Transanal irrigation (TAI), which has emerged as a therapy for patients with bowel dysfunction, can aid emptying of the bowel and help to re-establish control of bowel function by choosing the time and place of evacuation. Because of the ever-growing numbers of TAI systems available, choosing the optimal equipment can be overwhelming. Therefore, a consensus review of best practice from a working party of experts was thought to represent the most appropriate means of arriving at clinically meaningful advice. This led to the production of an article as well as a decision-guide booklet to aid choice of equipment, initiation, patient education, regimen setting and follow-up. These are designed to help healthcare providers initiating TAI to make optimal decisions for each individual patient.
Transanal irrigation (TAI) systems for bowel dysfunction are increasingly used as a management option for patients with constipation or faecal incontinence who fail to adequately improve their symptoms with conservative bowel management. A wide range of products available can make deciding which system to use challenging and overwhelming. The growing use and variety of TAI systems has created the need for guidelines to help clinicians initiating TAI choose the right device for the right patient for the right reasons. Therefore, an evidence-informed decision guide was developed by an expert consensus group to help clinicians make decisions tailored for each individual patient, based on theory and practicalities and promoting safe practice. Feedback from evaluations suggests that this guide is allowing clinicians to access a useful summary to assist consultations and practical discussions.
BSG abstractsmeasures (area under curve (AUC)) were anchored around known anatomical landmarks as identified by compartmental pH changes. 60-minute epochs were used to quantify antral, duodenal, ileal, caecal and distal colonic contractility. The maximum and minimum pH was measured either side of the ileo-caecal junction. All data are presented as means (±95% CI). Results No differences were seen in any of the motility parameters, compartmental transit times or maximal ileal pH between the two groups. Minimum caecal pH was significantly lower in patients compared to control (Px = 5.14 ± 0.14 v Cx = 6.12 ± 0.16, p < 0.0001). The 95% CI for maximum pH drop across the ICJ in health was 1.65 units. There was a significant correlation between caecal pH and caecal contractility (r = 0.498, p = 0.05). Conclusion In this study, we have shown that patients with lower abdominal symptoms typically associated with, but not limited to, conditions such as irritable bowel syndrome (IBS) have a significantly lower caecal pH compared to controls. This low pH environment is maintained by fermentation and subsequent SCFA production. SCFA have been shown to inhibit colonic motility in-vitro and contractility as measured by the WMC was correlated with caecal pH. With the recent success of anti-biotic therapy and low fermentable diets in the treatment of lower bowel symptoms in IBS, measurement of caecal pH using the WMC provides an objective and quantifiable biomarker of fermentation. This may be used to sub-classify patients with a broad spectrum of GI disorders and identify those that may benefit most from antibiotic, probiotic and dietary interventions providing novel insights into the pathophysiological mechanisms of lower GI symptoms.
FINCH Unit, Sandwell and West Birmingham NHS Trust, Birmingham, UKIntroduction Biofeedback is safe and effective in the management of rectal evacuatory dysfunction (RED), but there is limited data on medium to long-term follow-up. This study evaluated the effectiveness of biofeedback in the medium-term for patients with RED secondary to pelvic floor dyssynergia (PFD) and rectal hyposensitivity (RH). Methods Prospective data was collected from 2010 -2013 of 81 consecutive patients who underwent specialist nurse-led verbal biofeedback therapy in the form of rectal sensory re-training or balloon expulsion for PFD or RH. The primary outcome measure was patient satisfaction with their symptom improvement, assessed using a visual analogue scale (Likert scale 0-10). Secondary outcome measures were complete spontaneous bowel movements (CSBMs)/ week, time to defecation-assessed using bowel diaries, and KESS/ SF-36 quality of life questionnaire scores. All discharged patients received telephone follow-up. Results 85% patients met the primary outcome measure, with the Likert score improving [mean baseline 3.2 (1-7) vs. post-biofeedback 7.6 (5-9) p < 0.001]. Improvements were seen in CSBMs/week [mean baseline: 3.0 (1-14) vs. post-biofeedback: 6.9 (1-13) P < 0.001] and time taken to defecate in minutes [mean ...
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