P2340 - Does Anorectal Manometry Predict the Response to Pelvic Floor Biofeedback in Patients With Constipation? A Retrospective Study

Theja Channapragada, DO, MBA, MS¹, Smriti Kochhar, DO², Vinayak Shenoy, DO², Julie Murone, DO², Carolyn Low, ², Junjia Zhu, MS, PhD³, Ann Ouyang, MD^2
1Penn State Health Milton S. Hershey Medical Center, Springfield, NJ; ²Penn State Health Milton S. Hershey Medical Center, Hershey, PA; ³Penn State College of Medicine, Hershey, PA

Introduction: Dyssynergic defecation (DD) is defined by symptoms and abnormalities in 2 of 3 studies: anorectal manometry (ARM), balloon expulsion test, and defecography. The primary treatment for DD is biofeedback therapy (BFT). This study aimed to determine if there was a difference in outcome from BFT when a patient is referred following ARM compared to direct referral (DR) based on clinical complaints and if any clinical or ARM features predict a successful outcome.

Methods: Records of 262 patients who underwent BFT by a single therapist between 2020-2022 were reviewed. Only patients referred for constipation, on no opioids, and with more than 2 BFT sessions were included. This left 138 patients of whom 95 had undergone ARM and BFT (ARM group), and 43 directly referred for BFT without ARM (DR group). The Colorectal-Anal Distress Inventory-8 (CRADI-8), abdominal pain, impact on the quality-of-life scores, and patient and therapist perceptions of improvement were documented at each BFT session, with success determined by the therapist. Between-group comparisons were performed using Fisher’s exact test and 2-sample t-test as appropriate. Data is shown as mean ± SD.

Results: A successful outcome was achieved in 61(44.2%) patients; 21(15.2%) did not reach the goal, and 56 (40.6%) were lost to follow-up. No difference in outcomes was seen between the ARM and DR groups (p=0.36). In ARM patients, the type of DD did not impact BFT outcomes (p=0.29) nor did normal vs. abnormal balloon expulsion test (p=0.28). Those with successful outcomes were younger, had higher initial weight, greater improvements in CRADI-8 score, sense of bowel emptying, patient-perceived quality of life scores, and perception of outcome (Table 1). ARM patients had a higher initial CRADI-8 score than DR patients 51±10.7 vs 46.5±9.3 (p=0.02). No significant difference was found in the number of biofeedback sessions, colonic stool burden noted on X-ray, constipation duration, initial CRADI-8 score, change in abdominal pain, or medications for constipation between those with successful vs. unsuccessful outcomes.

Discussion: In this study, ARM prior to BFT did not impact outcome. Biofeedback may be more successful in younger patients and those with higher weights. Successful BFT significantly improved the CRADI-8 score, sense of bowel emptying, and patient-perceived quality of life. Finding factors that predict a higher success rate is important given relative scarcity of motility centers and pelvic floor biofeedback.


Disclosures:


Theja Channapragada, DO, MBA, MS¹, Smriti Kochhar, DO², Vinayak Shenoy, DO², Julie Murone, DO², Carolyn Low, ², Junjia Zhu, MS, PhD³, Ann Ouyang, MD². P2340 - Does Anorectal Manometry Predict the Response to Pelvic Floor Biofeedback in Patients With Constipation? A Retrospective Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.