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Spindler L, Etienney I, Abramowitz L, de Parades V, Pigot F, Siproudhis L, Adam J, Balzano V, Bouchard D, Bouta N, Bucau M, Carlo A, Chanal J, Charpentier C, Clifford G, Draullette M, Fathallah N, Ferré V, Fléjou JF, Fouéré S, Higuero T, Kassouri L, Kurt S, Laurain A, Leclerc E, Lepiller Q, Lesage AC, Mège D, Ménard A, Merle P, Mortreux P, Noël C, Péré H, Prétet JL, Roland D, Staumont G, Tracanelli L, Vuitton L, Wylomanski S, Zaegel-Faucher O. Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice. Tech Coloproctol 2024; 28:23. [PMID: 38198036 PMCID: PMC10781838 DOI: 10.1007/s10151-023-02899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.
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Affiliation(s)
- L Spindler
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - I Etienney
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - L Abramowitz
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - V de Parades
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Siproudhis
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Adam
- Service d'Anatomopathologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Balzano
- Service de Gastroentérologie et Oncologie Digestive, CHU Tours, Tours, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - N Bouta
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - M Bucau
- Service d'Anatomopathologie, AP-HP Hôpital Bichat-Claude Bernard, Paris, France
| | - A Carlo
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Chanal
- Service de Dermatologie, AP-HP, Hôpital Tarnier, Paris, France
| | - C Charpentier
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - G Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research On Cancer, Lyon, France
| | - M Draullette
- Service d'Hépato-Gastroentérologie et Assistance Nutritive, AP-HP, Hôpital Beaujon, Clichy, France
| | - N Fathallah
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Ferré
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - J-F Fléjou
- Service d'Anatomopathologie, Cerbapath, Paris, France
| | - S Fouéré
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
- Centre des Maladies Sexuellement Transmises, AP-HP, Hôpital Saint-Louis, Paris, France
| | - T Higuero
- Gastro-entérologue, proctologue medico-chirurgical, Beausoleil, France
| | - L Kassouri
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Kurt
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Laurain
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - E Leclerc
- Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Inserm, 3iHP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Q Lepiller
- Laboratoire de Virologie, CHU de Besançon, Besançon, France
| | - A-C Lesage
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - D Mège
- Service de Chirurgie Digestive, Université d'Aix Marseille, AP-HM, Hôpital de la Timone, Marseille, France
| | - A Ménard
- Institut Hospitalo-Universitaire Méditerranée Infection, AP-HM, Hôpital Nord, Université d'Aix Marseille, Marseille, France
| | - P Merle
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - P Mortreux
- Service de Gastroentérologie, Centre Hospitalier de Bethune Beuvry, Beuvry, France
| | - C Noël
- Service d'Hépato-Gastroentérologie, CHU de Brest, Brest, France
| | - H Péré
- Laboratoire de Virologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Functional Genomics of Solid Tumors (FunGeST), Centre de Recherche des Cordelier, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - J-L Prétet
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - D Roland
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - G Staumont
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - L Tracanelli
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Vuitton
- Service de Gastroentérologie, CHU de Besançon, Université de Bourgogne Franche-Comté, Besançon, France
| | - S Wylomanski
- Service de Gynécologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - O Zaegel-Faucher
- Service d'Immuno-Hématologie Clinique, AP-HM, CHU Sainte-Marguerite, Marseille, France
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Levaillant M, Venara A, Damon H, Siproudhis L, Brochard C, Hamel JF. Young women and elderly men at risk of severe faecal incontinence: results of a French nationwide database analysis : Faecal incontinence in France. Int J Colorectal Dis 2023; 38:131. [PMID: 37191698 DOI: 10.1007/s00384-023-04431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The incidence of severe faecal incontinence (FI) in young people is likely underestimated. The objective of this study is to assess the incidence of FI by using the French national insurance information system (SNDS). METHODS The SNDS was used, including 2 health insurance claims databases. The study included 49,097,454 French people who were ≥ 20 years old in 2019. The main outcome measure was the occurrence of FI. RESULTS In 2019, 123,630 patients out of the entire French population (n = 49 097 454) (0.25%) were treated for FI. The numbers of male and female patients were similar. The data showed a dramatic increase in the incidence of FI between the ages of 20 and 59 in female patients, compared to 60 and 79 in male patients. The risk of FI increased with age (OR of 3.6 to 11.3 depending on age). Women had a higher risk of severe FI compared to men between the ages of 20 and 39 (OR = 1.3; 95%CI:1.3-1.4) and the ages of 40 and 59 (OR = 1.1; 95%CI:1.08-1.13). This risk decreased after the age of 80 (OR = 0.96; 95%CI:0.93-0.99). The rate of diagnosis of FI also increased where there were greater numbers of proctologists practising in the region of residence in question (OR of 1.07 to 1.35 depending on the number of proctologists). CONCLUSION Young women who have given birth and elderly men are at risk of FI and must be targeted by public health information campaigns. The development of coloproctology networks should be encouraged.
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Affiliation(s)
- M Levaillant
- Faculty of Health, Department of Medicine, Angers, France
| | - A Venara
- Faculty of Health, Department of Medicine, Angers, France.
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 09, France.
- IHFIH, UPRES EA 3859, University of Angers, Angers, France.
| | - H Damon
- Hospices Civils de Lyon, 69437, Lyon, France
- Clinique Protestante, 69300, Caluire et Cuire, France
| | - L Siproudhis
- Unité d'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France
- Service des Maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, Rennes, France
| | - C Brochard
- Unité d'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France
- Service des Maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, Rennes, France
| | - J F Hamel
- Faculty of Health, Department of Medicine, Angers, France
- Department of Biostatistics, La Maison de la Recherche, University Hospital of Angers, Angers Cedex 9, France
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Haudebert C, Hascoet J, Samson E, Voiry C, Jezequel M, Brochard C, Richard C, Kerdraon J, Siproudhis L, Manunta A, Peyronnet B. Risk factors for upper urinary tract deterioration in adult patients with spina bifida. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Tracanelli L, Fathallah N, Babin-Pigot E, Ferry M, Bouguen G, Laharie D, Cotte E, Panis Y, Peyrin-Biroulet L, Roblin X, Zerbib P. Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus. Tech Coloproctol 2022; 26:805-811. [DOI: 10.1007/s10151-022-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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Venara A, Brochard C, Fritel X, Bridoux V, Abramowitz L, Legendre G, Siproudhis L. Management of obstetrical injuries to the anal sphincter: A survey of French current practice and perceptions according to the specialties. J Visc Surg 2021; 158:378-384. [PMID: 33446467 DOI: 10.1016/j.jviscsurg.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY To conduct a survey of current practice in the management of obstetrical anal sphincter injuries (OASI) and to compare short, medium and long-term practices according to the specialty of the surgeon. PATIENTS AND METHODS A 50-item questionnaire was addressed by mail to various specialists via the national learned societies. The questionnaire was addressed only to practitioners who currently managed OASI in their practice. RESULTS Of the 135 healthcare professionals who responded, 57 were sub-specialists in ano-rectal surgery (42.2%) and 78 were obstetrical or gynecological specialists (OB-GYN) (57.8%). Management in the acute period after OASI was similar among the specialties and 50% of the practitioners did not perform suture repair of the internal sphincter. Furthermore, few gynecological specialists recommended systematic consultation with an ano-rectal specialist during acute management. In the medium term, ano-rectal specialists were more likely to explore gastro-intestinal symptoms, either clinically or through para-clinical studies. However, these studies did not systematically lead to interventional management in the absence of consensus, particularly for medium-term sphincter repair. In addition, 25% of practitioners recommended that patients undergo systematic delivery by caesarean section for further pregnancies after OASI. In the long term (>12 months), there were substantial differences in management of OASI not only between specialties but also within the same specialty. CONCLUSION The various specialists should coordinate to propose multidisciplinary recommendations on the management of OASI.
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Affiliation(s)
- A Venara
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Association française de chirurgie (AFC), France; Faculté de santé, département de médecine, université Angers, 49045 Angers cedex 01, France; Laboratoire IHFIH, UPRES EA 3859, France.
| | - C Brochard
- Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Service des maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, 35000 Rennes, France
| | - X Fritel
- Collège national des obstétriciens et gynécologues français (CNGOF), France; Université de Poitiers-CHU de Poitiers, service de gynécologie-obstétrique et médecine de la reproduction, 86021 Poitiers, France
| | - V Bridoux
- Association française de chirurgie (AFC), France; Service de chirurgie viscérale et endocrinienne, CHU de Rouen, 76000 Rouen, France
| | - L Abramowitz
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Société nationale française de coloproctologie (SNFCP), France; Service d'hépato-gastroentérologie et proctologie, hôpital Bichat-Claude Bernard, 75018 Paris, France; Ramsay général de santé, clinique Blomet, 75015 Paris, France
| | - G Legendre
- Collège national des obstétriciens et gynécologues français (CNGOF), France; Service de gynécologie obstétrique, CHU d'Angers, 49933 Angers cedex 9, France
| | - L Siproudhis
- Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Laboratoire IHFIH, UPRES EA 3859, France
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Herissay A, Siproudhis L, Le Balc'h E, Merlini L'Heritier A, Dewitte M, Wallenhorst T, Bouguen G, Brochard C. Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors. Colorectal Dis 2021; 23:159-168. [PMID: 32640112 DOI: 10.1111/codi.15241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/21/2020] [Indexed: 12/13/2022]
Abstract
AIM The medico-surgical strategy for the treatment of perianal fistulizing Crohn's disease (CD) following surgical drainage remains challenging and debated. Our aims were to describe the failure rate of therapeutic interventions after drainage of the fistula tract and determine the factors associated with failure to optimize medico-surgical strategies. METHOD All consecutive patients with perianal fistulizing CD who underwent surgical drainage with at least a 12-week follow-up were included. Failure was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening and further drainage procedure(s). RESULTS One hundred and sixty-nine patients were included. The median follow-up was 4.0 years. The cumulative failure rates were 20%, 30% and 36% at 1, 3 and 5 years, respectively. The cumulative failure rates in patients who had sphincter-sparing surgeries or seton removal were significantly higher than in those who had a fistulotomy. Anterior fistula [hazard ratio (HR) = 2.52 (1.13-5.61), P = 0.024], supralevator extension [HR = 20.78 (3.38-127.80), P = 0.001] and the absence or discontinuation of immunosuppressants after anal drainage [HR = 3.74 (1.11-12.5), P = 0.032] were significantly associated with failure in the multivariate analysis model. CONCLUSION Combined strategies for perianal fistulizing CD lead to a failure rate of 36% at 5 years. Where advisable, fistulotomy may be preferred because it has a lower rate of recurrence. The benefits of immunosuppressants require a dedicated prospective randomized trial.
