| Sacral nerve stimulation for intractable constipation. | |
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MedLine Citation:
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PMID: 20207638 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of sacral nerve stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation). METHODS: In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation. RESULTS: 62 patients (55 female, median age 40 years) underwent test stimulation, of whom 45 (73%) proceeded to chronic stimulation. 39 (87%) of these 45 patients achieved treatment success. After a median 28 (range 1-55) months follow-up, defecation frequency increased from 2.3 to 6.6 evacuations per week (p<0.001). Days per week with evacuation increased from 2.3 to 4.8 (p<0.001). There was a decrease in time spent toileting (10.5 to 5.7 min, p=0.001), straining (75-46% of successful evacuations, p<0.001), perception of incomplete evacuation (71.5-46% of successful evacuations, p<0.001) and subjective rating of abdominal pain and bloating (p<0.001). Cleveland Clinic constipation score (0=no to 30=severe constipation) decreased from 18 to 10 (p<0.001). Visual analogue scale (VAS) score (0=severe to 100=no symptoms) increased from 8 to 66 (p<0.001). Patients with slow and normal transit benefited. Quality of life significantly improved. Colonic transit normalised in half of those with baseline slow transit (p=0.014). CONCLUSION: SNS is effective in the treatment of idiopathic slow and normal transit constipation resistant to conservative treatment. Clinical Trial Number NCT00200005. |
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Authors:
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Michael A Kamm; Thomas C Dudding; Jarno Melenhorst; Michael Jarrett; Zengri Wang; Steen Buntzen; Claes Johansson; Søren Laurberg; Harald Rosen; Carolynne J Vaizey; Klaus Matzel; Cor Baeten |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Gut Volume: 59 ISSN: 1468-3288 ISO Abbreviation: Gut Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-08 Completed Date: 2010-05-19 Revised Date: 2010-07-22 |
Medline Journal Info:
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Nlm Unique ID: 2985108R Medline TA: Gut Country: England |
Other Details:
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Languages: eng Pagination: 333-40 Citation Subset: AIM; IM |
Affiliation:
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University Department of Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, Melbourne 3065, Australia. mkamm@unimelb.edu.au |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00200005 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Chronic Disease Constipation / physiopathology, therapy* Defecation / physiology Electric Stimulation Therapy / adverse effects, methods* Electrodes, Implanted Epidemiologic Methods Female Gastrointestinal Transit / physiology Humans Lumbosacral Plexus / physiopathology* Male Middle Aged Quality of Life Treatment Outcome Young Adult |
| Comments/Corrections | |
Comment In:
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Gut. 2010 Aug;59(8):1156-7; author reply 1157
[PMID:
20587549
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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