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Clinical and Economic Impact of a Multidisciplinary Management Program in Patients with Fecal Incontinence: Do Symptomatic Improvements in Fecal Incontinence Decrease Personal Costs?
Change in fecal incontinence symptoms and related outcomes
AGA Abstracts
Functional incontinence characteristics stratified by gender.
Statistics were reported as mean ± SD. Change in resource use
Statistics were reported as n/N (%) or mean ± SD
Sa1625 IDENTIFICATION OF A NOVEL PATTERN OF ALTERED DEFECATION USING THREE-DIMENSIONAL HIGH-RESOLUTION ANORECTALMANOMETRY IN PATIENTS WITH CHRONIC CONSTIPATION Mohammed Zakari, Judy W. Nee, Braden Kuo, Kyle Staller, Anthony J. Lembo
a Females served as the reference group. Ordinal logistic regression models adjusted for sex, age, race/ethnicity, education level, marital status, employment status, household income, diarrhea and/or constipation within the past week, and diagnosis of Crohn's disease, ulcerative colitis, Celiac disease, diabetes, HIV/AIDS, irritable bowel syndrome, and chronic idiopathic constipation.
BACKGROUND: Dyssynergic defecation is characterized by paradoxical contraction or inadequate relaxation of the pelvic floor muscles (i.e. anal sphincter and/or puborectalis) during attempted defecation. Three-dimensional high resolution anorectal manometry (3DHRM) is composed of 256 independent circumferential transducers generating a 3D pressure topographic profile of the anorectum, allowing for assessment of the puborectalis muscle (PRM). AIM: The aim of this study was to identify topographical patterns on 3D-HRM in patients with dyssynergia and to determine possible correlation with symptoms, anorectal manometry (ARM), and balloon expulsion time (BET). METHODS 462 women with chronic constipation underwent ARM with 3D-HRM and BET from December 2012 to October 2016. Patients with dyssynergia on ARM were included for further 3D topographical pattern analysis. Patients completed the Rome III constipation module and the pelvic floor distress inventory (PFDI), which measures defecation symptoms. RESULTS 176 of 462 consecutive women demonstrated dyssynergia on ARM. Three distinct 3D topographical patterns were identified during simulated defecation: Type 1 predominant posterolateral wall indentation (Figure 1, n=60); Type 2 isolated posterior wall indentation (Figure 2, n=28); Type 3 lack of predominant posterior or posterolateral indentation (n=88). Compared to women with Type 3 pattern on 3D-HRM, women with Type 1 were more likely to have prolonged BET (75.0% vs 47.7%, P=0.001), higher mean resting pressures ((87.4 vs 77.7 mmHg, P=0.02), more negative rectoanal pressure differential (RAPD) (-86.9 vs -54.0, P=001), and reported more incomplete evacuation (median 4 vs 3, P=0.01). In contrast, women with Type 2 pattern had similar BET, resting pressures, RAPD and complaints of incomplete evacuation compared to women with Type 3 pattern. CONCLUSION Utilizing 3D-HRM, we were able to recognize three distinct dyssynergic defecation patterns. Both Type 1 and 2 are suggestive of paradoxical contraction of the puborectalis muscle during simulated defecation. However, Type 1 may represent a more clinically significant subgroup of dyssynergia.
Sa1624 CLINICAL AND ECONOMIC IMPACT OF A MULTIDISCIPLINARY MANAGEMENT PROGRAM IN PATIENTS WITH FECAL INCONTINENCE: DO SYMPTOMATIC IMPROVEMENTS IN FECAL INCONTINENCE DECREASE PERSONAL COSTS? Stacy B. Menees, Kenya Jackson, Xiao Xu, Dee Fenner Introduction: Fecal incontinence (FI) is a troublesome problem for approximately 1 out of 10 Americans. Cost data has been sparse in the literature. The goal of this study was to assess the effects of a multidisciplinary management program on patients' symptoms of fecal incontinence, quality of life, and use of resources. Methods: The Michigan Bowel Control Program specialty clinic with FI features multidisciplinary management of with diet, medicine, physical therapy and surgery prescribed per the individual's needs. Patients with FI seen in the clinic were prospectively enrolled during 9/2009-05/2015. Patients completed questionnaires at their initial visits and at 6 months, including Fecal Incontinence Quality of Life Instrument (FIQL), Patient Health Questionnaire (PHQ), Fecal Incontinence Severity Index (FISI) and an assessment of use of resources (absorbent products, laundry/dry clean, and productivity loss). Descriptive statistics were calculated for patient characteristics and bivariate analyses were performed using paired student's t tests to compare differences in symptoms, quality of life and resource use between baseline and 6 month follow-up. Results: 107 subjects were enrolled in the study with follow-up data available on 71 subjects. 90% were Caucasian, 90% were female, and the average BMI was 27.5 (SD=5). Compared to the initial visit, patients had significantly improved FI symptoms at 6 months follow-up (mean FISI score = 33.85 vs. 28.48, p=0.002) (Table 1). Moreover, patients had improved quality of life in the lifestyle (2.87 vs. 3.03, p=0.03), coping/behavior (2.09 vs. 2.41, p<0.001), and embarrassment (2.19 vs. 2.51, p<0.001) domains on the FIQL (Table 1). However, there were no statistically significant difference in patients' use of absorbent products, laundry/dry clean, and productivity loss between baseline and 6 months follow-up (Table 2). Conclusions: Over 6 months of treatment, patients with FI had statistical improvement in severity of symptoms and in quality of life. However, these changes were not reflected in non-medical services and productivity loss. Longer follow-up, greater symptom improvement or complete continence may be needed to have an impact on personal cost of FI. As more effective treatments continue to be sought to help improve symptoms, quality of life, the relationship to cost-effectiveness needs further research.
