The Effect Of Prokinetics On Clinical Efficacy And Anal Sphincter Function For Dissynergic Defecation Constipation Patients

AIM: To observe the curative effect of prokinetics on functional dyssynergic defecation constipation(FDD)and determine its influence on anorectal function.METHODS: Subjects were selected from a population of patients admitted to the Digestive Department at the First Affiliated Hospital of Zhejiang Chinese Medical University presenting with functional dyssynergic defecation.The FDD patients were divided into western medicine group and traditional Chinese medicine group.The western medicine group was treated with 2mg Prucalopride Succinate tablets once a day for four weeks.The traditional Chinese medicine group was treated with Zhizhu Tongbian Decoction,1 dose/ day,2 times a day for 4 weeks.All patients received a questionnaire inquiring about weekly defecation frequency,Bristol stool score(BSS),Cleveland Clinic Constipation Score(CCS),Patient Assessment of Constipation Quality of Life(PAC-QOL),Self-Rated Anxiety Scale(SAS)and Self-Rated Depression Scale(SDS).Furthermore,each patient underwent high-resolution anorectal manometry before and after treatment.According to the results of anorectal manometry before treatment,FDD was divided into two subtypes: dyssynergic defecation and deficieney of propulsion.RESULTS:1.A total of 43 FDD patients(20 in the Chinese medicine group,23 in the Western medicine group)were included in our analysis.Six patients in the Chinese medicine group refused to undergo anorectal manometry.2.Compared with the pre-treatment baseline,the weekly defecation frequency in both groups increased significantly(P<0.05).CCS score decreased significantly(P<0.05),BSS classification returned to type 3-4(P<0.05).However,there was no significant difference in the frequency of defecation per week,BSS and CCS scores between the two groups(P > 0.05).3.After treatment,CSS,PAC-QOL,SDS and SAS scores of FDD patients in the two groups were significantly decreased(P<0.05).However,there was no significant difference between the two groups(P>0.05).4.In the Western medicine group treated 13 cases of FDD patients with discordant defecation.r At the end of the treatment,esidual anal pressure(RAP)decreased significantly,and the rectum anal canal pressure difference(RAPD)increased,showing a statistical difference(P<0.05).5.Fourteen FDD patients with deficieney of propulsion were treated in the group of traditional Chinese medicine.After the treatment,rectal pressure(RP)increased significantly(P<0.05).In the western medicine group,10 cases of FDD patients with deficieney of propulsion were treated.After 4 weeks,RP and RAPD were significantly increased during defecation(P<0.05).There was no significant difference in anorectal pressure between the two groups(P>0.05).CONCLUSION: Dynamics can relieve the clinical symptoms of FDD patients,improve the quality of life,improve mood,but also coordinate anorectal function.It is speculated that dynamic therapy can coordinate anorectal motility by promoting gastrointestinal motility.