Transanal irrigation is a better choice for bowel dysfunction in adults with spina bifida: a randomized controlled trial

Charlène Brochard (1, 2) , Magali Jezequel (1) , Anne Blanchard-Dauphin (3) , Jacques Kerdraon (4) , Brigitte Perrouin-Verbe (2, 5) , Anne‐marie Leroi (6, 7, 8, 9) , Jean Michel Reymann (10, 1) , Benoît Peyronnet (1, 10, 11) , Jeff Morçet (10, 1) , Laurent Siproudhis (10, 12, 1, 13)

1 CHU Pontchaillou [Rennes]
2 TENS - The Enteric Nervous System in gut and brain disorders [U1235]
3 CHU Lille
4 Centre Mutualiste de Kerpape, Ploemeur,
5 CHU Nantes - Centre hospitalier universitaire de Nantes
6 ADEN - Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau
7 IRIB - Institute for Research and Innovation in Biomedicine
8 Service de physiologie digestive, urinaire, respiratoire et de l'exercice [CHU Rouen]
9 UNIROUEN - Université de Rouen Normandie
10 CIC - Centre d'Investigation Clinique [Rennes]
11 Service d'urologie [Rennes] = Urology [Rennes]
12 Service des Maladies de l'Appareil Digestif [CHU Rennes]
13 NuMeCan - Nutrition, Métabolismes et Cancer

Aim: To compare transanal irrigation with conservative bowel management for the treatment of bowel dysfunction in Spina bifida (SB) patients. Methods: Patients with SB and bowel dysfunction were randomly assigned to receive either transanal irrigation or conservative bowel management. The effectiveness of the treatment was defined as a decrease of 4 points in the neurogenic bowel dysfunction (NBD) score at week 10. Data on incontinence (Cleveland scores; Jorge-Wexner [JW]) and constipation (Knowles-Eccersley-Scott Symptom Constipation Score [KESS]) were recorded at 10 and 24 weeks after inclusion. Data were analysed on an intention-to-treat basis. Results: A total of 34 patients were randomised: 16 patients to conservative bowel management and 18 patients to transanal irrigation. A total of 19/31 (61%) patients improved at week 10, 13 (76%) in the transanal irrigation group versus six (43%) in the conservative group (p = 0.056). In the irrigation group, the decrease in NBD score was -6.9 (-9.9 to -4.02) versus -1.9 (-6.5 to -2.8) in the conservative group (p = 0.049 in univariate and p = 0.004 in multivariate analysis). The NBD, Cleveland (JW and KESS) and Rosenberg scores were significantly lower in the transanal irrigation group than in the conservative bowel management group at week 10. Conclusions: This prospective, randomised, controlled, multicentre study in adult patients with SB suggests that transanal irrigation may be more effective than conservative bowel management.

Keywords: Spina bifida; bowel dysfunction; conservative treatment; faecal incontinence; randomised controlled trial; transanal irrigation

Domains: Life Sciences [q-bio]; Hépatology and Gastroenterology

Charlène Brochard, Magali Jezequel, Anne Blanchard-Dauphin, Jacques Kerdraon, Brigitte Perrouin-Verbe, et al.. Transanal irrigation is a better choice for bowel dysfunction in adults with spina bifida: a randomized controlled trial. Colorectal Disease, 2023, ⟨10.1111/codi.16518⟩. ⟨hal-04008711⟩