Long‐term efficacy and safety of transanal irrigation in multiple sclerosis

Passananti, Valentina; Wilton, Andrew S.; Preziosi, Giuseppe; Storrie, Julie B.; Emmanuel, Anton

doi:10.1111/nmo.12833

Cited by 28 publications

(58 citation statements)

References 30 publications

(36 reference statements)

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“…Effective treatment of NBD is indeed associated with a reduction in need for hospitalization, physician visits, number of urinary tract infections, and need for surgery,33 with expected cost reductions 34. Patients with severe symptoms might be less likely to be employed,20 and although no data exist to quantify the societal financial impact, it is likely to be significant.…”

Section: Methodsmentioning

confidence: 99%

“…TAI has certainly made a big impact on the treatment of NBD; in fact, it not only improves symptoms, but also reduces the time spent for toileting 77. It has also proved to be a cost-effective treatment, reducing need for hospital admissions, physician’s visits, and occurrence of urinary tract infections (UTIs) 33. The latter is particularly relevant for MS patients, in whom UTIs can cause relapse of symptoms.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Preziosi¹,

Gordon–Dixon²,

Emmanuel³

2018

DNND

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Bowel dysfunction in patients with multiple sclerosis (MS) is highly prevalent. Constipation and fecal incontinence can coexist and alternate, impacting on the patient’s quality of life and social interactions, as well as burdening the caregivers. The cost for the health care providers is also significant, with increased number of hospital admissions, treatment-related costs, and hospital appointments. The origin is multifactorial, and includes alteration of neurological pathways, polypharmacy, behavioral elements, and ability to access the toilet. Every patient with MS should be sensitively questioned about bowel function, and red flag symptoms should prompt adequate investigations. Manipulation of life style factors and establishment of a bowel regime should be attempted in the first place, and if this fails, other measures such as biofeedback and transanal irrigation should be included. A stoma can improve quality of life, and is not necessarily a last-ditch option. Antegrade colonic enemas can also be an effective option, whilst neuromodulation has not proved its role yet. Effective treatment of bowel dysfunction improves quality of life, reduces incidence of urinary tract infection, and reduces health care costs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Preziosi¹,

Gordon–Dixon²,

Emmanuel³

2018

DNND

View full text Add to dashboard Cite

show abstract

“…Data for standard bowel care are taken from the baseline questionnaires for patients, except for the number of patients progressing to stoma, which is taken from the retrospective data of 157 patients prior to the introduction of Peristeen. Limited information on the audit is published [ 8 , 28 ], but an extract of some information was shared with Cedar by the company. The audit appears to have an appropriate NHS setting, with suitable patient pathways, and an appropriate, if heterogeneous, population.…”

Section: Cedar’s Review Of Evidencementioning

confidence: 99%

Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance

Dale

Morgan

Carter

et al. 2018

Appl Health Econ Health Policy

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The Peristeen transanal irrigation system is intended to allow people with bowel dysfunction to flush out the lower part of the bowel as part of their bowel management strategy. Peristeen was the subject of an evaluation by the National Institute for Health and Care Excellence, through its Medical Technologies Evaluation Programme, for the management of bowel dysfunction. The company, Coloplast, submitted a case for adoption of the technology, claiming that the technology improves the severity of chronic constipation or faecal incontinence and improves quality of life for people with bowel dysfunction. Other claimed benefits included reduced frequency of UTIs, stoma surgery and hospitalisation rates, as well as reduced costs. The submission was critiqued by Cedar. The clinical evidence assessed included one randomised controlled trial, and 12 observational studies for adults and 11 studies for children. Although there are limitations in the evidence, the assessed studies show some improvement in outcomes for patients who choose to continue using Peristeen. The committee heard from patient experts that Peristeen had improved their lives and allowed them increased independence. The submitted economic evidence had numerous flaws, however following Cedar’s changes to the model, and additional sensitivity analysis, the use of Peristeen was judged unlikely to be cost incurring compared with standard bowel care. The Peristeen transanal irrigation system received a positive recommendation in Medical Technologies Guidance 36.

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“…It correlates with the impaired quality of life and is sensitive to change. The score was developed for the SCI population and has also been used in MS cohorts [25]. It was not developed for clinical decision-making for individuals presenting with an ineffective bowel regimen [26].…”

Section: Introductionmentioning

confidence: 99%

Creation and validation of a new tool for the monitoring efficacy of neurogenic bowel dysfunction treatment on response: the MENTOR tool

et al. 2020

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Study design Prospective observational study. Objectives A tool to help decision-making tool for Neurogenic Bowel Dysfunction (NBD) in individuals with SCI is needed. We present a project to create and validate a new tool, the Monitoring Efficacy of NBD Treatment On Response (MENTOR), and to determine its level of concordance with decisions made by experienced clinicians in the field. Setting UK, Denmark, USA, Italy, The Netherlands, Germany. Methods The first phase was creation of the tool through a modified Delphi process. The second phase was the validation, wherein individuals with spinal cord injury with NBD were asked to complete the MENTOR tool immediately prior to clinic consultation. From the responses to the questionnaire of the tool, each participant was allocated into one of three categories reflecting the possible therapeutic recommendations ("recommend change", "further discussion" and "monitoring"). An expert clinician then assessed the participant, blinded to MENTOR results, and made an independent treatment decision. Results A total of 248 MENTOR forms were completed. Strong agreement was found when the MENTOR tool recommended monitoring (92%) or treatment change (83%); the lowest concordance when the decision was for the "further discussion" option (59%). Patient acceptability was reported by 97% of individuals. Conclusions MENTOR is an easy to use tool to monitor the treatment of NBD and determinate progression through the clinical pathway. This validation study shows good correspondence between expert clinician opinion and MENTOR result. The tool has potential to be used in other patient groups, following further studies.

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Long‐term efficacy and safety of transanal irrigation in multiple sclerosis

Abstract: Long-term continuation of TAI, with improved bowel symptomatology, is seen in the majority of patients. The EQ-5D is insufficiently sensitive to show change in MS patients that using TAI.

Cited by 28 publications

References 30 publications

Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance

Creation and validation of a new tool for the monitoring efficacy of neurogenic bowel dysfunction treatment on response: the MENTOR tool

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