Improvement of Refractory Ulcerative Proctitis With Sacral Nerve Stimulation.
OBJECTIVE
Sacral nerve stimulation (SNS) is recognized for its efficiency and safety for anal incontinence, preventing high morbidity. Evidence from the literature suggests extending SNS to diseases associated with problems of intestinal barrier permeability. The aim of this study was to highlight clinical evidence of the beneficial impact of SNS in a refractory proctitis case report.


METHODS
A permanent SNS was performed successfully in a patient with proctitis after implantation of the neuromodulator. Despite immunosuppressive drugs, the patient was experiencing mucus and blood discharge, pain, and fecal incontinence. To relieve fecal incontinence, SNS was tested without modification of medications. Disease activity, endoscopic and histologic score, ex vivo barrier permeability, expression of inflammatory cytokines (transforming growth factor-β, tumor necrosis factor α, Interleukin-6, Interleukin-8), and junctional proteins (ZO-1, claudin-1, occludin) were assessed before and after SNS to observe the impact of SNS other than for incontinence.


RESULTS
After a 3-week period of temporary stimulation, the patient experienced significant improvement with a decrease in fecal incontinence and disease activity scores. Both endoscopic and histologic scores showed improvement. The rectal barrier permeability decreased with SNS, whereas junctional protein mRNA expression transiently increased. Clinical and histologic improvement was sustained over time. After 18 months of permanent stimulation, the patient remained improved by SNS.


CONCLUSIONS
This work demonstrates the relevance to explore further indications of SNS beyond fecal incontinence.
*INSERM UMR 913, Institut des maladies de l'appareil digestif, CHU de Nantes, Université de Nantes †Laboratoire d'anatomie pathologique, CHU de Nantes, Nantes, France.
Jérémy
J
Brégeon
Michel
M
Neunlist
Céline
C
Bossard
Mandy
M
Biraud
Emmanuel
E
Coron
Arnaud
A
Bourreille
Guillaume
G
Meurette
D003113:Colonoscopy; D003131:Combined Modality Therapy; D016207:Cytokines / Q000378:metabolism; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D010539:Permeability; D011350:Proctocolitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012333:RNA, Messenger / Q000378:metabolism; D012447:Sacrum / Q000294:innervation; D062725:Tight Junction Proteins / Q000235:genetics / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D016207:Cytokines; D007166:Immunosuppressive Agents; D012333:RNA, Messenger; D062725:Tight Junction Proteins