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Affiliation(s)
- A Herissay
- CHU Rennes, Universitaire Rennes, Rennes, France
| | - L Siproudhis
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
| | - E Le Balc'h
- CHU Rennes, Universitaire Rennes, Rennes, France
| | | | - M Dewitte
- CHU Rennes, Universitaire Rennes, Rennes, France
| | | | - G Bouguen
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
| | - C Brochard
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
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Richard C, Voiry C, Freton L, Kerdraon J, Hascoet J, Brochard C, Bonan I, Jezequel M, Siproudhis L, Manunta A, Peyronnet B. Sexual dysfunction in adult women with spina bifida. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Le Berre C, Bourreille A, Flamant M, Bouguen G, Siproudhis L, Dewitte M, Dib N, Cesbron-Metivier E, Goronflot T, Hanf M, Gourraud PA, Kerdreux E, Poinas A, Trang-Poisson C. Protocol of a multicentric prospective cohort study for the VALIDation of the IBD-disk instrument for assessing disability in inflammatory bowel diseases: the VALIDate study. BMC Gastroenterol 2020; 20:110. [PMID: 32299390 PMCID: PMC7164208 DOI: 10.1186/s12876-020-01246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Inflammatory Bowel Diseases (IBD) affect psychological, family, social and professional dimensions of patients’ life, leading to disability which is essential to quantify as part of Patient-Reported Outcomes (PROs) newly included in the targets to reach in IBD patients. Up to now, the IBD-Disability Index (IBD-DI) was the only validated tool to assess disability, but it is not appropriate for use in clinical practice. The IBD Disk was developed, a shortened and self-administered tool, adapted from the IBD-DI, in order to give immediate representation of patient-reported disability. However, the IBD Disk has not been validated yet in clinical practice. The aims of the VALIDate study are to validate this tool in a large population of IBD patients and to compare it to the already validated IBD-DI. Methods The VALIDate study is an ongoing multicentric prospective cohort study launched in April 2018 in 3 French University Hospitals (Nantes, Rennes, Angers), with an objective to reach a sample of 400 patients over a period inclusion of 6 months. Each patient will fill in the two questionnaires IBD Disk and IBD-DI at baseline, then between 3 and 12 months later, during a follow-up visit. Clinical and socio-demographic data will also be collected. During these two consultations, gastroenterologists and patients will evaluate disease activity thanks to a semi-quantitative 4-grade scale, named respectively PGA (Physician Global Assessment) and PtGA (Patient Global Assessment). This cohort will allow to evaluate the validity of the IBD Disk with respect to the IBD-DI in order to generalize its use for clinical practice. Other psychometric criteria of the IBD Disk will also be analysed as its reliability or its discriminant capacity. Close attention will nonetheless be needed to minimize the number of lost to follow-up patients between baseline and follow-up. Discussion The VALIDate study is the study designed to validate the IBD Disk, a visual tool easily useable in daily practice to assess disability in IBD patients. The results of this trial should enable the diffusion of this tool. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT03590639. First posted: July 18, 2018.
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Affiliation(s)
- C Le Berre
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - M Flamant
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - M Dewitte
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - N Dib
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - E Cesbron-Metivier
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - T Goronflot
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - M Hanf
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - P-A Gourraud
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - E Kerdreux
- Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - A Poinas
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - C Trang-Poisson
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
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Brochard C, Ropert A, Chambaz M, Gouriou C, Cardaillac C, Grainville T, Bouguen G, Siproudhis L. Chronic pelvic pain and rectal prolapse invite consideration of enterocele. Colorectal Dis 2020; 22:325-330. [PMID: 31622543 DOI: 10.1111/codi.14877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/30/2019] [Indexed: 02/04/2023]
Abstract
AIM Data on the pathogenesis and symptoms of enterocele are limited. The objectives of this study were to determine the clinical phenotype of patients with enterocele, to highlight the main functional and/or anatomical associations and to improve the accuracy of the preoperative assessment of pelvic floor disorders. METHOD A total of 588 patients who were referred to a tertiary unit for an anorectal complaint completed a self-administered questionnaire and underwent physical examination, anorectal manometry and defaecography. Using defaecography, enterocele was defined as a radiological hernia of the small bowel into an enlarged rectovaginal space. One hundred and thirty-five patients with enterocele were age- and gender-matched with 270 patients without enterocele. Factors associated with enterocele were assessed using univariate and multivariate analysis models. RESULTS Patients with enterocele were less frequently obese than patients without enterocele (8/135 vs 36/270; P = 0.02) and more frequently had a past history of pelvic surgery (51/135 vs 75/270; P = 0.04). They complained more frequently of pelvic pain on bearing down (29/135 vs 24/270; P = 0.003), anal procidentia (37/135 vs 46/270; P = 0.01) and more frequently had irritable bowel syndrome (83/135 vs 131/270; P = 0.01) and severe constipation according to the Kess score (104/135 vs 182/270; P = 0.04). Anorectal function was comparable between the two groups. Patients with enterocele had more frequent rectoceles and overt rectal prolapses than patients without enterocele. CONCLUSIONS Enterocele should be investigated in patients with chronic pelvic pain, overt rectal prolapse and/or a past history of pelvic surgery.
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Affiliation(s)
- C Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennesss 1, Rennes, France.,Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U1241, Equipe EXPRES, Université de Rennes 1, Rennes, France.,INPHY, Université de Rennes 1, Rennes, France
| | - A Ropert
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INPHY, Université de Rennes 1, Rennes, France
| | - M Chambaz
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - C Gouriou
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennesss 1, Rennes, France
| | - C Cardaillac
- Service de Gynécologie-obstétrique et Médecine de la Reproduction, Hôpital Mère-Enfant, CHU de Nantes, Nantes, France
| | - T Grainville
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennesss 1, Rennes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennesss 1, Rennes, France.,INSERM U1241, Equipe EXPRES, Université de Rennes 1, Rennes, France.,INPHY, Université de Rennes 1, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennesss 1, Rennes, France.,INSERM U1241, Equipe EXPRES, Université de Rennes 1, Rennes, France.,INPHY, Université de Rennes 1, Rennes, France
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10
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Mege D, Meurette G, Brochard C, Damon H, Lambrescak E, Faucheron JL, Wyart V, Lehur PA, Sielezneff I, Siproudhis L, Mion F, Etienney I, Houivet E, Bridoux V, Leroi AM. Sacral nerve modulation for faecal incontinence: influence of age on outcomes and complications. A multicentre study. Colorectal Dis 2019; 21:1058-1066. [PMID: 30985984 DOI: 10.1111/codi.14649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 02/08/2023]
Abstract
AIM Faecal incontinence is frequent in the elderly. Little is currently known about the efficacy of sacral nerve modulation (SNM) in the elderly. The present study aimed to assess the impact of age on the outcome of SNM and on the surgical revision and explantation rates by comparing the results of a large data set of patients. METHOD Prospectively collected data from patients who underwent an implant procedure between January 2010 and December 2015 in seven French centres were retrospectively evaluated. In total, 352 patients [321 women; median age (range): 63 (24-86) years] were included. Clinically favourable and unfavourable outcomes, and surgical revision and explantation rates, were compared according to the age of the patients. RESULTS A similar outcome was observed when comparing patients < 70 years and ≥ 70 years (a favourable outcome in 79.2% and 76.2%, respectively, P = 0.89). The probability of a successful treatment as a function of time was similar for the two age groups (< 70 years and ≥ 70 years, P = 0.54). The explantation and revision rates were not influenced by age (explantation rate: 17% in patients < 70 years vs 14% in patients ≥ 70 years, P = 0.89; and revision rate: 42% in patients < 70 years vs 40% in patients ≥ 70 years, P = 0.89). The probability of explantation as a function of time was similar for the two age groups (P = 0.82). The limitations of this study were its retrospective status, the rate of loss at follow-up and different durations of patient follow-up. CONCLUSIONS Our results suggest that patients ≥ 70 years suffering from faecal incontinence benefit from SNM with a similar risk as a younger population.
