Dyssynergic Defecation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Issue 5 (24th February 2018)

• Record Type: Journal Article
• Authors: Rezaie, Ali; Gu, Phillip; Kaplan, Gilaad G; Pimentel, Mark; Al-Darmaki, Ahmed K
• Is Part Of: Inflammatory bowel diseases. Volume 24:Issue 5(2018)
• Page Start: 1065
• Page End: 1073
• Publication Date: 2018-02-24
• Subjects: dyssynergic defecation -- nonrelaxing pelvic floor dysfunction -- inflammatory bowel disease -- Crohn's disease -- ulcerative colitis; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izx095
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Inflammatory bowel disease (IBD) patients often continue to experience nonspecific gastrointestinal symptoms despite quiescent disease. Unlike non-IBD patients, IBD patients with dyssynergic defecation (DD) may present with various symptoms such as diarrhea, fecal incontinence, constipation, and rectal discomfort. Despite its importance and treatability, DD in IBD patients is not well recognized in practice. We conducted a systematic review and meta-analysis on the prevalence, diagnosis, and management of DD in IBD patients with ongoing defecatory symptoms. Methods: We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (from 1966 through February 2017) to identify relevant studies on the prevalence, diagnostic methods, or management of DD in IBD patients with and without ileal pouch-anal anastomoses (IPAAs). A random effects model was used to calculate the pooled estimates with 95% confidence intervals (CIs). Heterogeneity was assessed with I 2 statistics, Cochran Q statistic, and sensitivity analyses. Results: Seven studies (n = 442) were included. In patients with ongoing defecatory symptoms, the prevalence of DD without IPAA ranged from 45% to 97%, and in patients with IPAA, it ranged from 25% to 75%. The prevalence of DD in IPAA patients with and without pouchitis ranged from 17% to 67% and 29% to 50%, respectively. The pooled response rate to biofeedback therapy in patients without IPAA was 70% (95% CI, 55%–84%; I 2 = 95%; P < 0.01), and it was 86% (95% CI, 67%–98%; I 2 = 61%; P = 0.05) in those with IPAA. Conclusions: Despite limited data, the current literature suggests that DD is highly prevalent in active or quiescent IBD patients with ongoing defecatory symptoms and is responsive to biofeedback therapy. Although more studies are needed, DD should be considered in IBD patients with persistent defecatory symptoms.