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Xu X, Wang Y, Long Y, Cheng Y. Chronic constipation and gut microbiota: current research insights and therapeutic implications. Postgrad Med J 2024:qgae112. [PMID: 39237119 DOI: 10.1093/postmj/qgae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/21/2024] [Accepted: 08/16/2024] [Indexed: 09/07/2024]
Abstract
Chronic constipation is a prevalent clinical condition. Its etiology and pathogenesis have not yet been fully understood. In recent years, mounting evidence suggests a close association between chronic constipation and intestinal dysbiosis, including alterations in the colony structure and metabolites, as well as the modulation of bowel movements via the brain-gut-microbiota axis. With the deepening of related research, probiotic-related therapies are expected to become a potential first-line treatment for chronic constipation in the future. In this review, we summarize the current research insights into the intricate relationships between chronic constipation and the gut microbiota and briefly discuss several different approaches for treating chronic constipation. The findings from this review may advance our understanding of the pathological mechanisms underlying chronic constipation and, ultimately, translate them into improvements in patient care.
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Affiliation(s)
- Xiaoqian Xu
- Department of Gastroenterology, The First Hospital of Tsinghua University, No. 6 Jiuxianqiao, 1st Street, Chaoyang District, Beijing 100016, China
| | - Yali Wang
- Department of Gastroenterology, The First Hospital of Tsinghua University, No. 6 Jiuxianqiao, 1st Street, Chaoyang District, Beijing 100016, China
| | - Yiyan Long
- Department of Gastroenterology, The First Hospital of Tsinghua University, No. 6 Jiuxianqiao, 1st Street, Chaoyang District, Beijing 100016, China
| | - Yanli Cheng
- Department of Gastroenterology, The First Hospital of Tsinghua University, No. 6 Jiuxianqiao, 1st Street, Chaoyang District, Beijing 100016, China
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Çetinkaya O, Ovayolu Ö. The Effect on Constipation of Abdominal Massage Applied to the Elderly in the Nursing Home: A Randomized Controlled Experimental Study. Gastroenterol Nurs 2024:00001610-990000000-00105. [PMID: 39235867 DOI: 10.1097/sga.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/15/2024] [Indexed: 09/07/2024] Open
Abstract
The aim of this study was to evaluate how abdominal massage affects the constipation of the elderly in the nursing home. This randomized controlled experimental study was conducted with an intervention group ( n = 30) and a control group ( n = 31) in the nursing home of a government institution. A 15-minute abdominal massage was applied to the intervention group once a day, 5 days a week for 1 month. The control group received only routine treatment. The data were collected with a questionnaire, the Constipation Severity Instrument, the Visual Analogue Scale, the Bristol Stool Scale, and the defecation diary. It was determined that the Constipation Severity Instrument mean score, which was 40.6 ± 10.0 before the massage in the intervention group, decreased to 16.0 ± 11.6 after the application. The Visual Analogue Scale total score of the intervention and control groups, which was 40.2 ± 8.4 and 33.2 ± 5.9 before the massage, decreased to 18.7 ± 9.3 and 29.1 ± 6.58, respectively, at the end of the fourth week; the decrease was higher in the intervention group, and this difference between the groups was significant ( p < .05). It was determined that abdominal massage applied to elderly individuals residing in a nursing home reduced constipation. In this sense, it is recommended for nurses to implement abdominal massage in the management of constipation for elderly individuals.
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Affiliation(s)
- Onur Çetinkaya
- About the authors: Onur Çetinkaya, PhD, is a Lecturer, Vocational School of Health Services, Osmaniye Korkut Ata University, Osmaniye, Turkey
- Özlem Ovayolu is affiliated with Faculty of Health Science, Department of Nursing, Gaziantep University, Gaziantep, Turkey
| | - Özlem Ovayolu
- About the authors: Onur Çetinkaya, PhD, is a Lecturer, Vocational School of Health Services, Osmaniye Korkut Ata University, Osmaniye, Turkey
- Özlem Ovayolu is affiliated with Faculty of Health Science, Department of Nursing, Gaziantep University, Gaziantep, Turkey
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Wu S, Yuan G, Wu L, Zou L, Wu F. Identifying the association between depression and constipation: An observational study and Mendelian randomization analysis. J Affect Disord 2024; 359:394-402. [PMID: 38806066 DOI: 10.1016/j.jad.2024.05.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Both depression and constipation are universal disorders that seriously affect quality of life. But the phenotypic relationship and causality between depression and constipation are still unclear. METHODS We first assessed phenotypic relationships by logistic regression analysis using large-scale data extracted from the National Health and Nutrition Examination Survey (N = 11,585). We then evaluated causality by bidirectional two-sample mendelian randomization (MR) analysis using Genome-wide association study (GWAS) data (depression: N = 807,553; constipation: N = 377,277). To investigate whether depression severity affects the causal relationship between depression and constipation, we conducted a further MR study on GWAS data of major depression (N = 480,359). RESULTS About 11.31 % of the participants in the constipation group suffered from depression, which was significantly higher than the normal bowel group (6.09 %). The observational study showed a positive correlation between depression and constipation (OR = 1.968, 95%CI = 1.530-2.532). Besides, the risk of constipation was higher in participants with severe depression (OR = 2.294, 95%CI = 1.538-3.422) than in participants with mild depression (OR = 1.549, 95%CI = 1.242-1.932). Bidirectional MR analysis revealed an obviously causal effect of depression on constipation, but no causal effect of constipation on depression. In addition, the MR analysis also revealed a causal relationship between major depression and constipation. LIMITATION The exact mechanism by which depression affects constipation is still unclear. CONCLUSION This study reveals a positive correlation between depression and constipation and the causal effect of depression on constipation. Clinicians should keep the risk of constipation in mind when treating patients with depression.
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Affiliation(s)
- Shasha Wu
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Guojun Yuan
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Linlin Wu
- Department of Psychosomatic diseases, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Long Zou
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China.
| | - Feixiang Wu
- Department of Urology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China.
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Lu WF, Liu L, Zhang YH, Liu H. Association Between the Inflammatory Potential of Diet and Constipation Among Adults in the United States: A Cross-sectional Study. J Clin Gastroenterol 2024:00004836-990000000-00339. [PMID: 39145808 DOI: 10.1097/mcg.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To investigate the potential association between Dietary Inflammatory Index (DII) scores and constipation among a sample of adults in the United States. METHODS This cross-sectional study used data from adult participants in the 2005 to 2010 National Health and Nutrition Examination Survey (ie, "NHANES"). Self-reported information was used to identify cases of constipation. The DII was used to assess inflammatory potential of the diet. Odds ratios (ORs) and corresponding 95% CIs for the association between the DII and constipation were determined using multivariate logistic regression modeling. Stratified analyses explored whether there was effect modification to influence the relationship between DII and constipation. RESULTS Of 8272 subjects, 759 reported constipation, and 7513 did not, corresponding to a prevalence of 9.2%. After adjusting for age, gender, race/ethnicity, marital status, education level, smoking status, alcohol consumption, physical activity, body mass index (BMI), cardiovascular diseases (CVD), hypertension, stroke, diabetes, energy intake, carbohydrate intake, and selective serotonin reuptake inhibitor (SSRI) use. Compared with lower DII scores group T1 (-5.28 to ≤0.72), the adjusted OR values for DII scores and constipation in T2 (>0.72 to ≤2.50) and T3 (>2.50 to 5.24) were 1.27 (95% CI: 1.02-1.58, P=0.029) and 1.43(95% CI: 1.14-1.8, P=0.002). Subgroup analyses showed that there were effect modification of gender and physical activity factors on DII scores and constipation. CONCLUSIONS Results of this cross-sectional study suggest that a higher dietary inflammatory index score was associated with increased risk of constipation after adjustment for confounding in a multivariable analysis. gender and physical activity were found to be an effect modifier of this relationship.
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Affiliation(s)
- Wang Feng Lu
- Department of Gastrointestinal Surgery, Shangluo Central Hospital, Shanxi, China
| | - Lei Liu
- Department of Gastrointestinal Surgery, Shangluo Central Hospital, Shanxi, China
| | - Yong Hong Zhang
- Department of Gastrointestinal Surgery, Shangluo Central Hospital, Shanxi, China
| | - Huanxian Liu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Li D, Si X, Hua Y, Qian Y, Li H, Lv N, Fang Q, Han X, Xu T. Tongbian formula alleviates slow transit constipation by increasing intestinal butyric acid to activate the 5-HT signaling. Sci Rep 2024; 14:17951. [PMID: 39095450 PMCID: PMC11297216 DOI: 10.1038/s41598-024-68473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
Slow transit constipation (STC) is a long-lasting and prevalent intestinal condition, marked by hard, dry feces. The primary cause of STC may be attributed to an imbalance in the gut's microbial community and alterations in its metabolic byproducts. Tongbian formula (TB), a traditional Chinese medicinal formula, has been used to treat STC and shows a great effect on relieving constipation. The role of TB in regulating intestinal microbiota has not been fully elucidated. Herein, we investigated the potential effect of TB on gut microbiota and further explored the potential mechanism behind its effects. Our study demonstrated that TB significantly increased fecal water content and intestinal ink propulsion rate in loperamide (Lope)-induced STC rats. 5-HT signaling was suppressed in STC colon tissue, and the abundance of butyric acid (BA) in colonic contents was significantly down-regulated after Lope treatment. Notably, TB administration led to the restoration of microbial dysbiosis and the up-regulation of BA content, subsequently activating 5-HT signaling pathways. When BA was combined with a tryptophan hydroxylase-1 (TPH1) inhibitor, which is crucial for 5-HT synthesis, its therapeutic efficacy for treating STC was compromised. TB alleviates STC by reversing the intestinal microbiota imbalance and activating the 5-HT signaling in the colon through increasing BA levels. These findings suggest that TB is an ideal candidate for STC treatment.
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Affiliation(s)
- Dongna Li
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Xianghuan Si
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Yuanqing Hua
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Yunzhi Qian
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hongjia Li
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Na Lv
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Qijun Fang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China.
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Xiaojuan Han
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China.
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School,, Nanjing, 210008, China.
| | - Tianshu Xu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China.
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Xiao CF, Li YF, Sun YY, Meng LY, Wu JW, Wang M, Cao YQ, Wang C, Yao YB. Influence of the examination position and distension medium on the rectal sensory test in patients with functional constipation. BMC Gastroenterol 2024; 24:238. [PMID: 39075408 PMCID: PMC11285343 DOI: 10.1186/s12876-024-03309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
PURPOSE To evaluate the impact of two different parameters (body position and distension medium) on the rectal sensory test in patients with functional constipation and provide data support for the development of standardized operating procedures in clinical practice. METHODS Based on a single-center process of the rectal sensory test, 39 patients with functional constipation were recruited for rectal sensory test under different body positions and distension mediums. RESULTS Among the items of the Constipation Scoring System, the score of frequency of bowel movements showed a negative correlation with the first constant sensation volume (r = -0.323, P = 0.045). Conversely, the score of painful evacuation effort showed a positive correlation with the desire to defecate volume (r = 0.343, P = 0.033). There was a statistically significant difference in the first constant sensation volume (when the distension medium was gas) measured in different body positions (left lateral position, sitting position, squatting position), and the data measured in the squatting position were significantly higher than those in left lateral position (P < 0.05). In terms of research on distension medium, it was found that the first constant sensation volume measured in the squatting position (when the distension medium was water) was significantly lower than that of gas (P < 0.05). CONCLUSION For patients with functional constipation, there are differences in the results of rectal sensory tests between body positions and distension mediums. When conducting multicenter studies, it is necessary to unify the standard operating procedure (SOP) for operational details to ensure consistency and reliability of the test results.
