Introduction Recent international consensus guidelines on anorectal disorders from the Neurogastroenterology and Motility societies (ANMS-ESNM) recommend biofeedback therapy (BFT) for constipation with dyssynergic defecation (DD) and for faecal incontinence (FI).1 We conducted a national survey to understand the current practice and opinions on anorectal function tests and BFT in the UK & Ireland.
Methods An online survey was developed by a multi-disciplinary panel with medical, surgical and GI physiology representation. All GI clinicians and physiologists/scientists in the UK & Ireland were invited to take the survey through their national societies BSG, AGIP, AUGIS and ACPGBI. All respondents were asked about their views on anorectal function tests and BFT, whilst GI physiologists and lead clinicians regularly involved in these studies were asked specific questions relating to their clinical practice.
Results 313 responses (59% Gastroenterologists) included representatives from 98 GI physiology units. Of the units surveyed, 74% have anorectal manometry (ARM) (High Resolution 35%), 59% offer BFT and most have access to other imaging modalities (endoanal ultrasound 64%, colonic transit studies 86% and defecating proctography 67%). Overall, the majority agreed that anorectal function tests are useful in managing chronic functional constipation (FC) (69%) and FI (76%). In FI, 61% found BFT helpful, whereas opinions were divided in constipation with 52% finding BFT helpful for all forms of FC and 47% indicating BFT is only helpful in the DD sub-group. Surprisingly, a high proportion of respondents ‘did not know’ how useful anorectal function tests (FC 22% and FI 21%) and BFT (FC 26%, DD 33%, FI 31%) were. Responses from GI physiologists/lead clinicians (n = 95) indicated that; 58% have separate rooms for lower GI studies and the numbers of ARMs performed/month in their units (where known) were; none in 20%, 1–20 cases in 37% and >20/month in 28% and similarly numbers of BFTs/month for DD, FC or FI were; none in 37%, 1–20 cases in 21%, >20 in 18%. Only half the GI physiologists/lead clinicians surveyed offer BFT (FI 52%, DD 53% and FC 47%).
Conclusion Whilst anorectal function tests are available in most units, BFT appears to be limited to specialist centres, with the majority agreeing that these interventions are useful in managing FC, DD and in particular FI. Up to a third were unsure about the utility of tests and BFT suggesting a worrying lack of knowledge and exposure amongst non-specialists which could affect the management of patients with these common anorectal disorders.
Reference 1 Rao S, et al. NMO 2015;27(5):594–609.
Disclosure of Interest None Declared
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