New objective scoring system to clinically assess fecal incontinence

Abstract

Tumor necrosis factor-α (TNF-α) antagonists, the first biologics approved for treating patients with inflammatory bowel disease (IBD), are effective for the induction and maintenance of remission and significantly improving prognosis. However, up to one-third of treated patients show primary nonresponse (PNR) to anti-TNF-α therapies, and 23%-50% of IBD patients experience loss of response (LOR) to these biologics during subsequent treatment. There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs. This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients. Most predictors remain controversial, and only previous surgical history, disease manifestations, drug concentrations, antidrug antibodies, serum albumin, some biologic markers, and some genetic markers may be potentially predictive. In addition, we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists. Therapeutic drug monitoring plays an important role in treatment selection. Dose escalation, combination therapy, switching to a different anti-TNF drug, or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.

Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas

“…The clinical objective incontinence scoring was done by Garg incontinence scores (GIS) (Table 2). 11,12 GIS was utilized as they were scientifically better and improved the shortcomings in the previous scoring systems (Wexner's and Vaizey's), especially assigning equal weightage to all types of fecal incontinence. 11 Unlike previous scoring systems, in GIS, different weights were assigned to different types of fecal incontinence (derived by a robust statistical methodology).…”

“…11,12 GIS was utilized as they were scientifically better and improved the shortcomings in the previous scoring systems (Wexner's and Vaizey's), especially assigning equal weightage to all types of fecal incontinence. 11 Unlike previous scoring systems, in GIS, different weights were assigned to different types of fecal incontinence (derived by a robust statistical methodology). 11 The solid, liquid, flatus, mucous, stress, and urge fecal incontinence were assigned weights of 8, 8, 6, 6, 5, and 7, respectively, in GIS.…”

“…11 Unlike previous scoring systems, in GIS, different weights were assigned to different types of fecal incontinence (derived by a robust statistical methodology). 11 The solid, liquid, flatus, mucous, stress, and urge fecal incontinence were assigned weights of 8, 8, 6, 6, 5, and 7, respectively, in GIS. 11 The scores for the three levels of frequency of each fecal incontinence were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤1 episode of FI/ week), and common = 2 (>1 episode of FI/ week), and was termed as frequency score.…”

“…11 The solid, liquid, flatus, mucous, stress, and urge fecal incontinence were assigned weights of 8, 8, 6, 6, 5, and 7, respectively, in GIS. 11 The scores for the three levels of frequency of each fecal incontinence were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤1 episode of FI/ week), and common = 2 (>1 episode of FI/ week), and was termed as frequency score. 11 The score for each fecal incontinence would be derived by multiplying the frequency score and the weight for that fecal incontinence type.…”

“…11 The scores for the three levels of frequency of each fecal incontinence were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤1 episode of FI/ week), and common = 2 (>1 episode of FI/ week), and was termed as frequency score. 11 The score for each fecal incontinence would be derived by multiplying the frequency score and the weight for that fecal incontinence type. The maximum possible score was 80 (total incontinence), and the lowest score could be 0 (implied full continence) (Table 2).…”