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Affiliation(s)
- Chang-Fang Xiao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yi-Fan Li
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yang-Yang Sun
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Ling-Yun Meng
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Jing-Wen Wu
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Min Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yong-Qing Cao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yi-Bo Yao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
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Jiang C, Shao Y. The effects of specific vegetable subtypes on constipation incidence in the general United States population. Front Nutr 2024; 11:1403636. [PMID: 39114125 PMCID: PMC11304535 DOI: 10.3389/fnut.2024.1403636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background While the intake of larger quantities of vegetables has been linked to a reduction in constipation risk, which vegetables in particular underlie this risk reduction remains incompletely understood. As such, the present study was developed to explore correlations between the intake of particular vegetable types and the risk of constipation. Methods This cross-sectional analysis was based on data from the National Health and Nutrition Examination Survey (NHANES) collected from 2005-2010. Classifications and intake assessments for different vegetables were assessed with the Food Patterns Equivalents Database (FPED), while stool frequency or stool consistency was used to define constipation. Relationships between the intake of particular vegetable components and constipation were assessed through a weighted logistic regression approach. Subgroup and restricted cubic spline (RCS) regression analyses were further employed to explore associations between specific vegetable subtypes and constipation. Results This study included 13,860 eligible subjects, of whom 1,405 and 12,455 were respectively classified into the constipated and non-constipated groups. Following multivariate adjustment, the intake of non-starchy vegetables including orange, red, dark green, and other vegetables was found to be positively associated with a reduction in constipation risk. In contrast, constipation was unrelated to total starchy vegetable or potato intake. Tomatoes, in particular, were associated with a marked decrease in constipation risk (odds ratios: 0.80, 95% confidence interval: 0.71-0.91). These results were confirmed through RCS and subgroup analyses. Conclusion Non-starchy vegetables, particularly tomatoes, were found to be associated with a pronounced reduction in constipation risk, which was unaffected by the intake of potatoes or starchy vegetables.
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Affiliation(s)
- Chenyu Jiang
- Department of Geriatric, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Yaojian Shao
- Department of Gastroenterology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Sun W, Wang Y, Han L, Liu Y, Liu H, Tong Y, Jiang Z, Sun D, Xu C. Association between different composite dietary antioxidant indexes and constipation in American male adults: a cross-sectional study. Front Nutr 2024; 11:1404400. [PMID: 39091680 PMCID: PMC11292948 DOI: 10.3389/fnut.2024.1404400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Background Oxidative stress is acknowledged as a pivotal factor in the intricate pathophysiological processes and pathogenesis of constipation. Modifying dietary patterns can elevate in vivo antioxidant biomarker levels, consequently mitigating oxidative stress. The Composite Dietary Antioxidant Index (CDAI) provides a dependable scoring mechanism for quantifying the potential antioxidant capacity of diets. The association between CDAI levels and the risk of constipation remains uncertain. Purpose To investigate the potential correlation between CDAI and constipation, aiming to improve constipation management through dietary guidance. Methods A total of 11,165 adults aged ≥20 years, drawn from the 2005-2010 National Health and Nutrition Examination Survey, were enrolled in this cross-sectional study. We evaluated the correlation between CDAI levels and the risk of constipation through three weighted logistic regression models. Restricted cubic spline (RCS) analysis was employed to assess nonlinear trends, and stratified analyses were conducted. Results After adjusting for all confounding variables, the findings revealed an association between CDAI and constipation [OR = 0.937; 95% CI (0.892, 0.984), p = 0.012]. Moreover, individuals in the highest quartile of CDAI demonstrated a 40.1% lower likelihood of experiencing constipation compared to those in the lowest quartile [OR = 0.599; 95% CI (0.382, 0.939), p = 0.027]. The RCS analysis indicated a linear relationship between CDAI and constipation (P-non-linear =0.1016). Subgroup analysis by gender revealed a negative correlation in the male population [OR = 0.871; 95% CI (0.801, 0.947), p = 0.002], with men in the highest CDAI quartile exhibiting a 59.8% lower likelihood of experiencing constipation compared to those in the lowest quartile [OR = 0.402; 95% CI (0.206, 0.787), p = 0.010]. Furthermore, alterations in selenium [OR = 0.997; 95% CI (0.995, 1.000), p = 0.039] per milligram were independently linked to constipation. In a gender subgroup analysis of a single antioxidant, changes per milligram of vitamin E [OR = 0.904; 95% CI (0.838 to 0.975), p = 0.011] among males were independently associated with constipation. Conclusion The fully adjusted model showed a correlation between CDAI and constipation and a significant correlation in quartiles. Meanwhile, subgroup analysis by gender showed that CDAI was negatively associated with constipation in the male population. Moreover, the findings of this study imply that investigations into antioxidant diets should be contextualized within dietary patterns.
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Affiliation(s)
- Wei Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuchao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Lu Han
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yinshi Liu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Hongru Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yunbing Tong
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ziying Jiang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Xu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
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Ezquerra-Durán A, Barba E. Management of abdominal bloating and distension, from subjective to objective. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116. [PMID: 38989882 DOI: 10.17235/reed.2024.10482/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Abdominal distension is a clinical occurrence that involves a measurable, objective increase in abdominal circumference, which patients report as feeling like pregnant or like having a balloon inside the abdomen. This sign is often preceded by a subjective feeling of abdominal heaviness or bloating, reported as the sensation of having a huge amount of gas trapped inside. These manifestations are highly prevalent and may reflect on their own a gut-brain axis condition, such as functional abdominal distension, or be part of other disorders such as functional dyspepsia or irritable bowel syndrome (IBS). The prevalence of abdominal distension and bloating is 3.5 %. However, when associated with other gut-brain axis disorders such as dyspepsia or IBS, prevalence grows above 50 %. The etiology and pathophysiology of abdominal bloating and distension are highly complex and represent a challenge for both the practitioner and the patient. The patient often associates these sensations with trapped gas, and attributes them to some food intolerance, hence he/she adopts a highly restrictive diet that fails to resolve distension while incurring the risk of nutritional deficiencies or secondary dysbiosis, making a directed treatment guideline necessary.
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Miao Y, Xie X, Zhang Y, Ma X, Zhu X, Li R, Bi J, Duan R, Ai X. Analysis of differentially expressed lncRNAs and mRNAs associated with slow‑transit constipation. Gene 2024; 914:148400. [PMID: 38527672 DOI: 10.1016/j.gene.2024.148400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
Slow transit constipation (STC) is a refractory gastrointestinal disease, accounting for approximately 13 ∼ 37 % of chronic constipation. However, the molecular mechanism of STC remains poorly understood. Herein, this study aims to identify the key mRNAs and lncRNAs associated with STC. To this end, we performed high-throughput RNA sequencing to identify differentially expressed (DE) mRNAs and lncRNAs in the whole-layer sigmoid intestinal tissues from 4 STC patients and 4 non-STC patients. The identified DE lncRNAs and mRNAs were validated through quantitative real-time PCR. Weighted gene co-expression network analysis (WGCNA) and Pearson correlation analysis were conducted to determine the significantly correlated DE mRNA-lncRNA pairs. A total of 1420 DE lncRNAs and 1634 DE mRNAs were identified. Kyoto Encyclopedia of Genes and Genomes analysis of DE mRNAs indicated that these DE mRNAs might be associated with systemic lupus erythematosus, alcoholism, intestinal immune network for IgA production, inflammatory bowel disease, NF-kappa B signaling pathway. WGCNA and Pearson correlation analyses jointly identified 16,577 significantly correlated DE mRNA-lncRNA pairs. Furthermore, lncRNAs LINC00641, LINC02268, LINC03013 were identified as hub lncRNAs. The protein-protein interaction (PPI) network of proteins encoded by DE mRNAs was established, and PPI-based analysis revealed that Interleukin 2(IL2), CD80 molecule (CD80), interleukin-17A (IL-17A) might play significant roles in the development of STC. This study analyzes the expression profiles of lncRNAs and mRNAs associated with STC. Our findings will contribute to further understanding of the molecular mechanism of STC and provide potential diagnostic or therapeutic biomarkers for STC.
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Affiliation(s)
- Yuanxin Miao
- Research Institute of Agricultural Biotechnology, Jingchu University of Technology, Jingmen 448000, China
| | - Xiongwei Xie
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China
| | - Yonglian Zhang
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China
| | - Xu Ma
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China
| | - Xiaoxuan Zhu
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China
| | - Rong Li
- Research Institute of Agricultural Biotechnology, Jingchu University of Technology, Jingmen 448000, China
| | - Jinhua Bi
- Research Institute of Agricultural Biotechnology, Jingchu University of Technology, Jingmen 448000, China
| | - Rui Duan
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China.
| | - Xu Ai
- Clinical Medical Research Center for Functional Colon Diseases of Hubei Province, Jingmen Central Hospital, Hubei Province, China.
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Taclob JA, Kalas MA, McCallum RW. Examining linaclotide for the treatment of chronic idiopathic constipation. Expert Opin Pharmacother 2024; 25:1281-1290. [PMID: 39058326 DOI: 10.1080/14656566.2024.2386160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is characterized by infrequent bowel movements and hard stools lasting for at least three months or longer. This disease affects 8-12% of the US population and 10-17% of the world population. Treatment and management involve identifying the primary cause, changing dietary habits, and adequate physical activity. Linaclotide is a guanylate cyclase-agonist acting locally in the luminal surface of the intestinal enterocyte leading to a signal transduction cascade, activation of the cystic fibrosis transmembrane conductance regulator (CFTR), thus increasing secretion of chloride and bicarbonate into the intestinal lumen with eventual increased intestinal fluid and faster transit time. AREAS COVERED We reviewed multiple studies and did a thorough literature review on CIC including its pathophysiology. Through this literature review, we were able to discuss and give the context and rationale for drug regimens indicated for CIC. EXPERT OPINION The era we live in right now is akin to nutrient-rich and fertilized soil as knowledge and resources are abundant. The opportunities and potential are endless. Constipation being more extensively studied, our understanding of medications and diseases broadens, leading to novel medications being discovered. Linaclotide is a pioneer in this aspect and can pave the way for future generations.
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Affiliation(s)
- Jeff Angelo Taclob
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - M Ammar Kalas
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Garg P, Clemente N, Mahak G, James KCW. Letter to the editor regarding primary idiopathic constipation: could it be mediated through lack of thirst? A novel observation. J Gastrointest Surg 2024; 28:1220-1221. [PMID: 38740255 DOI: 10.1016/j.gassur.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Pankaj Garg
- CEO and Chief Colorectal Surgeon, Garg Fistula Research Institute, Panchkula, India.
| | - Nicola Clemente
- Consultant Colorectal Surgeon, U.O. Chirugia, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Veneto, Italy
| | - Garg Mahak
- Chief Research and Scientific Officer, Garg Fistula Research Institute, Panchkula, India
| | - Khaw C W James
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Penang General Hospital, Penang, Malaysia
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13
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Salaja B, Kunna M, Hogan A. Three twisted tales: A case series of caecal volvulus. Int J Surg Case Rep 2024; 120:109776. [PMID: 38810294 PMCID: PMC11153927 DOI: 10.1016/j.ijscr.2024.109776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Caecal volvulus is a form of intestinal obstruction with life-threatening potential. While rare, it represents a perilous aetiology of intestinal blockage, with clinical manifestations spanning from abdominal discomfort to mortality. CASE SERIES We report the cases of three young adults (two males and one female) who presented to the emergency department with different manifestations of severe abdominal pain. All occurred within one month in a tertiary referral centre. Radiological evaluations confirmed the diagnosis of caecal volvulus in all. Subsequently, these individuals underwent right hemicolectomies with end-to-end anastomosis. All experienced an uncomplicated perioperative course. CLINICAL DISCUSSION Caecal volvulus is uncommon, but its yearly incidence is increasing. Early detection and a heightened level of suspicion lead to a timely diagnosis, reducing morbidity and mortality rates. CONCLUSION We report a case series of caecal volvulus, emphasizing its variable presentation and highlighting the critical importance of an early diagnosis. Typically, patients have a history of similar episodes that resolve without any medical intervention. Definitive treatment involves right hemicolectomy while conservative management is associated with very high recurrence rates. Early detection allows for prompt intervention, resulting in reduced morbidity and mortality rates.
