Does Biofeedback Therapy Modulate Anorectal (Gut)-Brain Axis in Patients With Dyssynergic Defecation?

Rao, Satish S.; Tantiphlachiva, Kasaya; Remes-Troche, José María; Attaluri, Ashok; Valestin, Jessica; Cheeney, Gregory; Hamdy, Shaheen

doi:10.1016/s0016-5085(11)61499-6

Cited by 7 publications

(22 citation statements)

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“…Sample Size analysis: For a proposed sample size of 40 (2:1) subjects, and assuming a SD of 15 and 29 milliseconds respectively for the anal and rectal N1 latency (CEP), and a correlation of r = 0.5 between the baseline and post‐treatment measures of latency from the same subject, the statistical test will be able to detect a mean change in N1 latency of at least 6 milliseconds for the anal and 16 milliseconds for the rectal latency at the 0.05 significance level, with 0.80 power. In a previous study, a mean change of 32 milliseconds for the anal and 19 milliseconds for the rectal N1 latency was observed following a therapeutic intervention 31 …”

Section: Methodsmentioning

confidence: 82%

Randomised clinical trial: linaclotide vs placebo—a study of bi‐directional gut and brain axis

Rao

Xiang

Yan

et al. 2020

Aliment Pharmacol Ther

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Background: Linaclotide, a guanylate cyclase C agonist relieves irritable bowel syndrome with predominant constipation (IBS-C) symptoms, but how it improves pain in humans is unknown. Aims:To investigate the effects of linaclotide and placebo on the afferent and efferent gut-brain-gut signalling in IBS-C patients, in a randomised clinical trial. Methods:Patients with IBS-C (Rome III) and rectal hypersensitivity were randomised (2:1) to receive linaclotide (290 µg) or placebo for 10 weeks and undergo bi-directional gut and brain axis assessment using anorectal electrical stimulations and transcranial/transspinal-anorectal magnetic stimulations. Rectal sensations were examined by balloon distention. Assessments included abdominal pain, bowel symptoms and quality of life (QOL) scores. Primary outcomes were latencies of recto-cortical and cortico-rectal evoked potentials.Results: Thirty-nine patients participated; 26 received linaclotide and 13 received placebo. Rectal cortical evoked potentials latencies (milliseconds) were significantly prolonged with linaclotide compared to baseline (P1:Δ 19 ± 6, P < 0.005; N1:Δ 20 ± 7, P < 0.02) but not with placebo (P1:Δ 3 ± 5; N1:Δ 4.7 ± 5,P = 0.3) or between groups.The efferent cortico-anorectal and spino-anorectal latencies were unchanged. The maximum tolerable rectal volume (cc) increased significantly with linaclotide compared to baseline (P < 0.001) and placebo (Δ 29 ± 10 vs 4 ± 20, (P < 0.03). Abdominal pain decreased (P < 0.001) with linaclotide but not between groups. Complete spontaneous bowel movement frequency increased (P < 0.001), and IBS-QOL scores improved (P = 0.01) with linaclotide compared to baseline and placebo. There was no difference in overall responders between linaclotide and placebo (54% vs 23%, P = 0.13). Conclusions:Linaclotide prolongs afferent gut-brain signalling from baseline but both afferent and efferent signalling were unaffected compared to placebo. Linaclotide significantly improves rectal hypersensitivity, IBS-C symptoms and QOL compared to placebo.These mechanisms may explain the effects of linaclotide on pain relief in IBS-C patients. ClinicalTrials.Gov: Registered at Clinical trials.gov no NCT02078323.This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations.

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Section: Methodsmentioning

confidence: 82%

Randomised clinical trial: linaclotide vs placebo—a study of bi‐directional gut and brain axis

Rao

Xiang

Yan

et al. 2020

Aliment Pharmacol Ther

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“…The anorectal factors that predict the response to biofeedback therapy, the ingredients of biofeedback therapy which are critical for its success, and the mechanism(s) by which biofeedback therapy improves symptoms and pathophysiology in dyssynergia are unclear. The latency of cortical evoked potentials in response to rectal or anal stimulation is prolonged and declines after biofeedback therapy in patients with dyssynergic defecation, suggesting improved corticoanal function 43 . Biofeedback therapy was also effective in approximately 60% of patients with inflammatory bowel disease and DD 17, 18 .…”

Section: Defecatory Disordersmentioning

confidence: 98%

An Update on Anorectal Disorders for Gastroenterologists

2014

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Gastroenterologists frequently encounter pelvic floor disorders, which affect 10–15% of the population. The anorectum is a complex organ that collaborates with the pelvic floor muscles to preserve fecal continence and enable defecation. A careful clinical assessment is critical for the diagnosis and management of defecatory disorders and fecal incontinence. Newer diagnostic tools (e.g., high resolution manometry and magnetic resonance defecography) provide a refined understanding of anorectal dysfunctions and identify phenotypes in defecatory disorders and fecal incontinence. Conservative approaches including biofeedback therapy are the mainstay for managing these disorders; new minimally-invasive approaches may benefit a subset of patients with fecal incontinence but more controlled studies are needed. This mini-review highlights these advances, current concepts and controversies in the area.

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“…Improvements in defecation appear to be mediated by enhanced rectal propulsive forces and by anal and pelvic floor relaxation and by improved sensory thresholds. [11][12][13][14][15]24 Recent studies using bidirectional cortical evoked potentials and transcranial magnetic stimulations have revealed significant bi-directional brain-gut dysfunction in patients with DD, 25 and biofeedback appears to improve these dysfunctions. 26 Because biofeedback is an instrument-based treatment, standardization of both equipment and protocols is desirable.…”

Section: Strengths and Confounding Issuesmentioning

confidence: 99%

ANMS‐ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders

Rao

Benninga

Bharucha

et al. 2015

Neurogastroenterology Motil

231

214

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Anorectal disorders such as dyssynergic defecation, fecal incontinence, levator ani syndrome and solitary rectal ulcer syndrome are common, and affect both the adult and pediatric populations. Although they are treated with several treatment approaches, over the last two decades, biofeedback therapy using visual and verbal feedback techniques has emerged as an useful option. Because it is safe, it is commonly recommended. However, the clinical efficacy of biofeedback therapy in adults and children is not clearly known, and there is a lack of critical appraisal of the techniques used and the outcomes of biofeedback therapy for these disorders. The American Neurogastroenterology and Motility Society and the European Society of Neurogastroenterology and Motility convened a task force to examine the indications, study performance characteristics, methodologies used and the efficacy of biofeedback therapy, and to provide evidence-based recommendations. Based on the strength of evidence, biofeedback therapy is recommended for the short term and long term treatment of constipation with dyssynergic defecation (Level I, Grade A), and for the treatment of fecal incontinence (Level II, Grade B). Biofeedback therapy may be useful in the short-term treatment of Levator Ani Syndrome with dyssynergic defecation (Level II, Grade B), and solitary rectal ulcer syndrome with dyssynergic defecation (Level III, Grade C), but the evidence is fair. Evidence does not support the use of biofeedback for the treatment of childhood constipation (Level 1, Grade D).

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Does Biofeedback Therapy Modulate Anorectal (Gut)-Brain Axis in Patients With Dyssynergic Defecation?

Cited by 7 publications

References 0 publications

Randomised clinical trial: linaclotide vs placebo—a study of bi‐directional gut and brain axis

Randomised clinical trial: linaclotide vs placebo—a study of bi‐directional gut and brain axis

An Update on Anorectal Disorders for Gastroenterologists

ANMS‐ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders

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