

P0807 Impact of Risankizumab on Patient-reported Outcomes and Biomarkers Over Time: Post-Hoc Analysis of Phase 3 INSPIRE and COMMAND Studies

Abstract Background Patients with ulcerative colitis (UC) may experience debilitating symptoms that impact their quality of life. This post hoc analysis evaluates changes in patient-reported outcomes (PROs) and biomarkers over time during maintenance treatment with risankizumab (RZB), a specific inhibitor of IL-23, among patients who responded to RZB induction treatment. Methods Patients with a clinical response to 12 weeks of intravenous (IV) RZB treatment from the Phase 2b and Phase 3 INSPIRE induction studies were randomised 1:1:1 to subcutaneous (SC) placebo (PBO) withdrawal, 180 mg RZB SC, or 360 mg RZB SC every 8 weeks during maintenance (COMMAND). Individual PROs were examined as no bowel urgency, no abdominal pain, no nocturnal bowel movements, no tenesmus, no faecal incontinence, no UC-related sleep interruption, and no fatigue (Functional Assessment of Chronic Illness-Fatigue [FACIT-F] ≥ 40). Biomarkers examined were faecal calprotectin (FCP) and high-sensitivity C-reactive protein (hs-CRP). Results were reported as the percentage of patients achieving each outcome for all PROs and median values for biomarkers at Week (wk) 0 of induction and every 8 wks from wk 0–52 of maintenance, unless otherwise stated for FACIT-F ≥ 40.1, hs-CRP and FCP. Non-responder imputation with no special data handling for missing data due to logistic restrictions (COVID-19 or the geo-political conflict in Ukraine and surrounding impacted regions) was used for missing data. Results In total, 548 patients (PBO SC, n=183; RZB 180 mg SC, n=179; RZB 360 mg SC, n=186) were randomised into the maintenance study. A higher proportion of patients achieved PROs at maintenance wk 0 compared to the induction baseline (Figures 1 and 2). Throughout maintenance, achievement of PROs persisted in patients receiving RZB, regardless of dosage, except for no nocturnal bowel movements, no fecal incontinence, and no UC-related sleep interruption, which showed a slight decrease in response for all treatment groups. A decline in achievement of all PROs in the PBO withdrawal arm was seen from wk 32 onwards. Both biomarkers showed a decrease in median levels from induction wk 0 to maintenance wk 0. During maintenance, median FCP levels were lower for both RZB doses compared to PBO. Lower median hs-CRP levels persisted during maintenance but were similar among all treatment groups. Conclusion Improvements in most PROs and biomarkers were sustained throughout maintenance, with declines seen in the PBO maintenance group likely due to the withdrawal of RZB from RZB induction treatment. These findings show that RZB may decrease common UC-related symptoms and may improve patients’ quality of life and inflammatory burden.

P0127 Fistula-derived fibroblasts express genes associated with a dysfunctional wound healing process

Abstract Background Approximately a third of patients with Crohn’s Disease will develop perianal fistulas. Perianal fistulas greatly impact the quality of life by causing pain, discharge and faecal incontinence. Current drug treatments in combination with surgery are not very effective in curing fistulas, and only a low number of patients with complex fistulas reach complete remission. One of the main reasons for the lack of treatment options is our limited understanding of the formation of these fistulas. In this study we investigated the role of fibroblasts in the formation of perianal fistulas by evaluating their expression profiles compared to healthy colonic fibroblasts. Methods To gain more insight into the characteristics of fistula fibroblasts, fibroblasts were isolated from fistula scrapings derived during drainage surgery from both CD (n = 8) and non-CD patients (n = 6) and from healthy colon tissue of non-IBD patients (n = 18). After expanding the fibroblasts in vitro, they were subjected to mRNA sequencing. After sequence alignment, gene set enrichment and pathway activation analysis was performed. Differentially regulated processes were further investigated in vitro to confirm these results. Results Remarkably, fibroblasts isolated from CD and non-CD fistulas share a similar transcriptional profile, with only 25 differentially expressed genes (DEGs) found between them. Comparing fistula derived fibroblasts with healthy colon fibroblasts revealed 3606 DEGs. Pathway analysis revealed increased extracellular matrix remodelling and proliferation but reduced inflammation in fistula fibroblasts compared to healthy colon. Strikingly, although collagen type 1 production was increased, myofibroblast-associated genes such as ACTA2, LRRC17, LRRC32, NKX2-3 and RSPO3 were decreased in fistula fibroblasts. We confirmed these observations in vitro. Conclusion Currently, CD and non-CD fistulas are treated differently. Whereas surgical removal is the main treatment for non-CD fistulas, CD fistulas are primarily treated with the combination of surgery and medication targeting inflammation. However, our results suggest that at least the fibroblasts isolated these fistulas are very much similar on a transcriptional level. We found these fibroblasts display a signature that seems to point at aberrant wound-healing. Further research in 3D co-cultures, comparing the role of fistula and healthy fibroblasts, will elucidate the role of these cells in the formation of fistulas.