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Affiliation(s)
- Bisola Salaja
- Department of Colorectal Surgery, University Hospital Galway, Newcastle Rd, Galway H91 YR71, Ireland.
| | - Mobarak Kunna
- Department of Colorectal Surgery, University Hospital Galway, Newcastle Rd, Galway H91 YR71, Ireland
| | - Aisling Hogan
- Department of Colorectal Surgery, University Hospital Galway, Newcastle Rd, Galway H91 YR71, Ireland; School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Ireland
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Whorwell P, Lange R, Scarpignato C. Review article: do stimulant laxatives damage the gut? A critical analysis of current knowledge. Therap Adv Gastroenterol 2024; 17:17562848241249664. [PMID: 38887508 PMCID: PMC11181897 DOI: 10.1177/17562848241249664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 06/20/2024] Open
Abstract
Stimulant laxatives are well established as first- or second-line treatments for constipation and although they have a reliable therapeutic effect, alleged safety concerns still exist, particularly with long-term use. The potential harmful effects on the gastrointestinal system (including carcinogenicity) of the long-term use of diphenylmethane [bisacodyl, sodium picosulfate (SPS)] and senna stimulant laxatives were assessed in a comprehensive review of the publications identified in literature searches performed in PubMed and Embase up to and including June 2023. We identified and reviewed 43 publications of interest. While stimulant laxatives at supratherapeutic doses have been shown to cause structural alterations to surface absorptive cells in animals and humans, these effects are reversible and not considered clinically relevant. No formal long-term studies have demonstrated morphological changes in enteric neural elements or intestinal smooth muscle with bisacodyl or SPS in humans. Furthermore, there is no convincing evidence that stimulant laxatives are associated with the development of colon cancer, and in fact, chronic constipation itself has been reported to potentially increase the risk of colon cancer, therefore, the use of stimulant laxatives might reduce this risk. Many studies suggesting a possible harmful effect from laxatives were limited by their failure to consider confounding factors such as concomitant neurological disease, metabolic disorders, and age. These findings highlight the lack of evidence for the harmful effects of laxatives on the colon, and thus, the benefits of treatment with stimulant laxatives, even in the long-term, should be reconsidered for the management of patients with constipation.
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Affiliation(s)
- Peter Whorwell
- Neurogastroenterology Unit, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | | | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta
- Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
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Yamamoto S, Ohashi W, Yamaguchi Y, Igari H, Koshino A, Sugiyama T, Nagao K, Tamura Y, Izawa S, Mano M, Ebi M, Usami J, Hamano K, Izumi J, Wakita Y, Funaki Y, Ogasawara N, Sasanabe R, Sasaki M, Maekawa M, Kasugai K. Factors Associated with Defecation Satisfaction among Japanese Adults with Chronic Constipation. J Clin Med 2024; 13:3216. [PMID: 38892926 PMCID: PMC11172833 DOI: 10.3390/jcm13113216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Constipation causes substantial morbidity worldwide. Methods: This survey assessed constipation-related factors in Japan using the Japanese version of the Irritable Bowel Syndrome Quality of Life (IBS-QOL-J) instrument. We also examined the relationship among laxative type, Bristol Stool Form Scale (BSFS) scores, and treatment cost. Finally, we examined differences in satisfaction scores according to laxative type, treatment type, treatment cost, and BSFS score. Results: IBS-QOL-J was higher among those taking salt and/or irritation laxatives. Those paying >JPY 5000 (USD 50.00) had the lowest IBS-QOL-J. IBS-QOL-J was significantly lower among those with a BSFS score of 1 or 2 (severe constipation). Conclusions: This study's findings suggest that a variety of factors, including treatment type and cost, are associated with defecation satisfaction. Those who had hard stools, used multiple laxatives, or spent more on treatment were less satisfied. Future strategies should target therapies that do not require multiple laxatives with lower treatment costs. Adequate defecation with a small number of appropriate laxatives at minimal cost appears to improve defecation satisfaction. It is desirable to identify appropriate laxatives and improve dietary habits and exercise routines. It is also necessary to stop blindly increasing laxative usage and properly diagnose constipation disorders such as anatomical abnormalities other than functional constipation.
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Affiliation(s)
- Sayuri Yamamoto
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yoshiharu Yamaguchi
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroki Igari
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Akira Koshino
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Tomoya Sugiyama
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Kazuhiro Nagao
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yasuhiro Tamura
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Shinya Izawa
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Mamiko Mano
- Division of Sleep Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Masahide Ebi
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Jun Usami
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Koichi Hamano
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Junko Izumi
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yoshinori Wakita
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yasushi Funaki
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Naotaka Ogasawara
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ryujiro Sasanabe
- Division of Sleep Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Makoto Sasaki
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Masato Maekawa
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
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Huai Y, Fan Q, Dong Y, Li X, Hu J, Liu L, Chen Y, Yin P. Efficacy and mechanism of acupuncture for functional constipation in older adults: study protocol for a randomized controlled trial. Front Neurol 2024; 15:1341861. [PMID: 38685950 PMCID: PMC11056592 DOI: 10.3389/fneur.2024.1341861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Functional constipation (FC) is a common functional gastrointestinal disorder in clinical practice, with the prevalence of which increasing with age. With the increasing aging of the population worldwide, this problem is bound to become more prominent. Acupuncture is effective and recommended for the treatment of FC. However, little is known about how acupuncture affects the gut microbiota and inflammatory cytokines and thus improves gut function. Meanwhile, there are few high-quality clinical trials specifically focusing on acupuncture in treating FC in older people. The objective of this study is to assess the efficacy and safety of acupuncture in treating FC in older people. Additionally, the research aims to explore the mechanism of action of acupuncture in treating FC in older people by affecting intestinal microbiota and inflammation cytokines. Methods and analysis This study is designed as a single-center, randomized, sham-controlled clinical trial. A total of 98 eligible FC patients will be randomized in a 1:1 ratio into an acupuncture group and a sham acupuncture group. Both groups will receive 24 treatments over 8 weeks with a 12-week follow-up. The primary outcome of the study is the treatment response rate, which is the proportion of participants with ≥3 mean weekly Complete Spontaneous Bowel Movements (CSBMs) over weeks 3-8. The secondary outcomes will include the proportion of participants with ≥3 mean weekly CSBMs during other assessment periods; the percentage of patients with ≥1 increase in mean weekly CSBMs from baseline; the average changes in CSBMs; Patient Assessment of Constipation-Symptoms (PAC-SYM), Bristol Stool Scale, Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and weekly usage of emergency bowel medications. Adverse events will be recorded throughout the study. Data for the outcomes will be collected at Week 0 (baseline), Week 4 (the intervention period), Week 8 (the post-treatment), Week 12 (the follow-up period) and Week 20 (the follow-up period). In addition, changes in intestinal microbiota will be analyzed using 16S rRNA high-throughput detection, and the concentration of relevant inflammatory cytokines in serum will be measured by ELISA based on blood samples. The intention-to-treat analysis will be performed in this study.Clinical trial registration: [https://www.chictr.org.cn/], identifier [ChiCTR2300070735].
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Affiliation(s)
| | | | | | | | | | | | - Yuelai Chen
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Yin
- Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Valiyeva S, Tiso D, Cerri P, Pisciaroli A, Pietroletti R. Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome. Front Surg 2024; 11:1361049. [PMID: 38650661 PMCID: PMC11033349 DOI: 10.3389/fsurg.2024.1361049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction The term "obstructive defecation syndrome" (ODS) describes a complex condition characterized by defecatory disorders. Such a condition represents a significant proportion of patients, which is estimated to be up to 30% of patients affected by chronic constipation. Presently, a broad agreement has been reached on diagnostic studies, whereas the choice of treatment that aims to improve the quality of life and/or correct the prevalent abnormalities or all anatomical abnormalities remains controversial. Methods This was a retrospective cohort study on 174 patients out of a total of 232 with ODS who were observed in a specialized university unit of surgical coloproctology between 2018 and 2022. Clinical assessment included examining the values of the Agachan-Wexner constipation score and Patient Assessment of Constipation (PAC)-quality of life (QoL) scores, a full digital anorectal examination, anoscopy, RX defecography, and a urogynecological consultation; a functional anorectal test, an endoanal ultrasound, and colonoscopy were performed in select patients. The patients were reevaluated after an 8-10-week course of medical treatment based on a high-fiber diet and fluid intake and 6 g of psyllium combined with lactobacillus and tryptophan b.i.d. The results were analyzed by means of the Wilcoxon rank-sum test, comparing pretreatment scores with the results at the first follow-up visit. Results After 8-10 weeks of conservative treatment, 128 patients declared full satisfaction, 29 reported moderate satisfaction, and 17 (9.7%) declared no improvement. Among these 17, there were 5 patients with paradoxical puborectal contractions. The value of the Agachan-Wexner constipation score after treatment decreased from the pretreatment Agachan-Wexner constipation score mean value of 23.4 ± 3.7 (mean ± SD range 15-27) to a mean value of 5.3 ± 0.7 (range 3-8, p < 0.001). The quality of life improved, as shown by the PAC-QoL score, indicating great improvement in social relationships. Conclusions Given the benefits of conservative therapies, they represent a cornerstone in the treatment of ODS, a complex disorder. Diet and bulking agents are mandatory forms of treatment prior to making any surgical attempt, also considering the fact that the psychosomatic component of ODS is an essential prerequisite to match patient expectations.
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Affiliation(s)
- Sayali Valiyeva
- Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila, L'Aquila, Italy
| | - Domenico Tiso
- Clinical Nutrition, “Villa Maria” Hospital, Rimini, Italy
| | - Paolo Cerri
- General Surgery Department, Val Vibrata Hospital, Sant’Omero, Italy
| | | | - Renato Pietroletti
- Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila, L'Aquila, Italy
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18
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Sun D, Yu J, Zhan Y, Cheng X, Zhang J, Li Y, Li Q, Xiong Y, Liu W. Lacidophilin tablets alleviate constipation through regulation of intestinal microflora by promoting the colonization of Akkermansia sps. Sci Rep 2024; 14:7152. [PMID: 38531966 DOI: 10.1038/s41598-024-57732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Constipation is a major health problem worldwide that requires effective and safe treatment options. Increasing evidence indicates that disturbances in gut microbiota may be a risk factor for constipation. Administration of lacidophilin tablets shows promising therapeutic potential in the treatment of inflammatory bowel disease owing to their immunomodulatory properties and regulation of the gut microbiota. The focus of this study was on investigating the ability of lacidophilin tablets to relieve constipation by modulating the gut microbiome. Rats with loperamide hydrochloride induced constipation were treated with lacidophilin tablets via intragastric administration for ten days. The laxative effect of lacidophilin tablets was then evaluated by investigating the regulation of intestinal microflora and the possible underlying molecular mechanism. Our results reveal that treatment with lacidophilin tablets increased the intestinal advancement rate, fecal moisture content, and colonic AQP3 protein expression. It also improved colonic microflora structure in the colonic contents of model rats mainly by increasing Akkermansia muciniphila and decreasing Clostridium_sensu_stricto_1. Transcriptome analysis indicated that treatment with lacidophilin tablets maintains the immune response in the intestine and promotes recovery of the intestinal mechanical barrier in the constipation model. Our study shows that lacidophilin tablets improve constipation, possibly by promoting Akkermansia colonization and by modulating the intestinal immune response.
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Affiliation(s)
- Denglong Sun
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Jingting Yu
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Yang Zhan
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Xiaoying Cheng
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Jingwen Zhang
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Yingmeng Li
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China
| | - Qiong Li
- Department of Food Nutrition and Safety, College of Pharmacy, Jiangxi University of Chinese Medicine, Nanchang, 330004, Jiangxi Province, China.
| | - Yanxia Xiong
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China.
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China.
| | - Wenjun Liu
- Research and Development Department, Jiangzhong Pharmaceutical Co., Ltd., No. 1899 Meiling Road, Nanchang, 330103, Jiangxi Province, People's Republic of China.
- National Key Laboratory for the Modernization of Classical and Famous Prescriptions of Chinese Medicine, No. 788 Huoju Avenue, Gaoxin Dev District, Nanchang, 330096, People's Republic of China.
