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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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Abber SR, Buchanan KL, Clukey J, Joiner TE, Staller K, Burton-Murray H. Latent profile analysis reveals the central role of psychological symptoms in driving disease severity in chronic constipation. Neurogastroenterol Motil 2024; 36:e14773. [PMID: 38396355 DOI: 10.1111/nmo.14773] [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: 09/19/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Chronic constipation (CC) is defined by symptom criteria reflecting heterogenous physiology. However, many patients with CC have significant psychological comorbidities-an alternative definition using a biopsychosocial classification model could be warranted to inform future treatments. We sought to: (1) empirically derive psychological symptom profiles of patients with CC using latent profile analysis and (2) validate these profiles by comparing them on symptom severity, GI-specific anxiety, body mass index (BMI), and anorectal manometry findings. METHODS Participants included adults presenting for anorectal manometry for CC (N = 468, 82% female, Mage = 47). Depression/anxiety symptoms and eating disorder (ED) symptoms (EAT-26) were used as indicators (i.e., variables used to derive profiles) representing unique psychological constructs. Constipation symptoms, GI-specific anxiety, BMI, and anorectal manometry results were used as validators (i.e., variables used to examine the clinical utility of the resulting profiles). KEY RESULTS A 5-profile solution provided the best statistical fit, comprising the following latent profiles (LPs): LP1 termed "high dieting, low bulimia;" LP2 termed "high ED symptoms;" LP3 termed "moderate ED symptoms;" LP4 termed "high anxiety and depression, low ED symptoms;" and LP5 termed "low psychological symptoms." The low psychological symptom profile (61% of the sample) had lower abdominal and overall constipation severity and lower GI-specific anxiety compared to the four profiles characterized by higher psychological symptoms (of any type). Profiles did not significantly differ on BMI or anorectal manometry results. CONCLUSIONS AND INFERENCES Profiles with high psychological symptoms had increased constipation symptom severity and GI-specific anxiety in adults with CC. Future research should test whether these profiles predict differential treatment outcomes.
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Affiliation(s)
- Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Kelly L Buchanan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jenna Clukey
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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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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Zou H, Gao H, Liu Y, Zhang Z, Zhao J, Wang W, Ren B, Tan X. Dietary inulin alleviated constipation induced depression and anxiety-like behaviors: Involvement of gut microbiota and microbial metabolite short-chain fatty acid. Int J Biol Macromol 2024; 259:129420. [PMID: 38219945 DOI: 10.1016/j.ijbiomac.2024.129420] [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: 05/30/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
Chronic constipation has been associated with depression-like behavior. Previous study identified the crucial role of gut microbiota in the development of constipation and depression. Dietary inulin (INU) could regulate gut microbiota. Whether INU treatment could ameliorate constipation induced depression was not clear. For this purpose, male CD-1 mice were administered diphenoxylate (20 mg/kg body weight/day) to induce constipation. We found that INU (10 % in standard diet) alleviated the diphenoxylate-induced constipation, manifested as the increase weight and moisture content of feces. Furthermore, the associated depression and anxiety-like behavior disorders were improved by inhibiting neuro-inflammation and preventing synaptic ultrastructure damage under INU treatment. Moreover, INU pretreatment improved the diphenoxylate-induced gut barrier damage by upregulating tight junction protein expression. INU also reshaped gut microbiota in constipation mice by increasing the relative abundance of Bacteroides and Proteobacteria and downregulating the abundance of Muribacalum and Melaminabacteria. The effects of INU on diphenoxylate-induced depression were abolished by gut microbiota depletion via antibiotic treatment. In addition, INU increased the concentration of short chain fatty acids (SCFAs) in feces contents. Meanwhile, supplementation of SCFAs could also partly improve diphenoxylate-induced depression. In conclusion, INU intake was a potential nutritional intervention strategy to prevent constipation induced depression via microbiota-gut-SCFAs axis.
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Affiliation(s)
- Hui Zou
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Huajing Gao
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Yanhong Liu
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Zhiwo Zhang
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Jia Zhao
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Wenxuan Wang
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China
| | - Bo Ren
- School of Food Science and Pharmaceutical Engineering, Nanjing Normal University, Nanjing 210023, China.
| | - Xintong Tan
- College of Food Science and Engineering, Key Laboratory of Food Processing Technology, Quality Control of Shandong Higher Education Institutes, Shandong Agricultural University, Taian 271018, China.
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Ishibashi K, Urabe Y, Vu NTH, Miyauchi S, Nakamura T, Konishi H, Mizuno J, Fukuhara M, Takigawa H, Yuge R, Quach DT, Oka S, Hiyama T. Clinical factors associated with stable treatment of chronic constipation in Japanese patients. BMC Gastroenterol 2024; 24:52. [PMID: 38287249 PMCID: PMC10823644 DOI: 10.1186/s12876-024-03140-y] [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: 06/05/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND/AIMS Chronic constipation (CC) is one of the most common gastrointestinal disorders in the general population. Although there are many treatment options, achieving a stable treatment for CC remains one of the challenges in clinical practice. This study aimed to evaluate the clinical factors associated with stable treatment for CC in Japanese patients. METHODS A retrospective, cross-sectional, and multicenter study was carried out. Patients were eligible for inclusion if they fulfilled the Rome IV criteria for diagnosing CC and had been treated for at least one and a half years. Patients with up to two prescription modifications for CC in one year were defined as the stable treatment group, whereas those with three or more prescription changes were defined as the unstable treatment group. Univariate and multivariate analyses were carried out to identify factors associated with CC. RESULTS A total of 114 patients have been recruited. There were 82 patients (77.0%) in the stable treatment group and 32 patients (23.0%) in the unstable treatment group. Based on multivariate likelihood analysis, only using acid-suppressive drugs contributed to stability treatment in CC patients (odds ratio: 2.81, 95% confidence interval: 1.12-7.08, p = 0.03). CONCLUSION Administration of acid-suppressive drugs was the only factor related to the stability of CC treatment. Further studies are needed to validate the results as well as clarify the causes.
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Affiliation(s)
- Kazuki Ishibashi
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Nhu Thi Hanh Vu
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shunsuke Miyauchi
- Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, 739-8514, Higashihiroshima, Japan
| | - Takeo Nakamura
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirona Konishi
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junichi Mizuno
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Motomitsu Fukuhara
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryo Yuge
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, 739-8514, Higashihiroshima, Japan.
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Vu NTH, Quach DT, Miyauchi S, Luu MN, Yoshida M, Nguyen DTN, Yoshino A, Miyaka Y, Okamoto Y, Oka S, Hiyama T. Prevalence and associated factors of chronic constipation among Japanese university students. Front Public Health 2024; 12:1258020. [PMID: 38292906 PMCID: PMC10824902 DOI: 10.3389/fpubh.2024.1258020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Chronic constipation (CC) is one of the most frequently reported gastrointestinal disorders in the general population and a prominent problem among university students. The study aimed to evaluate the prevalence and the associated factors of CC among Japanese university students. Methods This cross-sectional study was conducted among university students at Hiroshima University, Japan. Students answered the web questionnaire when making a web reservation for the health checkup (April 1 to May 31, 2023). The web questionnaire consisted of four sections, including baseline characteristics, lifestyle factors, family history of CC, and three scales to assess depression and eating disorders: the Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26 and Bulimic Investigatory Test (BITE). CC was diagnosed using Rome IV criteria. The multivariate logistic regression model was used to determine CC-related factors. Results Out of 10,500 individuals who participated in the annual health checkup, 7,496 participants answered the web questionnaire, of whom 5,386 answered all the survey questions. The mean age of the students was 21.1 ± 4.1 years. The male-to-female ratio was 1:1.17. The prevalence of CC was 13.7%. Factors significantly associated with CC in the multivariate model were first-degree family members with CC [Odd ratio (OR): 2.77, 95% confidence interval (CI): 2.31-3.31], severe depression according to BDI scale (OR: 2.59, 95% CI: 1.96-3.43), female sex (OR: 2.00, 95% CI: 1.69-2.36), and short sleep duration of 6 hours or less per day (OR: 1.28, 95% CI: 1.09-1.50). Lack of physical exercise tended to be associated with CC (OR: 1.19, 95% CI: 1.00-1.40). Conclusions CC is prevalent among Japanese university students. Significant risk factors for CC included the first-degree family history of CC, severe depression, female sex, and short sleep duration. Lack of physical exercise tended to be associated with CC. This may contribute to implementing suitable education health programs, health care professionals, and public health policies to identify individuals at risk for CC to prevent and treat CC effectively.
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Affiliation(s)
- Nhu Thi Hanh Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shunsuke Miyauchi
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Mahoko Yoshida
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Doan Thi Nha Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Atsuo Yoshino
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Yoshie Miyaka
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Yuri Okamoto
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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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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Boas Fernandes WV, Politti F, Blanco CR, Garcia Lucareli PR, Gomes CAFDP, Corrêa FI, Corrêa JCF. Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: Randomized controlled trial. J Bodyw Mov Ther 2023; 34:96-103. [PMID: 37301564 DOI: 10.1016/j.jbmt.2023.04.006] [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: 02/12/2021] [Revised: 12/14/2022] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.
