Satisfactory Bowel Research Articles

Quality of life and neuropsychological development at school age in Hirschsprung's disease

PurposeTo determine the quality of life and neuropsychological development of school-aged children with Hirschsprung's disease. MethodsIn this observational monocentric study, a multidisciplinary team prospectively assessed quality of life, neuropsychometric development and bowel functional outcomes. This study was registered on ClinicalTrial.gov (NCT03406741). Kidscreen and VSP-A questionnaires assessed the quality of life and were compared to the reference population (Eurostat database). Intelligence, attention and executive functions, perceptual organization and memory were evaluated using the Wechsler Children's Intelligence Scale, the NEuroPSYchological assessment, and the Rey figure test. Bowel functional outcomes were obtained using the Krickenbeck score. ResultsFifteen patients were included, with a mean age of 10.25 years. The children's Kidscreen-assessed quality of life index was higher than the reference population (p = 0.01). The Full-Scale Intelligent Quotient was dissociated in 64% of children. The Perceptional Reasoning Index and the Processing Speed Index were observed at lower levels. There were no disturbances in executive functions. A satisfactory bowel functional outcome was noted in 46.7% of children. ConclusionChildren with Hirschsprung's disease have been shown to have subtle decreased performances in some areas of intelligence. Performing a neuropsychological assessment upon entering elementary school could help to detect these specific learning disabilities. Levels of evidenceLevel II, prognosis study.

Very Early-Onset Inflammatory Bowel Disease: A Challenging Field for Pediatric Gastroenterologists.

With the increasing number of children with inflammatory bowel disease (IBD), very early-onset IBD (VEO-IBD), defined as IBD that is diagnosed or that develops before 6 years of age, has become a field of innovation among pediatric gastroenterologists. Advances in genetic testing have enabled the diagnosis of IBD caused by gene mutations, also known as monogenic or Mendelian disorder-associated IBD (MD-IBD), with approximately 60 causative genes reported to date. The diagnosis of VEO-IBD requires endoscopic and histological evaluations. However, satisfactory small bowel imaging studies may not be feasible in this small population. Both genetic and immunological approaches are necessary for the diagnosis of MD-IBD, which can differ among countries according to the available resources. As a result of the use of targeted gene panels covered by the national health insurance and the nationwide research project investigating inborn errors of immunity, an efficient approach for the diagnosis of MD-IBD has been developed in Japan. Proper management of VEO-IBD by pediatric gastroenterologists constitutes a challenge. Some MD-IBDs can be curable by allogenic hematopoietic stem cell transplantation. With an understanding of the affected gene functions, targeted therapies are being developed. Social and psychological support systems for both children and their families should also be provided to improve their quality of life. Multidisciplinary team care would contribute to early diagnosis, proper therapeutic interventions, and improved quality of life in patients and their families.

Congenital perianal lipoma: a case report and review of the literature

BackgroundThe surgical strategy for congenital perineal lipoma varies depending on the size, location, and accompanying congenital anomalies, with the optimum approach remaining to be determined. We herein report a case of congenital perianal lipoma that was first detected by prenatal ultrasound and review the literature.Case presentationA female neonate was referred to us for the evaluation of a perianal mass. She had been considered to be male prenatally because fetal ultrasound showed a perineal mass similar to a scrotum and penis. A postnatal examination revealed an appropriate-for-age neonate with a soft round mass 1.5 cm in diameter just to the left of the anal verge. She passed urine and stool smoothly, and contrast enema confirmed no anorectal malformation. Magnetic resonance imaging showed that the lesion had a signal intensity consistent with fat located close to the anal sphincter, and no spinal anomaly (e.g., spina bifida) was identified. We excised the lesion (pathologically confirmed to be lipoma) simply at 2 months old, taking care to avoid damaging the anal sphincter by using a muscle stimulator. She has been doing well with good bowel movement and satisfactory cosmetic results for a follow-up period of one and a half years.Our literature search revealed 49 cases of perineal lipoma reported in English in the last 25 years, and 74% of them—including ours—had other congenital anomalies, the breakdown of which was anorectal malformation in 40% of cases, labioscrotal fold or accessory scrotum in 28%, and urogenital malformation, congenital pulmonary airway malformation, and disorder of sex differentiation. The prenatal detection of the lesion, as in our case, was quite rare.ConclusionA thorough physical examination after birth, magnetic resonance imaging and contrast enema to identify the nature of the perineal lipoma and accompanying anomalies are crucial for planning the surgical strategy. The lesion may be deeply interspersed between the sphincter muscle, especially when it accompanies anorectal anomaly. A muscle stimulator is useful for preserving and repairing the sphincter muscles during resection in order to ensure satisfactory bowel movement.