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Affiliation(s)
- D Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - G Meurette
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France
| | - C Brochard
- Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, CHU Pontchaillou, CIC1414, INPHY, INSERM U1241, Université de Rennes 1, Rennes, France
| | - H Damon
- Digestive Physiology, University Hospital of Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France
| | - E Lambrescak
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France.,University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - V Wyart
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France
| | - P-A Lehur
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France.,Department of General Surgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - I Sielezneff
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - L Siproudhis
- Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, CHU Pontchaillou, CIC1414, INPHY, INSERM U1241, Université de Rennes 1, Rennes, France
| | - F Mion
- Digestive Physiology, University Hospital of Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France
| | - I Etienney
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - E Houivet
- Biostatistics Unit, INSERM CIC 1404, Rouen, France
| | - V Bridoux
- Department of Digestive Surgery, Normandie Univ, UNIROUEN Inserm U1073, Rouen University Hospital, Rouen, France
| | - A-M Leroi
- Department of Digestive Physiology and CIC-CRB 1404, Normandie Univ, UNIROUEN, Inserm U1073, Rouen University Hospital, Rouen, France
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11
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Merlini l'Héritier A, Siproudhis L, Bessi G, Le Balc'h E, Wallenhorst T, Bouguen G, Brochard C. Sphincter-sparing surgery for complex anal fistulas: radiofrequency thermocoagulation of the tract is of no help. Colorectal Dis 2019; 21:961-966. [PMID: 30897291 DOI: 10.1111/codi.14618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/12/2019] [Indexed: 02/08/2023]
Abstract
AIM To compare the rate of failure of radiofrequency thermocoagulation for anal fistula with that of rectal advancement flap in a case-matched study. METHOD Patients who underwent radiofrequency treatment were compared with age- and sex-matched patients with Crohn's disease (CD) who underwent a rectal flap procedure. Fistula features, general characteristics and the main clinical events were recorded in a prospective database. Failure was defined by at least one of following: abscess, purulent discharge, visible external opening or further drainage procedure. RESULTS A total of 62 patients [median age 45 (range 36.8-57.5) years; 22 women, 40 men; 22 with CD] were analysed. The failure rate of radiofrequency treatment was higher than that of rectal flap treatment (74.2% vs 32.2%; P = 0.004). The cumulative probabilities of failure of the radiofrequency treatment were 53.8% (38.8-68.3), 71.8% (55.3-84.0) and 87.4% (70.6-95.3) at 3, 6 and 12 months, respectively. Three patients in the radiofrequency group required drainage for an abscess and one had severe thermal ulceration. The Cox proportional hazards regression model (surgical procedure, obesity, CD) showed rectal flap treatment [3.48 (1.60-8.07); P = 0.001] and CD [2.60 (1.16-6.41); P = 0.02] to be the main independent predictors of healing. CONCLUSION Radiofrequency thermocoagulation is a less satisfactory sphincter-sparing treatment for the management of anal fistula than a rectal flap procedure.
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Affiliation(s)
- A Merlini l'Héritier
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - L Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
| | - G Bessi
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - E Le Balc'h
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - T Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - G Bouguen
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
| | - C Brochard
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
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12
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Geffrier C, de Parades V, Abramowitz L, Benfredj P, Bonnaud G, Bord C, Bouchard D, Bouguen G, Devulder F, Didelot JM, Fathallah N, Higuero T, Lesage X, Nouts A, Petit P, Pigot F, Pommaret E, Roumeguere P, Siproudhis L, Staumont G, Zeitoun JD, Marteau P. Online training on how to diagnose anoperineal lesions of Crohn's disease: Do pictures matter? A nationwide randomized study. Clin Res Hepatol Gastroenterol 2019; 43:483-496. [PMID: 30935906 DOI: 10.1016/j.clinre.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Abstract
UNLABELLED Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees. METHOD Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion. RESULTS Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS). CONCLUSION There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes.
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Affiliation(s)
- C Geffrier
- Department of digestive diseases, CHU de Louis-Mourier, AP-HP, 92700 Colombes, France
| | - V de Parades
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - L Abramowitz
- Department of proctology and digestive diseases, CHU de Bichat, AP-HP, Paris, France
| | - P Benfredj
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - G Bonnaud
- Department of digestive diseases, clinique des Cèdres, 31700 Cornebarrieu, France
| | - C Bord
- Department of proctology, clinique Beau Soleil, 34070 Montpellier, France
| | - D Bouchard
- Department of proctology, hôpital Bagatelle, 33401 Talence, France
| | - G Bouguen
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - F Devulder
- Department of digestive diseases and proctology, polyclinique de Courlancy, 51100 Reims, France
| | - J M Didelot
- Department of proctology, Clinique Clementville, 34070 Montpellier, France
| | - N Fathallah
- Department of proctology, Clinique St Antoine, 06004 Nice, France
| | - T Higuero
- Department of proctology, 59280 Armentieres, France
| | - X Lesage
- Department of proctology, 94120 Fontenay-sous-Bois, France
| | - A Nouts
- Department of proctology, clinique Saint Augustin, 44000 Nantes, France
| | - P Petit
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - F Pigot
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - E Pommaret
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - P Roumeguere
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - L Siproudhis
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - G Staumont
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - J D Zeitoun
- Department of digestive diseases and proctology, CHU de Saint Antoine, AP-HP, 75012 Paris, France
| | - P Marteau
- Philippe-Marteau, université Paris Sorbonne, AP-HP, pole digestif, hôpital Saint Antoine 75012 Paris, France.
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13
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Bouchard D, Brochard C, Vinson-Bonnet B, Staumont G, Abramowitz L, Benfredj P, Fathallah N, Faucheron JL, Higuero T, Panis Y, de Parades V, Siproudhis L, Laharie D, Pigot F. How to manage anal ulcerations and anorectal stenosis in Crohn's disease: algorithm-based decision making : French National Working Group Consensus 2018. Tech Coloproctol 2019; 23:353-360. [PMID: 30937646 DOI: 10.1007/s10151-019-01971-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/14/2019] [Indexed: 12/24/2022]
Abstract
The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for anal ulcerations and anorectal stenosis are suggested. Recommendations have been graded following international recommendations, and when absent professional agreement was established. For each situation, practical algorithms have been drawn.
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Affiliation(s)
- D Bouchard
- Bagatelle Hospital, 203 route de Toulouse, 33401, Talence Cedex, France.
| | - C Brochard
- University Hospital Center, Rennes Cedex 9, France
| | | | - G Staumont
- La Croix du Sud Clinic, Quint-Fonsegrives, France
| | - L Abramowitz
- Ramsay Générale de Santé, Blomet Clinic, Paris, France
| | | | | | - J-L Faucheron
- University Hospital Center Grenoble-Alpes, La Tronche, France
| | | | - Y Panis
- Beaujon Hospital, Clichy, France
| | | | - L Siproudhis
- University Hospital Center, Rennes Cedex 9, France
| | - D Laharie
- Umniversity Hospital Center Haut Lévêque, Pessac Cedex, France
| | - F Pigot
- Bagatelle Hospital, 203 route de Toulouse, 33401, Talence Cedex, France
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14
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Bouchard D, Pigot F, Staumont G, Siproudhis L, Abramowitz L, Benfredj P, Brochard C, Fathallah N, Faucheron JL, Higuero T, Panis Y, de Parades V, Vinson-Bonnet B, Laharie D. Management of anoperineal lesions in Crohn's disease: a French National Society of Coloproctology national consensus. Tech Coloproctol 2019; 22:905-917. [PMID: 30604249 DOI: 10.1007/s10151-018-1906-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022]
Abstract
The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for acute abscesses, active fistulas (active denovo and still active under treatment), fistulas in remission, and rectovaginal fistulas are suggested. Recommendations have been graded following the international recommendations, and when absent, professional agreement has been established. For each situation, practical algorithms have been drawn.
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Affiliation(s)
- D Bouchard
- Hôpital Bagatelle, 203 Route de Toulouse, 33401, Talence Cedex, France.
| | - F Pigot
- Hôpital Bagatelle, 203 Route de Toulouse, 33401, Talence Cedex, France
| | - G Staumont
- Clinique Saint Jean du Languedoc, 20 Route de Revel, 31400, Toulouse, France
| | - L Siproudhis
- Centre Hospitalier Universitaire, 35033, Rennes Cedex 9, France
| | - L Abramowitz
- Centre Hospitalier Universitaire Bichat, 75877, Paris, France
| | - P Benfredj
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - C Brochard
- Centre Hospitalier Universitaire, 35033, Rennes Cedex 9, France
| | - N Fathallah
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - J-L Faucheron
- Centre Hospitalier Universitaire Grenoble-Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - T Higuero
- , 11 Boulevard du Général Leclerc, 06240, Beausoleil, France
| | - Y Panis
- Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - V de Parades
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - B Vinson-Bonnet
- Hôpital de Poissy-Saint Germain en Laye, 10 Rue Champ Gaillard, 78300, Poissy, France
| | - D Laharie
- Centre Hospitalier Universitaire Haut Lévêque, Avenue Magellan, 33604, Pessac Cedex, France
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15
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Abramowitz L, Bouchard D, Siproudhis L, Trompette M, Pillant H, Bord C, Senejoux CA, Favreau‐Weltzer C, Berdeaux G, Zkik A. Psychometric properties of a questionnaire (HEMO-FISS-QoL) to evaluate the burden associated with haemorrhoidal disease and anal fissures. Colorectal Dis 2019; 21:48-58. [PMID: 30171745 PMCID: PMC7379620 DOI: 10.1111/codi.14393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022]
Abstract
AIM Current questionnaires designed to evaluate the burden of haemorrhoidal disease ignore symptoms such as bleeding, pain and itching. A specific questionnaire is needed to evaluate the global impact of anal disorders on patients' daily lives. METHOD We developed a questionnaire (HEMO-FISS-QoL) to assess the symptom burden of anal disorders and administered it to 256 patients (mean age 46.2 years; men 60.4%) with haemorrhoidal disease (67.2%), anal fissure (29.3%) or both (3.5%). Psychometric properties were evaluated by testing the acceptability, construct validity and reliability of the questionnaire. Principal components and multi-trait analyses were used to identify dimensions and to assess construct validity. Backward Cronbach alpha curves and a graded response model were used to reduce the number of items and modalities. External validity was evaluated against SF-12 and the Psychological Global Well-Being Index (PGWBI) using Spearman's correlation coefficient. RESULTS Principal component analysis defined four dimensions: physical disorders, psychology, defaecation and sexuality. The number of questions was reduced from 38 to 23. The HEMO-FISS-QoL scores correlated well with those of the SF-12 and PGWBI (P < 0.001). Cronbach's coefficients (all > 0.7) reflected good internal reliability of the different dimensions. The total score increased with the severity of the anal disorders and with their consequences (days off work and personal spending related to the disease). CONCLUSION The HEMO-FISS-QoL questionnaire reliably evaluates the global impact of haemorrhoids and anal fissures on patients' daily lives. This simple tool may prove useful for treatment evaluation in clinical trials and daily practice.
