Sa1373 Significant Findings From a Randomised Control Trial of Posterior Tibial Nerve Stimulation in Systemic Sclerosis Associated Faecal Incontinence

AGA Abstracts Sa1374 Assessment of Sexual Function in Relation to a Male Cohort Experiencing Functional Bowel Disorders Jason Baker, Jessica K. Haefner, Pamea Fairchild, William D. Chey, Richard J. Saad, Stacy B. Menees, Mitchell B. Berger Background: Sexual function is affected by functional bowel disorders (FBD). Limited information exists in the literature associated with sexual function and FBD in men. The International Index of Erectile Function (IIEF) is a widely utilized multi-dimensional self-administered instrument evaluating male sexual function within oncology, pharmacology, and urology disciplines. Limited sexual function data is available related to an adult male cohort experiencing FBD. Aims: (1) Evaluate differences within a male cohort experiencing a FBD, chronic constipation (CC) vs. fecal incontinence (FI), related to sexual function. (2) Assess whether sexual dysfunction impacts a male cohort experiencing FBD greater than a male urological disorder cohort. Methods: A prospective cross-sectional study of 105 adult male patients recruited from a Gastro-Intestinal Physiology Laboratory (GI) referred for Anorectal Manometry (ARM) with a diagnosis of CC or FI and an Urology Clinic at a single tertiary healthcare center from January 2014 through October 2014. All patients completed an IIEF questionnaire. The IIEF is separated into five domains, erectile function (0-30), orgasm function (0-10), sexual desire (0-10), intercourse satisfaction (0-10), and overall sexual satisfaction (0-10), each using the summation of a 5 point Likert scale. Overall sexual dysfunction is represented by a summation of all five domains < 64.9. Erectile function summation < 14 is considered to represent erectile dysfunction. The lower the summation for the additional four domains represents severe dysfunction. Comparisons of sample proportions and function indices were performed using Pearson's chi-square test, independent t-tests, and generalized linear regression models. A p-value of 0.05 was considered statistically significant. Results: Data from 105 male patients (46 GI and 59 Urology) were analyzed: mean age 51.2 and 90% Caucasian. Within the GI cohort, the diagnoses were 31 CC and 15 FI. Sexual dysfunction was depicted in 64% of CC pts and 80% in FI pts, p= 0.009. All IIEF domains besides sexual desire were statistically significantly higher in CC pts vs. FI pts (Table 1). ARM (GI) patients reported statistically significant higher summation scores for all IIEF domains, besides overall sexual satisfaction, compared to the Urology cohort (Table 1). Conclusions: FBDs impact sexual function in a male cohort. Males with a diagnosis of FI report a greater severity of sexual dysfunction compared to a CC cohort. GI male patients describe less severity for sexual dysfunction compared to the urology cohort; however, GI male patients IIEF summation mean score depicts sexual dysfunction compared to healthy controls. Sexual history should be explored by providers in males experiencing FBD. IIEF Domain Summation Scores

Sa1373 Significant Findings From a Randomised Control Trial of Posterior Tibial Nerve Stimulation in Systemic Sclerosis Associated Faecal Incontinence Shamaila Butt, Ahsan Alam, Amanda J. Raeburn, Jorge Liwanag, Voon Ong, Christopher Denton, Charles Murray, Natalia Zarate, Anton Emmanuel Background The gastrointestinal tract is affected in up to 90% of Systemic Sclerosis (SSc) patients with faecal incontinence (FI) being reported in up to 38%. Passive faecal incontinence secondary to internal anal sphincter atrophy is the characteristic finding. We have shown that neuropathic changes are implicated in SSc patients with FI and sacral nerve stimulation has emerged as a potentially beneficial therapy in SSc. However this is expensive, invasive, not widely available and we have shown that medium term efficacy is poor. Posterior tibial nerve stimulation (PTNS) is a potential alternative to modulate the sacral plexus indirectly, with none of these disadvantages. This is the preliminary data on a randomized placebo controlled trial of PTNS versus sham PTNS to determine if nerve modulation is an effective treatment in SSc associated FI. Methods We commenced a prospective randomised singleblind study of SSc patients with FI in February 2013 from a specialist Scleroderma unit. Baseline symptom scoring (bowel diary, Wexner), manometry and endoanal ultrasound were completed prior to randomization to PTNS or sham. PTNS was administered conventionally, by insertion of an acupuncture needle according to anatomical landmarks, connected to an electrical stimulator. Sham PTNS was administered in identical fashion but the PTNS surface electrode was not connected and instead separate TENS surface electrodes were connected to a TENS unit. Each patient underwent blinded intervention for 30 minute periods, once a week for 12 weeks. The primary endpoints were reduction in faecal incontinence episodes/ week and a reduction in Wexner incontinence scores. A Wexner responder was defined as a post-treatment reduction in score to ≤ 10 with the maximum score at 20. Results A total of 23 SSc patients (20 f), mean age 62 (41-82) completed the trial by October 2014. Of these 12 (10 f) underwent PTNS and 11 (10 f) patients underwent sham stimulation. All PTNS patients showed a reduction in the number of FI episodes/week when compared to SHAM patients at 12 weeks (p=0.0025) (plot 1). 6/12 (50%) PTNS patients were Wexner responders compared to 0/11 SHAM patients with the % change in Wexner score significantly reduced in the PTNS group (p=0.0019) (plot 2). Conclusion. Our results demonstrate significant short-term benefits of PTNS in SSc associated FI. This argues for a neuropathic and reversible cause for incontinence in SSc. PTNS could be considered as an alternative to permanent SNS placement.

S-307

AGA Abstracts