469 Efficacy of Biofeedback Therapy for Dyssynergic Constipation Among Elderly Patients

INTRODUCTION: The prevalence of constipation among older adults is estimated to be as high as 40% (Melton et al, 1996). Dyssynergic defecation (DD) is an important cause of constipation for a large proportion of these patients. While biofeedback (BFB) therapy has been shown to be highly effective in correcting DD, it involves operant conditioning which requires learning new techniques and few studies have looked at how older adults respond to BFB. METHODS: This is a retrospective analysis of age 65+ patients enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each BFB visit. 58 patients met criteria. ARM is utilized with sensors in the rectum and anal canal. Stool retention simulation is performed involving inflation of a rectal balloon during the BFB sessions. RESULTS: Patients described improvement in several meaningful clinical outcomes. The overall median education level was completed high school and some college. Mean global bowel satisfaction on a scale of 1 (very dissatisfied) to 10 (very satisfied) showed a statistically significant increase, 2.77 to 5.01 with BFB (P ≤ 0.0001). In addition, the important symptom of a feeling of incomplete evacuation after stooling decreased from 95% down to 24% (P = 0.0025). Most significantly, 79% of the age 65+ patients showed resolution of their dysyynergia on HR-ARM at their final session (P = 0.0006). The defecation index (DI), intrarectal pressure divided by intra-anal pressure during simulated defecation, also trended towards improvement (0.564 to 0.681, P = 0.12). In terms of types of dyssynergia (1 through 4), subjects with defects in both propulsion and paradoxical contraction of sphincter muscles during defecation, i.e. type 2 dyssynergia, showed the most substantial objective gains in defecation index, with an average increase of 0.486, P-value 0.01 (2 vs 1) and 0.02 (2 vs 3). CONCLUSION: Biofeedback for DD shows meaningful improvement in both patient reported outcomes and objective manometric parameters in older adults. This is an important finding because our data supports the efficacy of BFB among older adults, across all levels of education. Given the profound burden of constipation with DD in older adults, we propose biofeedback therapy continue to be given strong consideration as first line therapy for this population.