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Affiliation(s)
- L. Abramowitz
- AP‐HPProctologie Médico Chirurgicale du Service de GastroentérologieCHU BichatParisFrance,Clinique BlometRamsay GDSGREP (Groupe de Recherche en Proctologie de la SNFCP)ParisFrance
| | - D. Bouchard
- Service de ProctologieHôpital BagatelleTalenceFrance
| | - L. Siproudhis
- Service de Gastroentérologie et Groupe Imphy CIC1414CHUPontchaillouRennesFrance
| | - M. Trompette
- AP‐HPProctologie Médico Chirurgicale du Service de GastroentérologieCHU BichatParisFrance,Clinique BlometRamsay GDSGREP (Groupe de Recherche en Proctologie de la SNFCP)ParisFrance
| | - H. Pillant
- Service de ProctologieGroupe Hospitalier Saint JosephParisFrance
| | - C. Bord
- Polyclinique de Saint RochMontpellierFrance
| | | | | | | | - A. Zkik
- Pierre Fabre SABoulogne‐BillancourtFrance
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16
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Bessi G, Siproudhis L, Merlini l'Héritier A, Wallenhorst T, Le Balc'h E, Bouguen G, Brochard C. Advancement flap procedure in Crohn and non-Crohn perineal fistulas: a simple surgical approach. Colorectal Dis 2019; 21:66-72. [PMID: 30199606 DOI: 10.1111/codi.14417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023]
Abstract
AIM Rectal flap advancement is still a part of therapeutic management of anal fistulas. Data on the outcome of rectal flap advancement in patients with Crohn's disease (CD) is scarce. Our objective was to ascertain rates of failure of rectal flap advancement and to determine predictive factors for failure, with a special focus on CD METHOD: The patients' details, the characteristics of the fistula and the main clinical and therapeutic events were prospectively assessed among patients who underwent rectal flap advancement. All patients had a partial-thickness rectal flap advancement. Failure of primary rectal flap advancement was defined as the occurrence of at least one of the following: abscess, discharge, visible external opening, further drainage procedure. The rates of failure of rectal flap and the predictive factors of failure were assessed. RESULTS Eighty-seven patients (34 patients with CD) were included. The median (interquartile range) follow-up was 13.3 (3.8-38.1) months. The cumulative failure rates were 15.9% (10.3-23.6), 23.0% (16.0-31.8), 31.6% (22.9-41.8) and 41.3% (30.5-53.0) at 3, 6, 12 and 24 months respectively. These data were comparable in Crohn's patients. Those with a supralevator fistula [hazard ratio 2.53 (1.01-7.71), P = 0.0476] and patients who had fewer than two fistula drainages before rectal flap [hazard ratio 3.19 (1.40-8.23), P = 0.005] were associated with higher rectal flap failure rates. In CD patients, the absence of biological therapy at referral was predictive of failure. CONCLUSION Rectal flap advancement is a satisfactory option for the therapeutic management of anal fistula, including CD populations. Fistula drainage is needed before performing this surgical technique.
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Affiliation(s)
- G Bessi
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - L Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
| | - A Merlini l'Héritier
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - T Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - E Le Balc'h
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - G Bouguen
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
| | - C Brochard
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France.,INSERM U1241, University of Rennes 1, Rennes, France.,INPHY CIC 1414, University Hospital of Rennes, Pontchaillou, France
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17
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Peyronnet B, Gao F, Brochard C, Oger E, Scailteux L, Alimi Q, Khene Z, Jezequel M, Olivari-Philiponnet C, Ménard H, Kerdraon J, Senal N, Gamé X, Siproudhis L, Manunta A. Urological disorders are still the leading cause of death in patients with spinal dysraphism. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Olivari-Philiponnet C, Manunta, Brochard C, Jezequel M, Menard H, Hascoet J, Senal N, Bonan I, Siproudhis L, Kerdraon J, Game X, Peyronnet B. Comparison of neurogenic lower urinary tract dysfunctions in open vs. closed spinal dysraphism: Results observed in a prospective cohort of 395 patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Mion F, Garros A, Brochard C, Vitton V, Ropert A, Bouvier M, Damon H, Siproudhis L, Roman S. 3D High-definition anorectal manometry: Values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD). Neurogastroenterol Motil 2017; 29. [PMID: 28251732 DOI: 10.1111/nmo.13049] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D-high definition anorectal manometry (3DARM) may aid the diagnosis of functional anorectal disorders, but data comparing asymptomatic and symptomatic subjects are scarce. We aimed to describe 3DARM values in asymptomatic volunteers and those with fecal incontinence (FI) or chronic constipation (CC), and identify which variables differentiate best these groups. METHODS Asymptomatic subjects were stratified by sex, age, and parity. Those with FI or CC were included according to anorectal symptom questionnaires. Endoanal ultrasound examination and 3DARM were performed the same day. Anal pressures were analyzed at rest, during voluntary squeeze, and during push maneuver, and compared between the 3 groups. Anal pressure defects were defined and compared to ultrasound defects. KEY RESULTS A total of 126 subjects (113 female, mean age 52 years, range 18-83) were included; 36 asymptomatic, 38 FI, 42 CC. Anal resting and squeeze pressures, and rectal sensitivity values were lower in FI women than in the other groups. Typical anal sphincter asymmetry during squeezing was less frequently observed in FI women. A dyssynergic pattern during push maneuver was found in 70% of asymptomatic subjects, and with a similar frequency in the 2 symptomatic groups. There was slight concordance between 3D-pressure defects and ultrasound defects. CONCLUSIONS & INFERENCES 3D anal pressures in asymptomatic women were significantly lower than in men, and in FI compared to asymptomatic women. The classical dyssynergic pattern during push maneuver was found as frequently in asymptomatic and symptomatic patients. Further studies should try to identify 3DARM variables that could reliably identify dyssynergic defecation.
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Affiliation(s)
- F Mion
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - A Garros
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - C Brochard
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - V Vitton
- Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - A Ropert
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - M Bouvier
- Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - H Damon
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - L Siproudhis
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - S Roman
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
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Brochard C, Vénara A, Bodère A, Ropert A, Bouguen G, Siproudhis L. Pathophysiology of fecal incontinence in obese patients: A prospective case-matched study of 201 patients. Neurogastroenterol Motil 2017; 29. [PMID: 28229523 DOI: 10.1111/nmo.13051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity is an emerging risk factor for fecal incontinence (FI). The aim of this study was to characterize pathophysiologic mechanisms of FI in obese patients compared with non-obese patients in a prospective case-matched study. METHODS The general characteristics and data of the anorectal manometry and endosonography of patients who were evaluated for FI at a single institution from 2005 to 2015 were prospectively assessed. Fecal incontinence was defined by a Cleveland Clinic Incontinence Score (CCIS) >4. Obesity was defined by a body mass index ≥30 kg/m2 . Obese patients were case-matched with two age- and sex-matched non-obese patients. KEY RESULTS A total of 201 patients were included (67 obese matched with 134 non-obese). The CCIS, Knowles-Eccersley-Scott Symptom Constipation Score and quality of life score were comparable between obese and non-obese patients with FI. Factors significantly associated with obesity in FI patients were cholecystectomy (odds ratio [OR]=3.45 [1.19-10.32], P=.0230), irritable bowel syndrome - diarrhea (OR=2.94 [1.22-7.19], P=.0158), upper part of the anal canal resting pressure ≥22 mm Hg (OR=3.45 [1.45-8.76], P=.0045), maximum rectal tolerable volume ≥240 mL (OR=3.14 [1.34-7.54], P=.0082), and abdominal pressure ≥28 mm Hg (OR=2.75 [1.13-7.33], P=.0248) by multivariate analysis. CONCLUSIONS & INFERENCES Obese patients with FI had a comparable severity of FI to that of non-obese patients with FI. Regarding obesity in patients with FI, physicians should focus on stool consistency.
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Affiliation(s)
- C Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - A Vénara
- Service de Chirurgie Viscérale, Université d'Angers, Angers, France
| | - A Bodère
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - A Ropert
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
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21
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Gerfaud A, Bridoux-Henno L, Bretagne JF, Siproudhis L, Bouguen G, Dabadie A. Évaluation de la transition pédiatrie-gastroentérologie d’adultes des enfants atteints de maladie inflammatoire cryptogénique intestinale. Arch Pediatr 2017; 24:534-541. [DOI: 10.1016/j.arcped.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/26/2017] [Accepted: 03/10/2017] [Indexed: 01/28/2023]
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22
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Brochard C, Queralto M, Cabarrot P, Siproudhis L, Portier G. Technique of the transobturator puborectal sling in fecal incontinence. Tech Coloproctol 2017; 21:315-318. [DOI: 10.1007/s10151-017-1609-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/21/2017] [Indexed: 11/29/2022]
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23
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Peyronnet B, Gao F, Brochard C, Oger E, Menard H, Arnaud A, Hascoet J, Kerdraon J, Siproudhis L, Game X, Manunta A. Épidémiologie du spina bifida en France. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zerbib F, Siproudhis L, Lehur PA, Germain C, Mion F, Leroi AM, Coffin B, Le Sidaner A, Vitton V, Bouyssou-Cellier C, Chene G, Zerbib F, Simon M, Denost Q, Lepicard P, Lehur PA, Meurette G, Wyart V, Kubis C, Mion F, Roman S, Damon H, Barth X, Leroi AM, Bridoux V, Gourcerol G, Coffin B, Castel B, Gorbatchef C, Le Sidaner A, Mathonnet M, Vitton V, Lesavre N, Orsoni P, Siproudhis L, Brochard C, Desfourneaux V. Randomized clinical trial of sacral nerve stimulation for refractory constipation. Br J Surg 2016; 104:205-213. [DOI: 10.1002/bjs.10326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT.
Methods
Patients with at least two of the following criteria were included: fewer than three bowel movements per week; straining to evacuate on more than 25 per cent of attempts; or sensation of incomplete evacuation on more than 25 per cent of occasions. Response to therapy was defined as at least three bowel movements per week and/or more than 50 per cent improvement in symptoms. Responders to an initial 3-week peripheral nerve evaluation were offered permanent implantation of a pulse generator and were assigned randomly in a crossover design to two 8-week intervals of active or sham stimulation. At the end of the two trial periods, the patients received active stimulation until the final evaluation at 1 year.
