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      Treatment of irritable bowel syndrome with a novel colonic irrigation system: a pilot study

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          Abstract

          Background

          Medical treatments for irritable bowel syndrome (IBS) are often disappointing. A colonic irrigation system, the Ashong colonic irrigation apparatus (ACIA), was designed as a patient-administered device for defecation disorders. This pilot study evaluated the efficacy and safety of ACIA for IBS.

          Methods

          Eighteen patients, 12 with constipation-dominant IBS (IBS-C) and 6 with diarrhea-dominant IBS (IBS-D) group, were studied. Patients were randomized into treatments of 1–4 weeks. Colonic irrigation was performed twice daily for 6 consecutive days per week. To determine the response to treatment, bowel movement frequency, stool consistency, abdominal pain, patient satisfaction with bowel movements, and distress/discomfort due to symptoms were assessed.

          Results

          The scores of abdominal pain ( p < 0.001), satisfaction ( p < 0.001), and distress/discomfort ( p < 0.001) improved significantly. The frequency of bowel movements in the IBS-C group increased from 1.68 to 3.78 times per week ( p < 0.001). The occurrence of Bristol Stool Scale type 1 and 2 stool passage decreased from 45 to 13 % ( p = 0.009) in the IBS-C group and type 6 and 7 stools decreased from 62 to 28 % ( p = 0.005) in the IBS-D group. Only mild adverse events occurred, and all patients completed treatment.

          Conclusions

          Colonic irrigation with ACIA is safe and can improve abdominal pain, constipation, and diarrhea associated with IBS. Patients were more satisfied with their bowel movements and found their symptoms were less disturbing. Larger studies on long-term efficacy and quality of life and on placebo effects are needed.

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          Most cited references20

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          Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis.

          To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients.
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            Visceral hypersensitivity in irritable bowel syndrome.

            Altered central processing, abnormal gastrointestinal motility and visceral hypersensitivity may be possible major pathophysiology of irritable bowel syndrome (IBS). These factors affect each other and are probably associated with development of IBS symptoms. It has been confirmed that lower pain threshold to colonic distention was observed in most of patients with IBS than healthy subjects. We have investigated pain perception of the descending colon among different subtypes of IBS. There was no difference in pain threshold to colonic distention between IBS with diarrhea and constipation. Some brain regions such as the anterior cingulate cortex (ACC) may play a major role for generating pain and/or pain-related emotion in humans. IBS patients showed greater activation in the perigenual ACC during painful rectal distention compared with healthy subjects. Inflammation, stress and the combination of both stimuli can induce significant increase in visceral sensitivity in animal models. Serotonin (5-HT) can modulate visceral perception. It has been thought that 5-HT(3) receptors may play an important role for conveying visceral sensation from the gut. Corticotropin-releasing hormone (CRH) may also modulate visceral pain hypersensitivity in IBS. CRH receptor-1 antagonist significantly prevented an increase in gut sensitivity in rats. It has been demonstrated that non-specific CRH receptor antagonist α-helical CRH significantly reduced abdominal pain score during gut stimulus in patients with IBS. In conclusion, visceral hypersensitivity is common in IBS patients and probably plays a major role in development of the symptoms and both central and peripheral factors may enhance the pain sensitivity. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
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              Long-term follow-up of retrograde colonic irrigation for defaecation disturbances.

              Irrigation of the distal part of the large bowel is a nonsurgical alternative for patients with defaecation disturbances. In our institution, all patients with defaecation disturbances, not responding to medical treatment and biofeedback therapy, were offered retrograde colonic irrigation (RCI). This study is aimed at evaluating the long-term feasibility and outcome of RCI. Between 1989 and 2001, a consecutive series of 267 patients was offered RCI. All patients received instructions about RCI by one of our enterostomal therapists. Twenty-eight patients were lost to follow-up. A detailed questionnaire was sent by mail to 239 patients. The total response rate was 79% (190 patients). Based on the returned questionnaires it became clear that 21 (11%) patients never started RCI. The long-term feasibility and outcome of RCI was therefore assessed in the remaining group of 169 patients. Thirty-two patients were admitted with soiling, 71 patients with faecal incontinence, 37 patients with obstructed defaecation and 29 had defaecation disturbances after low anterior resection or pouch surgery. According to the returned questionnaires, RCI was considered effective by 91 (54%) patients. Among patients with soiling and faecal incontinence, RCI was found to be effective in, respectively, 47 and 41% of the subjects. Despite of the reported effectiveness, 10 (67%) patients with soiling and 5 (17%) patients with faecal incontinence decided to stop. Among patients with obstructed defaecation and those with defaecation disturbances after low anterior resection or pouch surgery the effectiveness of RCI was found to be 65 and 79%, respectively. None of these patients ceased their therapy. The overall success-rate of long-term RCI was therefore 45%. Long-term RCI is beneficial for 45% of patients with defaecation disturbances. In the group of patients who considered RCI effective and beneficial, discontinuation of therapy was only observed among those with soiling and faecal incontinence.
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                Author and article information

                Contributors
                +886225433535 , leungwh22@gmail.com
                Journal
                Tech Coloproctol
                Tech Coloproctol
                Techniques in Coloproctology
                Springer Milan (Milan )
                1123-6337
                1128-045X
                19 May 2016
                19 May 2016
                2016
                : 20
                : 551-557
                Affiliations
                [1 ]Division of Colorectal Surgery, Department of Surgery, Mackay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
                [2 ]Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
                Article
                1491
                10.1007/s10151-016-1491-x
                4960275
                27194235
                e6f4b16c-9e90-4bf9-8c75-48193badb275
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 30 August 2015
                : 7 March 2016
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag Italia Srl 2016

                Gastroenterology & Hepatology
                ashong colonic irrigation apparatus,colonic irrigation,irritable bowel syndrome

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