S-309
AGA Abstracts
AGA Abstracts
Functional incontinence characteristics stratified by gender.
Statistics were reported as mean ± SD. Change in resource use
Statistics were reported as n/N (%) or mean ± SD
Sa1625 IDENTIFICATION OF A NOVEL PATTERN OF ALTERED DEFECATION USING THREE-DIMENSIONAL HIGH-RESOLUTION ANORECTALMANOMETRY IN PATIENTS WITH CHRONIC CONSTIPATION Mohammed Zakari, Judy W. Nee, Braden Kuo, Kyle Staller, Anthony J. Lembo
a Females served as the reference group. Ordinal logistic regression models adjusted for sex, age, race/ethnicity, education level, marital status, employment status, household income, diarrhea and/or constipation within the past week, and diagnosis of Crohn's disease, ulcerative colitis, Celiac disease, diabetes, HIV/AIDS, irritable bowel syndrome, and chronic idiopathic constipation.
BACKGROUND: Dyssynergic defecation is characterized by paradoxical contraction or inadequate relaxation of the pelvic floor muscles (i.e. anal sphincter and/or puborectalis) during attempted defecation. Three-dimensional high resolution anorectal manometry (3DHRM) is composed of 256 independent circumferential transducers generating a 3D pressure topographic profile of the anorectum, allowing for assessment of the puborectalis muscle (PRM). AIM: The aim of this study was to identify topographical patterns on 3D-HRM in patients with dyssynergia and to determine possible correlation with symptoms, anorectal manometry (ARM), and balloon expulsion time (BET). METHODS 462 women with chronic constipation underwent ARM with 3D-HRM and BET from December 2012 to October 2016. Patients with dyssynergia on ARM were included for further 3D topographical pattern analysis. Patients completed the Rome III constipation module and the pelvic floor distress inventory (PFDI), which measures defecation symptoms. RESULTS 176 of 462 consecutive women demonstrated dyssynergia on ARM. Three distinct 3D topographical patterns were identified during simulated defecation: Type 1 predominant posterolateral wall indentation (Figure 1, n=60); Type 2 isolated posterior wall indentation (Figure 2, n=28); Type 3 lack of predominant posterior or posterolateral indentation (n=88). Compared to women with Type 3 pattern on 3D-HRM, women with Type 1 were more likely to have prolonged BET (75.0% vs 47.7%, P=0.001), higher mean resting pressures ((87.4 vs 77.7 mmHg, P=0.02), more negative rectoanal pressure differential (RAPD) (-86.9 vs -54.0, P=001), and reported more incomplete evacuation (median 4 vs 3, P=0.01). In contrast, women with Type 2 pattern had similar BET, resting pressures, RAPD and complaints of incomplete evacuation compared to women with Type 3 pattern. CONCLUSION Utilizing 3D-HRM, we were able to recognize three distinct dyssynergic defecation patterns. Both Type 1 and 2 are suggestive of paradoxical contraction of the puborectalis muscle during simulated defecation. However, Type 1 may represent a more clinically significant subgroup of dyssynergia.
Sa1624 CLINICAL AND ECONOMIC IMPACT OF A MULTIDISCIPLINARY MANAGEMENT PROGRAM IN PATIENTS WITH FECAL INCONTINENCE: DO SYMPTOMATIC IMPROVEMENTS IN FECAL INCONTINENCE DECREASE PERSONAL COSTS? Stacy B. Menees, Kenya Jackson, Xiao Xu, Dee Fenner Introduction: Fecal incontinence (FI) is a troublesome problem for approximately 1 out of 10 Americans. Cost data has been sparse in the literature. The goal of this study was to assess the effects of a multidisciplinary management program on patients' symptoms of fecal incontinence, quality of life, and use of resources. Methods: The Michigan Bowel Control Program specialty clinic with FI features multidisciplinary management of with diet, medicine, physical therapy and surgery prescribed per the individual's needs. Patients with FI seen in the clinic were prospectively enrolled during 9/2009-05/2015. Patients completed questionnaires at their initial visits and at 6 months, including Fecal Incontinence Quality of Life Instrument (FIQL), Patient Health Questionnaire (PHQ), Fecal Incontinence Severity Index (FISI) and an assessment of use of resources (absorbent products, laundry/dry clean, and productivity loss). Descriptive statistics were calculated for patient characteristics and bivariate analyses were performed using paired student's t tests to compare differences in symptoms, quality of life and resource use between baseline and 6 month follow-up. Results: 107 subjects were enrolled in the study with follow-up data available on 71 subjects. 90% were Caucasian, 90% were female, and the average BMI was 27.5 (SD=5). Compared to the initial visit, patients had significantly improved FI symptoms at 6 months follow-up (mean FISI score = 33.85 vs. 28.48, p=0.002) (Table 1). Moreover, patients had improved quality of life in the lifestyle (2.87 vs. 3.03, p=0.03), coping/behavior (2.09 vs. 2.41, p<0.001), and embarrassment (2.19 vs. 2.51, p<0.001) domains on the FIQL (Table 1). However, there were no statistically significant difference in patients' use of absorbent products, laundry/dry clean, and productivity loss between baseline and 6 months follow-up (Table 2). Conclusions: Over 6 months of treatment, patients with FI had statistical improvement in severity of symptoms and in quality of life. However, these changes were not reflected in non-medical services and productivity loss. Longer follow-up, greater symptom improvement or complete continence may be needed to have an impact on personal cost of FI. As more effective treatments continue to be sought to help improve symptoms, quality of life, the relationship to cost-effectiveness needs further research.
S-309
AGA Abstracts