222 Biofeedback Therapy for Dyssynergic Defecation Is Effective Among Patients With Opioid Exacerbated Constipation

INTRODUCTION: Up to 90% of patients on opioids complain of constipation (Wurzelmann et al, 2007). Among opioid users, causes of chronic constipation can be multifactorial and related to other contributing factors such as dyssynergic defecation (DD). Biofeedback (BFB) therapy has been shown to be effective in patients with DD, but has not been studied among those who have DD and are on opioids. METHODS: This study was a retrospective analysis of patients enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each BFB visit. RESULTS: 117 patients met criteria, of these, 20 patients were on active opioid therapy. Compared to those not on narcotic analgesics, opioids users were more likely to have a higher baseline defecation index (DI), intrarectal pressure divided by intra-anal pressure during simulated defecation (0.669 vs. 0.456 P < 0.0007). Decreased rectal sensation at baseline was seen in 20% of opiate patients and 19% of those not on opioids (P = 1.0). Opiate users compared to those not on narcotic analgesics also had a lower baseline health rating on the SF-36 scale (3.9 vs. 3.4 1-5 Likert scale P = 0.05) and were more likely to withdraw before completing a full course of BFB (P < 0.01). On stool diary, opiate users did not report a significant improvement in global bowel satisfaction rating (2.9 to 4.2, 10-point Likert scale P = 0.13), in contrast to non-opiate users who did repot improvement (2.7 to 4.9, P < 0.0001). Opiate users, however, had a significant decrease in number of stooling medications used (1.8 to 1.1 P = 0.04). On HR-ARM, there was a greater change in DI among non-opiate users as compared to opiate users. After BFB, opiate users effectively normalized their dyssynergia (79% improved) (P < 0.0001). Non-opiate users also showed significant improvement in normalizing their dyssynergia (74%) (P < 0.0001). CONCLUSION: Patients with opioid exacerbated constipation and DD showed meaningful clinical improvement in both subjective outcomes as well as manometric parameters. While they had lower baseline health rating at the outset and did not report significant improvement in global bowel satisfaction rating, unlike the non-opioid users, they nevertheless clearly benefited from BFB therapy. Overall, this data suggests that opioid users with DD may benefit from enrollment in BFB therapy.

2113 Biofeedback Therapy With the Rao Protocol for Dyssynergic Defecation Is Effective Among Patients With Inflammatory Bowel Disease

INTRODUCTION: Dyssynergic defecation (DD) symptoms are common in patients with inflammatory bowel disease (IBD). Biofeedback (BFB) is a standard of care treatment for DD, however, few studies have evaluated its efficacy in IBD patients with DD. CASE DESCRIPTION/METHODS: This is a case series that looks at 5 patients with IBD who were enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. All patients had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each DD BFB visit. The Rao protocol for BFB is a physician-led program that consists of an active phase with the number of sessions tailored to each patient’s progress, followed by refresher sessions. A solid state HR-ARM catheter is utilized with sensors in the rectum/pouch and anal canal. Stool retention simulation consists of inflation of a rectal balloon during manometry based BFB. A total of 5 patients were identified for this case series. The average age of the patients was 46 years. Of these 5 patients, 3 had Crohn’s disease and 2 had ulcerative colitis. After completion of BFB, IBD patients experienced a significant improvement in stool form (Bristol stool scale type 2 to 6, P = 0.01), rise in the defecation index (intrarectal/pouch pressure divided by intra-anal pressure during simulated defecation; 0.39 to 0.81, P = 0.04), and complete resolution of DD with a rectal balloon inflated to simulate stool present in the rectum/pouch on final BFB session (P < 0.01). IBD patients did not report a significant improvement in global bowel satisfaction rating on a 10-point Likert scale (2.2 to 3.6, P = 0.22). DISCUSSION: Biofeedback with the Rao protocol in conjunction with use of HR-ARM catheters shows efficacy in the correction of dyssynergia pattern, leading to improvement in objective measures such as defecation index and stool form on diary in IBD patients. Subjective improvement in global bowel satisfaction rating was less than the non-IBD cohort. In conclusion, patients with IBD who are found to have DD should be given consideration for enrollment in a BFB program, which is a labor-intensive approach but has no adverse effects.

Colonoscopic miss rate for colorectal cancer: a district general hospital experience

