Biofeedback Therapy Is an Effective Treatment Strategy in Refractory Fecal Incontinence

2014 ◽  
Vol 109 ◽  
pp. S527
Author(s):  
Francis Okeke ◽  
Ahmed Salem ◽  
John Clarke ◽  
Sameer Dhalla ◽  
Monica Nandwani ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Effective Treatment ◽  
Treatment Strategy ◽  
Biofeedback Therapy

scholarly journals The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Yuhang Yuan ◽  
Mengyao Xu ◽  
Heying Yang ◽  
Beibei Sun ◽  
Yanan Li ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Effective Treatment ◽  
Anorectal Manometry ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Complete Disappearance ◽  
Biofeedback Therapy ◽  
The Poor ◽  
Surgical Methods ◽  
Poor Group

Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

Effect of biofeedback therapy on anorectal functions of patients with fecal incontinence

2006 ◽  
Vol 44 (05) ◽  
Author(s):  
A Illés ◽  
C Csizmadia ◽  
L Nagy ◽  
B Pordány ◽  
S Undi ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Biofeedback Therapy

scholarly journals The Role of Pharmacogenetics in the Treatment of Diabetes Mellitus / ULOGA FARMAKOGENETIKE U LEČNJU DIJABETES MELITUSA

2014 ◽  
Vol 33 (1) ◽  
pp. 58-70 ◽  
Author(s):  
Elizabeta Topić
Keyword(s):  
Diabetes Mellitus ◽  
Effective Treatment ◽  
Treatment Strategy ◽  
Screening Program ◽  
Economic Consequences ◽  
Dipeptidyl Peptidase 4 ◽  
Glucosidase Inhibitors ◽  
Baseline Information ◽  
Approved Drugs ◽  
Therapeutic Decision Making

Summary Diabetes mellitus is a heterogeneous group of disorders in which particular disease phenotypes can be characterized by a specific etiology and/or pathogenesis of the disease, but in many cases its classification is greatly impeded due to significant phenotype overlapping. Diabetes is a wordwide epidemic with significant health and economic consequences. The frequency of type 2 diabetes (T2D) is much higher than type 1 diabetes (T1D). In adults, around 285 million people suffer from T2DM with a projected rise to 438 million in the next 20 years. A variety of pharmacological treatments exist for patients with T2D, in addition to dietary and physical activity. Pharmacologically, diabetes is treated with nine major classes of approved drugs, including insulin and its analogues, sulfonylureas, biguanides, thiazolidinediones (TZDs), meglitinides, a-glucosidase inhibitors, amylin analogues, incretin hormone mimetics, and dipeptidyl peptidase 4 (DPP4) inhibitors. Treatment strategy for T2D is based mostly on oral hypoglycemic drug (OHD) efficacy assessed usually by HbA1c and/or fasting plasma glucose. The patients are often treated with more than one OHD in combination with the purpose to receive more effective treatment. Characterization of drug response is expected to substantially increase the ability to provide patients with the most effective treatment strategy. If pharmacogenetic testing for diabetes drugs could be used to predict treatment outcome, appropriate measures could be taken to treat T2D more efficiently. To date, major pharmacogenetic studies have focused on response to sulfonylureas, biguanides, and TZDs, the most used OHD. A comprehensive review of the pharmacogenetic studies of specific OHD is presented in this article. Understanding the pharmacogenetics of these drugs will provide critical baseline information for the development and implementation of a genetic screening program into therapeutic decision making, enabling a personalized medicine approach for T2D patients.

scholarly journals Effective treatment of different types of polycystic ovary syndrome in adolescent girls

2022 ◽  
pp. 56-60
Author(s):  
E. V. Uvarova ◽  
E. P. Khashchenko ◽  
S. O. Kyurdzidi
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Effective Treatment ◽  
Adolescent Girls ◽  
Treatment Strategy ◽  
Polycystic Ovary ◽  
Young Female ◽  
Diagnosis And Treatment ◽  
Medical Community ◽  
Ovary Syndrome ◽  
Female Patients

This review is addressing an urgent problem of diagnosis and treatment strategy of polycystic ovary syndrome in adolescent girls. We analysed data from modern literary publications on the epidemiology and classification of the disease, as well as the adaptation of general principles for the management of young female patients tailored to their age peculiarities. The effective treatment strategies for adolescent girls with PCOS depending on its type are presented. Today there are several contradictions associated with both the diagnosis and treatment of the disease in the medical community. Thus, the use of the well-known Rotterdam criteria makes it difficult to diagnose PCOS in adolescent girls, since the criteria do not take into account characteristic changes that occur during puberty. Such manifestations as acne, hirsutism, menstrual irregularities, high androgen levels and morphology of polycystic ovaries on pelvic ultrasound imaging should be assessed with due account for age, puberty, hormonal balance with an assessment of the ratio of LH (luteinizing hormone)/FSH (follicle-stimulating hormone) and Free Androgen Index. There is no consensus in the medical community regarding the treatment strategy for PCOS. International communities have identified two main goals in the management of patients: normalization of menstrual function and improvement of the patients’ quality of life by preventing clinical symptoms of hyperandrogenism, and metabolic disorders of hyperplastic processes in target organs.Our analysis of objective scientific data showed that modern monophasic combined oral contraceptives (COCs) supplemented by of a folate component should be used to treat young female patients with PCOS, hyperandrogenism and psychosomatic disorders.

Treatment of patients waitlisted for liver transplant with all-oral direct-acting antivirals is a cost-effective treatment strategy in the United States

Hepatology ◽  
2017 ◽  
Vol 66 (1) ◽  
pp. 46-56 ◽  
Author(s):  
Aijaz Ahmed ◽  
Stevan A. Gonzalez ◽  
George Cholankeril ◽  
Ryan B. Perumpail ◽  
Justin McGinnis ◽  
...  
Keyword(s):  
United States ◽  
Liver Transplant ◽  
Effective Treatment ◽  
Treatment Strategy ◽  
Cost Effective ◽  
The United States ◽  
Direct Acting Antivirals ◽  
Cost Effective Treatment ◽  
Direct Acting

scholarly journals A novel combined anorectal biofeedback and percutaneous tibial nerve stimulation protocol for treating fecal incontinence

2020 ◽  
Vol 13 ◽  
pp. 175628482091638
Author(s):  
Yoav Mazor ◽  
Gillian M. Prott ◽  
Carol Sequeira ◽  
Michael Jones ◽  
Anastasia Ejova ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Patient Comfort ◽  
Future Research ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Biofeedback Therapy ◽  
Tibial Nerve Stimulation

Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.

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