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Lacy BE, Delfini R, Fladung B, Lange R. Prevalence and patterns of laxative use in subjects with self-reported constipation: results from a multinational digestive health survey. Therap Adv Gastroenterol 2024; 17:17562848241232605. [PMID: 38445248 PMCID: PMC10913501 DOI: 10.1177/17562848241232605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/17/2024] [Indexed: 03/07/2024] Open
Abstract
Background Constipation is characterized by symptoms of straining, hard stool, difficult evacuation, and infrequent bowel movements. Online surveys provide valuable information about patients' perspectives, symptoms, management, treatment satisfaction, and risk factors. Methods This survey explored subject experiences involving 20 gastrointestinal (GI) conditions. In total, 20,099 respondents in seven countries with varied cultural and socioeconomic backgrounds participated. Post hoc analysis of 'self-reported constipation' and related symptoms experienced within the past 6 months and the last episode of constipation provided data on prevalence, demographics, frequency and duration of episodes and related symptoms, impact on quality of life (QoL), management with or without laxatives, and resulting treatment satisfaction. Results In total, 10,425 subjects reported constipation within 6 months and 2637 at the last episode. Prevalence was highest in females and younger adults. Most subjects reported various coexisting GI symptoms. Almost 80% of 6865 episodes reported by 5337 subjects occurred every 2-3 months to every 2-3 weeks. A higher frequency of constipation correlated with a greater impact on QoL. On a 10-point scale, the mean impact was 6.4. More than 90% of respondents had episodes ranging from 1 day to 1 week. More than 90% took action; 16% used laxatives, of whom 80.3% were satisfied. Conclusion Constipation, a highly prevalent disorder, spans cultures and socioeconomic classes. Its chronic recurrence has a significant impact on QoL, resulting in symptom self-management in >90% of subjects. Significantly higher satisfaction rates in subjects treated with than without laxatives reflect subjects' reports that self-reported constipation can be treated effectively with laxatives.
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Affiliation(s)
- Brian E. Lacy
- Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Bernward Fladung
- Freelance Medical Advisor, Linnich, Germany
- Régis Delfini is currently affiliated to Boehringer Ingelheim, Ingelheim, Germany
| | - Robert Lange
- Industriepark Hoechst, Building K 607, 65929 Frankfurt am Main, Germany
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Kawamata Y, Sugawara N, Sasaki T, Yokoyama S, Okayasu H, Shinozaki M, Takeuchi Y, Sato A, Ishikawa T, Komahashi‐Sasaki H, Miyazaki K, Fukasawa T, Furukori H, Yasui‐Furukori N. Factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20-year period: Retrospective cohort study. Neuropsychopharmacol Rep 2024; 44:60-66. [PMID: 37698084 PMCID: PMC10932797 DOI: 10.1002/npr2.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Constipation is a common adverse effect of antipsychotics, but little investigation has been conducted. We aimed to address the factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20-year period. METHODS We enrolled patients with schizophrenia attending each hospital (n = 14) from April 1, 2021, and retrospectively examined all prescriptions as of April 1, 2016, 2011, 2006, and 2001, every 5 years starting in 2021, for this population. 716 participants with complete data were included in the analysis. The Cochran Q test followed by Bonferroni correction and the Cochran-Armitage trend test were used to determine the differences and trends of the frequency of each laxative. Multivariate logistic regression analysis was performed to assess the factors on the initiation of laxative use over a 20-year period. RESULTS Of the patients, 25.1% were treated with laxatives in 2001, and 34.1% were treated in 2021. The numbers of patients treated with any laxatives significantly differed over the 20-year period, with a significant increasing trend. In all laxatives, the numbers of patients treated with magnesium oxide, lubiprostone and elobixibat differed with a significant increasing trend. Female sex, age, the total DZP equivalent dose, and the doses of levomepromazine maleate, olanzapine, quetiapine, zotepine, lithium, and carbamazepine in 2021 were significant factors associated with the initiation of laxative use over the 20-year period. CONCLUSIONS Careful monitoring is needed for patients treated with levomepromazine maleate, olanzapine, quetiapine and zotepine. Optimizing prescriptions according to treatment guidelines could reduce antipsychotic-induced constipation.
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Affiliation(s)
- Yasushi Kawamata
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryKikuchi HospitalTochigiJapan
| | - Norio Sugawara
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryTMC ShimotsugaTochigiJapan
| | - Taro Sasaki
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryAsahi HospitalTochigiJapan
| | - Saaya Yokoyama
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryAoki HospitalTochigiJapan
| | - Hiroaki Okayasu
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryFudogaoka HospitalSaitamaJapan
| | - Masataka Shinozaki
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryTakizawa HospitalTochigiJapan
| | - Yoshitaka Takeuchi
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryOkamotodai HospitalTochigiJapan
| | - Aoi Sato
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryMuroi HospitalTochigiJapan
| | - Takaaki Ishikawa
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatrySaitama‐Konan HospitalSaitamaJapan
| | - Hazuki Komahashi‐Sasaki
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryKanuma HospitalTochigiJapan
| | - Kensuke Miyazaki
- Department of NeuropsychiatryHirosaki‐Aiseikai HospitalAomoriJapan
| | | | - Hanako Furukori
- Department of NeuropsychiatryKuroichi‐Akebono HospitalAomoriJapan
| | - Norio Yasui‐Furukori
- Department of Psychiatry, School of MedicineDokkyo Medical UniversityTochigiJapan
- Department of PsychiatryTMC ShimotsugaTochigiJapan
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21
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Jiang HY, Ma RA, Ji FL, Liu Y, Wang B, Fu SQ, Ma LS, Wang S, Liu CX, Guo Z, Li R, Wang YC, Sun W, Dong L, Dong CX, Sun DQ. Structure characterization of polysaccharides from Cistanche deserticola and their neuroprotective effects against oxidative stress in slow transit constipation mice. Int J Biol Macromol 2024; 260:129527. [PMID: 38246435 DOI: 10.1016/j.ijbiomac.2024.129527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
Oxidative stress-induced enteric neuropathy is an important factor in slow transit constipation (STC). Cistanche deserticola crude polysaccharides (CDCP) are natural antioxidants with various biological activities. We prepared CDCP through water-extract and alcohol-precipitation methods. The structural characteristics of CDCP were analyzed by infrared spectroscopy and methylation analysis. The results showed that CDCP was primarily composed of (1 → 4)-linked glucans with minor amounts of pectic polysaccharides. Different doses of CDCP (100, 200, and 400 mg/kg) were administered to loperamide-induced STC mice to explore the therapeutic effects of CDCP. Compared with the untreated group, CDCP treatment significantly improved constipation symptoms, relevant gut-regulating peptides levels, colonic pathological damage, and colonic myenteric nerons injury. CDCP enhanced the antioxidant capacity by decreasing Malondialdehyde (MDA) content, increasing Superoxide Dismutase (SOD) activity and Reduced Glutathione (GSH) content. CDCP significantly reduced oxidative stress-induced injury by preserving mitochondrial function in the colonic myenteric plexus. Furthermore, the neuroprotective effects of CDCP might be associated with the Nrf2/Keap1 pathway. Thus, our findings first revealed the potential of CDCP to protect the colonic myenteric plexus against oxidative stress-induced damage in STC, establishing CDCP as promising candidates for natural medicine in the clinical management of STC.
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Affiliation(s)
- Hong-Yu Jiang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Department of General Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin 300074, China
| | - Rui-An Ma
- Department of Pharmacognosy, College of Pharmacy, Jiamusi University, Jiamusi 154007, China; Tianjin Key Laboratory on Technologies Enabling Development of Clinical, Therapeutics and Diagnosis, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Fu-Long Ji
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yong Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bo Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Si-Qi Fu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lu-Shun Ma
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Song Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chun-Xiang Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zheng Guo
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Rui Li
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yu-Chao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wei Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Liang Dong
- Department of General Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin 300074, China.
| | - Cai-Xia Dong
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical, Therapeutics and Diagnosis, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China.
| | - Da-Qing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Lodhia NA, Hiramoto B, Horton L, Goldin AH, Thompson CC, Chan WW. Obesity Is Associated with Altered Rectal Sensitivity in Chronic Constipation. Dig Dis Sci 2024; 69:884-891. [PMID: 38184499 PMCID: PMC10961196 DOI: 10.1007/s10620-023-08246-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between obesity and anorectal function on physiologic testing in patients presenting with CC. METHODS This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m2) vs non-obese (BMI < 30 kg/m2) groups at the time of HRAM. Fisher-exact/student t-test for univariate analyses and general linear regression for multivariable analysis were performed. RESULTS 383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg, p = 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg, p = 0.043). No significant differences in dyssynergia (61% vs 53%, p = 0.294) and failed balloon expulsion (18% vs 25%, p = 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL, p = 0.042) and urge sensation (113.9 vs 103.7 mL, p = 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (β-coefficient 13.7, p = 0.049). CONCLUSION Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.
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Affiliation(s)
- Nayna A Lodhia
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Brent Hiramoto
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Horton
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alison H Goldin
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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23
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Zhu F, Li F, Lyu MH, Feng BC, Lin L, Tang YR, Qian D, Yu T. Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis. J Dig Dis 2024; 25:176-190. [PMID: 38697922 DOI: 10.1111/1751-2980.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Functional constipation (FC), a common functional gastrointestinal disorder, is usually overlapping with upper gastrointestinal symptoms (UGS). We aimed to explore the clinical characteristics of patients with FC overlapping UGS along with the related risk factors. METHODS The differences in the severity of constipation symptoms, psychological state, quality of life (QoL), anorectal motility and perception function, autonomic function, and the effect of biofeedback therapy (BFT) among patients with FC in different groups were analyzed, along with the risk factors of overlapping UGS. RESULTS Compared with patients with FC alone, those with FC overlapping UGS had higher scores in the Patient Assessment of Constipation Symptoms and Self-Rating Anxiety Scale and lower scores in the Short Form-36 health survey (P < 0.05). Patients with FC overlapping UGS also had lower rectal propulsion, more negative autonomic nervous function, and worse BFT efficacy (P < 0.05). Overlapping UGS, especially overlapping functional dyspepsia, considerably affected the severity of FC. Logistic regression model showed that age, body mass index (BMI), anxiety, exercise, and sleep quality were independent factors influencing overlapping UGS in patients with FC. CONCLUSIONS Overlapping UGS reduces the physical and mental health and the QoL of patients with FC. It also increases the difficulty in the treatment of FC. Patient's age, BMI, anxiety, physical exercise, and sleep quality might be predictors for FC overlapping UGS.
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Affiliation(s)
- Feng Zhu
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Gastroenterology, The First People's Hospital of Kunshan, Kunshan, Jiangsu Province, China
| | - Fei Li
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Mei Hui Lyu
- Department of Gastroenterology, Yixing People's Hospital, Wuxi, Jiangsu Province, China
| | - Ben Chang Feng
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lin Lin
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yu Rong Tang
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Dong Qian
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ting Yu
- Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
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Wang X, Guo R, Yu Z, Zikela L, Li J, Li S, Han Q. Torreya grandis Kernel Oil Alleviates Loperamide-Induced Slow Transit Constipation via Up-Regulating the Colonic Expressions of Occludin/Claudin-1/ZO-1 and 5-HT3R/5-HT4R in BALB/c Mice. Mol Nutr Food Res 2024; 68:e2300615. [PMID: 38152983 DOI: 10.1002/mnfr.202300615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/11/2023] [Indexed: 12/29/2023]
Abstract
SCOPE Torreya grandis kernel has traditionally been used to remove intestinal parasites and increases intestinal motility. However, the effect of Torreya grandis kernel oil (TKO) on constipation has not yet been investigated. Therefore, mouse model is used to investigate the effect of TKO on slow transit constipation (STC) and its possible mechanism. METHODS AND RESULTS The effects of TKO on intestinal motility of STC mice are evaluated by fecal weight, fecal water content, colon length, defecation test, and intestinal propulsion test. The mechanism of TKO alleviating STC is explored by detecting biochemical analysis, histological analysis, western blot, qRT-PCR, immunohistochemistry, and gut microbiota analysis. The results reveal that TKO effectively promotes defecation and intestinal motility, increases the level of endothelin-1, and restores the histopathological morphology of the colon under LOP pretreatment. The expression levels of occludin, claudin-1, and zonula occludens-1 (ZO-1) mRNA and protein are up-regulated in mice receiving TKO treatment. The colonic 5-hydroxytryptamine 3R/4R (5-HT3R/5-HT4R) expressions are also increased by TKO supplementation. Additionally, TKO rescues LOP-caused disorders of the gut microbiota. CONCLUSION Consumption of TKO is beneficial to STC recovery, and it can alleviate LOP-induced STC by up-regulating the colonic expressions of Occludin/Claudin-1/ZO-1 and 5-HT3R/5-HT4R.
