Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

Christensen, Peter; Andreasen, Jakob; Ehlers, Lars Holger

doi:10.1038/sc.2008.98

Cited by 68 publications

(45 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These encouraging results have been subsequently confirmed by an Italian multicenter study, which concluded it may be considered as the treatment of choice for this type of patients (145). Furthermore, this therapy is cost-effective when compared to conservative management (145,146).…”

Section: Efficacysupporting

confidence: 58%

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Mearin¹,

Ciriza²,

Mínguez³

et al. 2016

Rev Esp Enferm Dig

103

151

View full text Add to dashboard Cite

In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

show abstract

Section: Efficacysupporting

confidence: 58%

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Mearin¹,

Ciriza²,

Mínguez³

et al. 2016

Rev Esp Enferm Dig

103

151

View full text Add to dashboard Cite

show abstract

“…51 Although product-related costs were higher with TAI, this was offset by lower costs for a caregiver to help with bowel management and changes/washing due to leakage, as well lower costs associated with urinary tract infections, and less time spent by the patient on bowel management. 51 …”

Section: Tai Systemsmentioning

confidence: 99%

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

Emmanuel

2010

Spinal Cord

View full text Add to dashboard Cite

Study design: Neurogenic bowel dysfunction (NBD) is a common occurrence after spinal cord injury (SCI) and in patients with spina bifida or multiple sclerosis. The impact of NBD on well-being is considerable, affecting both physical and psychological aspects of quality of life. Transanal irrigation (TAI) of the colon promotes the evacuation of faeces by introducing water into the colon and rectum through a catheter inserted into the anus. Regular and controlled evacuation in this manner aims at preventing both constipation and faecal soiling. Objectives: The aim of this study was to review current evidence for the efficacy and safety of TAI in patients with NBD. Materials and methods: A literature search was conducted in PubMed. All identified papers were assessed for relevance based on the title and abstract; this yielded 23 studies that were considered to be of direct relevance to the topic of the review. Results: A multicentre, randomized, controlled trial has supported observational reports in demonstrating that TAI offers significant benefits over conservative bowel management in patients with SCI, in terms of managing constipation and faecal incontinence, reducing NBD symptoms and improving quality of life. Among other populations with NBD, TAI shows the greatest promise in children with spina bifida; however, further investigation is required. The overall safety profile of TAI is good, with few, and rare, adverse effects. Conclusions: Building on the positive data reported for patients with SCI, continued evaluation in the clinical trial setting is required to further define the utility of TAI in other populations with NBD.

show abstract

“…Although gender, predominant symptom and colonic transit time were significantly associated with successful outcome, we would not recommend patient selection for TAI based only on these parameters. As TAI is a reversible safe treatment that enhances QoL both short term 18 and long term and has also recently been shown to be cost-effective for society compared with conservative bowel management, 22 we suggest that a trial and error strategy for the introduction of TAI to patients with NBD is used until more solid knowledge about factors associated with a positive outcome of TAI is gained from a prospective multicentre database. However, to some patients it may be an advantage to choose surgical treatment modalities earlier if significant practical problems with TAI are encountered.…”

Section: Side Effects In 75 Patientsmentioning

confidence: 99%

Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction

et al. 2008

Self Cite

View full text Add to dashboard Cite

Methods: Between 1994 and 2007, 211 (115 female) patients with NBD (age: 7-81 years (median 49)) were introduced to TAI. One hundred and seventy-three patients had spinal cord injury and 38 had other neurological disorders. Data were obtained from hospital records and a mailed questionnaire. Treatment was considered successful in patients still using TAI, patients who had used TAI until they died and patients whose symptoms had resolved while using TAI. Results: Successful outcome was achieved in 98 (46%) patients after a mean follow-up of 19 months (range 1-114 months). A Kaplan-Meier plot showed a dropout of 20% in the first 3 months. After 3 years, the rate of success was 35% and remained almost unchanged afterwards. A regression analysis showed male gender (odds ratio (OR) 2.1), mixed symptoms (OR 2.9) and prolonged colorectal transit time (OR 2.4) to be significantly associated with successful outcome. One non-lethal bowel perforation occurred in approximately 50 000 irrigations (0.002%), whereas minor side effects were observed in 48%. Conclusion: After a mean follow-up of 19 months, 46% was successfully treated. The rate of success was 35% after 3 years and remained almost unchanged afterwards. TAI is safe and can be introduced to most patients suffering from NBD.

show abstract

Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

Cited by 68 publications

References 18 publications

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction

Contact Info

Product

Resources

About