RESUMO
Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia [anismus]. It is a behavioural disorder [no associated morphological or neurological abnormalities]; consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Sixty patients [35 females and 25 males] with a mean age of 30 +/- 12 years and a 4 year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions [colon-transit time, anorectal manometry, EMG and defaecography] were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of [6 +/- 2] sessions. At the end of sessions, 55 out of 60 patients [91.6%] reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia
RESUMO
GERD may occur with acid, bile or in a mixed form. Endoscopic injury and mucosal metaplasia are a known sequlae to pathological GERD to study the contribution of acid and duodenogas-troesophageal reflux [DGER] to endoscopic severity in patients with GERD and Barrett's esophagus. Ninety-one patients [60 males, 31 females; mean age 36.12 +/- 12.65 years] complaining of reflux symptoms underwent upper gastrointestinal endoscopy and graded to non-erosive reflux disease [NERD], erosive reflux disease [ERD] and Barrett's esophagus [BE]. Esophageal manometry and simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring [Bilitec 2000] were done to all patients. Seventy one patients [78.0%] had ERD [Savory-Miller [grade I-III], 11 patients [12.1%] had NERD and 9 patients [9.9%] had BE by endoscopy. Combined 24-h esophageal bilirubin and pH monitoring revealed that: 39 patients [42.9%] had mixed acid and bile reflux, 16[17.6%] had pathological acid reflux only, 18 [19.8%] had bile reflux only and 18 patients [19.8%] had no evidence of abnormal reflux. The percentage of the total time that bilirubin absorbance was 0.14, in 71 patients with ERD was [8.18 +/- 11.28%], and in 9 patients with BE was [15.48 +/- 30.48%] which was significantly greater than that in 11 patients with NERD [4.48 +/- 8.99%], p<0.05 and p=0.01 respectively. All BE patients had abnormal esophageal bile reflux [3 bile alone and 6 mixed bile and acid]; 44 of 71 patients [61.97%] with ERD had abnormal esophageal bile reflux [13 bile alone and 31 mixed bile and acid]; meanwhile 15 of them [21.2%] had abnormal acid exposure alone. Despite having NERD, 4 patients [36.4%] had abnormal esophageal bile reflux, two of them mixed with acid. Mixed reflux [acid and bile] is the chief pattern of reflux in GERD patients. Bile reflux either alone or in a mix with acid reflux contributes to severity of erosive, non-erosive reflux disease as well as in Barrett's esophagus