Ghislain Devroede - Academia.edu (original) (raw)
Papers by Ghislain Devroede
European Journal of Gastroenterology & Hepatology, 2016
Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients... more Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients with functional bowel or anorectal disorders complain of fecal urge and stool output after eating. In this prospective observational study, 408 consecutive outpatients with functional bowel and/or anorectal disorders (74% female, 50.2±15.6 years, 24.8±5.0 kg/m²) filled Rome III questionnaires. Depression and anxiety scores, a physiological evaluation (total and segmental colonic transit time, colonic transit response to eating using a standard 1000 kcal test meal, and anorectal manometry), were measured. Univariate analysis and multivariate logistic regression were carried out according to the presence or not of stool output after eating. Defecation after eating was found in 21% of patients. These patients were not different according to the demographic characteristics of sex ratio (P=0.702), age (P=0.830), and BMI (P=0.314). In contrast, they had lower state anxiety (P=0.032), but similar scores of depression (P=0.240) and trait anxiety (P=0.933). They had similar manometric characteristics (anal pressure and rectal sensitivity), but a greater response to eating in all segments of the colon. There was an increase in the frequency of functional diarrhea (odds ratio=2.576, 95% confidence interval=1.312-5.056; P=0.006) and levator ani syndrome (odds ratio=2.331, 95% confidence interval=1.099-4.944; P=0.017), but no other functional bowel disorder including irritable bowel syndrome and its subtypes was found. Stool output after eating is associated with clinical disorders but not physiological parameters. This symptom is not associated with irritable bowel syndrome, but a higher frequency of functional diarrhea.
Gastroenterology, 1973
Eighteen healthy volunteers were assigned at random to eat exclusively either an elemental diet (... more Eighteen healthy volunteers were assigned at random to eat exclusively either an elemental diet (Mead-Johnson 3200-AS) or a control diet (Mead-Johnson 3200-AU), which differed in that the protein fraction was not hydrolyzed and no medium chain triglycerides were added to the lipid fraction. Neither diet had much effect on serum biochemical and hematological parameters, hepatic secretion of bile salts, pancreatic secretion of enzymes under standard stimuli, and transit time of radio-opaque markers. Mean weight of the subjects decreased from 147 to 145 lb (P 0.05) in the elemental group. It is concluded that the elemental diet investigated in this study is safe for human use for a period of at least 12 days.
Gastroenterology, 1976
Nine healthy human volunteers underwent colonic perfusion and recording of the intraluminal press... more Nine healthy human volunteers underwent colonic perfusion and recording of the intraluminal pressure simultaneously in the right, transverse, and left colon. Isotonic saline was infused into the caecum at various flow rates from 10 to 30 ml per min. During colonic perfusions, pressure waves were simple and distorted only by respiratory artifacts. Their amplitude was large (10 to 44 cm of H2O), of long duration (8 to 68 sec), and of low frequency (0.2 to 1.8 wave per min). The frequency of the waves was very stable and this stability was uninfluenced by the site of recording and the rate of perfusion. A pressure wave in the right colon was always followed within 3 sec by a wave in the transverse and left colon. The frequency and amplitude of the waves increased in all subjects and at all rates of perfusion from right to left colon (P less than 0.001). The wave frequency increased with the perfusion flow rate (P less than 0.001). The relationship between the perfusion flow rate and th...
Journal of Pediatric Surgery, 1983
This article presents an in-depth study of constipation. The problem of defining constipation and... more This article presents an in-depth study of constipation. The problem of defining constipation and evaluating its severity is examined, the pathophysiologic manifestations are described, and surgical approaches are suggested for various disorders.
Visceral Medicine
Background/Aims: Little is known about the improvement in defecation frequently reported by women... more Background/Aims: Little is known about the improvement in defecation frequently reported by women around menses. We aimed to describe clinical, physiological, and psychological correlates of this improvement in those with functional bowel disorders. Patients and Methods: We recruited 478 consecutive premenopausal adult females with no indication of gynecologic or psychiatric disease, who were attending an outpatient functional bowel disorders clinic. Patients completed a Rome III questionnaire, psychological evaluation stool form, and a 10-point Likert scale for constipation, diarrhea, bloating, and abdominal pain. These patients underwent physiological tests, anorectal manometry, and colonic transit time and were classified according to the presence or the absence of improvement in defecation during menses. The reverse selection procedure was used for model selection during multivariate logistic regression where statistically significant variables (p < 0.01) remained in the adju...