Results
Thirty-six patients (34 women; mean(s.d.) age 45(14) years) underwent peripheral nerve evaluation. Twenty responded and received a permanent stimulator. A positive response was observed in 12 of 20 and 11 of 20 patients after active and sham stimulation periods respectively (P = 0·746). Pain related to the device occurred in five patients and wound infection or haematoma in three, leading to definitive removal of the pulse generator in two patients. At 1 year, 11 of the 20 patients with an implanted device continued to respond. Stimulation had no significant effect on colonic transit time.
Conclusion
These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - L Siproudhis
- Department of Gastroenterology, Rennes University Hospital, and Université de Rennes, Rennes, France
| | - P-A Lehur
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - C Germain
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
| | - F Mion
- Department of Digestive Physiology, Lyon University Hospital, and Université Claude Bernard, Lyon, France
| | - A-M Leroi
- Department of Digestive and Urinary Physiology, Rouen University Hospital, and Université de Rouen, Rouen, France
| | - B Coffin
- Department of Gastroenterology, Louis Mourier University Hospital, Assistance Publique – Hôpitaux de Paris, Colombes, and Université Denis Diderot Paris 7, Paris, France
| | - A Le Sidaner
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - V Vitton
- Department of Gastroenterology, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, and Plateforme d'Interface Clinique, CRN2M, Unité Mixte de Recherche 7286, and Aix Marseille Université, Marseille, France
| | - C Bouyssou-Cellier
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - G Chene
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
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Brochard C, Bouguen G, Bodère A, Ropert A, Mallet AL, Morcet J, Bretagne JF, Siproudhis L. Prospective cohort study of phenotypic variation based on an anal sphincter function in adults with fecal incontinence. Neurogastroenterol Motil 2016; 28:1554-60. [PMID: 27144375 DOI: 10.1111/nmo.12855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/18/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND One-third of patients with fecal incontinence (FI) do not have any anal dysfunction. The aim was to characterize patients with FI with normal anal function compared with patients with anal weakness. METHODS The general characteristics and data of anal manometry, endosonography, and defecography of patients who were evaluated for FI at a single institution from 2005 to 2015 were prospectively assessed. Fecal incontinence was defined by the Cleveland Clinic Incontinence Score (CCIS) >4. Anal weakness was defined by one or more of the three following parameters: <25 mmHg at the upper part of the anal canal, <26 mmHg at the lower part of the anal canal, and <60 mmHg for the mean squeeze pressure. KEY RESULTS A total of 439 patients with FI were included (152 with normal anal function/287 with anal weakness). Severe constipation (Kess score ≥21) was predominant in patients with normal anal function (44/151 vs 50/284, respectively; p = 0.0054). Fecal incontinence with normal anal function was significantly associated with lower age (>63 years; odds ratio [OR] = 0.29), higher weight (>65 kg; OR = 1.69), fecal urgency (OR = 1.58), less severe FI score (CCIS score >10; OR = 0.52), higher abdominal pressure (>36 mmHg; OR = 2.15), and paradoxical puborectal contraction (OR = 2.07) in a multivariate analysis model. CONCLUSION & INFERENCES Fecal incontinence with normal anal function is a specific phenotype that involves distal constipation and may be an early stage of FI with anal weakness. Physicians should adapt their management to focus on the treatment of constipation.
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Affiliation(s)
- C Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France. .,Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France. .,INSERM U991, Université de Rennes 1, Rennes, France. .,CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - A Bodère
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - A Ropert
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - A-L Mallet
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - J Morcet
- CIC, Université de Rennes 1, Rennes, France
| | - J-F Bretagne
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
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Siproudhis L, Graf W, Emmanuel A, Walker D, Shing RNK, Pediconi C, Pilot J, Wexner S, Scholefield J. Libertas: a phase II placebo-controlled study of NRL001 in patients with faecal incontinence showed an unexpected and sustained placebo response. Int J Colorectal Dis 2016; 31:1205-16. [PMID: 27075314 PMCID: PMC4867152 DOI: 10.1007/s00384-016-2585-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Faecal incontinence (FI) is distressing, significantly reduces quality of life (QoL) and has few pharmacological treatments. The α1-adrenoceptor agonist NRL001 (1R,2S-methoxamine hydrochloride) improves anal sphincter tone. NRL001 efficacy was evaluated by changes in Wexner scores at week 4 vs. baseline in NRL001-treated patients compared with placebo. Impact of NRL001 on QoL and safety were also assessed. METHODS Four hundred sixty-six patients received NRL001 (5, 7.5 or 10 mg) or placebo as suppository, once daily over 8 weeks. Wexner score, Vaizey score and QoL were analysed at baseline, week 4 and week 8. FI episodes and adverse events were recorded in diaries. RESULTS At week 4, mean reductions in Wexner scores were -3.0, -2.6, -2.6 and -2.4 for NRL001 5, 7.5, 10 mg and placebo, respectively. All reduced further by week 8. As placebo responses also improved, there was no significant treatment effect at week 4 (p = 0.6867) or week 8 (p = 0.5005). FI episode frequency improved for all patients, but not significantly compared with placebo (week 4: p = 0.2619, week 8: p = 0.5278). All patients' QoL improved, but not significantly for all parameters (p > 0.05) except depression/self-perception at week 4 (p = 0.0102) and week 8 (p = 0.0069), compared with placebo. Most adverse events were mild and judged probably or possibly related to NRL001. CONCLUSIONS All groups demonstrated improvement in efficacy and QoL compared with baseline. NRL001 was well-tolerated without serious safety concerns. Despite the improvement in all groups, there was no statistically significant treatment effect, underlining the importance of relating results to a placebo arm.
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Affiliation(s)
| | - W Graf
- Institution of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, 75185, Uppsala, Sweden
| | - A Emmanuel
- University College Hospital, 235 Euston Road, London, UK
| | - D Walker
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK.
| | - R Ng Kwet Shing
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - C Pediconi
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - J Pilot
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - S Wexner
- Cleveland Clinic Florida, Weston, FL, USA
| | - J Scholefield
- Division of Surgery, University Hospital Nottingham, Nottingham, UK
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Higuero T, Abramowitz L, Castinel A, Fathallah N, Hemery P, Laclotte Duhoux C, Pigot F, Pillant-Le Moult H, Senéjoux A, Siproudhis L, Staumont G, Suduca JM, Vinson-Bonnet B. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg 2016; 153:213-8. [PMID: 27209079 DOI: 10.1016/j.jviscsurg.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Société nationale française de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.
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Affiliation(s)
- T Higuero
- 11, boulevard du général Leclerc, 06240 Beausoleil, France.
| | - L Abramowitz
- Unité de proctologie médico-chirurgicale, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; 95, rue de Passy, 75016 Paris, France
| | - A Castinel
- 43, bis rue de Strasbourg, 33000 Bordeaux, France
| | - N Fathallah
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Hemery
- 5, rue Marceau, 44000 Nantes, France
| | | | - F Pigot
- Hôpital Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - H Pillant-Le Moult
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Senéjoux
- CHP Rennes Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - L Siproudhis
- Service de gastroentérologie, CHU Pontchaillou, 35033 Rennes cedex 9, France
| | - G Staumont
- Clinique St.-Jean Languedoc, 20, route de Revel, Cs 37707, 31077 Toulouse cedex 4, France
| | - J M Suduca
- Clinique St.-Jean Languedoc, 20, route de Revel, Cs 37707, 31077 Toulouse cedex 4, France
| | - B Vinson-Bonnet
- Service de chirurgie digestive, centre hospitalier inter-communal de Poissy Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 73082, 78303 Poissy cedex, France
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Senéjoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, Bourreille A, Dewit O, Stefanescu C, Vernier G, Louis E, Grimaud JC, Godart B, Savoye G, Hebuterne X, Bauer P, Nachury M, Laharie D, Chevret S, Bouhnik Y. Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. J Crohns Colitis 2016; 10:141-8. [PMID: 26351393 DOI: 10.1093/ecco-jcc/jjv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Anal fistula plug [AFP] is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease [FAP-CD]. METHODS In a multicentre, open-label, randomised controlled trial we compared seton removal alone [control group] with AFP insertion [AFP group] in 106 Crohn's disease patients with non- or mildly active disease having at least one ano-perineal fistula tract drained for more than 1 month. Patients with abscess [collection ≥ 3mm on magnetic resonance imaging or recto-vaginal fistulas were excluded. Randomisation was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at Week 12. RESULTS In all, 54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59-4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively [RR of success = 2.17 in complex fistula vs RR = 1.20 in simple fistula; p = 0.45]. Concerning safety, at Week 12, 17 patients developed at least one adverse event in the AFP group vs 8 in the controls [p = 0.07]. CONCLUSION AFP is not more effective than seton removal alone to achieve FAP-CD closure.
