Interferential therapy: a new treatment for slow transit constipation. a pilot study in adults

AIM

The study aimed to assess, for the first time, the effectiveness of interferential therapy (IFT) in the treatment of slow transit constipation in adults and its impact on the quality of life.

METHOD

All consecutive patients with slow transit constipation diagnosed by symptomology and a colonic transit time (CTT) of > 100 h measured with radiopaque markers were included in this prospective study. IFT was performed for 1 h/day over 3 months. Clinical improvement was based on the stool diary and the Knowles-Eccersley-Scott Symptom and Cleveland Clinic Constipation Scores. Quality of life was assessed with the Gastrointestinal Quality of Life Index questionnaire.

RESULTS

Eleven patients with a median age of 51 years were included. At the end of the follow-up period, seven (63.6%) had significantly improved after IFT with a median of 0.66 stools per week [interquartile range (IQR) 0.33-0.66] before treatment and 1.66 (IQR 1.33-1.66) after (P = 0.007). The Knowles-Eccersley-Scott Symptom score changed from 30 (IQR 27-33) before treatment to 19 (IQR 17-26) after treatment (P = 0.005) and the Cleveland Clinic Constipation Score from 26 (IQR 25-28) to 17 (IQR 13-24; P = 0.005). The CTT improved from 103 h (IQR 101-113) to 98 h (IQR 94-107; P = 0.02). The Gastrointestinal Quality of Life Index score improved from 60 (IQR 57-63) to 95 (IQR 68-100; P = 0.005).

CONCLUSION

IFT is a new non-invasive treatment for slow transit constipation. Further studies to confirm these results with longer follow-up are necessary.

Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (CONSORT 1a)

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.

The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception

AIM

Optimal treatment of anal incontinence in a patients with a normal anal sphincter is controversial, as is the role of intra-anal rectal intussusception in anal incontinence. We evaluated the results of abdominal ventral rectopexy on anal continence in such patients.

METHOD

Forty consecutive patients with incontinence and intra-anal rectal intussusception without a sphincter defect were treated by abdominal ventral mesh rectopexy without sigmoidectomy. The Cleveland Clinic Incontinence Score (CCIS), patient satisfaction and constipation before and after surgery and recurrence were recorded.

RESULTS

The mean CCI scores were 13.2 (=/-4.25) preoperatively and 3 (±3.44) postoperatively (P<0.0001). Patient assessment was reported as 'cured' in 26 (65%), 'improved' in 13 (32.5%) and 'unchanged' in one (2.5%) patient. Constipation was induced in two (5%) patients and was cured in 13 of 20 (65%) patients who were constipated before surgery. One case of recurrent prolapse occurred after a mean follow-up of 38 months.

CONCLUSION

Intra-anal rectal intussusception may be associated with anal incontinence. For these patients, abdominal ventral mesh rectopexy appears to be an adequate treatment.

Preliminary results of peripheral transcutaneous neuromodulation in the treatment of idiopathic fecal incontinence

PURPOSE

Few therapeutic tools are available for treating idiopathic anal incontinence. Sacral neuromodulation appears to be effective in selected patients but requires surgical implantation of a permanent electrical stimulator. The aim of this work was to assess the efficiency of posterior tibial nerve (PTN) transcutaneous electrical nerve stimulation (TENS) in the treatment of anal idiopathic incontinence.

METHODS

Ten women were treated by PTN TENS, 20 min a day for 4 weeks. Functional results were evaluated by Wexner's incontinence score and anorectal manometry.

RESULTS

Eight of the ten patients showed a 60% mean improvement of their incontinence score after 4 weeks. This improvement remained stable over the 12-week follow-up period. Manometric parameters did not differ before and after stimulation.

CONCLUSION

PTN neuromodulation without surgically implanted electrode could represent a safe and low-cost alternative to permanent sacral neuromodulation for idiopathic anal incontinence.

Imaging of diffuse esophageal leiomyomatosis: two case reports and review of the literature

Diffuse esophageal leiomyomatosis is a rare disorder which may be found in association with leiomyomas in other locations or with other disorders. We report two cases in men, one with associated tracheobronchial involvement, which illustrate the value of imaging in differentiating this entity from other causes of dysphagia and in establishing a diagnosis.

[The contribution of gallbladders' infusion tomography in the diagnosis of acute cholecystitis (author's transl)]

The detection of opacification of the wall of the gallbladder after the intravenous injection of hydrosoluble iodinated contrast medium (gallbladder parietography) was sought in 82 patients suspected of suffering from acute cholecystitis. In 35 cases, the examination was negative and operation or the clinical course made it possible to eliminate the diagnosis of acute cholecystitis. In 47 cases, it was positive. The diagnosis was confirmed in 39 cases out of 40 patients undergoing surgery. The appearance of the opacification makes it possible to distinguish two types of positive gallbladder parietography: -- with a thin wall and gallbladder of normal size, corresponding to moderate inflammatory lesions; -- with a thickened wall associated with a large gallbladder corresponding to major inflammatory lesions. The examination is simple, reliable, may be carried out as an emergency and combined with intravenous urography. The diagnosis of acute cholecystitis may be made in difficult causes, and appropriate therapeutic steps taken.