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Affiliation(s)
- Xuezhu Wang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Rui Guo
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Zhuoli Yu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Lalai Zikela
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Jiaomei Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Songtao Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Qiang Han
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
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Brenner DM, Corsetti M, Drossman D, Tack J, Wald A. Perceptions, Definitions, and Therapeutic Interventions for Occasional Constipation: A Rome Working Group Consensus Document. Clin Gastroenterol Hepatol 2024; 22:397-412. [PMID: 37797905 DOI: 10.1016/j.cgh.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND & AIMS Functional constipation is the most common of the disorders of gut-brain interaction, affecting approximately 12% of the world population. Although classically considered a chronic condition, many individuals experience shorter yet repetitive bouts of constipation representing a different clinical entity. There has been increased interest in this latter disorder, which has recently been classified as occasional constipation. This Rome Foundation working group document reflects the consensus of an international team of specialists who summarized currently available research to provide a working definition of and treatment algorithm for occasional constipation. The recommendations herein are based on current evidence, accounting for gaps in the literature as well as international variance in definitions and health seeking behaviors for constipation. METHODS The committee members reviewed the scientific literature, focusing specifically on occasional constipation, with the understanding that as a new entity, a paucity of data would be available. We used Rome IV research and clinical definitions to establish the framework for our definition of occasional constipation. Where possible, treatment recommendations were determined on the basis of the earliest extractable data from functional constipation studies, focusing on positive results within the first 2 weeks of treatment. We used the Delphi method to create consensus with 100% agreement between the authors. RESULTS An evidence-based review of the literature resulted in the definition of occasional constipation as follows: "individuals who experience the presence of at least 1 functional constipation symptom, in the absence of alarm signs or symptoms, occurring at irregular and infrequent intervals, which is bothersome enough to induce a patient to seek medical management." Medical management whether seeking medical care or self-treatment was left to the individual's discretion, and we did not include time anchors because these thresholds require further investigation. Polyethylene glycol and stimulant laxatives are recommended as first-line interventions, whereas magnesium-containing compounds are suggested in individuals failing to respond to these therapies. There are insufficient data to make recommendations for using fiber or stool softeners. Prescription laxatives should be reserved for individuals with chronic constipation. CONCLUSIONS Occasional constipation is a unique clinical entity characterized by infrequent but recurrent symptoms. Data are limited because consensus definitions have been lacking. Establishing a standardized definition and therapeutic recommendations provides a framework for future studies focusing on epidemiologic and symptoms-based outcomes. Further studies are needed to confirm and refine these recommendations.
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Affiliation(s)
- Darren M Brenner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Maura Corsetti
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Douglas Drossman
- Center for Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology, Chapel Hill, North Carolina
| | - Jan Tack
- Department of Gastroenterology, University Hospitals, Leuven, Belgium
| | - Arnold Wald
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Jia ZF, Wang JL, Pan W, Hu J. Croton tiglium L. seeds ameliorate loperamide-induced constipation via regulating gastrointestinal hormones and gut microbiota before and after processing. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117378. [PMID: 37923254 DOI: 10.1016/j.jep.2023.117378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Crotonis Fructus (CF), the seeds of Croton tiglium L., have been commonly used in the treatment of constipation for more than two thousand years in traditional Chinese medicine (TCM). CF needs to be processed before clinical use and Crotonis Semen Pulveratum (CP) is the processed cream of CF, which could reduce the drastic purgative action and gastrointestinal damages. However, the mechanism of CF and CP in the treatment of constipation is still unclear. AIM OF THE STUDY This study was to evaluate the effects of CF and CP on loperamide-induced constipation and the underlying mechanism. MATERIALS AND METHODS The chemical compositions of CF and CP were analyzed by UPLC-Q-TOF-MS. Constipated mouse model was established by loperamide (9.6 mg/kg, b.w., i.g.) for two weeks. After successful modeling, the mice were treated with CF or CP (45.5 and 136.5 mg/kg, b.w., i.g.) once a day for seven days. The physiological status, defecation indices, defecation time, and intestinal propulsion rate in mice were measured. Histopathologic examination and serum biochemical parameters were further estimated. 16S rDNA gene sequencing was carried out to characterize the effects of CF and CP on intestinal microbiome structure. Spearman correlation analysis was also performed to explore the association between gut microbiotic abundance and serum indices. RESULTS The results verified the therapeutic effects of CF and CP on loperamide-induced constipation. CF and CP could significantly ameliorate the reduction of fecal number, fecal weight, fecal water content, and intestinal propulsion rate in mice with constipation, and the first stool defecation time was also obviously reduced. Moreover, CF and CP could regulate the secretion of gastrointestinal hormones and inflammatory factors induced by constipation. Histopathologic examination showed that CP was superior to CF in relieving pathological injury and inflammatory cell infiltration. According to 16S rDNA sequencing, CF and CP treatment could improve gut microbiota disturbance in mice with constipation and the abundance of opportunistic pathogens such as Parabacteroides, Parasutterella and Bacillus remarkably declined, while the levels of beneficial bacterial such as Candidatus_Arthromitus significantly increased. Besides, CP may play a better role in correcting the intestinal flora disorder than CF, which was more obvious in the high-dose group. In addition, phytochemical analysis revealed the presence of diterpenoids and alkaloids in CF and CP. CONCLUSIONS CF and CP could ameliorate loperamide-induced constipation by regulating gastrointestinal hormones secretion, reducing the levels of inflammatory cytokines and improving the disturbance of gut microbiota. Moreover, CP was superior to CF in the enrichment of beneficial bacteria and reduction of harmful bacteria and histopathological damage induced by constipation, which may be related to the changes in the species and content of diterpenoids after processing. The study provides new evidence for the processing mechanism and clinical application of CF and CP.
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Affiliation(s)
- Ze-Fei Jia
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Tianjin, 301617, China
| | - Jia-Li Wang
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Tianjin, 301617, China
| | - Wen Pan
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Tianjin, 301617, China
| | - Jing Hu
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Tianjin, 301617, China.
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27
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Chen Y, Luo S, Luo M. Efficacy and safety of Buzhongyiqi decoction combined with acupoint application for functional constipation in elderly people: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36579. [PMID: 38241527 PMCID: PMC10798694 DOI: 10.1097/md.0000000000036579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/20/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of Buzhongyiqi decoction combined with acupoint application in the treatment of functional constipation in elderly people. METHODS (1) Four Chinese databases (China National Knowledge Infrastructure, China Science Periodical Database, Chinese Citation Database, China Biology Medicine) and 4 foreign databases (PubMed, Web of Science, Cochrane Library, Embase) were searched, excluded, and included in randomized controlled trials of Buzhongyiqi decoction combined with acupoint application for the treatment of functional constipation in elderly people. (2) Systematic evaluation and meta-analysis using the RevMan 5.3 software. (3) Harbord linear regression and sensitivity analyses were conducted to evaluate publication bias using Stata 14.0. (4) Reliability of the conclusion assessment by sequential test analysis in TSA0.9 software. (5) Quality of evidence evaluation of outcome indicators was evaluated using Gradepro 3.6 software. RESULTS Eight randomized controlled trials including 658 case sample sizes were included. Compared with the control group, the intervention group showed improved clinical cure rate and effective rate of functional constipation in elderly people, reduced recurrence rate, and efficacy regulated the levels of defecation-related indices and indices of gastrointestinal function. In addition, trial sequential analysis indicated that the total clinical efficacy rate was conclusive, which showed that the therapeutic efficacy of the intervention group was superior to that of the control group. However, the incidence of adverse effects in intervention group was comparable to that of control group, and trial sequential analysis suggests that this result needs to be supported by additional research. CONCLUSION Buzhongyiqi decoction combined with acupoint application has potential value in the treatment of functional constipation in elderly people. Currently, there is insufficient clinical evidence to objectively evaluate safety grades for this combination therapy.
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Affiliation(s)
- Yanjie Chen
- The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Shu Luo
- The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Min Luo
- The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China
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Ding F, Hu M, Ding Y, Meng Y, Zhao Y. Efficacy in bowel movement and change of gut microbiota on adult functional constipation patients treated with probiotics-containing products: a systematic review and meta-analysis. BMJ Open 2024; 14:e074557. [PMID: 38238054 PMCID: PMC10806726 DOI: 10.1136/bmjopen-2023-074557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/31/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES This study aimed to pool the efficacy in bowel movement and explore the change of gut microbiota on adult functional constipated patients after probiotics-containing products treatment. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Cochrane Library for published studies and ClinicalTrials.gov for 'grey' researches were independently investigated for randomised controlled trials up to November 2022. ELIGIBILITY CRITERIA, DATA EXTRACTION AND SYNTHESIS The intervention was probiotics-containing product, either probiotics or synbiotics, while the control was placebo. The risk of bias was conducted. The efficacy in bowel movement was indicated by stool frequency, stool consistency and Patient Assessment of Constipation Symptom (PAC-SYM), while the change of gut microbiota was reviewed through α diversity, β diversity, change/difference in relative abundance and so on. The subgroup analysis, sensitivity analysis and random-effect meta-regression were conducted to explore the heterogeneity. The Grading of Recommendations Assessment Development and Evaluation was conducted to grade the quality of evidence. RESULTS 17 studies, comprising 1256 participants, were included with perfect agreements between two researchers (kappa statistic=0.797). Compared with placebo, probiotics-containing products significantly increased the stool frequency (weighted mean difference, WMD 0.93, 95% CI 0.47 to 1.40, p=0.000, I²=84.5%, 'low'), improved the stool consistency (WMD 0.38, 95% CI 0.05 to 0.70, p=0.023, I²=81.6%, 'very low') and reduced the PAC-SYM (WMD -0.28, 95% CI: -0.45 to -0.11, p=0.001, I²=55.7%, 'very low'). In subgroup analysis, synbiotics was superior to probiotics to increase stool frequency. Probiotics-containing products might not affect α or β diversity, but would increase the relative abundance of specific strain. CONCLUSIONS Probiotics-containing products, significantly increased stool frequency, improved stool consistency, and alleviated functional constipation symptoms. They increased the relative abundance of specific strain. More high-quality head-to-head randomised controlled trials are needed.
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Affiliation(s)
- Fei Ding
- Department of Gastroenterology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Mengyang Hu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifei Ding
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yingying Meng
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yanchao Zhao
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Vlismas LJ, Wu W, Ho V. Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:108. [PMID: 38256369 PMCID: PMC10819559 DOI: 10.3390/medicina60010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Slow transit constipation (STC) has an estimated prevalence of 2-4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others.
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Affiliation(s)
- Luke J. Vlismas
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - William Wu
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Vincent Ho
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
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Kang Y, Yan J. Exploring the connection between caffeine intake and constipation: a cross-sectional study using national health and nutrition examination survey data. BMC Public Health 2024; 24:3. [PMID: 38167025 PMCID: PMC10759350 DOI: 10.1186/s12889-023-17502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Caffeine has been reported to increase gastrointestinal motility and change intestinal microbiota. Constipation may be caused by colonic motor dysfunction and colonic microbiomeis disturbances. In this study, we aimed to explore the association between caffeine intake and constipation. METHODS This was a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). Caffeine intake was assessed using 24-h dietary recall method, and constipation was defined based on stool consistency or stool frequency. Logistic regression analysis was used to assess the association between caffeine intake and constipation, and results were expressed as odds ratio (OR) with 95% confidence intervals (95%CI). Subgroup analysis was performed based on age. RESULTS A total of 13,816 participants were finally included for analysis. After adjusting potential confounders, high intake of caffeine was found to be associated with the low odds of constipation (Q3: OR = 0.60, 95%CI: 0.49-0.74; Q4: OR = 0.77, 95%CI: 0.59-0.99; Q5: OR = 0.72, 95%CI: 0.56-0.92). The similar association was found in young people and middle-age people (P < 0.05). CONCLUSION High caffeine intake was associated with the low odds of constipation. Our finding indicated that individuals should develop consciousness and habit of consuming caffeinated foods and drinks to prevent and relief the constipation.