Background: The aim of the study was to review our post-colonoscopy colorectal cancer (PCCRC) diagnoses rate and compare it to national standards, to identify any common factors in our missed cancer cases and create a policy for capturing missed cancers data.Methods: We analyzed retrospectively collected data on patients with colorectal cancer from January 2015 to July 2017. Patients who had a previous colonoscopy within 3 years of diagnosis were then identified. We excluded colonoscopies done within 6 weeks of diagnosis or repeat colonoscopies due to poor bowel preparation.Results: 503 colorectal cancer patients were identified. 135 (26.8%) were initially diagnosed without a lower GI endoscopy. 30 had a negative colonoscopy 6 weeks to 3 years prior to diagnosis. Only 10 patients (2.7%) were true missed lesions (false negative colonoscopy). Male/female: 5/5. Mean age was 68.4 (49-80). 9 patients had good or satisfactory bowel preparation. 50% of lesions were found during follow-up or treatment of a different lesion. Average time from false negative scope to diagnosis was 20.3 months (4-31). Sites of missed lesions are left colon- 4, low rectum- 3, caecum- 2 and transverse colon- 1.Conclusions: Our PCCRC rate is below the GUT recommended target of <5% and well below the national average 8.5%. We identified no common features across all missed cases. Contrary to other published data, right sided lesions were less common with no female predominance. We recognize the limitations of access to only local trust data. We propose to monitor PCCRC rate annually, present this at clinical governance meetings and review each case individually as an adverse event.

Local staging of rectal cancer using fused high resolution diffusion weighted imaging and modified MR rectography.

Rectal cancer (RC) is a common malignant tumor with high mortality. MR imaging plays an important role in treatment decision making of RC. Unfortunately, the contents (gas and feces) in the rectum often induce artifacts and thus negatively affect the depicting and staging of RC. We developed a new protocol for MR rectography using oral administration of iso-osmotic mannitol to distend lumen after bowel cleansing preparation. Fused MR rectography and high resolution diffusion weighted imaging (DWI) is then performed to facilitate detection and staging of RC. Our present technique can eliminate the effect of gas and feces on image quality, especially on DWI, and can achieve satisfactory bowel distention, lesion depicture and visualization of surgical planes. Fused high resolution DWI and MR rectography can be a promising technique to improve the accuracy of RC local staging.

The change over time in the postoperative bowel function in male anorectal malformation patients who underwent sacroperineal anorectoplasty and sacroabdominoperineal anorectoplasty.

Many kinds of operative procedures have been proposed for anorectal malformation (ARM) patients. At our institution, sacroperineal or sacroabdominoperineal anorectoplasty (SP-SAP) have been performed from 1984 to 2007. The aim of this study is clarify the change over the time in the postoperative bowel function in male ARM patients. Patient data were collected from 1984 to 2007. Fifty-two male patients with high- and intermediate-type ARM were enrolled. The patients' characteristics and bowel function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the evacuation score (ES) of the Japan Society of ARM Study Group. The operative procedures were SP-SAP in 52 male patients. The total ES improved chronologically and significantly until 11years of age. Regarding the clinical stratification of the ES, the ratio of "excellent" and "good" results was over 91.9% at 11years of age. A satisfactory bowel movement score was achieved by 9years of age. The constipation, incontinence and soiling scores improved slowly but continuously until 11years of age. The ES showed continuous improvement after a definitive operation. An understanding of the characteristics of improvement is very important in managing the postoperative bowel function in ARM patients.

PEG vs. sennosides for opioid-induced constipation in cancer care.

This randomized double-blind, double-dummy, 2-treatment, 2-period crossover study aimed to compare the efficacy and tolerability of polyethylene glycol (PEG) and sennosides in ambulatory cancer patients with opioid-induced constipation. Outpatients ≥ 18years old with cancer, at risk of or already experiencing opioid-induced constipation, were randomly assigned to begin a standard bowel protocol of escalating doses of sennosides or PEG, plus a dummy preparation. After 3weeks, the patients switched to the alternate active product and dummy preparation. Constipation was assessed using the revised Victoria Bowel Performance Scale (rBPS) at the end of each of the 2 consecutive 21-day study periods for the number of days with a satisfactory bowel movement, the time in days to goal rBPS (G), and the treatment preference of each patient. Seventy patients were recruited, with 42 completing their first treatment period and 28 completing both treatment periods. For the typical patient, the expected number of days with a satisfactory bowel movement per days of treatment was found to be 1.21 times higher on PEG than on sennosides in a particular period (95% credible interval 0.96 to 1.55). Patients taking PEG were 1.47 times more likely to reach a rBPS of G before patients taking sennosides in the first period (95% confidence interval 0.74 to 2.94). There was no evidence of a difference in patient preference between laxatives. Our study found weak evidence that PEG is superior to sennosides with respect to overall effectiveness in cancer patients with opioid-induced constipation.