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Affiliation(s)
- Walkyria Vilas Boas Fernandes
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil; Federal University of Mato Grosso, Rondonópolis, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil
| | | | | | | | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil
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Ma T, Yang N, Xie Y, Li Y, Xiao Q, Li Q, Jin H, Zheng L, Sun Z, Zuo K, Kwok LY, Zhang H, Lu N, Liu W. Effect of the probiotic strain, Lactiplantibacillus plantarum P9, on chronic constipation: a randomized, double-blind, placebo-controlled study. Pharmacol Res 2023; 191:106755. [PMID: 37019193 DOI: 10.1016/j.phrs.2023.106755] [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: 01/26/2023] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
Chronic constipation (CC) is a common gastrointestinal condition associated with intestinal inflammation, and the condition considerably impairs patients' quality of life. We conducted a large-scale 42-day randomized, double-blind, placebo-controlled trial to investigate the effect of probiotics in alleviating CC. 163 patients diagnosed with CC (following Rome IV criteria) were randomly divided into probiotic (n = 78; received Lactiplantibacillus plantarum P9 [P9]; 1×1011 CFU/day) and placebo (n = 85; received placebo material) groups. Ingesting P9 significantly improved the weekly mean frequency of complete spontaneous bowel movements (CSBMs) and spontaneous bowel movements (SBMs), while significantly reducing the level of worries and concerns (WO; P < 0.05). Comparing with the placebo group, P9 group was significantly enriched in potentially beneficial bacteria (Lactiplantibacillus plantarum and Ruminococcus_B gnavus), while depriving of several bacterial and phage taxa (Oscillospiraceae sp., Lachnospiraceae sp., and Herelleviridae; P < 0.05). Interesting significant correlations were also observed between some clinical parameters and subjects' gut microbiome, including: negative correlation between Oscillospiraceae sp. and SBMs; positive correlation between WO and Oscillospiraceae sp., Lachnospiraceae sp. Additionally, P9 group had significantly (P < 0.05) more predicted gut microbial bioactive potential involved in the metabolism of amino acids (L-asparagine, L-pipecolinic), short-/medium-chain fatty acids (valeric acid and caprylic acid). Furthermore, several metabolites (p-cresol, methylamine, trimethylamine) related to the intestinal barrier and transit decreased significantly after P9 administration (P < 0.05). In short, the constipation relief effect of P9 intervention was accompanied by desirable changes in the fecal metagenome and metabolome. Our findings support the notion of applying probiotics in managing CC.
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Abrosimov IN, Yaltonsky VM, Sirota NA, Lisitsyna TA, Yaltonskaya AV, Lila AM. Immunoinflammatory rheumatic diseases: the role of the perception of the disease and coping with it in the psychological adaptation of the patient. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-6-20-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: to analyze the subjective perception of the disease, coping behavior and adherence to treatment as parameters of psychological adaptation of patients with immunoinflammatory rheumatic diseases (IIRD).Patients and methods. 163 women with IIRD who were on inpatient treatment were examined: 63 with systemic lupus erythematosus, 50 with rheumatoid arthritis, and 50 with systemic scleroderma. The mean age of the patients was 34.00±17.46 years.Results and discussion. Groups of patients with different types of perception of the disease were identified: "Unformed perception of the disease" (group 1), "Positive perception of disease control" (group 2), "Negative perception of disease threat" (group 3). When comparing the three groups, it was found that in the group with an unformed perception of the disease, negative emotional experiences were less pronounced than in the other two groups. At the same time, the coping strategies "Self-control" and "Problem solving planning" were significantly higher in the group of patients who positively perceived the control of their disease.Conclusion. Psychological adaptation of patients with IIRD depends on the type of perception of the disease. The identification of two basic profiles (“Disease threat perception” and “Disease and treatment control perception”) and three types of disease perception (“Unformed type of disease perception”, “Positive perception of disease control”, “Negative perception of the disease threat”) made it possible to obtain new, more differentiated ideas about the perception of the disease, which is the target of correctional psychological work with patients suffering from IIRD.
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Affiliation(s)
- I. N. Abrosimov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - V. M. Yaltonsky
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - N. A. Sirota
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | | | - A. V. Yaltonskaya
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Niu T, Zhou X, Li X, Liu T, Liu Q, Li R, Liu Y, Dong H. Development and validation of a dynamic risk prediction system for constipation in patients with amyotrophic lateral sclerosis. Front Neurol 2022; 13:1060715. [PMID: 36570448 PMCID: PMC9768031 DOI: 10.3389/fneur.2022.1060715] [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: 10/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Although constipation is a common non-motor symptom in patients with amyotrophic lateral sclerosis (ALS), it is poorly valued. Moreover, there is a bidirectional effect between constipation and neuropsychiatric and sleep disturbances. Thus, these symptoms are better treated simultaneously. Therefore, this study aimed to develop and validate a model for predicting the risk of constipation in ALS patients, to help clinicians identify and treat constipation early. Methods Data of 118 ALS admissions from an observational prospective cohort, registered between March 2017 and December 2021, were analyzed. Demographic data were obtained. Constipation was assessed using the Knowles-Eccersley-Scott Symptom Questionnaire. The severity of ALS was assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). The Pittsburgh Sleep Quality Index (PSQI) was used to assess patients' sleep status. The least absolute shrinkage and selection operator (LASSO) regression model was used to select factors and construct a nomogram. Nomogram model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). The model was internally validated using bootstrap validation in the current cohort. Results Age, family history of constipation, total ALSFRS-R score, site of onset, total PSQI score, and depressed, were identified as significant predictors of the risk of constipation in ALS patients. The prediction model was validated to have good accuracy (Hosmer-Lemeshow test: χ2 = 11.11, P > 0.05) and discrimination (AUC = 0.856, 95% confidence interval: 0.784-0.928). DCA and CIC showed that the nomogram model had excellent clinical performance. Conclusions A web-based ALS constipation risk calculator with good predictive performance was constructed to identify patients at high risk of constipation and to allow early intervention in a clinical context.
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Affiliation(s)
- Tongyang Niu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xiaomeng Zhou
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xin Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Tingting Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Qi Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Rui Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Yaling Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China,*Correspondence: Yaling Liu
| | - Hui Dong
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China,Hui Dong
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12
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Association between Depression, Anxiety Symptoms and Gut Microbiota in Chinese Elderly with Functional Constipation. Nutrients 2022; 14:nu14235013. [PMID: 36501044 PMCID: PMC9740187 DOI: 10.3390/nu14235013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to investigate the relationship between anxiety, depression, and gut microbiota in elderly patients with FC. METHODS in this cross-sectional study, a total of 198 elderly participants (85 male and 113 female) aged over 60 years were recruited. The study was conducted in Changsha city, China. The participants completed an online questionnaire, including The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), The Patient Assessment of Symptoms (PAC-SYM), and The Patient Assessment of Quality of Life (PAC-QoL). We selected the 16S rDNA V3 + V4 region as the amplification region and sequenced the gut microbiota using the Illumina Novaseq PE250 high-throughput sequencing platform. RESULTS in total, 30.3% of patients with constipation had depression, while 21.3% had anxiety. The relative abundance of intestinal microbiota in the normal group was higher than that in the anxiety and depression group. According to LEfSe analysis, the relative abundance of g_Peptoniphilus and g_Geobacter in the people without depression and anxiety was higher. The relative abundance of g_Pseudoramibacter-Eubacterium and g_Candidatus-Solibacter in the depression group was lower, and the relative abundance of g_Bacteroides and g_Paraprevotella, g_Cc_115 in the anxiety group was higher. In addition, according to the correlation analysis, g_Aquicella and g_Limnohabitans were negatively correlated with constipation symptoms, anxiety, and depression. CONCLUSIONS this study found that gut microbiota composition may be associated with a higher incidence of anxiety and depression in patients with FC, thus providing insight into the mechanisms that ameliorate mood disorders in patients with FC.
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Association between overall dietary quality and constipation in American adults: a cross-sectional study. BMC Public Health 2022; 22:1971. [PMID: 36303148 PMCID: PMC9615246 DOI: 10.1186/s12889-022-14360-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 10/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Constipation seriously affects people’s life quality, and dietary adjustment has been one of the effective methods. Overall dietary quality has been reported to be associated with some diseases, while its association with constipation has not been reported. This study aims to explore the association between overall dietary quality and constipation. Methods A cross-sectional study was designed and data were extracted from National Health and Nutrition Examination Survey (NHANES). Overall dietary quality was assessed by healthy eating index-2015 (HEI-2015), and constipation was defined by either stool consistency or stool frequency. The association between overall dietary quality or components of HEI-2015 and constipation was assessed using logistic regression, with results expressed as odds ratio (OR) and 95% confidence intervals (95%CI). Subgroup analysis was conducted according to age and gender. Results A total of 13,945 participants were eligible, with 1,407 in constipation group and 12,538 in non-constipation group. Results showed that higher adherence to HEI-2015 was associated with reduced odds of constipation (OR: 0.98, 95%CI: 0.98–0.99) after adjusting potential confounders. Further, we found higher intake of total fruits, whole fruits, total vegetables, greens and beans, whole grains, total protein foods, seafood and plant proteins, and higher fatty acids ratio decreased the odds of constipation, while higher intake of sodium increased the odds (all P < 0.05). We also found negative association between HEI-2015 and constipation in participants with male sex, female sex, age ≥ 65 years, and age < 65 years (all P < 0.05). Conclusion We found higher adherence to HEI-2015 decreased the odds of constipation, suggesting that increasing HEI-2015 adherence may be one of effective methods to alleviate constipation. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14360-w.