P0705 Features of optimal disease control in Crohn’s disease and Ulcerative Colitis: Views on IBD Expectations and Well-being by Patients and Treatment providers

Abstract Background With the expanding array of therapeutic options for Crohn’s disease (CD) and ulcerative colitis (UC), there is an increasing need to examine features of optimal disease control that reflect patient priorities. Views on IBD Expectations and Well-being - Patients and Treatment providers (VIEW-PT): an analysis based on the IBD Disease Specific Programme (DSP)™, aimed to identify features of optimal disease control in CD and UC, with inclusion of patient and healthcare professional (HCP) perspectives. Methods An iterative 3-Stage approach was used to identify features of optimal disease control in CD and UC (Table 1). In Stage 1, features of optimal disease control were identified by gastroenterologist (GI) advisors, a targeted literature search, and exploratory analyses of the Adelphi Real World IBD DSP. In Stage 2, features from Stage 1 were prioritized by patient advisors and additional features recommended for inclusion. In Stage 3, GI and advanced practice provider (APP) advisors provided further input on relevance of the expanded list of features, terminology, and categorisation. Features mentioned unprompted by patient, GI or APP advisors were cross-referenced to earlier stages and included if identified by ≥4 sources (see details in Table 1). GI and APP advisors provided feedback on similarities and differences of features of optimal disease control for CD vs UC. Results In Stage 1, nine features were identified as most relevant in defining optimal disease control in CD and UC: bleeding, bowel movement frequency, bowel urgency, endoscopic healing, fatigue, pain, quality of life, sleep disturbance, and steroid use. Faecal incontinence and mental health were added in Stage 2 following patient input. GI and APP advisors confirmed relevance of the 11 features in Stage 3; extraintestinal manifestations and biomarkers were added based on advisor recommendation and recurrence at earlier stages. Terminology was finalised and features ordered based on advisors’ recommendations, categorised as symptoms, functional outcomes, or markers of inflammation (Figure 1). GI and APP advisors advocated to include the same features for CD and UC, acknowledging expected variation in prioritisation by indication and across individual patients. Conclusion By considering a range of sources and including patient perspectives, optimal disease control in CD and UC was found to be a multi-faceted concept, incorporating symptoms, functional outcomes, and markers of inflammation. Patient advisors highlighted the importance of faecal incontinence and mental health, which may be overlooked in clinical practice. This robust framework of optimal disease control can be adopted to aid with development of individual IBD management plans in clinical practice.

Application of electroacupuncture in the treatment of hind limb movement disorders in dogs

The objective of this study was to apply and evaluate the effectiveness of electroacupuncture in the treatment of hind limb movement disorders in dogs, the study was conducted from June 2023 to June 2024 at VSA Pet Clinic. The neurological examination assessed the spinal cord lesions such as urinary incontinence, fecal incontinence, hopping, examined and evaluated the animal’s conscious position sense, superficial pain perception and deep pain perception. Classification of hind limb movement disorders in dogs included weakness and paralysis. Using the Acupuncture Unit 20-needle electroacupuncture machine with a 6V power source, frequency 0 - 60 Hz. A total of 32 dogs with hind limb movement disorders had 28.13% of weakness and 71.87% of paralysis, including mixed breed dogs, bulldog, dachshund, poodle, domestic dogs, chihuahua, pomeranian and corgi. Lower motor nerve (LMN) lesions accounted for 46.87%, while upper motor nerve (UMN) lesions were 53.13% (P &gt; 0.05). The results of Glasgow pain score, there was 28 dogs (87.5%) at scoring ≥ 6 points, the average pain scores were 9 points in paralysis cases, 6 points in weakness, 8.33 points in LMN lesions, and 8.00 points in UMN lesions. The effectiveness of treatment was 65.67%, with an average acupuncture time of 20 days, in which the recurrence rate was 14.28%. Electroacupuncture was highly effective and had a low recurrence rate in the treatment of hind limb motor neuropathy in dogs.