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Affiliation(s)
- A Senéjoux
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - L Siproudhis
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - L Abramowitz
- Hôpital Bichat, Université Diderot Paris 7, Paris, France
| | | | - K Desseaux
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - G Bouguen
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - O Dewit
- Clinique Universitaire Saint Luc, Bruxelles, Belgique
| | - C Stefanescu
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - G Vernier
- Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - E Louis
- CHU Sart Tilman, Université de Liège, Liège, Belgique
| | - J C Grimaud
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | | | - G Savoye
- Hôpital Charles Nicolle, Université de Rouen UR, Rouen, Franc
| | - X Hebuterne
- Hôpital de l'Archet, Université Nice Sophia-Antipolis, Nice, France
| | - P Bauer
- GH Diaconesses-Croix Saint-Simon, Paris, France
| | - M Nachury
- Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - D Laharie
- Hôpital Sud, Université Bordeaux Segalen, Bordeaux, France
| | - S Chevret
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - Y Bouhnik
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
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Peyronnet B, Hascoet J, Roumiguié M, Damphousse M, Castel-Lacanal E, Marque P, Soulié M, Brochard C, Siproudhis L, Rischmann P, Manunta A, Gamé X. Résultats des injections intra-détrusoriennes de toxine botulique A chez les patients spina-bifida. Prog Urol 2015; 25:737-8. [DOI: 10.1016/j.purol.2015.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Peyronnet B, Brochard C, Jezequel M, Menard H, Damphousse M, Bonan I, Siproudhis L, Gamé X, Manunta A. Fonctionnement de l’appareil urinaire chez les patients spina bifida : données observées sur une cohorte de 371 patients. Prog Urol 2015; 25:848. [DOI: 10.1016/j.purol.2015.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brochard C, Siproudhis L, Ropert A, Mallak A, Bretagne JF, Bouguen G. Anorectal dysfunction in patients with ulcerative colitis: impaired adaptation or enhanced perception? Neurogastroenterol Motil 2015; 27:1032-7. [PMID: 25940976 DOI: 10.1111/nmo.12580] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/07/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rectal disorders during ulcerative colitis (UC) drastically alter the quality of life and may result from an impairment of rectal perception and compliance. This study aims to assess anorectal disorders in patients with mild-to-moderate UC. METHODS Anal pressures and the rectal responses to phasic rectal isobaric distension in 10 patients with mild-to-moderate UC were prospectively compared with those in 10 healthy volunteers (HVs). KEY RESULTS The patients in each group were similar regarding age, gender, and delivery. In the resting state, the anal canal pressures were similar between the groups. Only the squeeze pressures of the lower anal canal were significantly lower in UC patients than in HVs. During phasic isobaric distension, rectal sensitivity was similar between the groups, whatever the step of distension. Isobaric rectal distension resulted in a significant decrease of the rectoanal inhibitory reflex and a decrease in rectal tone and a significant drop in rectal compliance in UC patients compared with HVs. CONCLUSIONS & INFERENCES Patients showing mild-to-moderate UC experience rectal compliance and innervation disorders without a significant change in rectal sensitivity. The findings of this work suggest impairment not only of the properties of the rectal wall but also of intrinsic innervation. Repeated evaluation over time may be helpful for analyzing the reversibility of the process after healing.
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Affiliation(s)
- C Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes, Rennes, France
| | - A Ropert
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - A Mallak
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - J-F Bretagne
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,INSERM U991, Université de Rennes, Rennes, France
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Body-Bechou D, Cabaret-Dufour AS, Siproudhis L, Berkelmans I, Manunta A, Odent S, Jezequel M, Prestel A, Poulain P. [Reproductive health care for women with spina bifida]. ACTA ACUST UNITED AC 2015; 43:522-7. [PMID: 26113168 DOI: 10.1016/j.gyobfe.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Few studies have focused on reproductive health care for women with spina bifida. This subject is rarely discussed, whether in patient groups or in the medical community. However, these patients need advice and a care that is appropriate to their condition. METHODS In association with the spina bifida reference center of the University Hospital of Rennes, we have conducted a four-year retrospective, observational study. Its aim was to analyze the characteristics of the patients' gynecological care and to adapt our practice to their needs. RESULTS Forty-eight patients were included. We demonstrated an increased risk of precocious puberty, labia minora hypertrophy and genital prolapse. CONCLUSION Some specific characteristics of the reproductive health care of patients with spina bifida are interesting to know. A study on a larger series of patients is needed to further analyze the obstetric, gynecological and sexological issues of these women.
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Affiliation(s)
- D Body-Bechou
- Service de gynécologie-obstétrique, hôpital sud, CHRU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | - A-S Cabaret-Dufour
- Service de gynécologie-obstétrique et centre de référence spina bifida, hôpital sud, CHRU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - L Siproudhis
- Service de gastro-entérologie et centre de référence spina bifida, hôpital Pontchaillou, CHRU de rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - I Berkelmans
- Service de gastro-entérologie et centre de référence spina bifida, hôpital Pontchaillou, CHRU de rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - A Manunta
- Service d'urologie et centre de référence spina bifida, hôpital Pontchaillou, CHRU de rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - S Odent
- Service de génétique médicale et centre de référence spina bifida, hôpital sud, CHRU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Jezequel
- Centre de référence spina bifida, hôpital Pontchaillou, CHRU de rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - A Prestel
- Centre de référence spina bifida, hôpital Pontchaillou, CHRU de rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - P Poulain
- Service de gynécologie-obstétrique et centre de référence spina bifida, hôpital sud, CHRU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
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Pradere B, Peyronnet B, Brochard C, Le Balc'h É, Vigneau C, Siproudhis L, Traxer O, Bensalah K. [Urinary stones and bowel diseases: Systematic review]. Prog Urol 2015; 25:557-64. [PMID: 26088584 DOI: 10.1016/j.purol.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to explain the relationship between urinary stones and bowel disease. METHODS A systematic review was performed on Medline, Embase and Cochrane using following keywords: urinary stones; urolithiasis; bowel; enteric and digestive. The literature selection was based on evidence and practical considerations. RESULTS Fifty-three articles were selected. Three types of urolthiasis are mainly involved in digestive pathologies: calcium oxalate stones, uric acid and ammonium acid urate stones. Bowel pathologies responsible for stone disease are divided into small bowel diseases, colonic lesions and lack of an oxalate degrading bacteria (Oxalobacter formigenes) in the intestinal flora. Resulting in a decreased urine output, pH, hyperoxaluria, hypocitraturia or a hypomagnesurie. Blood and urinary explorations are the basis of diagnostic management. CONCLUSION Bowel diseases can be responsible for urolthiasis. Understanding of the mechanisms, and metabolic evaluations can prevent recurrences. Increase fluid intake associated with specific supplementation and diet are the key of the treatment.
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Affiliation(s)
- B Pradere
- Service d'urologie, CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France.
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Brochard
- Service de gastro-entérologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - É Le Balc'h
- Service de gastro-entérologie, CHU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - C Vigneau
- Service de néphrologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Siproudhis
- Service de gastro-entérologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - O Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - K Bensalah
- Service d'urologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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Gautier M, Godeberge P, Ganansia R, Bozio G, Godart B, Bigard MA, Barthet M, Siproudhis L. Easy clip to treat anal fistula tracts: a word of caution. Int J Colorectal Dis 2015; 30:621-4. [PMID: 25675886 DOI: 10.1007/s00384-015-2146-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. MATERIALS AND METHODS Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. RESULTS Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion. CONCLUSION Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.
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Peyronnet B, Bendavid C, Manunta A, Damphousse M, Cheensse C, Brochard C, Castel-Lacanal E, Siproudhis L, Bensalah K, Gamé X. [The role of urinary markers in the assessment and follow-up of lower urinary tract disorders: a literature review]. Prog Urol 2014; 25:188-99. [PMID: 25482921 DOI: 10.1016/j.purol.2014.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To conduct a literature review on the role of urinary biomarkers in the initial assessment and follow-up of lower urinary tract symptoms. METHODS A literature review was conducted in August 2014 using the Medline/Pubmed database limiting the search to work in English or French. RESULTS Most studies were of level of evidence 2 or 3 (prospective cohort, controlled or not) and mainly about overactive bladder and bladder pain syndrome. Nerve Growth Factor (NGF) was the most studied and apparently the most promising in the evaluation of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). Urinary levels of ATP, prostaglandin E2 (PGE2), Brain-Derived Neurotrophic Factor (BDNF) and some cytokines were also significantly higher in most studies in patients with NDO or OAB. Epidermal Growth Factor (EGF), Heparin-Binding EGF (HBEGF) and Antiproliferative Factor (APF) were the most studied urinary markers in bladder pain syndrome, with a significant increase (EGF APF) or decrease (HBEGF) in cases of interstitial cystitis (compared to healthy controls). The urinary N-terminal-telopeptide (NTx) could be predictive of a failed mid-urethral sling. However, few studies reported the diagnostic values of the markers, their association with urodynamic parameters were rarely evaluated and the existence of a publication bias is likely. No randomized controlled study has so far compared the urinary markers to urodynamic evaluation. CONCLUSION In the future, urinary markers could complete or replace urodynamic examination. However, to date, there is no high level of evidence study comparing these markers to urodynamics and their use can therefore not be recommended in daily practice.
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Affiliation(s)
- B Peyronnet
- Service d'urologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse, France.
| | - C Bendavid
- Service de biochimie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Manunta
- Service d'urologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - M Damphousse
- Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Service de médecine physique et rééducation, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Cheensse
- Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Service de médecine physique et rééducation, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Brochard
- Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Service de gastro-entérologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Castel-Lacanal
- Service de médecine physique et rééducation, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhes, 31400 Toulouse, France
| | - L Siproudhis
- Centre de référence maladies rares spina bifida, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Service de gastro-entérologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse, France
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Brochard C, Siproudhis L, Wallenhorst T, Cuen D, d'Halluin PN, Garros A, Bretagne JF, Bouguen G. Anorectal stricture in 102 patients with Crohn's disease: natural history in the era of biologics. Aliment Pharmacol Ther 2014; 40:796-803. [PMID: 25109493 DOI: 10.1111/apt.12894] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/02/2014] [Accepted: 07/08/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The natural history of nonfistulising perianal Crohn's disease (PCD) remains unknown. AIM To assess the long-term outcome of anorectal strictures. METHODS All outcomes of PCD patients with anorectal stricture followed in a single unit from 2005 to 2013 were reviewed, as well as subsequent therapeutic management. Cumulative incidence of stricture healing (disappearance of the anal stricture) was estimated using a Kaplan-Meier method and factor associated with an unfavourable course (persistent stricture S2, persistent stoma or proctectomy) with nonparametric test. RESULTS A total of 102 patients (M/F: 37/65) were included. The duration of CD at diagnosis was 8.9 years. After a median follow-up period of 2.8 years, 52 of the 88 followed patients (59%) achieved anorectal stricture healing. Two patients (2%) developed anal adenocarcinoma. Female gender [HR 2.05 (1.1-4.03), P = 0.0221], disease duration of CD of less than 10 years [HR 1.94 (1.01-3.63), P = 0.0271], and anal fistula at stricture diagnosis [HR 2.36 (1.21-5.05), P = 0.0106) were significantly associated with anorectal stricture healing in a multivariate analysis model. Twenty-eight patients (32%) had an unfavourable course at the end of follow-up. Gender and introduction or optimisation of TNFα antagonist treatment decreased the risk of unfavourable course in multivariate analysis. Conversely, the Luminal B2 phenotype at CD diagnosis was the only factor associated with unfavourable course. CONCLUSIONS Anorectal stricture does not imply a nonreversible and complicated condition related to severe perianal Crohn's disease. However, both the diagnosis of cancer and sepsis drainage remain challenging in this situation.