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Adibi P, Abdoli M, Daghaghzadeh H, Keshteli AH, Afshar H, Roohafza H, Esmaillzadeh A, Feizi A. Relationship between Depression and Constipation: Results from a Large Cross-sectional Study in Adults. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:77-84. [PMID: 36004635 DOI: 10.4166/kjg.2022.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND/AIMS Accumulating evidence based on a few studies suggests a relationship between depression and functional constipation. This study examined whether depression is associated with a higher risk of functional constipation and whether it is gender specific. METHODS This cross-sectional study was carried out on 3,362 adults aged 18-55 years. In this study, functional gastrointestinal symptoms were determined using an Iranian reliable and valid version of the modified Rome III questionnaire. The Iranian validated version of the hospital anxiety and depression scale was used to evaluate the psychological health. Scores of eight or more on the depression subscale in the questionnaire were considered the presence of depression. Simple and multiple binary logistic regression were used for data analysis. RESULTS The mean±SD age of participants was 36.29±7.87 years, and 58.5% were female. The prevalence of depression and constipation in the study sample was 28.6% and 23.9%, respectively. In the full adjusted model, in the total sample, depressed people showed a significantly higher risk of constipation; adjusted OR (AOR), 1.69 (95% CI, 1.37-2.09). Although a significant association was observed between depression and constipation in both genders, the association was stronger in men than women (AOR, 2.28; 95% CI, 1.50, 3.63 vs. AOR, 1.55; 95% CI, 1.21, 1.99). CONCLUSIONS These study findings showed that depressed people are at a significantly higher risk of being affected by constipation. The current study findings justify the importance of mental health evaluations in all patients with functional gastrointestinal disorders, particularly among constipated individuals.
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Affiliation(s)
- Peyman Adibi
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Abdoli
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Daghaghzadeh
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hamid Afshar
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Lyu Z, Fan Y, Bai Y, Liu T, Zhong LLD, Liang HF. Outcome of the efficacy of Chinese herbal medicine for functional constipation: A systematic review and meta-analysis. World J Clin Cases 2022; 10:4856-4877. [PMID: 35801027 PMCID: PMC9198889 DOI: 10.12998/wjcc.v10.i15.4856] [Citation(s) in RCA: 2] [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: 05/31/2021] [Revised: 07/14/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional constipation (FC) is a common and chronic gastrointestinal disease and its treatment remains challenging.
AIM To evaluate the efficacy and safety of Chinese herbal medicine (CHM) on efficacy rate, global symptoms, bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials (RCTs).
METHODS RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20, 2020. Two independent reviewers assessed the quality of the included articles and extracted data. Meta-analyses were performed to odds ratio (OR), mean differences (MD) and 95% confidence interval (CI) using random-effects models. Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity. The funnel plot, Begg’s test and Egger’s test were used to detect publication bias.
RESULTS Ninety-seven studies involving 8693 patients were included in this work. CHM was significantly associated with a higher efficacy rate (OR: 3.62, 95%CI: 3.19-4.11, P < 0.00001) less severe global symptoms (OR: 4.03, 95%CI: 3.49-4.65, P < 0.00001) compared with control treatment, with the low heterogeneity between studies (I2 = 0%, P = 0.76). CHM was also associated with more frequent bowel movements (MD 0.83, 95%CI: 0.67-0.98, P < 0.00001), a lower score on the Bristol Stool Scale (OR: 1.63, 95%CI: 1.15-2.32, P < 0.006), and a not significant recurrence rate (OR: 0.47, 95%CI: 0.22-0.99, P = 0.05). No serious adverse effects of CHM were reported.
CONCLUSION In this meta-analysis, we found that CHM may have potential benefits in increasing the number of bowel movements, improving stool characteristics and alleviating global symptoms in FC patients. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are required.
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Affiliation(s)
- Zipan Lyu
- Teaching and Research Division, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR 99977, China
| | - Yibo Fan
- Teaching and Research Division, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR 99977, China
| | - Yang Bai
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Tao Liu
- Department of Digestive Endoscope Center, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Linda LD Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
| | - Hui-Feng Liang
- The Institute for Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Ito D, Yamamoto Y, Maekita T, Yamagishi N, Kawashima S, Yoshikawa T, Tanioka K, Yoshida T, Iguchi M, Kunitatsu K, Kanai Y, Kato S, Kitano M. Do synbiotics really enhance beneficial synbiotics effect on defecation symptoms in healthy adults?: Randomized, double-blind, placebo-controlled trial. Medicine (Baltimore) 2022; 101:e28858. [PMID: 35212286 PMCID: PMC8878738 DOI: 10.1097/md.0000000000028858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
GOALS We examined whether synbiotics enhance improvement by probiotics. BACKGROUND Probiotics, which are beneficial microbacteria, are a nutritional intervention for treatment of functional constipation or its tendency. Prebiotics, meanwhile, can promote the proliferation of probiotics in the gastrointestinal tract and enhance their beneficial effects. Synbiotics, a combination of probiotics and prebiotics, may be superior to probiotics in the treatment of defecation-related symptoms, but this requires elucidation. STUDY This randomized, double-blind, placebo-controlled study enrolled 69 healthy adults with constipation tendency. Participants were allocated to either control, probiotics, or synbiotics groups and they recorded details of their defecations and their condition. The first 2 weeks were the observation period and the latter 2 weeks were the intervention period, in which participants took test foods. Probiotic foods included Bifidobacterium longum NT strain (1010 CFU/day), synbiotic foods included the NT strain (1010 CFU/day) and galactooligosaccharide (1 g/day). Placebo foods contained the vehicle only. Participants answered questionnaires (Patient Assessment on Constipation Symptoms [PAC-SYM], and one on dietary history) on the last day of each period. RESULTS Nine participants withdrew consent, and 2 of the remaining 60 had missing data. Age, body mass index, and sex were not significantly different between the 3 groups. Frequency of bowel movements in the fourth week, the primary endpoint, was not increased in the probiotics or synbiotics groups compared with the control group, and the frequency of bowel movements and days with defecation were not changed by probiotics or synbiotics during the intervention period. Probiotics and synbiotics did not improve stool conditions, although incomplete defecation was improved by probiotics but not by synbiotics compared with placebo. PAC-SYM indicated that stool condition and total scores were improved by probiotics but not by synbiotics during the intervention compared with placebo. CONCLUSION The probiotic strain Bifidobacterium longum NT can improve constipation symptoms, especially stool condition, but it does not increase bowel movement frequency in healthy adults with constipation tendency. Synbiotics treatment seemed to diminish this improvement of constipation induced by probiotics. This study indicates the possibility of attenuation of beneficial effects from probiotics by the use of synbiotics, contrary to synbiotics theory.
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Affiliation(s)
- Daisaku Ito
- Second Department of Internal Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Yuta Yamamoto
- Department of Anatomy and Cell Biology, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Takao Maekita
- Second Department of Internal Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Naoko Yamagishi
- Department of Anatomy and Cell Biology, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Takanori Yoshikawa
- Clinical Study Support Center, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Kensuke Tanioka
- Clinical Study Support Center, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Takeichi Yoshida
- Second Department of Internal Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Yoshimitsu Kanai
- Department of Anatomy and Cell Biology, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Kimiidera 811-1 Wakayama, Japan
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Chen Z, Peng Y, Shi Q, Chen Y, Cao L, Jia J, Liu C, Zhang J. Prevalence and Risk Factors of Functional Constipation According to the Rome Criteria in China: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:815156. [PMID: 35252254 PMCID: PMC8889120 DOI: 10.3389/fmed.2022.815156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/04/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Functional constipation (FC) is a common bowel disorder that prevails worldwide. In China, although a heterogeneous prevalence of constipation is expected, it is currently not demonstrated. In this study, we aimed to evaluate the prevalence and related risk factors of FC in the Chinese population, according to the Rome criteria. METHODS We searched the PubMed, the Embase, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the Wanfang data knowledge service platform, the VIP information resource integration service platform, and the Chinese Biomedical Literature Service System (SinoMed) databases from the inception of database to July 2021. Population-based cross-section studies that enrolled adults with FC, diagnosed by the Rome criteria, were deemed eligible. We summarized the overall prevalence and detected the subgroup effect per the Rome I, Rome II, Rome III, and Rome IV criteria. We used the generalized linear mixed model (GLMM) with a random-effect intercept to pool the prevalence and performed pairwise meta-analyses for prevalence comparisons by risk factors. RESULTS We identified 3,213 records through our database search, and 39 studies from China, comprising 1,240,79 participants, met the eligibility criteria for our study. The pooled overall prevalence of FC using the Rome criteria was 8.5% in China. Heterogeneous prevalence was detected within the Rome criteria (Rome II: 10.6%, 95% CI: 7.2-15.4; Rome III: 6.5%, 95% CI: 3.4-12.0; Rome IV: 8.1%, 95% CI: 5.6-11.8). The prevalence increased between 1991 and 2020 (from 5.5% with 95% CI: 3.6-8.2 between 1991 and 2000 to 10.9% with 95% CI: 5.5-20.4 between 2011 and 2020). Higher prevalence was found in women [odds ratio (OR) = 1.53, 95% CI: 1.31-1.78] and the elderly (≥70 years vs. ≤ 29 years: OR = 3.38, 95% CI: 2.16-5.30) than in men and the younger population. A high-fiber diet was associated with lower prevalence (OR = 0.33, 95% CI: 0.15-0.75), whereas irregular bowel habit and inactivity were associated with higher prevalence (OR = 3.64, 95% CI: 2.64-5.03; OR = 1.97, 95% CI: 1.14-3.43). Unhealthy mental states, such as anxiety and depression, and poor sleep quality led to high prevalence (OR = 3.16, 95%C I: 1.96-5.11; OR = 2.74, 95% CI: 1.76-4.26; OR = 2.14, 95% CI: 1.69-2.72, respectively). CONCLUSION Various types of FC prevail in China based on the different Rome criteria, personal characteristics, and habits. The prevalence also increased over the past three decades. The FC should be included under the primary care setting with uniform diagnosis criteria in China. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO, CRD42021277172.
