Trans-anal irrigation therapy to treat adult chronic functional XXXX : systematic review and meta-analysis.

@entity1 @entity1142 @entity29
BACKGROUND: Trans-anal irrigation (TAI) is used widely to treat @entity29 , although evidence for its use in adult chronic functional @entity1142 remains unclear. Long-term outcome data are lacking, and the effectiveness of therapy in this @entity1 group is not definitively known. METHODS: Evidence for effectiveness and safety was reviewed and the quality of studies was assessed. Primary research articles of @entity1 with chronic functional @entity1142 , treated with TAI as outpatients and published in English in indexed journals were eligible. Searching included major bibliographical databases and search terms: @entity29 , defecation, @entity1142 and irrigation. Fixed- and random-effect meta-analyses were performed. RESULTS: Seven eligible uncontrolled studies, including 254 @entity1 , of retrospective or prospective design were identified. The definition of treatment response varied and was investigator-determined. The fixed-effect pooled response rate (the proportion of @entity1 with a positive outcome based on investigator-reported response for each study) was 50.4  % (95 % CI: 44.3-56.5  %) but featured substantial heterogeneity (I(2)   =   67.1  %). A random-effects estimate was similar: 50.9  % (95 % CI: 39.4-62.3  %). Adverse events were inconsistently reported but were commonplace and minor. CONCLUSIONS: The reported success rate of irrigation for functional @entity1142 is about 50  %, comparable to or better than the response seen in trials of pharmacological therapies. TAI is a safe treatment benefitting some @entity1 with functional @entity1142 , which is a chronic refractory condition. However findings for TAI vary, possibly due to varying methodology and context. Well-designed prospective trials are required to improve the current weak evidence base.
