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The use of biofeedback for children with fecal incontinence secondary to retentive constipation: Experience of a French Pediatric Center - 22/10/20

Doi : 10.1016/j.clinre.2020.09.011 
Elie Abi Nader a, b, , Ombeline Roche a, Jean-Philippe Jais c, Julie Salomon a, Olivier Goulet a, b, Florence Campeotto a, b
a Department of Pediatric Gastroenterology, Hepatology, and Nutrition, APHP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France 
b Université de Paris, Faculté de Médecine, 2 rue de l’Ecole de Médecine, 75006, Paris, France 
c Department of Biostatistics, Imagine Institute, AP-HP, Paris, France 

Corresponding author at: Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Reference Center for Rare Pediatric Digestive Diseases, Necker Enfants Malades University Hospital, APHP, Paris, France.Department of Pediatric Gastroenterology, Hepatology, and NutritionReference Center for Rare Pediatric Digestive DiseasesNecker Enfants Malades University HospitalAPHPParisFrance
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 October 2020

Highlights

What is already known on this subject: The management of fecal incontinence (FI) secondary to chronic retentive constipation includes laxatives, toilet training, and dietary advice.
What are the new findings: The volume to trigger defecation and envy score decrease with biofeedback sessions.
How might it impact on clinical practice in the foreseeable future: Biofeedback is a therapeutic option when FI is resistant to medical treatment.

Le texte complet de cet article est disponible en PDF.

Summary

Background

Fecal incontinence (FI) secondary to chronic retentive constipation is a frequent demand in pediatric gastroenterology clinics. The management of constipation in children includes laxatives (polyethylene glycol, PEG), enhanced toilet training, and dietary advice. Biofeedback is a possible treatment for children above the age of 7 years with resistant FI.

Aim

To analyze any changes in volume to trigger defecation (VTD) and envy score over the course of biofeedback sessions according to clinical response.

Methods

In this retrospective study, we reviewed the medical records of 23 children diagnosed with FI according to the Rome IV criteria and treated with biofeedback. For each biofeedback session, a mean VTD by subject was measured. At the end, therapy was considered a success if soiling disappeared and a failure if any persisted. The need to defecate expressed by the child was described as an envy score. A 0–10 visual analog scale was used to express the intensity of this sensation. Follow-up involved calling the parents 12 months after the biofeedback sessions had ended to assess symptoms remotely.

Results

The study included 19 boys and 4 girls with a median age of 10 years. Patients’ ages ranged between 7 and 17 years. None of them had any associated neurological disorders. All children had FI for >1 year. The median number of soiling episodes per week was 7. The average number of biofeedback sessions was 3 (range 1–5). At the end of the rehabilitation sessions, 12 children (52%) were in the "success" group. In the latter, median VTD decreased from 97 ml to 70 ml between the first and last session. In the "failure" group, VTD decreased from 120 ml to 100 ml. The between-group difference in the median VTD at the first session was not statistically significant. The last observation carried forward (LOCF) VTD was significantly lower in the "success" group compared to the "failure" group (70 ml versus 100 ml, p = 0.03). Median envy scores decreased during the biofeedback sessions with no statistical difference between the groups at the last session. Follow-up of children in the "success" group one year after the last biofeedback session revealed that 10 patients had no relapse (83%) and 2 were lost to follow-up.

Conclusions

Biofeedback might be an effective tool for the management of FI resistant to medical treatment in children.

Le texte complet de cet article est disponible en PDF.

Abbreviations : ARM, ETT, FI, IMT, LOCF, PEG, VTD

Keywords : Fecal incontinence, Biofeedback, Outcome, Children, Constipation


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