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Affiliation(s)
- Zhe Chen
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yingying Peng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingyang Shi
- Chinese Evidence-Based Medicine Center, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yongjie Chen
- Department of Epidemiology and Statistic, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lujia Cao
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiannan Jia
- Department of Gastroenterology, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine Nankai Hospital, Tianjin, China
| | - Chunxiang Liu
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Lackner JM, Gudleski GD, Radziwon CD, Krasner SS, Naliboff BD, Vargovich AM, Borden AB, Mayer EA. Cognitive flexibility improves in cognitive behavior therapy for irritable bowel syndrome but not nonspecific education/support. Behav Res Ther 2022; 154:104033. [DOI: 10.1016/j.brat.2022.104033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/06/2023]
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Yamamoto S, Kawamura Y, Yamamoto K, Yamaguchi Y, Tamura Y, Izawa S, Nakagawa H, Wakita Y, Hijikata Y, Ebi M, Funaki Y, Ohashi W, Ogasawara N, Sasaki M, Maekawa M, Kasugai K. Internet Survey of Japanese Patients With Chronic Constipation: Focus on Correlations Between Sleep Quality, Symptom Severity, and Quality of Life. J Neurogastroenterol Motil 2021; 27:602-611. [PMID: 34642281 PMCID: PMC8521473 DOI: 10.5056/jnm20135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Chronic constipation and lifestyle factors can affect sleep quality. We evaluated the relationship between chronic constipation and sleep in the Japanese population. Methods This cross-sectional internet-based survey included 3000 subjects with constipation, classified according to sleep status (good/poor). Primary endpoints were Bristol stool form scale (BSFS) score and correlations between sleep disorder criteria of the Pittsburgh Sleep Quality Index (PSQI) and sleep status (good/poor sleep). Secondary endpoints included correlations between quality of life (QOL) and mood, medical, lifestyle, and sleep factors. Results The proportion of participants with BSFS category 4 (normal stool) was significantly higher in the good sleep group (P < 0.001). Sleep disturbance (P < 0.05), sleep quality, and duration, use of hypnotic medication, and daytime dysfunction of PSQI (all P < 0.001) significantly correlated with poor sleep. In the poor sleep group, QOL was significantly worse and anxiety and depression levels were significantly higher (all P < 0.001) compared with the good sleep group. Anemia and smoking (both P < 0.05), recent body weight increases, and poor eating habits (all P < 0.001) were significantly higher in the poor sleep group. Male sex, onset associated with change in frequency of stools, sensation of incomplete evacuation for at least 25% of defecations, and manual maneuvers to facilitate at least 25% of defecations correlated with poor sleep. Conclusions Subjects with constipation and poor sleep experienced severe symptoms and had poor QOL. These data support the need for a multifocal treatment approach, including lifestyle advice and pharmacotherapy.
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Affiliation(s)
- Sayuri Yamamoto
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yurika Kawamura
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Kazuhiro Yamamoto
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yoshiharu Yamaguchi
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yasuhiro Tamura
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Shinya Izawa
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Hiroaki Nakagawa
- Division of General Medicine, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yoshinori Wakita
- Division of General Medicine, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yasutaka Hijikata
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Masahide Ebi
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yasushi Funaki
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Naotaka Ogasawara
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Makoto Sasaki
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Masato Maekawa
- Division of General Medicine, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
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Biopsychosocial Model and Perceived Constipation Severity According to the Constipation Phenotype. Dig Dis Sci 2021; 66:3588-3596. [PMID: 33073331 DOI: 10.1007/s10620-020-06654-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/03/2020] [Indexed: 12/09/2022]
Abstract
PURPOSE Constipation is a frequent complaint of patients with functional bowel disorders. The present study aimed to evaluate the relationship between the perceived constipation severity with demographics, clinical, physiological, and psychological parameters in constipated patients. PATIENTS AND METHODS Four hundred seven constipated patients were included and had clinical, physiological, and psychological evaluation. The self-reported severity of constipation was analyzed using stepwise linear regression in the total population and within each clinical group. RESULTS The patients were mainly of female gender (81%) and were 47.4 ± 16.5 years old. They complained of IBS (65%), and 62% had defecation disorders. The depression scale was abnormal in 200 patients (49%). The relationships of the constipation severity varied according to the Rome IV phenotype. In all phenotypes, it was positively associated with bloating severity, and negatively with Bristol stool form. In IBS patients, perceived constipation severity was also associated with abdominal pain severity. CONCLUSION Our data support the hypothesis that perceived constipation severity is associated with clinical and physiological factors but not demographics and psychological factors. Besides, the relationships of perceived constipation severity with these factors vary according to clinical phenotypes.
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21
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Liu X, Liu H, Wei F, Zhao D, Wang Y, Lv M, Zhao S, Qin X. Fecal Metabolomics and Network Pharmacology Reveal the Correlations between Constipation and Depression. J Proteome Res 2021; 20:4771-4786. [PMID: 34524820 DOI: 10.1021/acs.jproteome.1c00435] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Constipation and depression are tightly related and often co-occur and coexist in clinic. Yet, the relationships and the underlying mechanisms are still unclear. Fecal metabolomics and network pharmacology were, for the first time, applied to investigate the potential correlations from multiple levels including classic behaviors, metabolomics, and gene targets. The behavioral indicators were analyzed, providing behavioral correlations at a macrolevel. Besides, fecal samples were analyzed by nuclear magnetic resonance spectroscopy to screen the shared and the unique metabolites and pathways, revealing correlations from a metabolic perspective. Finally, the disease targets and the functional pathways were obtained via network pharmacology, demonstrating correlations at the molecular level. The correlations between constipation and depression were demonstrated and supported by four-level evidence: (1) general behaviors, (2) gastrointestinal functions, (3) fecal metabolites and pathways, and (4) common gene targets and functional pathways. Especially, the correlations of behaviors and common metabolites showed that metabolites, including choline, betaine, and glycine, were significantly associated with constipation and depression. Besides, inflammation and immune abnormalities and energy metabolism were significantly involved in the mechanisms. The current findings prove the correlations between constipation and depression, and provide a basis for deeply understanding the comorbidities of constipation and depression.
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Affiliation(s)
- Xiaojie Liu
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Huanle Liu
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Fuxiao Wei
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Di Zhao
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Yeze Wang
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Meng Lv
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
| | - Sijun Zhao
- Department of Pharmacology, Shanxi Institute for Food and Drug Control, Taiyuan 030001 Shanxi, China
| | - Xuemei Qin
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China.,Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Taiyuan 030006, China.,Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province, Taiyuan 030006, China
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22
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Eustis SJ, McCall MW, Murphy EA, Wirth MD. Association Between Gastrointestinal Symptoms and Depression in a Representative Sample of Adults in the United States: Findings From National Health and Nutrition Examination Survey (2005-2016). J Acad Consult Liaison Psychiatry 2021; 63:268-279. [PMID: 34461293 DOI: 10.1016/j.jaclp.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/08/2021] [Accepted: 08/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The microbiome's role in the etiology of depression has been a topic of many recent investigations. Findings suggest that dysbiosis, which describes a general disturbance in the gut microbiome, underlies negative gastrointestinal symptoms and is implicated in depression. We studied associations between gastrointestinal symptoms and depressive symptoms at a population level using cross-sectional data from the National Health and Nutrition Examination Survey (2005-2016, n = 36,287). We hypothesized that the odds of depressive symptoms would be significantly higher in those showing signs of gastrointestinal distress. METHODS We analyzed 31,191 adults participating in the National Health and Nutrition Examination Survey from 2005-2016. Outcomes included presence of mucus or liquid in bowel leakage and stomach illness in the past month, diarrhea in the past year, and number of weekly bowel movements. The survey (and thus, our analyses) does not include microbiome samples, only self-reported gastrointestinal symptoms. Depressive symptoms were measured using the Patient Health Questionnaire. Moderate, moderately severe, and severe scores were coded as a positive outcome. RESULTS Compared to those without depressive symptoms, those with moderate-to-severe depressive symptoms had elevated odds of bowel mucus (odds ratio = 2.78; 95% confidence interval = 1.82-4.24), bowel liquid (odds ratio = 2.16; 95% confidence interval = 1.63-2.86), stomach illness (odds ratio = 1.82; 95% confidence interval = 1.31-2.53), diarrhea (sometimes vs. never odds ratio = 1.72; 95% confidence interval = 1.30-2.29), and constipation (sometimes vs. never odds ratio = 2.76; 95% confidence interval = 2.11-3.62). Overall, those with gastrointestinal symptoms were significantly more likely to have depressive symptoms. CONCLUSIONS While the intricacies of the brain-gut axis are being investigated at the molecular level, these population data provide further evidence for the association between depressive symptoms and signs of dysbiosis, which may inform health care providers' patient interactions.