International journal of colorectal disease, Jan 10, 2018
Fecal soiling (FS) is the staining of underwear without loss of significant amounts of fecal mate... more Fecal soiling (FS) is the staining of underwear without loss of significant amounts of fecal material. It is frequently associated with defecation disorders in children. The aim of this study was to search for psychological and clinical correlates of adult patients with soiling. Clinically, the complaint of staining is confused with that of fecal incontinence (FI) in the mind of both patients and attending physicians. Observational study PATIENTS AND METHOD: We included 1454 consecutive outpatients (71% females). They filled out the Rome III questionnaire for functional gastrointestinal disorders (FGIDs); Beck depression inventory, and state and trait anxiety questionnaires; and Likert scales for constipation, diarrhea, bloating, and abdominal pain. Data were analyzed using ANOVA and logistic regression analysis. Soiling was found in 123 patients (8.5%). They reported similar frequencies of esophageal, gastroduodenal, and abdominal pain as patients without soiling. In contrast, pati...
Digestive diseases and sciences, Jul 28, 2018
Abdominal pain is not used to characterize constipated patients. This study aimed to compare clin... more Abdominal pain is not used to characterize constipated patients. This study aimed to compare clinical, psychological, and physiological features in patients with IBS-constipation (IBS-C) with those in patients with functional constipation (FC) according to the intensity of abdominal pain. All patients filled a standard Rome III questionnaire. In addition, they indicated the intensity of constipation, diarrhea, bloating, and abdominal pain on a 10-point Likert scale, and their stool form with the Bristol Stool Form Scale. Anxiety and depression were assessed with the Beck Depression Inventory and the State-Trait Anxiety Inventory. Physiological evaluation included anorectal manometry and total and segmental colonic transit time. A total of 546 consecutive patients, 245 with IBS-C and 301 with FC, were included. Painful constipation (PFC) was found by cluster analysis and subsequently defined as having a value over four on the Likert scale for abdominal pain. PFC was found in 67% of I...
Clinics and research in hepatology and gastroenterology, Dec 7, 2017
World journal of clinical cases, Jan 16, 2017
We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). ... more We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery sh...
Medecine Et Hygiene, 1985
International Journal of Colorectal Disease, 2016
The importance in constipated subjects of having difficult defecation is poorly known. According ... more The importance in constipated subjects of having difficult defecation is poorly known. According to the Rome III criteria, constipated patients are classified as having either irritable bowel syndrome with constipation or functional constipation, depending on the presence and characteristics of abdominal pain. But, the Rome III criteria also identify another group of patients, labeled as suffering from functional anorectal disorders. Within this group, two complaints are akin to being constipated, but not labeled so: having dyssynergic defecation or inadequate defecation. The aim of this study was to search for an association between difficult defecation and colonic transit abnormalities in constipated patients and, thus, shed some light on the definition of constipation according to the Rome III criteria. Four hundred four consecutive patients (81 % female), aged 44.9 ± 16.6 years, with a BMI of 25.5 ± 6.4 kg/m(2) (mean ± SD), suffering from chronic constipation were included in the present study. After filling out a standard Rome III questionnaire, patients were classified as suffering from an irritable bowel syndrome with constipation or functional constipation. In addition, they were classified as complaining of difficult defecation or not. Patients completed the Bristol Stool Form Scale as well as visual analogue scales for constipation, bloating, and abdominal pain. The colonic transit time was measured using radiopaque markers and analyzed according to three sites: the right colon, the left colon, and the rectosigmoid area. Difficult defecation is more frequent in patients with irritable bowel syndrome with constipation (84 %) than in patients with functional constipation (68 %). It is associated with an increase in constipation and abdominal pain scores on Likert scales, and a longer oroanal transit time, due to a delay in the left part of the colon. This study demonstrates that difficult defecation is part of a more generalized colorectal dysfunction in both irritable bowel syndrome and in functional constipation patients with an overlap of symptomatology. It also demonstrates the relative inadequacy of the Rome III criteria to describe the relationship between constipation and difficult defecation.