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Affiliation(s)
- Yulong Kang
- Department of Proctology, Northern Jiangsu People's Hospital, No.98 Nantong Western Road, Guangling District, Yangzhou, 225001, P.R. China
| | - Jin Yan
- Department of Proctology, Northern Jiangsu People's Hospital, No.98 Nantong Western Road, Guangling District, Yangzhou, 225001, P.R. China.
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Shanholtz G, Vergara FH, Amba KT, Ramos MD. Bowel Management Protocol: Impact on Care Transitions of Oncology Patients. Prof Case Manag 2024; 29:22-29. [PMID: 37983778 DOI: 10.1097/ncm.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
PURPOSE OF STUDY The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS). PRIMARY PRACTICE OF SETTING Oncology unit in a community hospital. METHODOLOGY AND SAMPLE A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS. RESULTS Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001). IMPLICATIONS TO CASE MANAGEMENT PRACTICE Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.
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Affiliation(s)
- Gayle Shanholtz
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Franz Henryk Vergara
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Katheryne Tifuh Amba
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Mary Dioise Ramos
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
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He J, Zhou MD, Wu WJ, Liu ZY, Wang D, Yang GG, Yang QY, Shen Z. The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study. BMC Gastroenterol 2023; 23:443. [PMID: 38104065 PMCID: PMC10725019 DOI: 10.1186/s12876-023-03062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). METHODS Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications. RESULTS The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence. CONCLUSIONS The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.
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Affiliation(s)
- Jun He
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Meng-Dan Zhou
- Department of Nursing, Hangzhou First People's Hospital, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Wen-Jing Wu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Zhi-Yong Liu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Dong Wang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Guan-Gen Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Qin-Yan Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
| | - Zhong Shen
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
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Yin J, Chen JD. Noninvasive electrical neuromodulation for gastrointestinal motility disorders. Expert Rev Gastroenterol Hepatol 2023; 17:1221-1232. [PMID: 38018087 PMCID: PMC10842705 DOI: 10.1080/17474124.2023.2288156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating various gastrointestinal motility disorders. AREAS COVERED In this review, several emerging noninvasive neuromodulation methods are introduced, including transcutaneous auricular vagal nerve stimulation, percutaneous auricular vagal nerve stimulation, transcutaneous cervical vagal nerve stimulation, transcutaneous electrical acustimulation, transabdominal interference stimulation, tibial nerve stimulation, and translumbosacral neuromodulation therapy. Their clinical applications in the most common gastrointestinal motility are discussed, including gastroesophageal reflux disease, functional dyspepsia, gastroparesis, functional constipation, irritable bowel syndrome, and fecal incontinence. PubMed database was searched from 1995 to June 2023 for relevant articles in English. EXPERT OPINION Noninvasive neuromodulation is effective and safe in improving both gastrointestinal symptoms and dysmotility; it can be used when pharmacotherapy is ineffective. Future directions include refining the methodology, improving device development and understanding mechanisms of action.
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Affiliation(s)
- Jieyun Yin
- Transtimulation Research Inc, Oklahoma City, OK, USA
| | - Jiande Dz Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor MI, USA
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Diez S, Kirchgatter A, Adam D, Füldner A, Müller H, Matzel KE, Besendörfer M. Noninvasive Sacral Neuromodulation in Children and Adolescents: A Case-Control Study of Patients With Chronic Refractory Constipation. Neuromodulation 2023; 26:1858-1866. [PMID: 36207226 DOI: 10.1016/j.neurom.2022.08.451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/24/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In adult patients with chronic refractory constipation, invasive sacral neuromodulation (SNM) has been applied successfully. There is a need for less invasive solutions while providing comparable therapeutic effects in children and adolescents. We present a prospective, interventional case-control study on the application of noninvasive SNM. MATERIALS AND METHODS Patients with chronic constipation refractory to conservative treatment were prospectively included in the study from 2018 to 2021 and randomized to either SNM (SNM group: single current stimulation for 24 h/d, frequency 15 Hz, pulse width 210 μs, intensity 1-10 mA) or conventional treatment (controls: full range of pharmacologic and nonpharmacologic options). Treatment was conducted for 12 weeks. Treatment effects were collected with specialized questionnaires and quality-of-life analysis (KINDLR). Outcome variables were defecation frequency, stool consistency, fecal incontinence (FI) episodes, and abdominal pain. RESULTS Analysis was conducted in 28 patients with SNM and 31 controls (median age 7.0, range 3-16 years). Overall responsiveness to treatment was 86% of the SNM group and 39% of the control group (p < 0.001). All outcome variables were positively influenced by SNM treatment. Defecation frequency improved in 46% of patients with SNM and in 19% of controls (p = 0.026), as did stool consistency in 57% of patients with SNM and in 26% of controls (p = 0.014). Fecal incontinence was significantly reduced in 76% of patients with SNM (n = 16/21 vs 42% of controls [n = 11/26], p = 0.042). Quality of life improved significantly during SNM treatment (71.32 [baseline] vs 85.00 [after 12 weeks], p < 0.001) and confirmed a positive influence of SNM treatment compared with the control group (85.00 [SNM after 12 weeks] vs 79.29 [controls after 12 weeks], p = 0.047). CONCLUSIONS Outcome of noninvasive SNM treatment in patients with chronic refractory constipation is better than conventional treatment.
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Affiliation(s)
- Sonja Diez
- Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Annemarie Kirchgatter
- Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dana Adam
- Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arne Füldner
- Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Müller
- Department of Pediatrics, Neonatology and Pediatric Intensive Care, University of Marburg, Marburg, Germany
| | - Klaus E Matzel
- Department of Surgery, Section of Coloproctology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manuel Besendörfer
- Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Shen Z, Qiu B, Chen L, Zhang Y. Common gastrointestinal diseases and chronic obstructive pulmonary disease risk: a bidirectional Mendelian randomization analysis. Front Genet 2023; 14:1256833. [PMID: 38046045 PMCID: PMC10690629 DOI: 10.3389/fgene.2023.1256833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
Background: Observational studies suggest an association between gastrointestinal diseases and chronic obstructive pulmonary disease (COPD), but the causal relationship remains unclear. Methods: We conducted bidirectional Mendelian randomization (MR) analysis using summary data from genome-wide association study (GWAS) to explore the causal relationship between common gastrointestinal diseases and COPD. Gastrointestinal diseases included gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS), Crohn's disease (CD), ulcerative colitis (UC), functional dyspepsia (FD), non-infectious gastroenteritis (NGE), and constipation (CP). Significant MR analysis results were replicated in the COPD validation cohort. Results: Bidirectional MR analysis supported a bidirectional causal relationship between GERD and COPD, and COPD was also found to increase the risk of IBS and CP. Our study also provided evidence for a bidirectional causal relationship between PUD and COPD, although the strength of evidence may be insufficient. Furthermore, we provided evidence that there is no causal association between CD, UC, FD, NGE, and COPD. Conclusion: This study offers some evidence to clarify the causal relationship between common gastrointestinal diseases and COPD. Further research is needed to understand the underlying mechanisms of these associations.
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Affiliation(s)
- Zixiong Shen
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Binxu Qiu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Lanlan Chen
- Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yiyuan Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
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Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Ld Zhong L. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:550-560. [PMID: 37989695 DOI: 10.1016/j.joim.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 08/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Functional constipation (FC) is a common intestinal disease worldwide. Despite the presence of criteria such as Roman IV, there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches. This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients. METHODS A systematic search of the PubMed, Cochrane Library, and China National Knowledge Infrastructure databases was performed from their inception to June 30th, 2022, collecting the current evidence about the efficacious integrative management for FC. We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process. RESULTS We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts. This pathway includes a hierarchy of recommendations for every step of the clinical process, including clinical intake, diagnostic examination, recommended labs, diagnostic flowchart, and guidance for selection of therapeutic drugs. CONCLUSION This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine; it will help to provide high-quality medical services in Hong Kong for patients with FC. Please cite this article as: Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Zhong LL. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. J Integr Med. 2023; 21(6): 550-560.
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Affiliation(s)
- Dong-Jue Wei
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Hui-Juan Li
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zi-Pan Lyu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China; School of Biological Sciences, Nanyang Technological University, 637551, Singapore
| | - Ai-Ping Lyu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Linda Ld Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China; School of Biological Sciences, Nanyang Technological University, 637551, Singapore.
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Masaki H, Shimamoto K, Inokuchi S, Ishizaki S. Treatment of Chronic Constipation using Elobixibat in a Real-World Setting: A Retrospective Cohort Study using an Electronic Medical Records Database in Japan. CURRENT THERAPEUTIC RESEARCH 2023; 99:100724. [PMID: 38033932 PMCID: PMC10685011 DOI: 10.1016/j.curtheres.2023.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
Background Chronic constipation is a common condition affecting people of all ages; therefore, the socioeconomic burden of chronic constipation is nonnegligible. Elobixibat (ELO), an ileal bail acid transport inhibitor, was launched in Japan in 2018. However, evidence of its use in diverse populations is limited. Objectives This study aimed to evaluate the prescription of ELO, risk factors associated with ELO discontinuation, and the continuation of stimulants or saline laxatives during ELO treatment in a real-world setting using an extensive electronic medical records database that primarily includes data from acute-care hospitals. Methods Data of patients prescribed for ELO from April 1, 2018, to March 31, 2022, were extracted from the database. The discontinuation of ELO and stimulant or saline laxatives during ELO treatment was evaluated using the Kaplan-Meier method. The Cox proportional hazards model evaluated risk factors associated with laxative discontinuation. Results In total, 11,062 patients were evaluated. The rate of ELO discontinuation within 360 days of initiation was 78.7%. Hospitalized at the ELO initiation, stage 5 chronic kidney disease, and diagnosis of constipation by departments of obstetrics and gynecology or by departments of malignant neoplasm were identified as risk factors for discontinuation. Diagnosis of constipation, diabetes mellitus, Parkinson's disease, and previous laxative treatment was associated with a lower risk of ELO discontinuation. The prescription rate of stimulants and saline laxatives markedly decreased after ELO initiation; furthermore, nearly half of patients who were continuously prescribed ELO discontinued these laxatives within 360 days. Conclusions The discontinuation of ELO was associated with various factors and using ELO may be beneficial in the withdrawal of concurrent stimulants and saline laxatives. These findings may help effectively manage chronic constipation.
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Affiliation(s)
- Hisanori Masaki
- Medical Department, Medical Science Group, EA Pharma Co, Ltd, Tokyo, Japan
| | - Koji Shimamoto
- Research and Analytics Department, Real World Data Co, Ltd, Kyoto, Japan
| | - Shoichiro Inokuchi
- Research and Analytics Department, Real World Data Co, Ltd, Kyoto, Japan
| | - Sonoko Ishizaki
- Medical Department, Medical Science Group, EA Pharma Co, Ltd, Tokyo, Japan
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Luo M, Xie P, Deng X, Fan J, Xiong L. Rifaximin Ameliorates Loperamide-Induced Constipation in Rats through the Regulation of Gut Microbiota and Serum Metabolites. Nutrients 2023; 15:4502. [PMID: 37960154 PMCID: PMC10648458 DOI: 10.3390/nu15214502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Structural changes in the gut microbiota are closely related to the development of functional constipation, and regulating the gut microbiota can improve constipation. Rifaximin is a poorly absorbed antibiotic beneficial for regulating gut microbiota, but few studies have reported its effects on constipation. The purpose of this study was to investigate the effect of rifaximin on loperamide-induced constipation in SD rats. The results showed that rifaximin improved constipation by increasing serum 5-HT, SP, and the mRNA expression of AQP3, AQP8, and reducing the mRNA expression of TLR2 and TLR4. In addition, rifaximin could regulate the gut microbiota of constipated rats, such as increasing the potentially beneficial bacteria Akkermansia muciniphila and Lactobacillus murinus, reducing the Bifidobacterium pseudolongum. According to metabolomics analysis, many serum metabolites, including bile acids and steroids, were changed in constipated rats and were recovered via rifaximin intervention. In conclusion, rifaximin might improve loperamide-induced constipation in rats by increasing serum excitatory neurotransmitters and neuropeptides, modulating water metabolism, and facilitating intestinal inflammation. Muti-Omics analysis results showed that rifaximin has beneficial regulatory effects on the gut microbiota and serum metabolites in constipated rats, which might play critical roles in alleviating constipation. This study suggests that rifaximin might be a potential strategy for treating constipation.