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Affiliation(s)
| | - Michael W McCall
- Department of Psychology, University of South Carolina, Columbia, SC
| | - E Angela Murphy
- Departments of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC
| | - Michael D Wirth
- Tufts University School of Medicine, Boston, MA; College of Nursing, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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23
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Allemeyer E, Müssig K. Chronische Obstipation und Diabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1320-9358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Kerekes N, Zouini B, Tingberg S, Erlandsson S. Psychological Distress, Somatic Complaints, and Their Relation to Negative Psychosocial Factors in a Sample of Swedish High School Students. Front Public Health 2021; 9:669958. [PMID: 34350150 PMCID: PMC8328276 DOI: 10.3389/fpubh.2021.669958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adolescence is a period in life characterized by major neurobiological, physiological, and psychological changes. Those changes may give rise to worsened mental health and an increased prevalence of somatic complaints combined with a negative psychosocial environment. Rapid changes in society, which may also affect young people in several ways, call for a renewed screening of today's adolescents' mental and somatic well-being. Aim: The present study's primary aim was to measure the level of self-rated psychological distress and the prevalence of somatic complaints in a sample of Swedish high school students. As a secondary aim, it identifies gender-specific patterns and examines mental and somatic health in relation to negative psychosocial factors (such as parental alcohol use problems or the experience of physical or psychological abuse). Method: Two hundred and eighty-seven Swedish high school students completed a survey including the Brief Symptom Inventory (BSI) and a questionnaire about the presence of defined somatic complaints. In order to examine the relationship between negative psychosocial factors and mental and somatic health, three groups were formed: those reporting (i) parental substance use problems, (ii) previous experience of abuse, (iii) none of these problems. Results: The majority of the Swedish high-school students (>80%) reported no or only a few problems with psychological distress and no or only one somatic complaint. Female students disclosed a significantly higher psychological distress level captured by each BSI domain. The number of somatic complaints was similarly distributed between the genders. The students rarely reported parental substance use problems, but almost 40% of the male and 50% of the female students indicated the experience of physical and/or psychological abuse. Such negative psychosocial circumstances were related to an increased level of anxiety in the male and an increased general level of psychological distress in female students. Conclusions: The study confirmed female students' higher psychological distress level. Gender differences in the type of somatic complaints, but not in the number were detected. The experience of physical and/or psychological abuse was found to significantly worsen psychological distress in students of both genders.
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Affiliation(s)
- Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Btissame Zouini
- Department of Biology, Faculty of Sciences, Abdelmalek Essaadi University, Tetouan, Morocco
| | - Sofia Tingberg
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Soly Erlandsson
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
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25
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Wong OWH, Lam AMW, Lai KYC, Ma SL, Hung SF, Chan S, Wong S, Leung PWL. An elevated anxiety level among prepubertal autistic boys with non-treatment-seeking functional gastrointestinal disorders: A case-control study. Autism Res 2021; 14:2131-2142. [PMID: 34114351 DOI: 10.1002/aur.2555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/28/2022]
Abstract
Children with autism commonly suffer from comorbid functional gastrointestinal disorders (FGID) and anxiety. The raised prevalence of both conditions in autism suggests complex reciprocal relationships, which are seldom explored in non-treatment-seeking FGID. The relationships between subtypes of FGID and anxiety are also unclear. This study recruited boys with autism and age-matched typically developing (TD) boys, aged 4-11 years, who were not actively seeking help for gastrointestinal problems. Their parents completed the Rome IV Diagnostic Questionnaires for Pediatric FGID. Four groups of children with and without autism/FGID were identified and compared on their anxiety level using the Spence children's anxiety scale. In 69 boys with autism and 69 age-matched TD boys, FGID were identified in 22 and 16 boys, respectively. ANCOVA demonstrated a significant interaction effect of autism and FGID on anxiety (F[1, 129] = 5.43, p = 0.021), while conditional logistic regression identified an interaction effect of autism and anxiety on the odds of FGID (OR 1.038, 95% CI 1.002-1.075, p = 0.038). Explorative post hoc analysis showed higher anxiety in functional nausea and vomiting disorder (p = 0.033) and functional abdominal pain disorder (p = 0.029) among boys with autism than TD boys with the same respective subtypes of FGID. In summary, among prepubertal boys with autism, the presence of FGID that are non-treatment-seeking in nature, has a significantly stronger association with higher levels of anxiety than TD boys. The strength of association may be more prominent in subtypes of FGID. Possible pathomechanisms including the underlying microbiota spectra and inflammatory paths should be explored in future studies. LAY SUMMARY: Anxiety and gastrointestinal problems are common symptoms in autism. Given that gut health could be linked to emotions, their association in young boys with autism was studied. The presence of nausea vomiting, or abdominal pain were associated with raised anxiety among boys with autism, yet this was not observed in typically developing boys. This suggests that anxiety among autistic children could be partly explained by the presence of FGID.
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Affiliation(s)
- Oscar W H Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Angela M W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kelly Y C Lai
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Suk Ling Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Se Fong Hung
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sandra Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sunny Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
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26
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Werth BL, Christopher SA. Potential risk factors for constipation in the community. World J Gastroenterol 2021; 27:2795-2817. [PMID: 34135555 PMCID: PMC8173388 DOI: 10.3748/wjg.v27.i21.2795] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Constipation is a common community health problem. There are many factors that are widely thought to be associated with constipation but real-world evidence of these associations is difficult to locate. These potential risk factors may be categorised as demographic, lifestyle and health-related factors. This review presents the available evidence for each factor by an assessment of quantitative data from cross-sectional studies of community-dwelling adults published over the last 30 years. It appears that there is evidence of an association between constipation and female gender, residential location, physical activity and some health-related factors such as self-rated health, some surgery, certain medical conditions and certain medications. The available evidence for most other factors is either conflicting or insufficient. Therefore, further research is necessary to determine if each factor is truly associated with constipation and whether it can be regarded as a potential risk factor. It is recommended that studies investigating a broad range of factors are conducted in populations in community settings. Multivariate analyses should be performed to account for all possible confounding factors. In this way, valuable evidence can be accumulated for a better understanding of potential risk factors for constipation in the community.
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Affiliation(s)
- Barry L Werth
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
| | - Sybele-Anne Christopher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
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27
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Barberio B, Judge C, Savarino EV, Ford AC. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:638-648. [PMID: 34090581 DOI: 10.1016/s2468-1253(21)00111-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs. FINDINGS Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used. INTERPRETATION Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability. FUNDING None.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Ciaran Judge
- Department of Gastroenterology, St James's University Hospital, Dublin, Ireland
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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28
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Tomita T, Kazumori K, Baba K, Zhao X, Chen Y, Miwa H. Impact of chronic constipation on health-related quality of life and work productivity in Japan. J Gastroenterol Hepatol 2021; 36:1529-1537. [PMID: 33047825 DOI: 10.1111/jgh.15295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/09/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The impact of chronic constipation on health-related quality of life (HRQoL), work productivity, and healthcare resource use in Japan is not well understood. This study aimed to evaluate and compare the humanistic burden of respondents with chronic constipation to respondents without chronic constipation and to respondents with type 2 diabetes mellitus (T2DM), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD), respectively. METHODS This cross-sectional study collected demographic and general health data and HRQoL data as measured by the Short Form 12-Item (Version 2) Health Survey and EuroQol 5-dimension health surveys. Health impacts on employment-related activities and indirect costs were measured using the Work Productivity and Activity Impairment questionnaire. Propensity score matching was used to identify a control group without chronic constipation. Multivariate generalized linear models were used to identify potential factors that may impact the outcomes of respondents. RESULTS A total of 30 001 individuals responded to the Japan National Health and Wellness Survey 2017, whereof 3373 (11.2%) reported having chronic constipation; 963 were physician diagnosed. Compared with matched controls, patients with physician-diagnosed chronic constipation had lower mean HRQoL scores and higher mean absenteeism, presenteeism, total Work Productivity and Activity Impairment, and indirect costs. Physician-diagnosed chronic constipation was associated with a higher health burden than T2DM, IBS, and GERD. CONCLUSIONS Chronic constipation is associated with a considerable health burden, which is higher compared with T2DM, IBS, and GERD. These results suggest an urgent need for effective treatment of Japanese patients with chronic constipation to improve their quality of life.
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Affiliation(s)
- Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Kenji Baba
- Medical Affairs, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | | | | | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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29
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Nishitani-Yokoyama M, Shimada K, Yamada M, Honzawa A, Kunimoto M, Sugita Y, Fujiwara K, Matsubara T, Matsumori R, Abulimiti A, Shimada A, Yamamoto T, Asai T, Amano A, Saitoh M, Morisawa T, Takahashi T, Daida H, Minamino T. Association Between Constipation and Frailty Components in Patients Undergoing Late Phase II Cardiac Rehabilitation. Cardiol Res 2021; 12:169-176. [PMID: 34046111 PMCID: PMC8139749 DOI: 10.14740/cr1246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Japanese Ministry of Health, Labour and Welfare reported that the overall constipation complaint rates among men and women are 2.5% and 4.6%, respectively. To evaluate the impact of constipation on patients with cardiovascular diseases, we investigated the association between constipation and frailty components in patients undergoing cardiac rehabilitation (CR). Methods We enrolled 102 consecutive patients undergoing late phase II CR (mean age: 62.7 ± 13.4 years; 68 (67%) were men). We investigated clinical characteristics, observed defecation status and evaluated frailty components assessed by the Kihon checklist. According to the Clinical Guidelines for Chronic Constipation, the subjects were divided into constipation and non-constipation groups. Results Constipation was noted in 33 patients (32%). Interestingly, the constipation complaint rate was only 15%. Age was significantly higher in the constipation group than in the non-constipation group; however, no differences in sex, underlying diseases and prevalence rates of coronary risk factors were observed between the two groups. Body mass index, hemoglobin level, albumin level and estimated glomerular filtration rate were significantly lower in the constipation group than in the non-constipation group. The prevalence of frailty was significantly higher in the constipation group than in the non-constipation group. Physical ability, seclusion and depression scores were significantly higher in the constipation group than the non-constipation group. Conclusions Constipation was associated with physical function and depression score as components of frailty in patients undergoing CR.