Medecine Et Chirurgie Digestives, 1985
Data Revues 22107401 V37i4 S2210740112003300, Jun 9, 2013
Gastroentérologie Clinique et Biologique
Vasopressin (VS) has been reported to stimulate colonic peristalsis in different therapeutic cond... more Vasopressin (VS) has been reported to stimulate colonic peristalsis in different therapeutic conditions. In order to determine the mechanisms involved in this effect, colonic function was studied with three different techniques staying: a) the transit time of radioopaque markers through the colon was measured in 7 healthy subjects after VS IM (0.3 U/kg of weight). A marked propulsive effect was observed. One hour after injection, 64.7 +/- 16.2 p. 100 of the markers (m +/- sem) had left the right colon vs 9.1 +/- 4.6 p. 100 after injection of NaCl (p less than 0.01) and 70.5 +/- 10.8 p. 100 of the markers emptied from the left colon vs 4.3 +/- 4.5 p. 100 after NaCl (p less than 0.01); b) an electromyographic study was carried out in 6 other healthy subjects with an intraluminal device equipped with contact electrodes, introduced into the left colon by colonoscopy. The injection of VS was followed by an increase in the number of the propagating electrical spike bursts that are known t...
Gastroenterology, 1982
In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly vi... more In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly visible scarring of the rectum and biopsy revealed mucosal atrophy and fibrosis. A steal from the hemorrhoidal arteries to the iliac vessels was demonstrated in 3 subjects. Maximum tolerable volumes within a rectal balloon were smaller than in control subjects, both in men (192 vs. 273 ml) and in women (142 vs. 217 ml) (p less than 0.01). The rectoanal inhibitory reflex was abnormal in all but 1 patient. Specific abnormalities were a decreased amplitude or a prolonged duration of the reflex. It was totally absent in 2 patients. This study is compatible with the hypothesis that chronic ischemia of the rectum may cause fecal incontinence or rectal pain.
L'unión médicale du Canada, 1972
Journal of applied physiology, 1974
European Journal of Gastroenterology & Hepatology, 2016
Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients... more Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients with functional bowel or anorectal disorders complain of fecal urge and stool output after eating. In this prospective observational study, 408 consecutive outpatients with functional bowel and/or anorectal disorders (74% female, 50.2±15.6 years, 24.8±5.0 kg/m²) filled Rome III questionnaires. Depression and anxiety scores, a physiological evaluation (total and segmental colonic transit time, colonic transit response to eating using a standard 1000 kcal test meal, and anorectal manometry), were measured. Univariate analysis and multivariate logistic regression were carried out according to the presence or not of stool output after eating. Defecation after eating was found in 21% of patients. These patients were not different according to the demographic characteristics of sex ratio (P=0.702), age (P=0.830), and BMI (P=0.314). In contrast, they had lower state anxiety (P=0.032), but similar scores of depression (P=0.240) and trait anxiety (P=0.933). They had similar manometric characteristics (anal pressure and rectal sensitivity), but a greater response to eating in all segments of the colon. There was an increase in the frequency of functional diarrhea (odds ratio=2.576, 95% confidence interval=1.312-5.056; P=0.006) and levator ani syndrome (odds ratio=2.331, 95% confidence interval=1.099-4.944; P=0.017), but no other functional bowel disorder including irritable bowel syndrome and its subtypes was found. Stool output after eating is associated with clinical disorders but not physiological parameters. This symptom is not associated with irritable bowel syndrome, but a higher frequency of functional diarrhea.
Gastroenterology, 1973
Eighteen healthy volunteers were assigned at random to eat exclusively either an elemental diet (... more Eighteen healthy volunteers were assigned at random to eat exclusively either an elemental diet (Mead-Johnson 3200-AS) or a control diet (Mead-Johnson 3200-AU), which differed in that the protein fraction was not hydrolyzed and no medium chain triglycerides were added to the lipid fraction. Neither diet had much effect on serum biochemical and hematological parameters, hepatic secretion of bile salts, pancreatic secretion of enzymes under standard stimuli, and transit time of radio-opaque markers. Mean weight of the subjects decreased from 147 to 145 lb (P 0.05) in the elemental group. It is concluded that the elemental diet investigated in this study is safe for human use for a period of at least 12 days.
