Electrical Stimulation Therapy in Chronic Functional Constipation: Five Years' Experience in Patients Refractory to Biofeedback Therapy and With Rectal Hyposensitivity

Abstract

Background/AimsBiofeedback therapy (BFT) can be unsuccessful in constipated patients, even those with pelvic floor dysfunction. Electrical stimulation therapy (EST) has been introduced as a novel therapeutic modality in patients with chronic constipation, especially those who have rectal hyposensitivity. We evaluated the efficacy of EST based on five years' clinical experience.MethodsFrom January 2002 to February 2007, 159 patients underwent EST. After exclusion of 12 drop-outs, 147 (M:F = 61:86, 49 ± 17 years) finished all treatment sessions. Among them, 88 (M:F = 29:59, 49 ± 17 years) were refractory to BFT without rectal hyposensitivity (RH), and 59 (M:F = 32:27, 54 ± 17 years) were those with RH.ResultsThe overall response to EST was 59.2% (87/147) by per-protocol analysis. In the EST-responsive group, overall satisfaction improved significantly (from 7.3 ± 3.0 to 4.3 ± 2.5, P < 0.05). Subgroup analysis showed that the response rate was 64.8% (57/88) in patients refractory to BFT without RH, and 50.8% (30/59) in those with RH.ConclusionsEST may have additional therapeutic efficacy in patients who are refractory to BFT. EST may also be effective in patients with RH, including restoration of rectal sensation. Therefore, EST could be considered as an alternative choice in patients refractory to BFT and with or without RH.

Five-fold Gastrointestinal Electrical Stimulation With Electromyography-based Activity Analysis: Towards Multilocular Theranostic Intestinal Implants

“…[1][2][3] From the esophagus to the anal sphincter, multifaceted motility disorders during the interdigestive and postprandial state may significantly impair patients' quality of life. [4][5] Furthermore, functional disorders in one GI segment increase the risk in others. 6 GI smooth muscle electromyography (EMG) has been clinically tested for recording pacesetter slow waves or action potential spikes.…”

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

“…[205][206][207] Acknowledgements: We would like to express our sincere gratitude to Eun-Ae Jeong, PhD of the Library of Medicine of Soonchunhyang University who searched existing guidelines during the first phase of the systematic literature review. In addition, we would like to thank Prof. Seung-Jae Myung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College Medicine) who reviewed the draft of this manuscript in the peer review process.…”

Chronic severe constipation

“…bran, psyllium) remain the first-line treatment for constipation (Level of Evidence: Class II; Grade of Recommendation: B). However, electrostimulation combined with biofeedback may be a selected treatment for incoordination of abdominal, rectoanal, and pelvic floor muscles as well as for rectal hyposensitivity [93,94]. polyethylene glycol, lactulose), lubiprostone (amitaza) and stimulant (bisacodyl) or prokinetic agents (e.g.…”