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Affiliation(s)
- Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Mitsuhiro Kunimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yurina Sugita
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rie Matsumori
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Saitoh
- Juntendo University, Faculty of Health Science, Tokyo, Japan
| | | | | | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Juntendo University, Faculty of Health Science, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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30
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Person H, Keefer L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110209. [PMID: 33326819 PMCID: PMC8382262 DOI: 10.1016/j.pnpbp.2020.110209] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
The high comorbidity of psychological disorders in both functional and organic gastrointestinal diseases suggests the intimate and complex link between the brain and the gut. Termed the brain-gut axis, this bidirectional communication between the central nervous system and enteric nervous system relies on immune, endocrine, neural, and metabolic pathways. There is increasing evidence that the gut microbiome is a key part of this system, and dysregulation of the brain-gut-microbiome axis (BGMA) has been implicated in disorders of brain-gut interaction, including irritable bowel syndrome, and in neuropsychiatric disorders, including depression, Alzheimer's disease, and autism spectrum disorder. Further, alterations in the gut microbiome have been implicated in the pathogenesis of organic gastrointestinal diseases, including inflammatory bowel disease. The BGMA is an attractive therapeutic target, as using prebiotics, probiotics, or postbiotics to modify the gut microbiome or mimic gut microbial signals could provide novel treatment options to address these debilitating diseases. However, despite significant advancements in our understanding of the BGMA, clinical data is lacking. In this article, we will review current understanding of the comorbidity of gastrointestinal diseases and psychological disorders. We will also review the current evidence supporting the key role of the BGMA in this pathology. Finally, we will discuss the clinical implications of the BGMA in the evaluation and management of psychological and gastrointestinal disorders.
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Affiliation(s)
- Hannibal Person
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Laurie Keefer
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Duan S, Liu L, Li G, Wang J, Hu Y, Zhang W, Tan Z, Jia Z, Zhang L, von Deneen KM, Zhang Y, Nie Y, Cui G. Altered Functional Connectivity Within and Between Salience and Sensorimotor Networks in Patients With Functional Constipation. Front Neurosci 2021; 15:628880. [PMID: 33776637 PMCID: PMC7991789 DOI: 10.3389/fnins.2021.628880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Functional constipation (FCon) is a common functional gastrointestinal disorder. A considerable portion of patients with FCon is associated with anxiety/depressive status (FCAD). Previous neuroimaging studies mainly focused on patients with FCon without distinguishing FCAD from FCon patients without anxiety/depressive status (FCNAD). Differences in brain functions between these two subtypes remain unclear. Thus, we employed resting-state functional magnetic resonance imaging (RS-fMRI) and graph theory method to investigate differences in brain network connectivity and topology in 41 FCAD, 42 FCNAD, and 43 age- and gender-matched healthy controls (HCs). FCAD/FCNAD showed significantly lower normalized clustering coefficient and small-world-ness. Both groups showed altered nodal degree/efficiency mainly in the rostral anterior cingulate cortex (rACC), precentral gyrus (PreCen), supplementary motor area (SMA), and thalamus. In the FCAD group, nodal degree in the SMA was negatively correlated with difficulty of defecation, and abdominal pain was positively correlated with nodal degree/efficiency in the rACC, which had a lower within-module nodal degree. The salience network (SN) exhibited higher functional connectivity (FC) with the sensorimotor network (SMN) in FCAD/FCNAD, and FC between these two networks was negatively correlated with anxiety ratings in FCAD group. Additionally, FC of anterior insula (aINS)-rACC was only correlated with constipation symptom (i.e., abdominal pain) in the FCNAD group. In the FCAD group, FCs of dorsomedial prefrontal cortex-rACC, PreCen-aINS showed correlations with both constipation symptom (i.e., difficulty of defecation) and depressive status. These findings indicate the differences in FC of the SN-SMN between FCAD and FCNAD and provide neuroimaging evidence based on brain function, which portrays important clues for improving new treatment strategies.
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Affiliation(s)
- Shijun Duan
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Lei Liu
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Guanya Li
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Jia Wang
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Yang Hu
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Wenchao Zhang
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Zongxin Tan
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Zhenzhen Jia
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Lei Zhang
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Karen M. von Deneen
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Yi Zhang
- Center for Brain Imaging, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Yongzhan Nie
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Guangbin Cui
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi’an, China
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Cui S, Yang Q, Xie S, Liu Q, Zhou G. Acupuncture for chronic constipation in patients with diabetes mellitus: A protocol for systematic review. Medicine (Baltimore) 2021; 100:e24886. [PMID: 33655948 PMCID: PMC7939182 DOI: 10.1097/md.0000000000024886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Assessing the effectiveness and safety of acupuncture for chronic constipation in patients with diabetes mellitus is the main purpose of this systematic review protocol. METHODS The following electronic databases will be searched from their respective inception dates to December 1st 2020: PubMed, the Cochrane Library, Embase, World Science Net, the Allied and Complementary Medicine Database, the Web of Science, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database and the Wanfang Database. All published randomized controlled trials in English or Chinese related to acupuncture for constipation in patient with diabetes mellitus will be included. The Bristol stool scale, spontaneous complete bowel movements, and observing symptoms (yes/no) including defecation feeling, defecation weakness, feeling of incomplete evacuation, bloating, and flatulence were considered as primary measures. The treatment efficiency consideration according to Bristol stool scale was considered as secondary measure. Two reviewers will conduct the study selection, data extraction and assessment independently. The assessment of risk of bias and data synthesis will be conducted with Review Manager Software (RevMan) V.5.2. RESULTS The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION The conclusion of our study will provide an evidence to judge whether.Acupuncture is an effective intervention for chronic constipation in patients with diabetes mellitus. ETHICS AND DISSEMINATION Formal ethical approval is not necessary as the data cannot be individualized. The results of this protocol will be disseminated in a peer-reviewed journal or presented at relevant conferences. PROSPERO REGISTRATION NUMBER INPLASY202110079.
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Meng YY, Li QD, Feng Y, Liu J, Wang EK, Zhong L, Sun QL, Yuan JY. Animal models of cathartic colon. World J Clin Cases 2021; 9:1251-1258. [PMID: 33644192 PMCID: PMC7896687 DOI: 10.12998/wjcc.v9.i6.1251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
The incidence of cathartic colon has been increasing, but satisfactory treatments are still lacking. In order to study the pathological mechanisms of the disorder and identify effective treatment methods, researchers have established different animal models of cathartic colon. This minireview briefly summarizes several common cathartic colon animal models, induced with anthraquinone laxatives such as rhubarb, total anthraquinone, rhein, and emodin, or induced with diphenylmethane laxatives such as phenolphthalein. The advantages and limitations of these models are evaluated and analyzed. We hope that this review will facilitate the selection of suitable models and improve relevant modeling methods. We anticipate the development of more convenient and stable models that can reflect the characteristics of cathartic colon in humans, and serve as useful tools for further studies.
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Affiliation(s)
- Yang-Yang Meng
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Qiao-Dong Li
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Ya Feng
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Jie Liu
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - En-Kang Wang
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Linda Zhong
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Qiao-Li Sun
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Jian-Ye Yuan
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Zhao X, Meng J, Dai J, Yin ZT. Effect of biofeedback combined with high-quality nursing in treatment of functional constipation. World J Clin Cases 2021; 9:784-791. [PMID: 33585624 PMCID: PMC7852631 DOI: 10.12998/wjcc.v9.i4.784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional constipation (FC) is a common functional gastrointestinal disease with various clinical manifestations. It is a physical and mental disease, which seriously affects patient physical and mental health and quality of life. Biofeedback therapy is the treatment of choice for FC, especially outlet obstructive constipation caused by pelvic floor dysfunction. High-quality nursing is a new nursing model in modern clinical work and a new concept of modern nursing service.
AIM To explore the effect of biofeedback combined with high-quality nursing in the treatment of FC.
METHODS A total of 100 patients with FC admitted to our hospital from March 2015 to July 2019 were selected for clinical observation. These patients were randomly divided into two groups of 50: Experimental group (biofeedback combined with high-quality nursing treatment group) and control group (biofeedback group).
RESULTS The constipation symptom score of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). The anal canal resting pressure and initial defecation threshold of the experimental group were significantly lower than those of the control group, and the maximum squeeze systolic pressure of the anal canal of the experimental group was significantly higher than that of the control group (P < 0.05). The Self-Rating Anxiety Scale and Zung’s Self-Rating Depression Scale scores of the two groups were significantly lower than before treatment. The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the experimental group were significantly lower than those of the control group (P < 0.05). The patient satisfaction score of the experimental group was significantly higher than that of the control group (P < 0.05).
CONCLUSION The application of biofeedback combined with high-quality nursing in the treatment of FC has significant advantages over pure biofeedback treatment, and it is worthy of promotion in clinical work.
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Affiliation(s)
- Xiu Zhao
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Jin Meng
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Jin Dai
- Department of Constipation, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Zhi-Tao Yin
- Department of Anorectal Disease, Shenyang Hospital of Traditional Chinese Medicine, Shenyang 110000, Liaoning Province, China
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Yang M, Feng Y, Zhang YL, Smith CM, Hou YN, Wang H, Deng G, Mao JJ. Herbal formula MaZiRenWan (Hemp Seed Pill) for constipation: A systematic review with meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 82:153459. [PMID: 33486266 DOI: 10.1016/j.phymed.2021.153459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/17/2020] [Accepted: 01/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is growing interest in using herbal supplements to treat constipation; however, little evidence exists for their use. PURPOSE This study evaluates the efficacy and safety of herbal formula MaZiRenWan (Hemp Seed Pill, HSP) in patients with functional or non-functional constipation. STUDY DESIGN Systematic review and meta-analysis METHODS: PubMed, CENTRAL, Embase, CNKI, and Wanfang were searched through April 20, 2020 for randomized trials of HSP versus placebo or medications for all types of constipation. The primary outcomes were complete response rate, complete spontaneous bowel movement (CSBM), patient-reported satisfactory treatment rate (prSTR), and adverse events (AEs). Clinical data were analyzed using a random-effects model, and the quality of evidence was evaluated with the GRADE system. RESULTS This review includes 1681 constipation patients from 17 moderate-to-high risk of bias trials that were conducted in east Asia. Two high-quality trials showed that HSP compared with placebo significantly increased weekly CSBM (mean difference, 0.95; 95% CI: 0.56, 1.35) and had a higher complete response rate (risk ratio [RR], 1.43; 95% CI: 1.20, 1.71) in patients with functional constipation. Low-quality evidence showed significant improvement in prSTR in HSP compared with conventional medications (RR, 1.79; 95% CI: 1.42, 2.25). Additionally, HSP use did not increase AEs compared with no HSP (p = 0.99). CONCLUSIONS This study found that HSP was effective among Asian patients with functional constipation. Rigorous trials need to be conducted in clinical populations outside of east Asia and in those with non-functional constipation to increase the generalizability of the evidence.
