This is a summary of the published article Long-term efficacy and safety of transanal irrigation in multiple sclerosis by Passananti V, Wilton A, Preziosi G, Storrie JB, Emmanuel AV. Neurogastroenterol Motil. 2016;28(9):1349-55
Forty-nine patients with Multiple Sclerosis (MS) were introduced to transanal irrigation (TAI) and observed a minimum of 12 and a mean duration of 40 months.
All patients underwent a structured interview, clinical examination, anorectal physiology study, quality of life assessment, and bowel function questionnaire at their first visit and at annual follow-up visits.
Compliance after 3 months was 75% and 63% after 6 months. At the last follow-up, 55% of the patients were still using TAI.
Reason for disrupting therapy:
- Disliked treatment (55%)
- Insufficient effect (14%)
- Adverse event (9%)
- Lost to follow-up (9%)
- Balloon burst (4%)
- Other pathology issues (9%)
Reduction of NBD score were observed after TAI (Table 1). Severity of neurogenic bowel disorder (NBD) score, symptom of constipation or fecal incontinence did not correlate with likelihood of interruption of TAI therapy.
| First visit | Last visit | |
|---|---|---|
| NBD score Severe (%) | 47 | 18 |
| NBD score Moderate (%) | 29 | 22 |
| NBD score Minor (%) | 16 | 7 |
| NBD score Very Minor (%) | 8 | 53 |
| Fecal Incontinence (weekly episodes) | 4.8 | 0.9 |
| UTI (events preceding year) | 32 | 19 |
| Hospitalizations (preceding year) | 32 | 19 |
Anal sensitivity was the only physiological factor that proved to be a statistically-significant predictor for long-term continuation of the therapy. That is, 10 out of 11 patients with elevated anal sensitivity responded to TAI.
Resource utilization was compared between first visit and last visit to evaluate cost-effectiveness (Table 1). Also, self-reported visits to GPs, medical specialists, and dieticians were reduced by 27%, 19% and 55% respectively.
Quality of life was measured with EQ-D5. The EQ-D5 utilities and quality of life declined over time whether or not the patients were using TAI. A regression model was used to control the data for potential confounders and heterogeneity. This showed that patients using TAI, experienced a marginal utility gain from the treatment. However, it was not statistically significant.
In the second part of the EQ-5D the patient is asked to indicate their current health state on a Visual Analog Scale (VAS) between 0-100, from worst to best health. The VAS-instrument showed that patients using TAI experienced an improvement of 42% while patients who had discontinued treatment experienced a decline of 6%.
TAI is an effective treatment option for MS patients with NBD, who have not responded to first line therapy. TAI reduces the use of other health-care services, which may prove to be cost-effective. The generic EQ-5D tool is insensitive to the effects of TAI in this population.