Fecal Incontinence in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Gu, Phillip; Kuenzig, M Ellen; Kaplan, Gilaad G.; Pimentel, Mark; Rezaie, Ali

doi:10.1093/ibd/izx109

Cited by 42 publications

(21 citation statements)

References 40 publications

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“…Rate of FI was similar among UC and CD patients. Higher risk of FI in IBD patients is likely due chronic changes in bowel habits, perianal disease/surgeries, loss of rectoanal inhibitory reflex and abnormal rectal sensation[86].…”

Section: Fecal Incontinencementioning

confidence: 99%

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

Barros

Farias

Rezaie

2019

WJG

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Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.

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Section: Fecal Incontinencementioning

confidence: 99%

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

Barros

Farias

Rezaie

2019

WJG

Self Cite

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“…There are many possible approaches to address fecal incontinence, such as pharmacotherapy, biofeedback therapy, sacral nerve stimulation, anal plugs, radiofrequency administration, anal sphincteroplasty, dynamic graciloplasty and colostomy. Those options range from suitable treatment for the mildest symptons only to therapeutics for last line refractory fecal incontinence [1, 4].…”

Section: Introductionmentioning

confidence: 99%

“…They are locally injected into the sphincter complex to cause the enlargement of the anal canal pads, promote reduction of lumen in the injection location and pose as a promising way to ameliorate this problem. They may also work by filling defects in the anal internal sphincter thus reestablishing anal canal symmetry [4, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

Effects of bacterial cellulose gel on the anorectal resting pressures in rats submitted to anal sphincter injury

Cavalcante

Lima

Souza

et al. 2018

Heliyon

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The aim of this study is to evaluate if a gel of bacterial cellulose gel can revert the loss of anal resting pressure after anorectum sphincter injury in rat model, elected as a model to simulate fecal incontinence. Thirty-nine animals were equally divided into three groups: Control (CG), Sphincter injury plus Saline injection (SG) and Sphincter injury plus Bacterial Cellulose Gel injection (BCG). Anal pressure at rest was assessed for all animal in the three groups using anorectum manometry. Saline and Gel groups were subject to anorectum sphincter injury to reduce the anal pressure at rest. Fifteen days later Saline or Gel was injected into the anorectum, according to their groups. Sixty days later first manometry, the anorectum of all animals were removed and processed histologically. The CG group showed maintenance of their mean anorectal resting pressure levels; SG presented a fall in their mean anorectal resting pressure. The BCG presented a significant elevation of the mean anorectal resting pressure levels, surpassing the pressure of CG. The gel of bacterial cellulose remained at the injection site and was neovascularized, colonized by fibroblasts and dense conjunctive tissue. Those data suggest that BC can be used as a future filling agent treatment for fecal incontinence in clinical trial protocols.

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“…Moreover, in IBD patients the involuntary loss of feces could be attributed to the underlying disease rather than a concomitant FI related to other causes, determining not only an underestimation of the problem but also a less comprehensive approach. A recent systematic review and meta‐analysis by Gu et al 377 analysed the prevalence, pathophysiology and treatment of FI in IBD patients, reporting questionnaires and anal manometry as the main instruments for FI diagnosis. No additional tool was used to reach the diagnosis of FI.…”

Section: Discussionmentioning

confidence: 99%

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

et al. 2020

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Background Fecal incontinence is a disabling condition affecting up to 20% of women. Objective We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials. Methods We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019. Results In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies. Conclusion Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.

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Fecal Incontinence in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract: FI is prevalent in IBD patients without IPAA, and more common than non-IBD controls. Additional controlled studies are warranted to further identify effective therapeutic interventions for FI in IBD. 10.1093/ibd/izx109_video1izx109_Video_15760611117001.

Cited by 42 publications

References 40 publications

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

Effects of bacterial cellulose gel on the anorectal resting pressures in rats submitted to anal sphincter injury

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

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