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Affiliation(s)
- C Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France; Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France
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Siproudhis L, Jones D, Shing RNK, Walker D, Scholefield JH. Libertas: rationale and study design of a multicentre, Phase II, double-blind, randomised, placebo-controlled investigation to evaluate the efficacy, safety and tolerability of locally applied NRL001 in patients with faecal incontinence. Colorectal Dis 2014; 16 Suppl 1:59-66. [PMID: 24499497 DOI: 10.1111/codi.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/29/2013] [Indexed: 12/27/2022]
Abstract
AIMS Faecal incontinence affects up to 8% of adults. Associated social isolation and subsequent depression can have devastating effects on quality of life (QoL). Faecal incontinence is an underreported health problem as the social isolation and stigma that patients experience makes it difficult for sufferers to discuss their condition with a physician. There have been few well-designed, placebo-controlled clinical trials of treatment for faecal incontinence and little clinical evidence is available to inform the most appropriate management strategies. Libertas, a robustly designed study will investigate the efficacy and safety of NRL001 (1R,2S-methoxamine), an α1 -adrenoceptor agonist, in the treatment of faecal incontinence. METHODS Libertas is a multicentre, Phase II, double-blind, randomised, placebo-controlled, parallel group study. Patient recruitment took place across 55 study centres in Europe. Patients suffering with faecal incontinence were randomised into four groups (approximately 110 each) to receive once daily self-administered doses of NRL001 (5, 7.5 or 10 mg or placebo in a suppository formulation) for 8 weeks. The primary objective of Libertas is to assess the impact of once daily administration of NRL001 on the severity and frequency of incontinence episodes as assessed by the Wexner score at 4 weeks, compared with placebo. Secondary outcomes include measures of efficacy of NRL001 compared with placebo following 8 weeks treatment; safety and tolerability; evaluation of plasma pharmacokinetics; establishment of any pharmacokinetic/pharmacodynamic relationship to adverse events; dose-response relationship; the efficacy of NRL001 therapy at 4 and 8 weeks assessed by the Vaizey score; and QoL using the Faecal Incontinence Quality of Life and the EQ-5D-5L Healthcare Questionnaires following 4 and 8 weeks NRL001 therapy. Overall patient satisfaction with the treatment will also be evaluated. DISCUSSION This is the first randomised controlled study to investigate the efficacy and safety of a selective α1 -adrenoceptor agonist for the treatment of faecal incontinence. Furthermore, this is the first time the impact of NRL001 on assessments of QoL, health outcomes and patient satisfaction will be assessed. Innovative strategies were developed to meet the challenge of recruiting patients for this study, for example, media advertising, posters and mailshots as allowed by each study centre.
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Affiliation(s)
- L Siproudhis
- Gastroenterology Unit, CHU Pontchaillou, Rennes, France
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Vitton V, Soudan D, Siproudhis L, Abramowitz L, Bouvier M, Faucheron JL, Leroi AM, Meurette G, Pigot F, Damon H. Treatments of faecal incontinence: recommendations from the French national society of coloproctology. Colorectal Dis 2014; 16:159-66. [PMID: 24521273 DOI: 10.1111/codi.12410] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/09/2013] [Indexed: 12/13/2022]
Abstract
Faecal incontinence is common and significantly affects quality of life. Its treatment involves dietary manipulation, medical treatments, perineal rehabilitation or surgery. In this paper, the French National Society of Coloproctology offers recommendations based on the data in the current literature, including those on recently developed treatments. There is a lack of high quality data and most of the recommendations are therefore based either on grade of recommendation B or expert recommendation (Level 4). However, the literature supports the construction of an algorithm based on the available scientific evidence and expert recommendation which may be useful in clinical practice. The French National Society of Coloproctology proposes a decision-making algorithm that includes recent developments of treatment. The current recommendations support sacral nerve modulation as the key treatment for faecal incontinence. They do not support the use of sphincter substitutions except in certain circumstances. Transanal irrigation is a novel often successful treatment of faecal incontinence due to neurological disorders.
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Affiliation(s)
- V Vitton
- Service de Gastroentérologie, Hôpital Nord, AP-HM, Interface de recherche translationnelle en neurogastroentérologie, CRN2M, UMR 7286, Aix-Marseille Université, Marseille, France
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Bouguen G, Ropert A, Lainé F, Pequin P, Morcet J, Bretagne JF, Siproudhis L. Effects of transcutaneous tibial nerve stimulation on anorectal physiology in fecal incontinence: a double-blind placebo-controlled cross-over evaluation. Neurogastroenterol Motil 2014; 26:247-54. [PMID: 24304363 DOI: 10.1111/nmo.12256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/05/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcutaneous electrical tibial nerve stimulation (TENS) is of growing interest for the treatment of fecal incontinence (FI), but its mechanism of action remains uninvestigated. We aimed to further assess the anorectal response to TENS in a dynamic model. METHODS We performed a placebo-controlled, randomized, double-blinded crossover study in 19 patients suffering from FI to assess the effects of TENS on anorectal function. Anorectal physiology and perception were recorded through two sequences of rectal isobaric distension using an electronic barostat device to measure anal and rectal pressures, rectal volumes, and perception scores. KEY RESULTS Maximal rectal pressure and volume variation were affected by TENS, with higher mean maximal rectal pressure (5.33 and 4.06 mmHg in the active and sham TENS respectively, p < 0.0001) and lower volume variation (11.45 and 14.7 mL in the active and sham stimulation respectively, p < 0.05). Rectal compliance was not modified by active TENS. Pressure of the upper anal canal was significantly lower with raised isobaric distension in sequences assigned to active TENS. CONCLUSIONS & INFERENCES Acute TENS modified anorectal physiology by strengthening the myogenic response to distension rather than increasing muscle relaxation and related rectal compliance in patients with FI.
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Affiliation(s)
- G Bouguen
- Service des Maladie de l'Appareil Digestif, Centre Hospitalier Pontchaillou et Université de Rennes 1, Rennes, France; INSERM U991, Université de Rennes 1, Rennes, France
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Desgrippes R, Beauchamp C, Henno S, Bouguen G, Siproudhis L, Bretagne JF. Prevalence and predictive factors of the need for surgery for advanced colorectal adenoma. Colorectal Dis 2013; 15:683-8. [PMID: 23398651 DOI: 10.1111/codi.12122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/11/2012] [Indexed: 12/11/2022]
Abstract
AIM Endoscopic resection is the primary treatment for colorectal adenoma, but in some cases surgery is necessary. The aim of this retrospective study was to define the prevalence and predictive factors for surgery in patients with advanced colorectal adenoma managed in a referral endoscopy centre. METHOD Consecutive patients diagnosed with advanced adenoma (Class 4 in the Vienna classification) during a colonoscopy from 2007 to 2009 in the endoscopy centre of the University Hospital of Rennes were included. Predictive factors of surgery were determined by univariate and multivariate analysis. RESULTS Two-hundred and twelve (135 male) patients with a mean age of 65.8 years were included. The reason for colonoscopy was for diagnosis in 63.2%, surveillance in 25.5% and screening in 11.3%. These referred patients amounted to 20.8% of all patients having colonoscopy. Surgery was performed in 13.7% of the 212 patients and in 16 (8.3%) of the 192 patients in whom endoscopic removal was attempted. In the subgroup of 192 patients, univariate analysis revealed that body mass index (P = 0.04), histology (P = 0.002), size (P = 0.03) and macroscopic appearance (P < 0.001) of the polyp were associated with surgery. Multivariate analysis revealed that the macroscopic appearance and histology only were significantly associated with surgery. CONCLUSION Surgery was needed in 13.7% of patients with an advanced adenoma, but in only 8.3% of the subgroup of 192 patients in whom endoscopic removal was attempted. Factors associated with surgery included macroscopic appearance and histology.
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Affiliation(s)
- R Desgrippes
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Rennes, France
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Cunin D, Siproudhis L, Desfourneaux V, Bouteloup PY, Meunier B, Ropert A, Berkelmans I, Bretagne JF, Boudjema K, Bouguen G. Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy. Colorectal Dis 2013; 15:470-6. [PMID: 22966956 DOI: 10.1111/codi.12027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to quantify incontinence before and after laparoscopic rectopexy in patients suffering from rectal prolapse. METHOD Eighty-five patients underwent laparoscopic rectopexy to treat rectal prolapse between 2003 and 2009. Symptomatic and functional data were collected prospectively before and after surgery by self-administered questionnaires including the Cleveland Clinic Fecal Incontinence Score (CCIS) and constipation, gastrointestinal quality of life and urinary incontinence questionnaires. Incontinence was considered to be present when the CCIS remained at ≥ 5 after surgery. RESULTS After a mean follow-up period of 36 months after surgery, 83% of the patients reported good to excellent results. Continence was improved in 58 (68%), with a significant decrease in the continence score (-3.4 ± 5.8, P = 0.001). However, 50 (58.9%) patients remained incontinent: 47 (55%) reported urge incontinence and 27 (32%) had passive leakage. Incontinence for liquid stool, incontinence for solid stool and the need for protection was seen in 43 (51%), 35 (41%) and 43 (51%) patients. Manometry, defaecography and ultrasonography were not associated with any improvement. In contrast, the patients' average age (60.2 ± 15.8 vs 46.9 ± 15.5 years; P = 0.003), symptom duration before surgery (58.1 ± 70.1 vs 29.5 ± 33.3 months; P = 0.011), preoperative urinary incontinence score (10.7 ± 10.8 vs 4.2 ± 5.7; P = 0.0131) and faecal incontinence score (12.9 ± 4.9 vs 7.1 ± 6; P < 0.0001) were significantly higher in patients suffering from postoperative incontinence. CONCLUSION Despite some continence improvement in two-thirds of patients who underwent surgery for rectal prolapse, the level of improvement remained low in more than half of the patients.
