Long-term efficacy and safety of transanal irrigation in multiple sclerosis.
BACKGROUND
Multiple sclerosis (MS) is the commonest disabling neurological disease in young adults. A majority of patients experience bowel dysfunction, reporting a wide spectrum of bowel symptoms that significantly negatively impact social activities and emotional state. Transanal irrigation (TAI) is a method of managing such bowel symptoms. We aimed to investigate long-term efficacy of TAI, to measure health status-related quality of life and identify factors predictive of TAI outcome.


METHODS
Forty-nine consecutive MS patients (37 female; mean age 51, range 26-80) were studied. We investigated predominant symptoms, reason for beginning TAI and medical comorbidity. All patients underwent anorectal physiology testing. They completed Neurogenic Bowel Dysfunction and EQ-5D questionnaires at baseline and annual follow-up.


RESULTS
Mean follow-up was 40 months, at which there was 55% rate of continuation of TAI. Severe bowel dysfunction was present in 47% at baseline, falling to 18%. The EQ-5D scores at latest follow-up were not statistically significant, but 42% had improved visual analog scores. The only predictive factor for successful therapy was impaired anal electrosensitivity (p = 0.008).


CONCLUSIONS
Long-term continuation of TAI, with improved bowel symptomatology, is seen in the majority of patients. The EQ-5D is insufficiently sensitive to show change in MS patients that using TAI.
GI Physiology Unit, University College London Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
V
V
Passananti
Department of Physiology, University of Bristol, Bristol, UK.
A
A
Wilton
GI Physiology Unit, University College London Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
G
G
Preziosi
GI Physiology Unit, University College London Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
J B
JB
Storrie
GI Physiology Unit, University College London Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
A
A
Emmanuel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005242:Fecal Incontinence / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D055556:Nasal Lavage / Q000639:trends*; D011788:Quality of Life; D016896:Treatment Outcome
constipation; fecal incontinence; health-related quality of life; multiple sclerosis; neurological bowel dysfunction; transanal irrigation