Fecobionics monitoring and prediction of biofeedback therapy outcome in patients with obstructed defecation.

摘要 排便障碍影响着25%的人口，而且它们得不到很好的识别和治疗。的发病率。 包括慢性便秘在内的排便障碍正在增加，它构成了主要的医疗负担。这个 这些疾病的潜在机制往往没有得到很好的理解。排便障碍(协同障碍) 有几个原因，并细分为四个亚型。尽管患病率和发病率很高，但诊断和 治疗选择很少。肛门直肠生理测试中的一个重要问题是缺乏生理学 相关和实用的诊断测试，以确定潜在的机制，以确定适当的治疗。 目前的诊断测试提供的信息不完整，而且往往相互矛盾，因为它们不能模拟粪便 或者是排便过程。毫不奇怪，这些测试的结果与症状和治疗的相关性很差。 结果。生物反馈疗法是一种公认的治疗排便障碍的方法，但尽管有实质性的 潜在的和有希望的结果，生物反馈治疗只在专门的中心进行，应该更密切地推进 到了关爱的地步。这个小型R01提案的目标是监控和预测生物反馈的结果 基于一种名为Fecobionics的新型模拟粪便设备的前所未有的集成视觉反馈进行治疗。 该装置是电子模拟粪便，具有正常大便的稠度和形状。生物仿生学将 通过可视化几何(横截面)为检查人员提供对排便的机械理解 排便前和排便过程中的模拟粪便的面积、弯曲和形状)和测压曲线。 中心假设是，模拟自然动态排便的仿生设备提供了有效的 排便系统不同组成部分的直肠排空尝试的数据，如肛门音调 括约肌和耻骨直肠肌，以及机械感觉特性。目标是监测和预测 生物反馈疗法基于基于机制的高度集成的数据，可在 肛门直肠神经肌肉练习。对于拟议的研究，我们将选择协同障碍患者，他们将 生物反馈治疗前、中、后分别进行生物仿生学监测。假设是生物仿生学数据 将比传统技术更好地与基于便秘评分的症状相关，而且这样 数据可以用来预测治疗有效和无效的情况。我们的建议旨在改变目前的情况 一种通过模拟提供机械洞察力的新型设备在便秘治疗中的研究 排便病理生理和多维检测的机械变化：压力， 可变形性、生物力学和地形图变化监测闭塞患者的潜在缺陷 排便，尤指协同失调。我们提议的独特之处在于用仿生学模拟凳子 一种综合了多个变量的设备，可以检查排便障碍的机械基础。这个 这个项目的影响是摆脱对便秘的新理解，并预测应答者。这将促进 利用生物仿生学作为生物反馈治疗工具，开发创新的肠道管理计划。

ABSTRACT Defecatory disorders affect 25% of the population and they are poorly recognized and treated. The incidence of defecatory disorders including chronic constipation is rising and it poses a major healthcare burden. The underlying mechanisms for these disorders are often not well understood. Obstructed defecation (dyssynergia) has several causes and is subdivided in four subtypes. Despite the high prevalence and incidence, diagnostics and treatment options are sparse. A significant problem in anorectal physiology testing is a lack of physiologically relevant and practical diagnostic test for identifying the underlying mechanisms to identify proper treatment. Current diagnostic tests provide incomplete and often conflicting information because they do not simulate feces or the defecation process. Not surprisingly, results of these tests correlate poorly with symptoms and treatment outcomes. Biofeedback therapy is a well-established therapy for obstructed defecation but despite the substantial potential and promising results, biofeedback therapy is only done at specialized centers and should be advanced closer to the point of care. The objective of this small R01 proposal is to monitor and predict the outcome of biofeedback therapy based on unprecedented integrated visual feedback from the novel simulated feces device termed Fecobionics. The device is electronic simulated feces that has the consistency and shape of normal stool. Fecobionics will provide mechanistic understanding of defecation for the examiner by visualizing the geometric (cross-sectional area, bending and shape of device) and manometric profiles of the simulated feces before and during defecation. The central hypothesis is that the Fecobionics device that mimics natural dynamic defecation provides valid data on rectal emptying attempts for the various components of the defecatory system such as the tone of anal sphincters and puborectalis muscle, and on mechanosensory properties. The objective is to monitor and predict biofeedback therapy based on mechanism-based and highly integrated data that can be visualized during anorectal neuromuscular exercises. For the proposed studies, we will select dyssynergia patients, who will be monitored with Fecobionics before, during and after biofeedback therapy. The hypothesis is Fecobionics data will correlate better to symptoms based on constipation scores than conventional technologies and that such data can be used to predict responders and non-responders to therapy. Our proposal seeks to shift current research in constipation therapy by use of a novel device that provides mechanistic insights by simulating defecation pathophysiologically and examining the mechanistic changes multi-dimensionally: Pressure, deformability, biomechanics, and topographic changes to monitor underlying defects in patients with obstructed defecation, especially in dyssynergia. The unique aspects of our proposal are to simulate stool with a bionics device that integrates multiple variables that examine the mechanistic underpinnings of obstructed defecation. The impact of this project is to shed new understanding of constipation and to predict responders. This will facilitate development of innovative bowel management programs using Fecobionics as the biofeedback therapy tool.