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Affiliation(s)
- D Cunin
- CHU Rennes Service de Chirurgie hépatobiliaire et digestive, Rennes, France
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42
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Leroi AM, Siproudhis L, Etienney I, Damon H, Zerbib F, Amarenco G, Vitton V, Faucheron JL, Thomas C, Mion F, Roumeguère P, Gourcerol G, Bouvier M, Lallouche K, Menard JF, Queralto M. Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (CONSORT 1a). Am J Gastroenterol 2012; 107:1888-96. [PMID: 23032981 DOI: 10.1038/ajg.2012.330] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of this study was to show that although transcutaneous electrical tibial nerve stimulation (TENS) is being increasingly used to treat fecal incontinence (FI), its efficacy has never been proved using controlled trials. METHODS In this randomized, double-blind, sham-controlled trial, 144 patients aged 30-82 years from nine centers were randomly assigned to receive either active or sham stimulations for 3 months. The primary end point was the response to treatment based on the number of incontinence and urgency episodes. Secondary end points were severity scores, quality of life scores, delay to postpone defecation, patient self-assessment of treatment efficacy, physician assessment of TENS efficacy, anorectal manometry, and adverse events. RESULTS No statistically significant difference was seen between active and sham TENS in terms of an improvement in the median number of FI/urgency episodes per week. Thirty-four patients (47%) who received the active TENS treatment exhibited a >30% decrease in the FI severity score compared with 19 patients (27%) who received the sham treatment (odds ratio 2.4, 95% confidence interval 1.1-5.1, P=0.02). No differences in delay to postpone defecation, patient self-assessment of treatment efficacy, or anorectal manometry were seen between the two groups. The evaluating physicians rated the active stimulations as more effective than the sham stimulations (P=0.01). One minor therapy-related adverse event was observed (1.5%) (see Supplementary Consort 1b). CONCLUSIONS We failed to demonstrate any benefit of TENS on our primary end-point.
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Affiliation(s)
- A M Leroi
- INSERM U1073, Service de Physiologie Digestive, Hôpital Charles Nicolle, CHU Rouen, INSERM CIC 0204, Rouen, France.
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Favreau C, Siproudhis L, Eleouet M, Bouguen G, Bretagne JF. Underlying functional bowel disorder may explain patient dissatisfaction after haemorrhoidal surgery. Colorectal Dis 2012; 14:356-61. [PMID: 21689305 DOI: 10.1111/j.1463-1318.2011.02612.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study was to assess patient dissatisfaction and functional symptoms following haemorrhoid surgery, aspects of which are seldom covered in other published series. METHOD A self-administered questionnaire was mailed to 359 consecutive patients (prospective database; 198 men, 161 women; median follow up, 59 [1-120] months) who underwent either Milligan-Morgan haemorrhoidectomy (n=205) or stapled haemorrhoidopexy (n=154). RESULTS The response rate was 72%; 2.4% of patients had no opinion, 13.6% were dissatisfied, 33.0% were satisfied, and 51.0% were very satisfied with the treatment. Dissatisfied patients were more likely to be women and more likely to have a long history of constipation and irritable bowel syndrome. The duration of surgery and the rates of pre- and postoperative complications did not differ between groups. Residual bleeding (49% vs 32%), prolapse (67% vs 31%) and pain (91% vs 55%) occurred more frequently in the dissatisfied group compared with the satisfied group (P<0.001). Incontinence (4 [0-16] vs 1 [0-15]; P=0.0003) and constipation (19 [1-34] vs 8 [0-31]; P<0.0001) scores were significantly higher in the dissatisfied group compared with satisfied patients. Anal pain was the predominant symptom associated with dissatisfaction in a logistic regression model. CONCLUSION Persistent pain remains the major long-term factor associated with dissatisfaction after surgery for haemorrhoids.
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Affiliation(s)
- C Favreau
- Gastroenterology Unit, Rennes University Hospital, Rennes Cedex, France
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Lombard M, Manunta A, Brissot R, Kerdraon J, Berkelmans I, Siproudhis L, B G, Hamlat A, Chatellier P, Guarnieri J, Odent S, Curt M, Poulain P, Journel H, Frémont B, Violas P. Centre de référence spina-bifida. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lombard M, Manunta A, Brissot R, Kerdraon J, Berkelmans I, Siproudhis L, B G, Hamlat A, Chatellier P, Guarnieri J, Odent S, Curt M, Poulain P, Journel H, Frémont B, Violas P. Reference center spina bifida. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gallas S, Michot F, Faucheron JL, Meurette G, Lehur PA, Barth X, Damon H, Mion F, Rullier E, Zerbib F, Sielezneff I, Ouaïssi M, Orsoni P, Desfourneaux V, Siproudhis L, Mathonnet M, Menard JF, Leroi AM. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients. Colorectal Dis 2011; 13:689-96. [PMID: 20236144 DOI: 10.1111/j.1463-1318.2010.02260.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. METHOD Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. RESULTS The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. CONCLUSION Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
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Affiliation(s)
- S Gallas
- ADEN EA 3234 ⁄ IFR MP 23, Rouen University Hospital, Grenoble, France
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Bouguen G, Roblin X, Bourreille A, Feier L, Filippi J, Nancey S, Bretagne JF, Flourié B, Hébuterne X, Bigard MA, Siproudhis L, Peyrin-Biroulet L. Infliximab for refractory ulcerative proctitis. Aliment Pharmacol Ther 2010; 31:1178-85. [PMID: 20222911 DOI: 10.1111/j.1365-2036.2010.04293.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Efficacy of infliximab in treating ulcerative proctitis remains unknown. AIM To evaluate the clinical, biological and endoscopic efficacy of infliximab therapy in refractory proctitis. METHODS The charts of 420 patients treated with infliximab for ulcerative colitis were reviewed. Thirteen patients were treated with infliximab for refractory ulcerative proctitis in six referral centres between 2005 and 2009. RESULTS Following infliximab therapy induction, 9/13 patients (69%) had a complete response (defined as absence of diarrhoea and blood), 2/13 (15%) had a partial response and 2/13 (15%) were primary nonresponders. The median follow-up was 17 months (range, 3-48). Among the 11 patients with clinical response after infliximab induction therapy, 9 (82%) patients maintained response at last follow-up. Disappearance of rectal disorders was observed in all nine patients who maintained clinical response at last follow-up. Following infliximab induction therapy, the mean CRP level fell from 12.8 mg/L to 4.7 mg/L. Endoscopic evaluation was performed before and after infliximab in seven patients, showing an improvement in mucosal lesions in four patients, persistent mild endoscopic activity in two patients and no improvement in one patient. One patient underwent proctocolectomy. CONCLUSION Infliximab therapy seems to be effective in inducing and maintaining a clinical response in refractory ulcerative proctitis.
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Affiliation(s)
- G Bouguen
- Inserm, Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
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Bouguen G, Trouilloud I, Siproudhis L, Oussalah A, Bigard MA, Bretagne JF, Peyrin-Biroulet L. Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn's disease in patients treated with infliximab. Aliment Pharmacol Ther 2009; 30:749-56. [PMID: 19583709 DOI: 10.1111/j.1365-2036.2009.04089.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Crohn's disease, anal ulcers and stricture can be disabling. AIM To evaluate long-term outcome of non-fistulizing perianal Crohn's disease under infliximab. METHODS The medical records of 99 patients with non-fistulizing perianal Crohn's disease at first infliximab infusion were reviewed. Complete responses (ulcer healing or stricture regression) after induction infliximab therapy and at the maximal follow-up were assessed. RESULTS Ninety-four patients (94.9%) had ulcers, 22 (22.2%) had stricture and 31 (31.3%) had draining perianal fistulas at first infliximab infusion. After infliximab induction therapy, 40/94 (42.5%) patients with ulcers, 4/22 (18.2%) with stricture and 10/31 (32.2%) with fistulas had a complete response. Eight patients were lost to follow-up. After a median follow-up of 175 weeks (range, 13-459), complete response rates for ulcers, stricture and fistulas were 72.3% (68/94), 54.5% (12/22) and 54.8% (20/31) respectively. Long-term response for cavitating ulcer was positively associated with concomitant immunosuppressant use (P = 0.017) and older age (P = 0.049). Among the 12 patients with complete regression of stricture, 6 patients also had anal dilatation. Complete response was associated with perianal pain relief and disappearance of soiling. Three patients with ulcers developed an anal abscess. CONCLUSIONS Infliximab therapy may be effective in inducing and maintaining response for ulcers.
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Affiliation(s)
- G Bouguen
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
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Bigard MA, Siproudhis L. [Anorectal disease: past, present, future]. Gastroenterol Clin Biol 2009; 33:713-723. [PMID: 19682811 DOI: 10.1016/j.gcb.2009.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Over the last decade, therapeutic approaches of anorectal disorders have been profoundly modified by new drugs, new procedures and functional considerations. In fact, the primary goals of these procedures emphasize minimal invasive approaches. Less functional postoperative complaints are often preferred over a radical efficacy. As compared to haemorrhoidectomy, haemorrhoidopexy procedure is today advocated to reduce postoperative care and complaints. As compared to lateral sphincterotomy, nitrates and botulinum toxin represent a second line therapy of chronic anal fissure to avoid faecal incontinence. As compared to fistulotmy, both glue and plug may be used to treat a high tract fistulae for the same reasons.
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Affiliation(s)
- M-A Bigard
- Service d'Hépatogastroentérologie, CHU de Nancy, Hôpital de Brabois, 54511 Vandoeuvre-Lès-Nancy cedex, France
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