Comparison of efficacy and tolerance of low-volume preparations prior to colonoscopy a randomized trial.

Introduction: The aim of the study was to compare the efficacy and tolerability of polyethylene glycol/ascorbic acid (PEGA), sodium picosulfate/ magnesium citrate (SPMC) and the oral sulfate formula (SIR) in a single- or split-dose regimen for bowel preparation prior to colonoscopy. Methods: Randomised, multicentre, open-label study. The subjects received either PEGA, SPMC or SIR in the single- or split-dose regimen before the colonoscopy. Quality and tolerability of the preparation and complaints during preparation were recorded using a 5 point scale. Results: 558 subject were analysed. Preparation quality was comparable in the single-dose regimen. The rate of satisfactory bowel cleansing (Aronchick score 1+2) was higher for split-dose SIR and PEGA compared to SPMC (95.6%, 86.2% vs. 72.5%, p<0.028). The highest tolerance rate (score 1+2) was reported for SPMC (82.3%, p<0.003) and the lowest for single-dose SIR (34.8%, p=0.008). The lowest frequency of nausea (10.4%) was observed for SPMC. The highest prevalence of bloating was linked with the use of PEGA (34.0%). Conclusion: Differences in bowel preparation quality were apparent only in the split-dose regimen, with SIR rated as most efficient. SPMC was the best tolerated formula. The split-dose regimen is more effective than single-dose preparation used in the evening before the examination.

Sa1672 – Evaluation of Differences in Symptom and Bowel Satisfaction Reporting and High-Resolution Anorectal Manometry Fndings in Functional Anorectal Pain Patients with and Without Dyssynergic Defecation

Sa1672 – Evaluation of Differences in Symptom and Bowel Satisfaction Reporting and High-Resolution Anorectal Manometry Fndings in Functional Anorectal Pain Patients with and Without Dyssynergic Defecation

A Practical Guide to Biofeedback Therapy for Pelvic Floor Disorders.

Biofeedback therapy (BFT) is effective for managing pelvic floor disorders (i.e., defecatory disorders and fecal incontinence). However, even in controlled clinical trials, only approximately 60% of patients with defecatory disorders experienced long-term improvement. The review serves to update practitioners on recent advances and to identify practical obstacles to providing biofeedback therapy. The efficacy and safety of biofeedback therapy have been evaluated in defecatory disorders, fecal incontinence, and levator ani syndrome. Recent studies looked at outcomes in specific patient sub-populations and predictors of a response to biofeedback therapy. Biofeedback therapy is effective for managing defecatory disorders, fecal incontinence, and levator ani syndrome. Patients who have a lower bowel satisfaction score and use digital maneuvers fare better. Biofeedback therapy is recommended for patients with fecal incontinence who do not respond to conservative management. A subset of patients with levator ani syndrome who have dyssynergic defecation are more likely to respond to biofeedback therapy.

Role and Effect of Plecanatide vs Lactulose Affects in Compensated Cirrhosis With Constipation Efficacy: A Randomized Open Level Prospective Clinical Pilot Study - REPLACE Trial

