title: Long-term efficacy of biofeedback therapy in patients with dyssynergic defecation: results of a median 44 months follow-up.
abstract: BACKGROUND
  The beneficial effect of biofeedback therapy (BFT) over a period of more than 2 years has not been studied in a large group of patients. The aim of this study was to evaluate the long-term efficacy of BFT for dyssynergic defecation (DD).
  
  
  METHODS
  We evaluated the results for 347 consecutive constipated patients with DD who underwent BFT for a median of five sessions between 2004 and 2009. Initial responses were assessed immediately after the completion of BFT. A responder was defined as a subject with at least a three-point improvement from before to after BFT on an 11-point global bowel satisfaction (GBS) scale, or a two-point improvement if the baseline GBS was more than six points. The probability of remaining a responder was estimated by non-parametric maximum likelihood estimation.
  
  
  RESULTS
  The initial response rate to BFT was 72.3% (n = 251), Parkinson's disease and higher baseline GBS scores were associated with initial non-response. The long-term efficacy of BFT was analyzed in 103 patients who were followed up for more than 6 months; the initial effects of BFT were maintained in 85 of the patients (82.5%) during a median of 44 months of follow-up (IQR = 12-68). The probability of remaining a responder was 60% at 2 years, and 58% at 5 years.
  
  
  CONCLUSIONS
  The efficacy of BFT is maintained for more than 2 years after BFT in a considerable proportion of constipated patients with DD. BFT is effective and durable treatment for managing DD.
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.|Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: H J
authors: HJ
authors: Lee
authors: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors: S-J
authors: SJ
authors: Boo
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: K W
authors: KW
authors: Jung
authors: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S
authors: S
authors: Han
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S Y
authors: SY
authors: Seo
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: H S
authors: HS
authors: Koo
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: I J
authors: IJ
authors: Yoon
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S H
authors: SH
authors: Park
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: D-H
authors: DH
authors: Yang
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: K-J
authors: KJ
authors: Kim
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: B D
authors: BD
authors: Ye
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: J-S
authors: JS
authors: Byeon
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S-K
authors: SK
authors: Yang
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: J-H
authors: JH
authors: Kim
authors: Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S-J
authors: SJ
authors: Myung
mesh_terms: D000368:Aged; D001003:Anal Canal; D001259:Ataxia / Q000628:therapy*; D001676:Biofeedback, Psychology / Q000379:methods*; D015331:Cohort Studies; D003248:Constipation / Q000628:therapy*; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012007:Rectum; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: biofeedback therapy; constipation; dyssynergic defecation; treatment outcome