Improvement in constipation with biofeedback linked to gut-specific effects

הסקירה באדיבות מדיקונטקסט: Last Updated: 2001-07-25 15:16:28 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – In patients with idiopathic constipation, response to biofeedback treatment is associated with improvement in activity of the direct cerebral innervation to the large bowel and in transit time, according to a report in the August issue of Gut.

Dr. M. A. Kamm and a colleague from St. Mark's Hospital, Middlesex, UK, note that "although…biofeedback successfully treats the pelvic floor abnormalities in patients with idiopathic constipation, many patients also normalize their impaired bowel frequency." They hypothesized that a response to biofeedback might be associated with "altered cerebral outflow via extrinsic autonomic nerves to the gut."

The researchers prospectively studied 49 patients with idiopathic constipation before and after a mean of five biofeedback sessions. They used laser Doppler flowmetry to measure rectal mucosal blood flow in order to examine direct extrinsic gut nerve autonomic activity, and assessed general autonomic activity. They compared the results with those from 26 healthy controls.

Twenty-nine patients reported symptomatic improvement at the end of treatment. Twenty-seven patients reported a bowel frequency of less than 3 per week before treatment, compared with nine patients after treatment. In addition, 26 patients reported a need to strain before treatment, compared with 9 patients after treatment. Also, 34 patients used laxatives or suppositories before treatment, compared with 9 after treatment.

Fourteen of 22 patients with slow transit reported symptomatic improvement. Thirteen of these patients developed normal transit.

The mean increase in rectal mucosal blood flow for patients who improved subjectively was 28.7%, compared with 6.5% for patients who reported no subjective improvement. In those with improved bowel frequency, rectal mucosal blood flow increased by 33%, compared with 9% for those not reporting improved bowel frequency.

"None of the general cardiorespiratory autonomic reflexes was changed by treatment," the authors report. They infer that "amelioration of autonomic activity is gut specific."

Gut 2001;49:214-219.

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