Introduction: Cirrhosis of liver carries multiple clinical morbidities; portal Hypertension, Minimal and overt Encephalopathy, renal Insufficiency, Esophageal and rectal Varies, Small bowel Ischemia, ascetics and constipation. Usage of lactulose to regulate bowel movements was optimal to relief constipation lowering Encephalopathy. Disaccharides cause Glucose Intolerance and Diarrhea depleting electrolyte provoking Hepato Renal Syndrome. Rifaximin is the standard of care for MHE or OHE, further precipitates constipation. Plecanatide is a natural Uroguanyle Agonist without systemic Absorption, a Ph dependent drug for constipation with minimal side effects. This clinical study evaluates the efficacy of Plecanatide in compensated cirrhosis. Methods: The total study population (n = 60) comprised of Sixty Compensated cirrhotics with a mean MELD 0f 8 were randomized in two groups: A (Lactulose 30 cc Bid with Rifaximin 550 mg BID for 12 weeks) and B (Plecanatide 3 mg orally plus Rifaximin 550 mg bid for 12 weeks). All groups had a washout time two weeks from all existing medications for Constipation or Enemas or Suppository. The daily diet contained Total 3000 cal/day, Total protein 150 gm/day (vegetable), Total Fat 30 gm/day, Total fiber 100 gm/day, Total salt of 2 grams and total fluid 1000cc. All HE was measured by Flicker test and Trial Test Block test. Satisfactory Bowel Movement score was calculated for all the patients (0 - dissatisfactory, 4 -Satisfactory). Modified QOL was obtained. (0-Poor, 1- Good, 2 & 3 - Very good, 4 - Excellent) Exclusion Criteria: Renal failure, TIPS, HCC, post-Transplant, sepsis, HRS, CHF, IBD, Dialysis, Severe Ascites, Uncontrolled DM Cardiac Arrhythmia, BMI Drugs: Calcium Blocker, Anticholinergic medication, Herbal and OTC for Constipation, Miralax, suppositories, Enema, Prostaglandin analogs and other prescription drugs for constipation. Patient Characteristics: Table1 Results: Primary endpoint: Complete Spontaneous Bowel Movement (CSBM) in 24 hours Secondary endpoint: Sustained bowel movement post 12 weeks Table 2 Side Events Table 3 Conclusion: Clinical pilot reveals higher Efficacy of Plecanatide on Complete Spontaneous Bowel movements and Sustained Bowel Movements without drop out. No difference in regard to Overall HE in both groups. Large cohort studies required to validate.910_A Figure 1 No Caption available.910_B Figure 2 No Caption available.910_C Figure 3 No Caption available.

Conservative treatment of severe defecatory urgency and fecal incontinence: minor strategies with major impact.

Bowel disturbances have been identified as the most important risk factor for fecal incontinence (FI). However, few studies have evaluated the impact of fiber supplementation. Our aim was to assess the correlation between the improvement in stool consistency by fiber supplementation and the changes in urgency and number of FI episodes and in the QoL of patients with FI. Eighty-three patients who came to our institution with FI and/or fecal urgency associated with loose stools or diarrhea were prospectively included in the study The intervention included dietary advice and methylcellulose 500mg every 8h for 6weeks. All assessments were carried out at baseline and 6weeks after the start of the intervention, and included a Bristol Stool Scale, a 3-week bowel diary, the St Mark's score, the Fecal Incontinence Quality of Life scale (FIQL) and a bowel satisfaction score. Sixty-one patients completed the study. At baseline 50 reported episodes of urge incontinence, while 11 did not report FI episodes because they rarely left home to avoid leakage. The Bristol score improved to normal stools in 65.6% of patients after treatment. Bowel diaries showed a statistically significant reduction in the number of bowel movements, urge episodes, urge fecal incontinence episodes and soiling per week. The St Mark's score and the bowel satisfaction score significantly improved after methylcellulose and overall deferment time also increased. FIQL significantly improved in two subdomains (lifestyle, coping/behavior). Thirty-one patients (51.7%) were discharged with methylcellulose as the only treatment. FI may significantly improve with methylcellulose in selected cases. Assessment of fecal consistency and initial treatment with methylcellulose could be started at primary care level to reduce the need for specialist referral.

