Tsarkov P, Tulina I, Sheikh P, Shlyk DD, Garg P. Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference? World J Gastroenterol 2024; 30(3): 204-210 [PMID: 38314129 DOI: 10.3748/wjg.v30.i3.204]
Corresponding Author of This Article
Pankaj Garg, MS, CEO, Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2024; 30(3): 204-210 Published online Jan 21, 2024. doi: 10.3748/wjg.v30.i3.204
Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?
Petr Tsarkov, Inna Tulina, Parvez Sheikh, Darya D Shlyk, Pankaj Garg
Petr Tsarkov, Darya D Shlyk, Department of Colorectal Surgery, Sechenov First Moscow State Medical University, Moscow 119991, Russia
Inna Tulina, Department of Oncologic Colorectal Surgery, Sechenov First Moscow State Medical University, Moscow 119991, Russia
Parvez Sheikh, Department of Colorectal Surgery, Saifee Hospital, Mumbai 400004, Maharashtra, India
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Author contributions: Tsarkov PV conceived and designed the study, collected and analyzed the data, revised the data, and finally approved and submitted the manuscript; Tulina I collected and analyzed the data, revised the data, finally approved and submitted the manuscript; Shaikh P critically analyzed the data, reviewed and edited the manuscript, finally approved and submitted the manuscript; Shlyk DD analyzed the data, revised the data, finally approved and submitted the manuscript; Garg P analyzed the data, revised the data, and finally approved and submitted the manuscript (Guarantor of the study).
Conflict-of-interest statement: No conflict of interest for any of the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MS, CEO, Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Received: October 7, 2023 Peer-review started: October 7, 2023 First decision: December 4, 2023 Revised: December 6, 2023 Accepted: December 22, 2023 Article in press: December 22, 2023 Published online: January 21, 2024
Abstract
The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023; 29: 4593–4603. The authors in the published article developed a new scoring system, Garg incontinence scores (GIS), for fecal incontinence (FI). FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients. Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month. The associated social stigmatization often leads to significant under-reporting of the condition, which further impairs management. An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians. Due to this, the management becomes even more difficult. This issue is resolved up to a considerable extent by a scoring questionnaire. There were several scoring systems in use for the last three decades. The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system, St. Marks Hospital or Vaizey’s scores, and the FI severity index. However, there were several shortcomings in these scoring systems. In the opinion review, we tried to analyze the strength of GIS and compare it to the existing scoring systems. The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI (solid, liquid, flatus, etc.), were not comprehensive, and took only the surgeon’s perception of FI into view. In GIS, almost all shortcomings of previous scoring systems had been addressed: different weights were assigned to different types of FI by a robust statistical methodology; the scoring system was made comprehensive by including all types of FI that were previously omitted (urge, stress and mucus FI) and gave priority to patients’ rather than the physicians’ perceptions while developing the scoring system. Due to this, GIS indeed looked like a paradigm shift in the evaluation of FI. However, it is too early to conclude this, as GIS needs to be validated for accuracy and simplicity in future studies.
Core tip: Several scoring systems were used to assess fecal incontinence (FI), among which the most commonly used were Wexner’s, Vaizey’s, and FI Severity Index scoring systems. However, there are major lacunae and shortcomings in these scoring systems. A new scoring system, Garg incontinence scores (GIS), attempted to sort out the lacunae in the existing scoring systems. In the commentary, we analyzed the GIS while comparing it to the existing scoring systems. GIS seemed to be a major improvement over the existing scoring systems as almost all shortcomings of previous scoring systems have been addressed. However, this needs to be validated in further studies.