And after surgery, what's new for the rectal cancer survivor?

Low anterior resection syndrome is a common but underestimated complication after rectal cancer surgery that significantly impacts the quality of life of the surviving patient. It is characterized by symptoms such as fecal incontinence and voiding dysfunction and affects up to 90% of patients undergoing low anterior rectal resection. The etiology of the syndrome is multifactorial with no clear determining factor. It includes the use of preoperative radiotherapy, the indication for a protective ileostomy, sphincteric lesions, nerve damage to the rectal autonomic plexuses, and changes in left colon motor function. Although various therapeutic modalities have been shown to be effective in the management of the symptoms of the syndrome, there is still no standard treatment or patient selection pattern. In this article, a critical review of the therapeutic possibilities for patients who have survived rectal surgery will be made.

P1086 Achieving early symptom resolution and endoscopic outcomes is associated with improved long-term outcomes in ulcerative colitis: A post-hoc analysis of INSPIRE and COMMAND studies

Abstract Background Early disease control, which includes symptom remission with mucosal healing (endoscopic and histological remission) is emerging as a potential therapeutic goal in ulcerative colitis, which may be achieved by effective therapeutic intervention.1 This post-hoc analysis examined the impact of achieving individual symptom resolution, endoscopic improvement (EI) or endoscopic remission (ER) post 12 Weeks (Wk) of risankizumab (RZB; a specific inhibitor of interleukin-23) induction treatment on achieving long-term clinical, endoscopic, and quality of life (QoL) outcomes at maintenance Wk 52. Methods This analysis included patients (pts) who achieved a clinical response after 12 wks of intravenous RZB in Phase 2b and Phase 3 INSPIRE induction studies and received subcutaneous RZB 180 or 360 mg in COMMAND maintenance study. The frequency and proportions of pts achieving maintenance Wk 52 outcomes (clinical remission [CR], EI, ER, or meaningful change in QoL) between pts who achieved the absence of symptoms (abdominal pain, bowel urgency [BU], tenesmus, fecal incontinence [FI], sleep interruption [SI], nocturnal bowel movements [NBM]), achieved fatigue normalization, or achieved EI/ER at end of induction vs those who did not was determined. Adjusted predictive analyses assessed the relationship between achieving outcomes at induction Wk 12 and maintenance Wk 52, reported as logistic regression-derived odds ratios (ORs) and 95% confidence intervals. Results In total, 179 and 186 pts received RZB 180 and 360 mg during maintenance, respectively. After adjusting for pt characteristics, pts who achieved absence of symptoms at Wk 12 had significantly greater odds of achieving CR, EI, or ER at Wk 52; specifically, absence of BU, FI, and NBM were significantly associated with CR (OR 1.793, 1.722, 1.645), absence of BU and NBM were significantly associated with EI (OR 1.557, 1.563), and absence of FI, NBM, and SI were significantly associated with ER (OR 2.337, 2.318, 2.355). Similarly, pts who achieved endoscopic outcomes of EI/ER at induction Wk 12 had a significantly greater odds of achieving CR (OR 2.011/3.332) and maintaining EI (OR 2.278/5.974) and ER (OR 3.222/7.426) at Wk 52 (Figure). Pts achieving absence of BU, tenesmus, NBM, and ER at Wk 12 had significantly greater odds of achieving meaningful within-person change in QoL outcomes such as work time missed, impairment while working, and overall work and activity impairment at Wk 52 (Table). Conclusion Achieving early disease control with RZB treatment through symptom and specifically endoscopic outcome improvements at Wk 12 was generally associated with greater odds of achieving improved long-term clinical, endoscopic, and QoL outcomes at Wk 52.