[Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)]

Functional Abdominal Cramping Pain: Expert Practical Guidance

Functional abdominal cramping pain (FACP) is a common complaint, which may present either on its own or in association with a functional gastrointestinal disorder. It is likely caused by a variety of, probably partly unknown, etiologies. Effective management of FACP can be challenging owing to the lack of usable diagnostic tools and the availability of a diverse range of treatment approaches. Practical guidance for their selection and use is limited. The objective of this article is to present a working definition of FACP based on expert consensus, and to propose practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients. A panel of experts on functional gastrointestinal disorders was convened to participate in workshop activities aimed at defining FACP and agreeing upon a recommended sequence of diagnostic criteria and management recommendations. The key principles forming the foundation of the definition of FACP and suggested management algorithms include the primacy of cramping pain as the distinguishing symptom; the importance of recognizing and acting upon alarm signals of potential structural disease; the recognition of known causes that might be addressed through lifestyle adjustment; and the central role of antispasmodics in the treatment of FACP. The proposed algorithm is intended to assist physicians in reaching a meaningful diagnostic endpoint based on patient-reported symptoms of FACP. We also discuss how this algorithm may be adapted for use by pharmacists and patients.

Observation of the Intervention Effect of Biofeedback Therapy Combined With Cluster Nursing on Perioperative Constipation in Patients With Thoracolumbar Fracture

Purpose

To discuss the intervention effect of biofeedback therapy combined with cluster nursing on perioperative constipation in patients with thoracolumbar fracture.

Methods

From June 2019 to June 2020, a total of 482 patients with thoracolumbar fracture who were treated by surgery in our department were selected. The random number table method was used to divide into experimental group (n = 241) and control group (n = 241). The control group was given routine constipation care, the experimental group was given biofeedback therapy combined with cluster nursing based on the control group. The constipation score, Bristol stool scale score, the short health questionnaire (SF-36) scale score, and the satisfaction of two groups were observed.

Results

The constipation scores of the experimental group were lower than those of the control group, while the Bristol stool scale score, SF-36 score, and satisfaction degree of the experimental group were higher than those of the control group (p < 0.05).

Conclusion

Biofeedback therapy combined with cluster nursing has a good intervention effect in perioperative constipation of patients with thoracolumbar fracture, which can reduce the degree of constipation, improve stool traits, improve the quality of life, and improve the satisfaction of patients.

Acupoint Massage Therapy Alters the Composition of Gut Microbiome in Functional Constipation Patients

Results

Results showed the overall structure of gut microbiome has no significant difference between experimental and control groups. In the genus level, the abundance of Pseudobutyrivibrio and Ruminiclostridium is higher in the experiment group than in the control, whereas that of Fusicatenibacter is less. The 16S KEGG function prediction suggested that Parkinson disease, retinol metabolism, and arachidonic acid metabolism could explain the biological function of different gut microbiome. Furthermore, cytokines in the serum showed a correlation with the abundance of Pseudobutyrivibrio in CFC.

Conclusion

AMT could change the composition of gut microbiome which is associated with cytokines in CFC patients.

Placebo Response in Chronic Idiopathic Constipation: A Systematic Review and Meta-Analysis

OBJECTIVES

Chronic idiopathic constipation (CIC), like other functional gastrointestinal disorders, has been associated with a high placebo response rate. However, the placebo response in randomized controlled trials has not been described.

METHODS

We conducted a search of the medical literature following the protocol outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement using MEDLINE, EMBASE and EMBASE Classic, Web of Science, and the Cochrane Central Register of Controlled Trials for all drugs used for the treatment of CIC. Two independent reviewers performed eligibility assessment and data extraction. The mean response rate was examined for the following 2 responder endpoints: (i) greater than or equal to 3 complete spontaneous bowel movements (CSBMs)/wk (≥3 CSBMs/wk responders) and (ii) mean increase of ≥1 CSBM/wk compared with baseline (increase in ≥1 CSBM/wk responders).

RESULTS

A total of 23 placebo-controlled trials met our inclusion criteria and were included in this meta-analysis. The placebo response in CIC trials ranged from 4% to 44%. The magnitude of the placebo response was 13% (95% confidence interval 11%-16%) with the ≥3 CSBM/wk responder endpoint and 28% (95% confidence interval 21%-30%) with the increase of ≥1 in the CSBM responder endpoint. Higher baseline CSBM, older age, and trials with more male participants were significantly associated with a stronger placebo response for both the ≥3 CSBMs/wk endpoint and increase in the ≥1 CSBM/wk endpoint. Trial characteristics such as location (Europe vs Asia/United States) and laxative class (prokinetic vs secretagogue) revealed key differences in the placebo response for both endpoints. The placebo response was not significantly affected by the number of study visits, study duration, year of publication, number of drop outs, or likelihood of receiving active drug.

DISCUSSION

The placebo response in CIC trials ranges from 4% to 44% depending on the endpoint. Modifying factors of the placebo response include multiple subject and trial characteristics.

Correlation between depression and coping styles in elderly patients with chronic functional constipation in a tertiary hospital

BACKGROUND

Functional constipation seriously affects the physical and mental health of patients, most of whom have a certain degree of negative psychological problems, even causing suicide. Therefore, exploring depression in elderly patients with functional constipation and its correlation with coping styles is of great significance in improving clinical therapeutic effects and reducing adverse events.

AIM

To explore the correlation between depression and coping styles in elderly patients with chronic functional constipation in a tertiary hospital.

METHODS

Eighty-six elderly patients with chronic functional constipation admitted to Jinhua Second Hospital of Zhejiang Province from August 2017 to August 2019 were selected as study subjects to develop a self-rating depression questionnaire and a questionnaire on coping styles. All patients were required to complete the questionnaires independently and returned them within 48 h after administration.

RESULTS

A total of 86 questionnaires were administered, and all were recovered within 48 h, with a recovery rate of 100%. Among the 86 questionnaires recovered, according to the scoring results, patients with a depression score ≥ 50 were considered as having depression. The highest score was 62 and the lowest score was 50, with an average of 56.7 ± 7.3. The scores of problems-solving, remorse, help-seeking, fantasy, avoidance, and rationalization in chronic functional constipation patients with depressive symptoms were 0.52 ± 0.16, 0.55 ± 0.20, 0.52 ± 0.14, 0.55 ± 0.18, 0.55 ± 0.16, and 0.47 ± 0.18, respectively. The coping styles of elderly patients with chronic functional constipation were correlated with depression (P < 0.05), in which problem solving and help-seeking were negatively correlated with depression (r = -0.678, -0.569, P < 0.01), while remorse and rationalization were positively correlated with depression (r = 0.765, 0.364, P < 0.01).

CONCLUSION

All patients with chronic functional constipation have a certain degree of depression, which is related to coping styles in different degrees. In clinical practice, individual psychological counseling should be given to these patients to reduce negative emotions and improve the therapeutic effect.