Introduction: The goal of this project was to create an up‐to‐date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI.Methods: These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework. For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher‐level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus.Results: These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients.Conclusion: These multidisciplinary European guidelines provide an up‐to‐date comprehensive evidence‐based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.

The St. Mark's incontinence score is widely used to evaluate the severity of fecal incontinence. It is unknown to what extent such scores relate to patients' perceptions about their condition. The primary goal of this study was to assess this correlation. Secondary goals were to evaluate the relationship between different types of incontinence, age, gender, and the continence score and to assess the sensitivity of St. Mark's incontinence score to a change in patients' perception and outcome evaluation after treatment. Patients' subjective perception of bowel control (using a 0-10 scale) and St. Mark's incontinence score for 390 patients were reviewed. Change in the score was documented for 131 patients who underwent biofeedback treatment and compared with patients' outcome evaluation. There was a moderate correlation between patients' perception of bowel control and the St. Mark's incontinence score (r= −0.55;P< 0.001). The correlation was maintained, regardless of type of incontinence (r= −0.48 to −0.55), age (≤60 years:r= −0.54; >60 years:r= −0.58;P< 0.001) or gender (male:r= −0.48; female:r= −0.53;P< 0.001) of patients. St. Mark's incontinence score was sensitive to a change in patients' subjective evaluation after the treatment. The St. Mark's incontinence score correlates moderately well with patients' subjective perception and is reliable regardless of the type of incontinence, patients' age, or gender. It is suitable for the severity assessment of fecal incontinence and the evaluation of a treatment outcome.

Background: The potential for metronidazole 10 per cent ointment to exert therapeutic benefit in perianal Crohn's disease, while minimizing the adverse effects found with oral metronidazole, was evaluated in a randomized placebo-controlled study. Methods: Subjects with perianal Crohn's disease were randomized to metronidazole 10 per cent ointment, 0·7 g applied perianally three times daily, or placebo ointment. The Perianal Crohn's Disease Activity Index (PCDAI) was scored at baseline and after 4 weeks of treatment. Perianal pain was assessed on a visual analogue scale. Results: Seventy-four subjects (33 metronidazole, 41 placebo) were evaluated. The mean(s.e.m.) reduction in PCDAI score at 4 weeks was 2·4(0·5) in the metronidazole group and 2·2(0·4) in the placebo group (P = 0·660). More subjects in the metronidazole group than the placebo group showed a reduction in PCDAI score of at least 5 points (10 of 27 versus 4 of 34; P = 0·031). Perianal discharge was reduced significantly in metronidazole-treated subjects (P = 0·012). A greater reduction in perianal pain was seen in the metronidazole group, which approached statistical significance (P = 0·059). No serious adverse events were reported. Conclusion: Metronidazole 10 per cent ointment was not effective in the reduction of PDCAI score, but some secondary outcomes showed improvement suggestive of a treatment effect. It is well tolerated, with minimal adverse effects, and has potential as treatment for pain and discharge associated with perianal Crohn's disease. Registration number: NCT00509639 (http://www.clinicaltrials.gov).