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Affiliation(s)
- Mingxiao Yang
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States
| | - Ye Feng
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States; Department of Integration of Chinese and Western Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yi Lily Zhang
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States
| | - Colleen M Smith
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States
| | - Yen-Nien Hou
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States
| | - Hui Wang
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States; Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing, 100053, China
| | - Gary Deng
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, United States.
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Ebisutani N, Fukui H, Nishimura H, Nakanishi T, Morimoto K, Itou S, Nakamura A, Masutani M, Hori M, Tomita T, Oshima T, Kasahara E, Sekiyama A, Miwa H. Decreased Colonic Guanylin/Uroguanylin Expression and Dried Stool Property in Mice With Social Defeat Stress. Front Physiol 2021; 11:599582. [PMID: 33381053 PMCID: PMC7767843 DOI: 10.3389/fphys.2020.599582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022] Open
Abstract
Psychological stress is deeply involved in the pathophysiology of not only mental illness but also functional gastrointestinal disorders. In the present study, we examined the relationship between psychological stress and abnormality of stool properties, focusing on the alteration of plasma glucocorticoid and guanylin (GN)/uroguanylin (UGN) expression in the colon. A murine model of chronic social defeat stress (CSDS) was established by exposing a C57BL/6N intruder mouse to a CD-1 aggressor mouse for 3–5 min. Thereafter the mice were kept in the same cage but separated by a divider for the remainder of the day. This procedure was repeated for 10 consecutive days, and then a social interaction test was performed to evaluate social avoidance. Fresh fecal and blood samples were collected for stool property analysis and measurement of the plasma glucocorticoid level by ELISA. The expression of GN, UGN, and guanylate cyclase 2C in the colonic tissues was examined by real-time RT-PCR and immunohistochemistry. Moreover, Lovo cells were stimulated with dexamethasone, and the expression of GN/UGN mRNA was examined. In the CSDS group, the time spent in the social interaction zone was significantly shorter when the CD-1 aggressor mouse was present than when it was absent. The social interaction ratio was also significantly lower in the CSDS group relative to the controls. The mean Bristol scale score was significantly lower in the CSDS group, but the fecal sodium concentration did not differ between CSDS mice and controls. The level of plasma corticosterone was significantly higher in the CSDS group than in the controls immediately after the 10th day of CSDS. The expression of both GN and UGN was significantly decreased in the CSDS mice. GN was expressed in all colonic epithelial cells, and UGN was expressed in ovoid or pyramidal epithelial cells in the colonic mucosa. The expression of both GN and UGN was significantly decreased in the CSDS mice relative to controls. The expression of both GN and UGN was significantly suppressed in Lovo cells upon stimulation with dexamethasone. Psychological stress-induced glucocorticoid may suppress colonic GN/UGN expression, resulting in a change in stool properties leading to constipation.
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Affiliation(s)
- Nobuhiko Ebisutani
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Heihachiro Nishimura
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Nakanishi
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenki Morimoto
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Shiho Itou
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Ayumi Nakamura
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Mizuki Masutani
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Mika Hori
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Emiko Kasahara
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Atsuo Sekiyama
- Department of Preemptive Medical Pharmacology for Mind and Body, Graduate School and School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hapatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Pankowski D, Wytrychiewicz-Pankowska K, Janowski K, Pisula E, Walicka M. The Role of Illness-Related Beliefs in Depressive, Anxiety, and Anger Symptoms: An On-line Survey in Women With Hypothyroidism. Front Psychiatry 2021; 12:614361. [PMID: 33967846 PMCID: PMC8100212 DOI: 10.3389/fpsyt.2021.614361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Hypothyroidism may affect 3-8.5% of the population and is a growing global health problem. Objective: The aim of the current study was to assess the relationships between cognitive representations of this illness and the severity of symptoms of depression, anxiety, and anger in women who suffer from hypothyroidism. Methods: The study used a cross-sectional design with on-line recruitment and measurements. A total of 354 women took part in the study and completed the following questionnaires: a 5-point self-rating scale that measures the three major symptoms of hypothyroidism, the Illness-Related Beliefs Questionnaire, the Hospital Anxiety and Depression Scale-Modified (HADS-M), and a clinical and sociodemographic data questionnaire. Results: The study found a relationship between the severity of emotional distress symptoms and illness-related beliefs. These beliefs were correlated with depressive symptoms, anxiety, and anger regardless of age, education, hormone levels or time since the diagnosis. In addition, the results of regression analyses, both hierarchical and stepwise, indicated that beliefs about the disease explained relatively high levels of the outcome variables (about 30% of the variance of depressive and anxiety symptoms and 16% of anger) as measured by HADS-M. Conclusions: Psychological factors seem to play an important role in the development of symptoms of depression, anxiety, and anger in patients with hypothyroidism. Psychosocial interventions targeting personal beliefs about the nature of the disease and its social aspects may be an effective way to reduce emotional distress symptoms.
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Affiliation(s)
- Daniel Pankowski
- Department of Psychology, University of Warsaw, Warsaw, Poland.,Department of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Kinga Wytrychiewicz-Pankowska
- Department of Psychology, University of Warsaw, Warsaw, Poland.,Department of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Konrad Janowski
- Department of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Ewa Pisula
- Department of Psychology, University of Warsaw, Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology, and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,Department of Human Epigenetics, Mossakowski Medical Research Institute Polish Academy of Sciences, Warsaw, Poland
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Li P, Luo Y, Wang Q, Shu S, Chen K, Yu D, Fan C. Efficacy and Safety of Acupuncture at Tianshu (ST25) for Functional Constipation: Evidence from 10 Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:2171587. [PMID: 33204283 PMCID: PMC7665928 DOI: 10.1155/2020/2171587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the evidence for the efficacy and safety of acupuncture at Tianshu (ST25) for functional constipation (FC). METHODS We systematically searched seven databases to identify randomized controlled trials of acupuncture at ST25 alone or in combination with conventional therapy in the treatment of FC. Risk ratios (RRs) and mean differences (MDs) were calculated using RevMan 5.3 with 95% confidence interval (CI). RESULTS The study included ten trials with 1568 participants. Meta-analysis showed that the Cleveland Constipation Score (CCS) for deep needling was significantly lower than that for lactulose (deep needling with low-frequency dilatational wave: MD -0.58, 95% CI -0.94 to -0.22; deep needling with sparse wave: MD -3.67, 95% CI -6.40 to -0.94; deep needling with high-frequency dilatational wave: MD -3.42, 95% CI -5.03 to -1.81). Furthermore, CCS for shallow needling with high-frequency dilatational wave was lower than that for lactulose (MD -1.77, 95% CI -3.40 to -0.14). In addition, when deep needling was combined with high-frequency dilatational wave, the weekly frequency of spontaneous defecation (FSD) was significantly higher than that for lactulose (MD 1.57, 95% CI 0.93 to 2.21). Colonic Transit Time (CTT) scores were significantly higher when deep needling was combined with sparse wave (MD -14.36, 95% CI -18.31 to -10.41) or high-frequency dilatational wave (MD -11.53, 95% CI -19.25 to -3.81). The time of first defecation after treatment (TFD) of the shallow needling therapy was significantly longer than that of the lactulose (MD 13.67, 95% CI 5.66 to 21.67). The CCS 6 months after treatment (CCS6m) for deep needling was significantly lower than that for lactulose (MD -4.90, 95% CI -5.97 to -3.84). Moreover, the FSD 6 months after treatment (FSD6m) for shallow needling was significantly higher than that for lactulose (MD 0.49, 95% CI 0.02 to 0.97). The adverse event (AE) rate for lactulose was significantly higher than that achieved with the needling treatments, and this held true for both deep needling therapy (RR 0.41, 95% CI 0.23 to 0.72) and shallow needling therapy (RR 0.33, 95% CI 0.15 to 0.77). CONCLUSIONS The meta-analysis demonstrates that acupuncture at ST25 appears to be more effective than lactulose in the treatment of functional constipation. This was found to be especially true for deep needling with high-frequency dilatational wave, which had a greater impact on improving CCS, FSD, CTT, and CCS6m. Additionally, acupuncture at ST25 was shown to be safer than conventional treatment, with the rate of AE being significantly lower for both deep needling and shallow needling. The trial is registered with https://www.crd.york.ac.uk/prospero/(CRD42019141017)).