Immediate results from biofeedback and anorectal electrostimulation in the treatment of paradoxical puborectal muscle contraction in women with obstructed defecation

ObjectiveThis study was conducted to evaluate the effects of “biofeedback” (BF), electrostimulation (ES), and of the high-fiber diet associated with behavioral therapy in women with obstructed evacuation and paradoxical puborectalis contraction and to compare the results among these three modalities. MethodThirty-one women were evaluated who fulfilled the Rome III Criteria, and with an electromanometric test positive for the presence of contraction in the evacuation maneuver. These patients were randomized into three groups: group I – conventional treatment of constipation, group II – conventional treatment of constipation associated with biofeedback and group III – conventional treatment of constipation associated with electrostimulation. At the beginning of this study and after six weeks, subjective and objective parameters of the anorectal function were evaluated using the Wexner constipation scoring system, the Bristol scale, an visual analogical scale, and anorectal electromanometry. ResultsAll patients demonstrated improvement in bowel satisfaction, stool frequency, effort and feeling of incomplete evacuation, stool-type modifications, and improvement in the quality of life. On examination, there was increased mean pressure of voluntary contraction in group III (p=0.043), decreased sensitivity threshold in group II (p=0.025) and III (p=0.012) and decreased maximum rectal capacity in group II (p=0.005). Only 19.4% (n=6) had their dynamic defecation normalized, and 80.6% (n=25) expressed clinical, non-instrumental, improvement. ConclusionThe conventional treatment of constipation, biofeedback and electrostimulation show a significant subjective improvement in symptoms of obstructed evacuation and in quality of life, regardless of the reversal of the paradoxical puborectalis contraction.

Factors Associated With Response to Biofeedback Therapy for Dyssynergic Defecation

Biofeedback therapy is effective for dyssynergic defecation (DD), but it is not widely available or reimbursed, and is labor intensive. It is therefore important to select the appropriate patients for this treatment. We investigated symptoms and demographic, manometric, and other factors associated with outcomes of biofeedback therapy in patients with DD. We performed a post hoc analysis of 2 prospective studies of biofeedback therapy in 127 adult outpatients (18-75 years old, 120 female) with chronic constipation who failed to respond to treatment with dietary fiber or laxatives (>1 year) and were diagnosed with DD based on standard criteria. In each study, patients received 1-hour, biweekly office biofeedback therapy (6 sessions) or home biofeedback therapy with a device. A therapist used visual feedback, postural, and diaphragmatic breathing techniques to teach subjects to improve defecation. Treatment success was defined by a composite of normalization of dyssynergia pattern and increase of 20 mm in baseline bowel satisfaction score. Factors were compared between the treatment success and failure groups. Intention-to-treat analysis was performed. Of the 127 patients enrolled, 77 (61%) had treatment success. Dyssynergia was corrected in 78% of patients and bowel satisfaction improved in 64% of patients. Baseline demographic features, constipation symptoms, manometric and sensory parameters, balloon expulsion time, and colonic transit results were similar between treatment failure and success groups. Patients with lower baseline bowel satisfaction score (P= .008) and patients who used digital maneuvers (P= .04) were more likely to have successful biofeedback therapy. Biofeedback therapy is successful in more than 60% of patients with DD. Patients who used digital maneuvers and patients with lower baseline levels of bowel satisfaction were more likely to have treatment success, whereas other factors were not associated with success. Biofeedback therapy should be offered to all patients with DD, irrespective of baseline symptoms or anorectal physiology findings.

Evaluation of the effect of GLP‐1 agonists on quality of bowel preparation for colonoscopy in patients with diabetes

