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Biofeedback efficacy to improve clinical symptoms and endoscopic signs of solitary rectal ulcer syndrome

Mojgan Forootan, Masood Shekarchizadeh, Hamedreza Farmanara, Ahmad Reza Shekarchizadeh Esfahani, Mansooreh Shekarchizadeh Esfahani
  • Mojgan Forootan
    Department of Gastroenterology, Taleghani Hospital, Medical School, Shahid Beheshti University of Medical Science, Tehran, Iran, Islamic Republic of
  • Masood Shekarchizadeh
    Department of Internal Medicine, Imam Hossein Hospital, Medical School, Shahid Beheshti University of Medical Science, Rajaei Cardiovascular, Medical & Research Center, Tehran, Iran, Islamic Republic of
  • Hamedreza Farmanara
    Department of Sport Medicine, Medical School, Iran University of Medical Science,Tehran, Iran, Islamic Republic of
  • Ahmad Reza Shekarchizadeh Esfahani
    Department of Managment, Najafabad Branch, Islamic Azad University, Najafabad, Iran, Islamic Republic of
  • Mansooreh Shekarchizadeh Esfahani
    Department of Gastroenterology, Taleghani Hospital, Medical School, Shahid Beheshti University of Medical Science, Tehran, Iran, Islamic Republic of | mshekarchizadeh@yahoo.com

Abstract

Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. This study assessed the effect of biofeedback in decreasing the symptoms and the healing of endoscopic signs in SRUS patients. Before starting the treatment, endoscopy and colorectal manometry was performed to evaluate dyssynergic defecation. Patients were followed every four weeks, and during each visit their response to treatment was evaluated regarding to manometry pattern. After at least 50% improvement in manometry parameters, recipients underwent rectosigmoidoscopy. Endoscopic response to biofeedback treatment and clinical symptoms were investigated. Duration of symptoms was 43.11±36.42 months in responder and 63.9±45.74 months in non-responder group (P=0.22). There were more ulcers in non-responder group than responder group (1.50±0.71 versus 1.33±-0.71 before and 1.30 ± 0.95 versus 0.67±0.50 after biofeedback), although the difference was not significant (P=0.604, 0.10 respectively). The most prevalent symptoms were constipation (79%), rectal bleeding (68%) and anorectal pain (53%). The most notable improvement in symptoms after biofeedback occured in abdominal pain and incomplete evacuation, and the least was seen in mucosal discharge and toilet waiting as shown in the bar chart. Endoscopic cure was observed in 4 of 10 patients of the non-responder group while 8 patients in responder group experienced endoscopic improvement. It seems that biofeedback has significant effect for pathophysiologic symptoms such as incomplete evacuation and obstructive defecation. Improvement of clinical symptoms does not mean endoscopic cure; so to demonstrate remission the patients have to go under rectosigmoidoscopy.

Keywords

Solitary rectal ulcer syndrome, endoscopy, colorectal manometry, dyssynergic

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Submitted: 2018-02-05 00:17:00
Published: 2018-03-06 10:49:09
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