Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation
Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation
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DOI：
10.1016/j.cgh.2006.12.023
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发表时间：
2007-03-01
影响因子：
12.6
通讯作者：
Schulze, Konrad
中科院分区：
文献类型：
--
作者：
Rao, Satish S. C.;Seaton, Kara;Schulze, Konrad
背景与目的：便秘是一种常见的疾病，目前的治疗通常不令人满意。生物反馈可能有助于便秘和排便失调的患者，但其疗效尚未得到证实，而且这种改善是由于操作性条件反射还是个人注意尚不清楚。方法：在一项前瞻性随机试验中，我们研究了生物反馈（压力测量辅助肛门放松、肌肉协调和模拟排便训练；生物反馈）与假反馈疗法（假）或标准疗法（饮食、运动、泻药；标准）对77名慢性便秘和排便障碍患者（69名女性）的疗效。在基线和治疗后（3个月），通过肛门直肠测压、球囊排出和结肠运输研究评估生理变化，通过视觉模拟量表和前瞻性粪便日记评估症状变化和粪便特征。主要结局指标（意向治疗分析）包括有无协同作用障碍、气囊排出时间、完全自发排便次数和总体排便满意度。结果：生物反馈组更容易纠正协同障碍。（P < 0.0001），改善排便指数（P < 0.0001），减少气囊排出时间（P = 0.02）。生物反馈组和标准组结肠运输改善（P = 0.01），假手术组无明显改善。在生物反馈组中，完全自发排便次数增加（P < 0.02），高于其他组（P < 0.05），数字操作的使用减少（P = 0.03）。生物反馈组总体肠道满意度高于假手术组（P = 0.04）。结论：生物反馈改善了便秘和肠功能失调患者的生理特征。这种效应是通过调节生理行为和结肠功能介导的。生物反馈是首选治疗便秘患者的协同作用障碍。
Background & Aims: Constipation is a common disorder, and current treatments are generally unsatisfactory. Biofeedback might help patients with constipation and dyssynergic defecation, but its efficacy is unproven, and whether improvements are due to operant conditioning or personal attention is unknown. Methods: In a prospective randomized trial, we investigated the efficacy of biofeedback (manometric-assisted anal relaxation, muscle coordination, and simulated defecation training; biofeedback) with either sham feedback therapy (sham) or standard therapy (diet, exercise, laxatives; standard) in 77 subjects (69 women) with chronic constipation and dyssynergic defecation. At baseline and after treatment (3 months), physiologic changes were assessed by anorectal manometry, balloon expulsion, and colonic transit study and symptomatic changes and stool characteristics by visual analog scale and prospective stool diary. Primary outcome measures (intention-to-treat analysis) included presence of dyssynergia, balloon expulsion time, number of complete spontaneous bowel movements, and global bowel satisfaction. Results: Subjects in the biofeedback group were more likely to correct dyssynergia. (P < .0001), improve defecation index (P < .0001), and decrease balloon expulsion time (P = .02) than other groups. Colonic transit improved after biofeedback or standard (P = .01) but not after sham. In the biofeedback group, the number of complete spontaneous bowel movements increased (P < .02) and was higher (P < .05) than in other groups, and use of digital maneuvers decreased (P = .03). Global bowel satisfaction was higher (P = .04) in the biofeedback than sham group. Conclusions: Biofeedback improves constipation and physiologic characteristics of bowel function in patients with dyssynergia. This effect is mediated by modifying physiologic behavior and colorectal function. Biofeedback is the preferred treatment for constipated patients with dyssynergia.