AbstractPeople with diabetes mellitus warrant a greater need for colonoscopy owing to the increased risk of colorectal cancer and autonomic neuropathy. Unfortunately, this population is reported to have a higher proportion of inadequate bowel preparation during colonoscopy, which translates into lower adenoma detection rates and repeat colonoscopies. Glucagon‐like peptide‐1 (GLP‐1) agonists commonly used in the management of diabetes are well known to cause delayed gastrointestinal (GI) transit times, yet it is unknown if they contribute to the higher frequency of inadequate bowel preparation in people with diabetes.Therefore, we conducted a retrospective medical record analysis of type 2 diabetic patients aged 45–75 who had an outpatient colonoscopy between 2012 and 2015. Our patients were taking either Byetta, Victoza or Bydureon and the method of bowel preparation used was polyethylene glycol electrolyte lavage solution. Patients who had a diagnosis of conditions known to cause delayed GI transit times (autonomic neuropathy, GI surgery, stroke and multiple sclerosis) were excluded. The final pool consisted of 126 diabetic patients taking a GLP‐1 agonist and a control group of 129 diabetic patients who were not taking this class of medication. The percentage of satisfactory bowel preparations in the group taking a GLP‐1 agonist was 92.06% and in the control group was 92.25%. Chi‐squared p‐value for significant difference between these two groups was p = 1.0 (95% confidence interval −0.066 to 0.069). Hence there were no significant differences in bowel preparation among diabetic patients taking GLP‐1 agonists vs the control group; GLP‐1 agonists can therefore continually be used according to the current standard protocols for colonoscopy before and after colonoscopy. Copyright © 2017 John Wiley & Sons.

Meta-analysis of split-dose and single-dose of polyethylene glycols for morning colonoscopy

Objective To evaluate the performance of split-dosed polyethylene(PEG) for colonoscopy preparation. Methods Split-dose means that 1-3 L of PEG is taken in the afternoon or evening before examination and the remains in the next morning. And single-dose refers to all PEG is taken in the evening before examination. A meta-analysis was conducted to compare bowel preparation quality, adenoma detection rate and patients′ acceptance between groups. Results Ten randomized controlled trials were included into this study with 3 222 participants(1 481 in split-dose group and 1 741 in single-dose group). Split-dose group had higher rate of satisfactory bowel preparation(OR=3.37, 95%CI: 2.37-4.79), and so did the subgroup of 2~3 L PEG(OR=3.88, 95%CI: 2.39-6.29). Split-dose group did not improve adenoma detection rate significantly(OR=0.94, 95%CI: 0.71-1.24), but reported less adverse events such as nausea(OR=0.56, 95%CI: 0.42-0.74) and vomiting(OR=0.51, 95%CI: 0.30-0.88). Conclusion Split-dosed PEG provides better colon cleansing with higher patient compliance, but does not improve detection rate of adenoma. Key words: Adenoma; Colonoscopy; Adenoma detection rate; Bowel preparation; Polyethylene glycols

Feasibility and safety of bowel cleansing using low-volume polyethylene glycol with ascorbic acid before pediatric colonoscopy: A pilot study.

To assess the feasibility and safety of same-day regimen of low-volume polyethylene glycol solution with ascorbic acid for bowel cleansing before colonoscopy in children. Data on children who received polyethylene glycol solution with ascorbic acid for bowel cleansing in our department were retrospectively analyzed. On the day before the procedure, patients ate a low-residue diet and received sodium picosulfate in the evening. The following day, patients took polyethylene glycol solution with ascorbic acid in the morning; the procedure was carried out in the afternoon. Dosages of sodium picosulfate and polyethylene glycol solution with ascorbic acid were adjusted based on bodyweight. Bowel cleansing efficacy was rated on a scale of 1-5 by the colonoscopist. Between July 2013 and November 2014, polyethylene glycol solution with ascorbic acid was used in 112 cases (96 patients; male : female 73:39; median age 10.9 years, range 4-19 years). Ninety-one cases (81%) were able to orally ingest the prescribed amount of polyethylene glycol solution with ascorbic acid. Satisfactory bowel cleansing (cleansing grade ≥3) was attained in 87% on intention-to-treat analysis and 85% on per-protocol analysis. Cleansing grade was significantly better in children who ingested polyethylene glycol solution with ascorbic acid within 60 min (P < 0.05). There were no serious adverse events. Same-day regimen of polyethylene glycol solution with ascorbic acid is effective and safe for bowel cleansing in children.