Gastroenterology, 1976
Nine healthy human volunteers underwent colonic perfusion and recording of the intraluminal press... more Nine healthy human volunteers underwent colonic perfusion and recording of the intraluminal pressure simultaneously in the right, transverse, and left colon. Isotonic saline was infused into the caecum at various flow rates from 10 to 30 ml per min. During colonic perfusions, pressure waves were simple and distorted only by respiratory artifacts. Their amplitude was large (10 to 44 cm of H2O), of long duration (8 to 68 sec), and of low frequency (0.2 to 1.8 wave per min). The frequency of the waves was very stable and this stability was uninfluenced by the site of recording and the rate of perfusion. A pressure wave in the right colon was always followed within 3 sec by a wave in the transverse and left colon. The frequency and amplitude of the waves increased in all subjects and at all rates of perfusion from right to left colon (P less than 0.001). The wave frequency increased with the perfusion flow rate (P less than 0.001). The relationship between the perfusion flow rate and th...
Journal of Pediatric Surgery, 1983
This article presents an in-depth study of constipation. The problem of defining constipation and... more This article presents an in-depth study of constipation. The problem of defining constipation and evaluating its severity is examined, the pathophysiologic manifestations are described, and surgical approaches are suggested for various disorders.
Visceral Medicine
Background/Aims: Little is known about the improvement in defecation frequently reported by women... more Background/Aims: Little is known about the improvement in defecation frequently reported by women around menses. We aimed to describe clinical, physiological, and psychological correlates of this improvement in those with functional bowel disorders. Patients and Methods: We recruited 478 consecutive premenopausal adult females with no indication of gynecologic or psychiatric disease, who were attending an outpatient functional bowel disorders clinic. Patients completed a Rome III questionnaire, psychological evaluation stool form, and a 10-point Likert scale for constipation, diarrhea, bloating, and abdominal pain. These patients underwent physiological tests, anorectal manometry, and colonic transit time and were classified according to the presence or the absence of improvement in defecation during menses. The reverse selection procedure was used for model selection during multivariate logistic regression where statistically significant variables (p < 0.01) remained in the adju...
International journal of colorectal disease, Jan 10, 2018
Fecal soiling (FS) is the staining of underwear without loss of significant amounts of fecal mate... more Fecal soiling (FS) is the staining of underwear without loss of significant amounts of fecal material. It is frequently associated with defecation disorders in children. The aim of this study was to search for psychological and clinical correlates of adult patients with soiling. Clinically, the complaint of staining is confused with that of fecal incontinence (FI) in the mind of both patients and attending physicians. Observational study PATIENTS AND METHOD: We included 1454 consecutive outpatients (71% females). They filled out the Rome III questionnaire for functional gastrointestinal disorders (FGIDs); Beck depression inventory, and state and trait anxiety questionnaires; and Likert scales for constipation, diarrhea, bloating, and abdominal pain. Data were analyzed using ANOVA and logistic regression analysis. Soiling was found in 123 patients (8.5%). They reported similar frequencies of esophageal, gastroduodenal, and abdominal pain as patients without soiling. In contrast, pati...
Digestive diseases and sciences, Jul 28, 2018
Abdominal pain is not used to characterize constipated patients. This study aimed to compare clin... more Abdominal pain is not used to characterize constipated patients. This study aimed to compare clinical, psychological, and physiological features in patients with IBS-constipation (IBS-C) with those in patients with functional constipation (FC) according to the intensity of abdominal pain. All patients filled a standard Rome III questionnaire. In addition, they indicated the intensity of constipation, diarrhea, bloating, and abdominal pain on a 10-point Likert scale, and their stool form with the Bristol Stool Form Scale. Anxiety and depression were assessed with the Beck Depression Inventory and the State-Trait Anxiety Inventory. Physiological evaluation included anorectal manometry and total and segmental colonic transit time. A total of 546 consecutive patients, 245 with IBS-C and 301 with FC, were included. Painful constipation (PFC) was found by cluster analysis and subsequently defined as having a value over four on the Likert scale for abdominal pain. PFC was found in 67% of I...
