Improvement of Refractory Ulcerative Proctitis With Sacral Nerve Stimulation
Improvement of Refractory Ulcerative Proctitis With Sacral Nerve Stimulation
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DOI：
10.1097/mcg.0000000000000331
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发表时间：
2015-11-01
影响因子：
2.9
通讯作者：
Meurette, Guillaume
中科院分区：
文献类型：
--
作者：
Bregeon, Jeremy;Neunlist, Michel;Meurette, Guillaume
背景和目的：骶神经刺激 (SNS) 因其治疗肛门失禁的有效性和安全性而得到认可，可防止高发病率。文献证据表明，SNS 可以扩展到与肠道屏障通透性问题相关的疾病。本研究的目的是强调 SNS 在难治性直肠炎病例报告中的有益影响的临床证据。材料和方法：在植入神经调制器后，成功地对一名直肠炎患者进行了永久性 SNS。尽管使用了免疫抑制药物，患者仍出现粘液和血液排出、疼痛和大便失禁。为了缓解大便失禁，在不修改药物的情况下测试了 SNS。在SNS前后评估疾病活动性、内镜和组织学评分、离体屏障通透性、炎性细胞因子（转化生长因子、肿瘤坏死因子、白细胞介素6、白细胞介素8）和连接蛋白（ZO-1、claudin-1、occludin）的表达，以观察SNS除失禁之外的影响。结果：经过3周的临时刺激后，患者出现明显改善，粪便减少失禁和疾病活动评分。内镜和组织学评分均显示改善。 SNS 使直肠屏障通透性降低，而连接蛋白 mRNA 表达短暂增加。随着时间的推移，临床和组织学的改善持续存在。经过 18 个月的永久刺激后，患者通过 SNS 仍然得到改善。结论：这项工作证明了探索 SNS 除大便失禁之外的进一步适应症的相关性。
Background and Aims:Sacral nerve stimulation (SNS) is recognized for its efficiency and safety for anal incontinence, preventing high morbidity. Evidence from the literature suggests extending SNS to diseases associated with problems of intestinal barrier permeability. The aim of this study was to highlight clinical evidence of the beneficial impact of SNS in a refractory proctitis case report.Materials and Methods:A permanent SNS was performed successfully in a patient with proctitis after implantation of the neuromodulator. Despite immunosuppressive drugs, the patient was experiencing mucus and blood discharge, pain, and fecal incontinence. To relieve fecal incontinence, SNS was tested without modification of medications. Disease activity, endoscopic and histologic score, ex vivo barrier permeability, expression of inflammatory cytokines (transforming growth factor-, tumor necrosis factor , Interleukin-6, Interleukin-8), and junctional proteins (ZO-1, claudin-1, occludin) were assessed before and after SNS to observe the impact of SNS other than for incontinence.Results:After a 3-week period of temporary stimulation, the patient experienced significant improvement with a decrease in fecal incontinence and disease activity scores. Both endoscopic and histologic scores showed improvement. The rectal barrier permeability decreased with SNS, whereas junctional protein mRNA expression transiently increased. Clinical and histologic improvement was sustained over time. After 18 months of permanent stimulation, the patient remained improved by SNS.Conclusion:This work demonstrates the relevance to explore further indications of SNS beyond fecal incontinence.