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Affiliation(s)
| | | | | | | | - Lishou Xiong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; (M.L.); (P.X.); (X.D.); (J.F.)
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HUANG X, XIA Y, HAN K, QI W, LINGHU Q, ZHANG Q, XUE J. Hetong decoction relieves loperamide-induced constipation in rats by regulating expression of aquaporins. J TRADIT CHIN MED 2023; 43:1160-1167. [PMID: 37946478 PMCID: PMC10623261 DOI: 10.19852/j.cnki.jtcm.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate whether Hetong decoction (, HTT) alleviates constipation via regulating AQPs expression. METHODS Constipation in rats was induced by loperamide, and rats were randomly assigned into model (saline), HHT-low (95 g/kg), HTT-medium (190 g/kg), HTT-high (380 g/kg) and positive control (mosapride) groups. Then the defecation function, the concentration of serum arginine vasopressin (AVP) and cyclic adenosine monophosphate (cAMP), and the expression of AQP3 and AQP8 in colon tissues were assessed. NCM460 colon cells with AQP3 and AQP8 knockdown or overexpression were exposed to serum from rats that received low or high dose of HTT, followed by detection of AQP3 and AQP8 expression. RESULTS The model group showed lower fecal weight and water content, weaker intestinal transit, higher serum concentration of AVP and cAMP, increased proximal and distal AQP8 expression, increased proximal but decreased distal AQP3 expression. However, these trends were reversed in both the HTT group (low, medium and high dose) and the positive control group. In NCM460 cells, HTT dose-dependently stabilized AQP3 and AQP8 expression under AQP3/8 plasmid interference or overexpression. CONCLUSIONS HTT relieves constipation in rats through regulating AQP3 and AQP8 expression.
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Affiliation(s)
- Xi HUANG
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Youguang XIA
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Kai HAN
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Weiwei QI
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Qing LINGHU
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Qing ZHANG
- 2 Department of Pathology, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Jingbo XUE
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
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Abdu Seid M, Diress M, Mohammed A, Sinamaw D. Chronic constipation and its associated factors in patients with type-2 diabetes: A multicenter cross-sectional study. Diabetes Res Clin Pract 2023; 204:110905. [PMID: 37757985 DOI: 10.1016/j.diabres.2023.110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Diabetes is one of the global public health concern and constipation is frequently seen among gastrointestinal symptoms in diabetes. Despite the fact that constipation is common, doctors and/or patients disregard it. This study aimed to determine the prevalence and contributing factors of constipation in patients with diabetes. METHODS Multi-center cross-sectional study was carried out and the data was analyzed using STATA 14. Binary and multilevel logistic regressions were also carried out to identify associated to factors. Factors having a p-value of less than 0.05 were deemed statistically significant in the final model. RESULTS 206 diabetics participated in the survey. The mean age of the participants was 52.7 years (SD ± 11.9). The prevalence of constipation was 16% (95% CI: 10.97-21.07). Age (AOR = 13.56; 95% CI: 1.71, 107.21), females (AOR = 4.58; 95% CI: 1.76, 11.87), the duration of the diabetes (AOR = 3.16; 95% CI: 1.21, 8.24), and psychological distress (AOR = 12.49, 95% CI: 1.53, 101.8) were significant factors. CONCLUSION The magnitude of constipation was considerable, and it was linked to psychological distress, longer-lasting diabetes, being a woman, and ageing. Patients with type-2 diabetes need to receive careful treatment in order to reduce the severity of the condition and its additional complications.
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Affiliation(s)
- Mohammed Abdu Seid
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Ethiopia.
| | | | | | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Ethiopia.
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Ajabnoor G, Eldakhakhny B, Hashim KT, Alzahrani MM, Eskandarani R, AlQusaibi B, Alqarni AK, Alsulaimani NM, Dahlan M, Enani S, Almoghrabi Y, Alamoudi AA, Alhozali A, Elsamanoudy A. The Effect of Chronic Laxative Use on Lipid Profile and HbA1c: A Hospital-Based Retrospective Study. Cureus 2023; 15:e45055. [PMID: 37829969 PMCID: PMC10567100 DOI: 10.7759/cureus.45055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Laxatives are over-the-counter medications used as a treatment for constipation. The lipid-lowering effect of the long-term use of laxatives has been proposed. AIM To investigate the possible impact of the chronic use of laxatives on serum lipid profile, body mass index (BMI), and hemoglobin A1c (HbA1c). METHODS An observational retrospective cohort study was conducted to analyze data related to patients who received laxatives for six or 12 months or more in the KAUH database system. BMI, weight, cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and HbA1c data were collected retrospectively from hospital records for three time points: baseline, six months, and 12 months of laxative treatment from the starting date for each patient. RESULTS A total of 106 patients' records fulfilled the inclusion criteria, 46 (43%) males with a mean age of 66 and 60 (57%) females with a mean age of 63. A significant decrease in plasma cholesterol and low-density lipoprotein-cholesterol (LDL-C) levels was observed in those who used laxatives for 12 months. Furthermore, an overall BMI and ALT reduction was seen in the combined. On the other hand, HbA1c levels appeared to improve in the combined group but not statistically significant. The change in the cholesterol level could be observed in patients receiving statin treatment and those without, with no statistical significance between the two groups. CONCLUSION Chronic laxative use for 12 months or more is associated with a decreased total and LDL-C level with no significant effect on high-density lipoprotein-cholesterol (HDL-C) levels. Additionally, there was a significant reduction in BMI and ALT. This effect is more prominent with combined therapy. Further multicentric studies on larger sample sizes are recommended to confirm our findings.
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Affiliation(s)
- Ghada Ajabnoor
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Food, Nutrition, and Lifestyle Research Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, SAU
- Department of Clinical Biochemistry, King Abdulaziz University Hospital, Jeddah, SAU
| | - Basmah Eldakhakhny
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Food, Nutrition, and Lifestyle Research Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, SAU
| | - Kamal T Hashim
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | | | | | - Mansour Dahlan
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Sumia Enani
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, SAU
| | - Yousef Almoghrabi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Aliaa A Alamoudi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Amani Alhozali
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ayman Elsamanoudy
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, EGY
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Wen Y, Zhan Y, Tang SY, Liu F, Wang QX, Kong PF, Tang XG. Zhizhu Decoction Alleviates Intestinal Barrier Damage via Regulating SIRT1/FoxO1 Signaling Pathway in Slow Transit Constipation Model Mice. Chin J Integr Med 2023; 29:809-817. [PMID: 36044116 DOI: 10.1007/s11655-022-3539-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the possible effects and mechanism of Zhizhu Decoction (ZZD) on the pathophysiology of slow transit constipation (STC). METHODS A total of 54 C57BL/6 mice was randomly divided into the following 6 groups by a random number table, including control, STC model (model), positive control, and low-, medium- and high-doses ZZD treatment groups (5, 10, 20 g/kg, namely L, M-, and H-ZZD, respectively), 9 mice in each group. Following 2-week treatment, intestinal transport rate (ITR) and fecal water content were determined, and blood and colon tissue samples were collected. Hematoxylin-eosin and periodic acid-Schiff staining were performed to evaluate the morphology of colon tissues and calculate the number of goblet cells. To determine intestinal permeability, serum levels of lipopolysaccharide (LPS), low-density lipoprotein (LDL) and mannose were measured using enzyme-linked immunosorbent assay (ELISA). Western blot analysis was carried out to detect the expression levels of intestinal tight junction proteins zona-occludens-1 (ZO-1), claudin-1, occludin and recombinant mucin 2 (MUC2). The mRNA expression levels of inflammatory cytokines including tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-4, IL-10 and IL-22 were determined using reverse transcription-quantitative reverse transcription reaction. Colon indexes of oxidative stress were measured by ELISA, and protein expression levels of colon silent information regulator 1/forkhead box O transcription factor 1 (SIRT1/FoxO1) antioxidant signaling pathway were detected by Western blot. RESULTS Compared with the model group, ITR and fecal moisture were significantly enhanced in STC mice in the M-ZZD and H-ZZD groups (P<0.01). Additionally, ZZD treatment notably increased the thickness of mucosal and muscular tissue, elevated the number of goblet cells in the colon of STC mice, reduced the secretion levels of LPS, LDL and mannose, and upregulated ZO-1, claudin-1, occludin and MUC2 expressions in the colon in a dose-dependent manner, compared with the model group (P<0.05 or P<0.01). In addition, ZZD significantly attenuated intestinal inflammation and oxidative stress and activated the SIRT1/FoxO1 signaling pathway (P<0.05 or P<0.01). CONCLUSION ZZD exhibited beneficial effects on the intestinal system of STC mice and alleviated intestinal inflammation and oxidative stress via activating SIRT1/FoxO1 antioxidant signaling pathway in the colon.
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Affiliation(s)
- Yong Wen
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Department of Traditional Chinese Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuang Province, 646000, China
| | - Yu Zhan
- Department of Anus and Intestine Surgery, Affiliated Hospital of Integrated Chinese Medicine and Western Medicine of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
- Department of Anus and Intestine Surgery, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, 610075, China
| | - Shi-Yu Tang
- Department of Integrated Traditional and Western Medicine Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuang Province, 637000, China
| | - Fang Liu
- Department of Integrated Traditional and Western Medicine Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuang Province, 637000, China
| | - Qiu-Xiao Wang
- Department of Integrated Traditional and Western Medicine Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuang Province, 637000, China
| | - Peng-Fei Kong
- Department of Integrated Traditional and Western Medicine Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuang Province, 637000, China
| | - Xue-Gui Tang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
- Department of Integrated Traditional and Western Medicine Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuang Province, 637000, China.
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Wang J, Kong W, Liu M, Wang Y, Zheng Y, Zhou Y. Association between dietary carotenoids intake and chronic constipation in American men and women adults: a cross-sectional study. BMC Public Health 2023; 23:1597. [PMID: 37608273 PMCID: PMC10463530 DOI: 10.1186/s12889-023-16367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/23/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Dietary carotenoids have been proven to improve intestinal disorders like inflammatory bowel disease and colon cancer, yet little is known about the link between dietary carotenoids and constipation. This study aims to examine the relationship between dietary carotenoids intake and constipation, using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. METHODS A total of 11,722 participants were enrolled. Chronic constipation was defined as type 1 (separate hard lumps, like nuts) and type 2 (sausage-like, but lumpy) in the Bristol stool form scale (BSFS). Carotenoids intake was obtained from the average of two 24-hour dietary recall questionnaires (if only one 24-hour was available, we used it) and divided into quartiles (Q). The prevalence of constipation was calculated across men and women individuals. The relationship between dietary carotenoids intake and constipation in men and women was assessed with weighted logistic regression and smoothed curve fitting after adjusting confounders, with results displayed as weighted odds ratio (OR) with 95% confidence intervals (95% CI). The model was further stratified by age, race, and HEI 2015 scores (with median as cutoff) among men and women. RESULTS The total weighted prevalence of chronic constipation in this study was 8.08%, 11.11% in women and 5.18% in men. After multivariable adjustment, compared with the lowest intake, participants with the highest dietary lycopene intake (ORQ4 vs. Q1= 0.55, 95% CI: 0.36-0.84, p for trend = 0.01) and total lycopene intake (ORQ4 vs. Q1 = 0.52, 95% CI: 0.34-0.80, p for trend = 0.01) were negatively associated with the risk of chronic constipation in men, whereas increased dietary α-carotene intake reduced the risk of chronic constipation in women (ORQ4 vs. Q1 = 0.69, 95% CI: 0.48-0.98, p for trend = 0.04). Smoothing curve fitting further supported these results and provided evidence of dose-response effects. No association was found between other types of carotenoids and chronic constipation in men and women. CONCLUSIONS Increasing lycopene intake may improve bowel function in men while increased α-carotene intake may reduce the risk of chronic constipation in women. Further studies are essential to explore the role that the intake of carotenoids plays in chronic constipation.
