Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy

BACKGROUND Defecation disorders are obscure sequelae that occurs after gastrectomy,and its implication on daily lives of patients have not been sufficiently investigated.AIM To examine the features of defecation disorders after gastrectomy and to explore its implication on daily lives of patients in a large cohort using the Postgast rectomy Syndrome Assessment Scale(PGSAS)-45.METHODS We conducted a nationwide multi-institutional study using PGSAS-45 to examine the prevalence of postgastrectomy syndrome and its impact on daily lives of patients after various types of gastrectomy.Data were obtained from 2368 eligible patients at 52 institutions in Japan.Of these,1777 patients who underwent total gastrectomy(TG;n=393)or distal gastrectomy(DG;n=1384)were examined.The severity of defecation disorder symptoms,such as diarrhea and constipation,and their correlation with other postgastrectomy symptoms were examined.The importance of defecation disorder symptoms on the living states and quality of life(QOL)of postgastrectomy patients,and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression analysis.RESULTS Among seven symptom subscales of PGSAS-45,the ranking of diarrhea was 4th in TG and 2nd in DG.The ranking of constipation was 5th in TG and 1st in DG.The symptoms that correlated well with diarrhea were dumping and indigestion in both TG and DG;while those with constipation were abdominal pain and mealrelated distress in TG,and were meal-related distress and indigestion in DG.Among five main outcome measures(MOMs)of living status domain,constipation significantly impaired four MOMs,while diarrhea had no effect in TG.Both diarrhea and constipation impaired most of five MOMs in DG.Among six MOMs of QOL domain,diarrhea impaired one MOM,whereas constipation impaired all six MOMs in TG.Both diarrhea and constipation equally impaired all MOMs in DG.Male sex,younger age,division of the celiac branch of vagus nerve,and TG,independently worsened diarrhea,while female sex worsened constipation.CONCLUSION Defecation disorder symptoms,particularly constipation,impair the living status and QOL of patients after gastrectomy;therefore,we should pay attention and adequately treat these relatively modest symptoms to improve postoperative QOL.

Effectiveness of Electro-acupuncture Combined with Biofeedback in Patients with Functional Defecation Disorder:A Meta-analysis

Objective:To systematically evaluate and compare the effects of electro-acupuncture combined with biofeedback training and simple biofeedback training on the intervention of patients with functional defecation disorder.Methods:Computer retrieval was performed to search randomized controlled trials about electroacupuncture combined with biofeedback training in the treatment of patients with functional defecation disoder from January 2000 to January 2019 via websites,including CNKI,Wanfang data knowledge service platform,CBM,VIP,Pub Med,EMBase,Cochrane Library,Web of Science,and Springerlink,JBI evidence-based Nursing database,RNAO,Nursing Consult,BIOSIS,Medline and so on.Screening was performed according to the inclusion and exclusion criteria,data were extracted,literature quality was evaluated,and Meta analysis was performed on the extracted data using Rev Man5.3 software.Results:Five studies including 363 subjects were included.The results of meta-analysis showed that the effective rate of electroacupuncture combined with biofeedback group(combined group)in the treatment of functional defecation disorder was higher than that of biofeedback group(control group)[RR=1.29,95%CI(1.17,1.42),P<0.00001],the difficulty score of defecation in combined group was lower than that of control group[MD=–0.71,95%CI(–1.22,–0.21),P=0.006],and anal rest pressure was lower than that of control group[MD=–0.44,95%CI(-0.80,–0.09),P=0.02].Tubing maximum systolic pressure is lower than the control group[MD=–2.06,95%CI(–3.60,–0.52),P=0.009).Conclusion:Acupuncture combined with biofeedback can effectively improve the defecation difficulty of patients with functional defecation disorder,as well as the anal resting pressure and the maximum anal systolic pressure.Due to the limitation of the number of included literatures and the heterogeneity among evaluation indexes,the evaluation of defecation difficulty score and anal dynamics still needs to be further evaluated under the support of clinical studies with more centers,high quality and large sample size.