Clinics and research in hepatology and gastroenterology, Dec 7, 2017
World journal of clinical cases, Jan 16, 2017
We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). ... more We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery sh...
Medecine Et Hygiene, 1985
International Journal of Colorectal Disease, 2016
The importance in constipated subjects of having difficult defecation is poorly known. According ... more The importance in constipated subjects of having difficult defecation is poorly known. According to the Rome III criteria, constipated patients are classified as having either irritable bowel syndrome with constipation or functional constipation, depending on the presence and characteristics of abdominal pain. But, the Rome III criteria also identify another group of patients, labeled as suffering from functional anorectal disorders. Within this group, two complaints are akin to being constipated, but not labeled so: having dyssynergic defecation or inadequate defecation. The aim of this study was to search for an association between difficult defecation and colonic transit abnormalities in constipated patients and, thus, shed some light on the definition of constipation according to the Rome III criteria. Four hundred four consecutive patients (81 % female), aged 44.9 ± 16.6 years, with a BMI of 25.5 ± 6.4 kg/m(2) (mean ± SD), suffering from chronic constipation were included in the present study. After filling out a standard Rome III questionnaire, patients were classified as suffering from an irritable bowel syndrome with constipation or functional constipation. In addition, they were classified as complaining of difficult defecation or not. Patients completed the Bristol Stool Form Scale as well as visual analogue scales for constipation, bloating, and abdominal pain. The colonic transit time was measured using radiopaque markers and analyzed according to three sites: the right colon, the left colon, and the rectosigmoid area. Difficult defecation is more frequent in patients with irritable bowel syndrome with constipation (84 %) than in patients with functional constipation (68 %). It is associated with an increase in constipation and abdominal pain scores on Likert scales, and a longer oroanal transit time, due to a delay in the left part of the colon. This study demonstrates that difficult defecation is part of a more generalized colorectal dysfunction in both irritable bowel syndrome and in functional constipation patients with an overlap of symptomatology. It also demonstrates the relative inadequacy of the Rome III criteria to describe the relationship between constipation and difficult defecation.
Medecine Et Chirurgie Digestives, 1985
Data Revues 22107401 V37i4 S2210740112003300, Jun 9, 2013
Gastroentérologie Clinique et Biologique
Vasopressin (VS) has been reported to stimulate colonic peristalsis in different therapeutic cond... more Vasopressin (VS) has been reported to stimulate colonic peristalsis in different therapeutic conditions. In order to determine the mechanisms involved in this effect, colonic function was studied with three different techniques staying: a) the transit time of radioopaque markers through the colon was measured in 7 healthy subjects after VS IM (0.3 U/kg of weight). A marked propulsive effect was observed. One hour after injection, 64.7 +/- 16.2 p. 100 of the markers (m +/- sem) had left the right colon vs 9.1 +/- 4.6 p. 100 after injection of NaCl (p less than 0.01) and 70.5 +/- 10.8 p. 100 of the markers emptied from the left colon vs 4.3 +/- 4.5 p. 100 after NaCl (p less than 0.01); b) an electromyographic study was carried out in 6 other healthy subjects with an intraluminal device equipped with contact electrodes, introduced into the left colon by colonoscopy. The injection of VS was followed by an increase in the number of the propagating electrical spike bursts that are known t...
Gastroenterology, 1982
In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly vi... more In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly visible scarring of the rectum and biopsy revealed mucosal atrophy and fibrosis. A steal from the hemorrhoidal arteries to the iliac vessels was demonstrated in 3 subjects. Maximum tolerable volumes within a rectal balloon were smaller than in control subjects, both in men (192 vs. 273 ml) and in women (142 vs. 217 ml) (p less than 0.01). The rectoanal inhibitory reflex was abnormal in all but 1 patient. Specific abnormalities were a decreased amplitude or a prolonged duration of the reflex. It was totally absent in 2 patients. This study is compatible with the hypothesis that chronic ischemia of the rectum may cause fecal incontinence or rectal pain.
L'unión médicale du Canada, 1972
Journal of applied physiology, 1974