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Affiliation(s)
- Jiangnan Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, China
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Wanru Kong
- Department of Infection Management, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Min Liu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Yuping Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Ya Zheng
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Yongning Zhou
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
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Talman L, Safarpour D. An Overview of Gastrointestinal Dysfunction in Parkinsonian Syndromes. Semin Neurol 2023; 43:583-597. [PMID: 37703887 DOI: 10.1055/s-0043-1771461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gastrointestinal (GI) dysfunction is a common nonmotor symptom in Parkinson's disease (PD) as well as other parkinsonian syndromes and may precede the onset of motor symptoms by decades. Involvement of all segments of the GI tract can lead to altered responses to medications and worsened quality of life for patients. While some GI symptoms occur in isolation, others overlap. Therefore, understanding the changes in different segments of the GI tract and how they relate to altered responses to PD treatment can guide both diagnostic and pharmacological interventions. Gut microbiota plays a critical role in immune activity and modulation of the enteric and central nervous systems. Understanding this bidirectional relationship helps to elucidate the pathogenesis of neurodegeneration. This review will describe the current understanding of how GI dysfunction develops in parkinsonian syndromes, common symptoms in PD and related disorders, and available treatments.
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Affiliation(s)
- Lauren Talman
- Department of Neurology School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Delaram Safarpour
- Department of Neurology School of Medicine, Oregon Health & Science University, Portland, Oregon
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45
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Wang J, Yang M, Xu K, Wan X, Xie J, Yu H, Fang J, Wang Z, Xu P. The causal associations between growth factors and constipation: a two-sample Mendelian randomization study. Front Physiol 2023; 14:1204146. [PMID: 37501926 PMCID: PMC10369006 DOI: 10.3389/fphys.2023.1204146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction: Certain growth factors (GFs) are associated with constipation, but few studies has analyzed the causal associations between the two. Therefore, this study used two-sample Mendelian randomization (MR) to systematically analyze the causal associations between GF levels and constipation based on data from genome-wide association studies (GWAS). Methods: Both GF and constipation data were obtained from European populations. GFs, as an exposure variable, were obtained from a genetic map of the human plasma proteome containing 3,301 samples, another GWAS dataset on 90 circulating proteins containing 30,931 samples, and a GWAS dataset containing 3,788 samples. Constipation, as an outcome variable, was obtained from the FinnGen project containing 26,919 cases and 282,235 controls and another UK Biobank dataset containing 3,328 cases and 459,682 controls. Single-nucleotide polymorphisms strongly associated with GFs were regarded as instrumental variables. Inverse-variance weighting, MR-Egger regression, weight median, simple mode, and weight mode methods were used to determine genetic associations. Cochran's Q test, Egger intercept, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier tests were used to analyze sensitivity. Results: The IVW analysis based on FinnGen showed that NGFI-A-binding protein 2 and vascular endothelial growth factor receptor 2 were inversely associated with constipation, and that fibroblast growth factor 7 and transforming growth factor beta receptor II levels were positively associated with constipation. The IVW analysis based on UK Biobank showed that proheparin-binding epidermal growth factor, platelet-derived growth factor AA, and vascular endothelial growth factor121 were inversely associated with constipation. Conclusion: This study showed that some GFs are genetically associated with the risk of constipation.
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Affiliation(s)
- Jiachen Wang
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Mingyi Yang
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ke Xu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xianjie Wan
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiale Xie
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hui Yu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiaxin Fang
- Department of Clinical Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zehua Wang
- Department of Clinical Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Peng Xu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Wang X, Chen JDZ. Therapeutic potential and mechanisms of sacral nerve stimulation for gastrointestinal diseases. J Transl Int Med 2023; 11:115-127. [PMID: 37408571 PMCID: PMC10318922 DOI: 10.2478/jtim-2023-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Background The aim of this systemtic review is to introduce clinical applications (especially emerging) and potential mechanisms of sacral nerve stimulation (SNS) for treating various gastrointestinal diseases. Materials and Methods PubMed and Web of Science were searched for studies published on SNS and its clinical applications in fecal incontinence (limited to systematic review and meta-analysis of clinical studies), constipation (limited to reviews and randomized control clinical studies), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and upper gastrointestinal motility disorders. The relevant studies were pooled, and their findings were summarized and discussed. Results SNS is an approved method for treating fecal incontinence. Systematic review and meta-analysis demonstrated high efficacy of the SNS therapy for fecal incontinence. Increased anal sphincter pressure and improvement in rectal sensation were reported as major mechanisms involved in the SNS therapy. SNS has also been proposed for treating constipation, but the therapy has been shown ineffective. There is a lack in SNS methodological optimization and mechanistic research. A few basic and clinical studies have reported the potential of SNS for treating visceral pain in IBS. SNS seemed capable of improving mucosal barrier functions. Several case reports are available in the literature on the treatment of IBD with SNS. Several laboratory studies suggested therapeutic potential of a special method of SNS for IBD. Cholinergic anti-inflammatory mechanisms were reported. Due to a recently reported spinal afferent and vagal efferent pathway of SNS, a few preclinical studies reported the potential of SNS for upper gastrointestinal motility disorders. However, no clinical studies have been performed. Conclusions SNS for fecal incontinence is a well-established clinical therapy. However, the current method of SNS is ineffective for treating constipation. Further methodological development and randomized clinical trials are needed to explore potential applications of SNS for IBS and IBD.
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Affiliation(s)
- Ximeng Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD21228, USA
| | - Jiande DZ Chen
- Department of Internal Medicine, University of Michigan School of Medicine, Ann ArborMI48109, USA
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Majd A, Richter MN, Samuel RM, Cesiulis A, Ghazizadeh Z, Wang J, Fattahi F. Combined GWAS and single cell transcriptomics uncover the underlying genes and cell types in disorders of gut-brain interaction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.02.23290906. [PMID: 37333423 PMCID: PMC10275016 DOI: 10.1101/2023.06.02.23290906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Disorders of gut-brain interaction (DGBIs), formerly known as functional gastrointestinal disorders, are extremely common and historically difficult to manage. This is largely because their cellular and molecular mechanisms have remained poorly understood and understudied. One approach to unravel the molecular underpinnings of complex disorders such as DGBIs is performing genome wide association studies (GWASs). However, due to the heterogenous and non-specific nature of GI symptoms, it has been difficult to accurately classify cases and controls. Thus, to perform reliable studies, we need to access large patient populations which has been difficult to date. Here, we leveraged the UK Biobank (UKBB) database, containing genetic and medical record data of over half a million individuals, to perform GWAS for five DGBI categories: functional chest pain, functional diarrhea, functional dyspepsia, functional dysphagia, and functional fecal incontinence. By applying strict inclusion and exclusion criteria, we resolved patient populations and identified genes significantly associated with each condition. Leveraging multiple human single-cell RNA-sequencing datasets, we found that the disease associated genes were highly expressed in enteric neurons, which innervate and control GI functions. Further expression and association testing-based analyses revealed specific enteric neuron subtypes consistently linked with each DGBI. Furthermore, protein-protein interaction analysis of each of the disease associated genes revealed protein networks specific to each DGBI, including hedgehog signaling for functional chest pain and neuronal function and neurotransmission for functional diarrhea and functional dyspepsia. Finally, through retrospective medical record analysis we found that drugs that inhibit these networks are associated with an increased disease risk, including serine/threonine kinase 32B drugs for functional chest pain, solute carrier organic anion transporter family member 4C1, mitogen-activated protein kinase 6, and dual serine/threonine and tyrosine protein kinase drugs for functional dyspepsia, and serotonin transporter drugs for functional diarrhea. This study presents a robust strategy for uncovering the tissues, cell types, and genes involved in DGBIs, presenting novel predictions of the mechanisms underlying these historically intractable and poorly understood diseases.
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Affiliation(s)
- Alireza Majd
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, California, USA
| | - Mikayla N Richter
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, California, USA
| | - Ryan M Samuel
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, California, USA
| | - Andrius Cesiulis
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, California, USA
| | - Zaniar Ghazizadeh
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Wang
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Faranak Fattahi
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, California, USA
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, California, USA
- Program in Craniofacial Biology, University of California, San Francisco, California, USA
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Falletto E, Martellucci J, Rossitti P, Bondurri A, Zaffaroni G, Ascanelli S, Chimisso L, Lauretta A, Mirafiori M, Clementi I, Ripetti V, Lufarelli P, Cestaro G, Bottini C, Bellini M, Lambiase C, Di Candido F, Zattoni D, Cornaglia S, Tonello P, Zucchi E. Transanal irrigation in functional bowel disorders and LARS: short-term results from an Italian national study. Tech Coloproctol 2023; 27:481-490. [PMID: 37160596 DOI: 10.1007/s10151-023-02800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). METHODS A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. RESULTS A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. CONCLUSION Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions.
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Affiliation(s)
- E Falletto
- Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Torino, Turin, Italy.
| | - J Martellucci
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - P Rossitti
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - A Bondurri
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - G Zaffaroni
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - S Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - L Chimisso
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - A Lauretta
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - M Mirafiori
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - I Clementi
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy
| | - V Ripetti
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Lufarelli
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - G Cestaro
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - C Bottini
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - M Bellini
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - C Lambiase
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - F Di Candido
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - D Zattoni
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - S Cornaglia
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - P Tonello
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - E Zucchi
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
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Gearry R, Fukudo S, Barbara G, Kuhn-Sherlock B, Ansell J, Blatchford P, Eady S, Wallace A, Butts C, Cremon C, Barbaro MR, Pagano I, Okawa Y, Muratubaki T, Okamoto T, Fuda M, Endo Y, Kano M, Kanazawa M, Nakaya N, Nakaya K, Drummond L. Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort-Results of an International Multicenter Randomized Controlled Trial. Am J Gastroenterol 2023; 118:1058-1068. [PMID: 36537785 PMCID: PMC10226473 DOI: 10.14309/ajg.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/02/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Consumption of green kiwifruit is known to relieve constipation. Previous studies have also reported improvements in gastrointestinal (GI) comfort. We investigated the effect of consuming green kiwifruit on GI function and comfort. METHODS Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week. Secondary outcomes included GI comfort which was measured using the GI symptom rating scale, a validated instrument. Data (intent-to-treat) were analyzed as difference from baseline using repeated measures analysis of variance suitable for AB/BA crossover design. RESULTS Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001). No significant adverse events were observed. DISCUSSION This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.
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Affiliation(s)
- Richard Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | - Sarah Eady
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Alison Wallace
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Christine Butts
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Isabella Pagano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Yohei Okawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Muratubaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoko Okamoto
- Department of Nutrition, Sapporo University of Health Sciences, Sapporo, Japan
| | - Mikiko Fuda
- Department of Clinical Nutrition, Tohoku University Hospital, Sendai, Japan
| | - Yuka Endo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Michiko Kano
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motoyori Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kumi Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Lynley Drummond
- Drummond Food Science Advisory Limited, Killinchy, Canterbury, New Zealand
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50
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Wang LW, Ruan H, Wang BM, Qin Y, Zhong WL. Microbiota regulation in constipation and colorectal cancer. World J Gastrointest Oncol 2023; 15:776-786. [PMID: 37275451 PMCID: PMC10237018 DOI: 10.4251/wjgo.v15.i5.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/23/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
The relevance of constipation to the development and progression of colorectal cancer (CRC) is currently a controversial issue. Studies have shown that changes in the composition of the gut microbiota, a condition known as ecological imbalance, are correlated with an increasing number of common human diseases, including CRC and constipation. CRC is the second leading cause of cancer-related deaths worldwide, and constipation has been receiving widespread attention as a risk factor for CRC. Early colonoscopy screening of constipated patients, with regular follow-ups and timely intervention, can help detect early intestinal lesions and reduce the risks of developing colorectal polyps and CRC. As an important regulator of the intestinal microenvironment, the gut microbiota plays a critical role in the onset and progression of CRC. An increasing amount of evidence supports the thought that gut microbial composition and function are key determinants of CRC development and progression, with alterations inducing changes in the expression of host genes, metabolic regulation, and local and systemic immunological responses. Furthermore, constipation greatly affects the composition of the gut microbiota, which in turn influences the susceptibility to intestinal diseases such as CRC. However, the crosstalk between the gut microbiota, constipation, and CRC is still unclear.
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Affiliation(s)
- Li-Wei Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hao Ruan
- China Resources Biopharmaceutical Company Limited, Beijing 100029, China
| | - Bang-Mao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yuan Qin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang Province, China
| | - Wei-Long Zhong
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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