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Affiliation(s)
- Pengfan Li
- Department of Traditional Chinese Medicine, Punan Hospital, Pudong New District, Shanghai 200125, China
| | - Yue Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Qi Wang
- Department of Traditional Chinese Medicine, Punan Hospital, Pudong New District, Shanghai 200125, China
| | - Shi Shu
- Department of Traditional Chinese Medicine, Punan Hospital, Pudong New District, Shanghai 200125, China
| | - Kanjun Chen
- Department of Traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Donghai Yu
- Department of Traditional Chinese Medicine, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Chunxiang Fan
- Department of Traditional Chinese Medicine, Punan Hospital, Pudong New District, Shanghai 200125, China
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Ye H, Shaw IC. Dietary isoflavone-induced, estrogen receptor-β-mediated proliferation of Caco-2 cells is modulated by gallic acid. Food Chem Toxicol 2020; 145:111743. [PMID: 32926937 DOI: 10.1016/j.fct.2020.111743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023]
Abstract
Dietary isoflavones and their biotransformation products (from food fermentation) are estrogen mimics which activate estrogen receptors (ER)α and ERβ. In silico molecular modelling is used to determine theoretical binding energies of genistein, daidzein and hydroxylated biotransformation products, and to investigate structure-binding energy relationships with ERβ. Results suggest that ligand hydroxyl arrangement determines binding energy and influences binding affinity. Caco-2 cells (ERβ expressing) are used to study the proliferative effect of genistein, daidzein and their hydroxylated biotransformation products. Isoflavones/biotransformation products showed weaker enhancement of Caco-2 proliferation than 17β-estradiol. The EC50s of isoflavones/biotransformation products agreed with in silico-predicted binding affinity order. Hydroxylated biotransformation products studied showed greater Caco-2 proliferative effects than the parent isoflavones except 8-hydroxygenistein, probably due to unfavourable ERβ interactions caused by 8-hydroxygenistein's extra hydroxyl. Caco-2 pre-treatment with UDP-glucose dehydrogenase inhibitor gallic acid promoted genistein/8-hydroxygenistein-mediated proliferation. This is probably due to a reduced isoflavone glucuronidation to form low estrogenicity glucuronides. Findings are discussed in the context of dietary isoflavones/gallic acid and effects on proliferation of ERβ-expressing gut cancer cells.
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Affiliation(s)
- Hui Ye
- Human Toxicology Research Group, School of Physical & Chemical Sciences, University of Canterbury, Christchurch, New Zealand.
| | - Ian C Shaw
- Human Toxicology Research Group, School of Physical & Chemical Sciences, University of Canterbury, Christchurch, New Zealand
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Abstract
GOAL To investigate the clinical characteristics of different primary constipation subtypes, including symptom clusters, psychological problems, quality of life (QOL), and to explore the role of constipation symptoms and the mental state in the QOL of constipation subtypes. BACKGROUND Patients with chronic constipation (CC) may be unsatisfied with their therapy and suffer recurrent symptoms. Different constipation subtypes require different treatments; therefore, it is important to identify the features of different constipation subtypes. STUDY CC patients (n=206) visiting our gastroenterology clinic were studied. CC subtypes were diagnosed using the Rome-IV criteria. We used validated questionnaires to investigate the symptom severity, mental state, and QOL of patients. QOL was assessed with the Patient Assessment of Constipation Quality of Life (PAC-QOL) and SF-36 questionnaire. Results of symptom, mental and QOL scores are expressed as means with 95% confidence interval. RESULTS Three groups of CC patients differed in their constipation scoring system and the Patient Assessment of Constipation Symptoms (PAC-SYM) total scores, and both were significantly higher in the functional defecation disorder (FDD) group compared with that in the normal transit constipation (NTC) group. FDD patients tended to have more severe "abdominal symptoms," "rectal symptoms" than NTC group. No significant difference in General Anxiety Disorder 7-item or Patient Health Questionnaire-9 results was found among the 3 groups. Significantly more patients with FDD suffered more "physical discomfort" and had poorer QOL in the "physical function" dimension of SF-36. FDD and NTC patients mainly showed associations between CC-related QOL and constipation severity, while slow transit constipation patients' QOL was significantly associated with anxiety and depression. CONCLUSION Patients with FDD suffer more severe constipation symptoms and have a lower QOL than patients in other CC subgroups. FDD and NTC patients' QOL is mainly linked to constipation symptoms, while that of slow transit constipation is mainly related to mental states such as anxiety and depression.
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Wytrychiewicz K, Pankowski D, Janowski K, Benoit CE, Bargiel-Matusiewicz K, Pisula E, Walicka M. The role of beliefs about the impact of illness on fertility and close relationships for psychopathological symptoms in women treated for hypothyroidism. J Clin Psychol 2020; 76:2314-2328. [PMID: 32592617 DOI: 10.1002/jclp.23011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE As demonstrated in a pilot study, hypothyroidism has a highly stressful impact on some areas of functioning. This study aims to evaluate the connection between illness-related beliefs (IRBs) and the impact of hypothyroidism on fertility and close relationships, which were the strongest stressors, and the level of depressive, anxiety, and anger symptoms. METHODS Two hundred and thirteen women being treated for hypothyroidism took part in an online survey and completed the modified Hospital Anxiety and Depression Scale, Hypothyroidism Symptoms Severity rating scales, and a measure of IRBs. Other relevant clinical data were also collected. RESULT Mean levels of thyroid-stimulating hormone indicated that the women were euthyroid. Four groups of participants were identified based on IRBs. The group holding a strong IRB about the negative impact of illness only on close relationships scored significantly higher on depressive symptoms than women in the other groups. The group holding strong IRBs about the negative impact of illness on both close relationships and fertility scored significantly higher on anxiety symptoms than the women in the other groups. Regression analysis showed that IRBs about the negative impact of hypothyroidism predicted anxiety, depressive, and anger symptoms. CONCLUSIONS Negative IRBs about the impact of illness on fertility and close relationships contribute to increased levels of emotional distress symptoms in women being treated for hypothyroidism.
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Affiliation(s)
- Kinga Wytrychiewicz
- Faculty of Psychology, University of Warsaw, Warsaw, Poland.,Faculty of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Daniel Pankowski
- Faculty of Psychology, University of Warsaw, Warsaw, Poland.,Faculty of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Konrad Janowski
- Faculty of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Charles E Benoit
- Faculty of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | | | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
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Wang L, Wang D, Xu M, Cao W, Liu Y, Hou T, Zheng Q, Li Y. Effectiveness of different acupuncture courses for functional constipation: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e20179. [PMID: 32481288 PMCID: PMC7249954 DOI: 10.1097/md.0000000000020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will evaluate the effectiveness of different acupuncture courses for functional constipation (FC) through network meta-analysis. METHODS Eight database (PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (Central), China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM) and Wanfang Database) will be searched from inception to October 2019. Only randomized controlled trials comparing different acupuncture courses or acupuncture versus sham acupuncture or placebo will be included. The outcomes involved weekly stool frequency, Bristol Fecal score, responder rate and safety evaluation. The risk of bias assessment and quality of evidence will be appraised using the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development and Evaluation guidelines. RevMan 5.3 software, STATA V.14.0 and GeMTC software will be used to perform the network meta-analysis. RESULTS This work will compare and arrange the comparative efficacy of different acupuncture treatments for FC by summarizing the current evidences. The results will be submitted in the form of a journal publication. CONCLUSION The results of this network meta-analysis may help doctors determine the best treatments for patients to manage FC. PROSPERO REGISTRATION NUMBER CRD42020153801.
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Affiliation(s)
- Lu Wang
- School of Acupuncture–Moxibustion and Tuina
| | | | - Mingmin Xu
- School of Acupuncture–Moxibustion and Tuina
| | - Wei Cao
- School of Acupuncture–Moxibustion and Tuina
| | - Ying Liu
- School of Acupuncture–Moxibustion and Tuina
| | | | | | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Xie XY, Sun KL, Chen WH, Zhou Y, Chen BX, Ding Z, Yu XQ, Wu YH, Qian Q, Jiang CQ, Liu WC. Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation. Gastroenterol Rep (Oxf) 2019; 7:449-454. [PMID: 31857907 PMCID: PMC6911993 DOI: 10.1093/gastro/goz014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/02/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022] Open
Abstract
Background Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC. Methods Between January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared. Results There were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285). Conclusions Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.
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Affiliation(s)
- Xiao-Yu Xie
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China
| | - Kong-Liang Sun
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Wen-Hao Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Yan Zhou
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China
| | - Bao-Xiang Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Zhao Ding
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Xue-Qiao Yu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Yun-Hua Wu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, Hubei, P. R. China.,Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, Hubei, P. R. China
| | - Cong-Qing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, Hubei, P. R. China
| | - Wei-Cheng Liu
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, Hubei, P. R. China
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Chu JR, Kang SY, Kim SE, Lee SJ, Lee YC, Sung MK. Prebiotic UG1601 mitigates constipation-related events in association with gut microbiota: A randomized placebo-controlled intervention study. World J Gastroenterol 2019; 25:6129-6144. [PMID: 31686768 PMCID: PMC6824284 DOI: 10.3748/wjg.v25.i40.6129] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 09/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Constipation is a common functional gastrointestinal disorder and its etiology is multifactorial. Growing evidence suggests that intestinal dysbiosis is associated with the development of constipation. Prebiotics are subjected to bacterial fermentation in the gut to produce short-chain fatty acids (SCFAs), which can help relieve constipation symptoms. The prebiotic UG1601 consists of inulin, lactitol, and aloe vera gel, which are known laxatives, but randomized, controlled clinical trials that examine the effects of this supplement on gut microbiota composition are lacking.
AIM To assess the efficacy of the prebiotic UG1601 in suppressing constipation-related adverse events in subjects with mild constipation.
METHODS Adults with a stool frequency of less than thrice a week were randomized to receive either prebiotics or a placebo supplement for 4 wk. All participants provided their fecal and blood samples at baseline and at the end of intervention. Gastrointestinal symptoms and stool frequency were evaluated. The concentrations of serum endotoxemia markers and fecal SCFAs were determined. The relative abundance of SCFA-producing bacteria and the gut microbial community in the responders and non-responders in the prebiotics supplementation group were evaluated.
RESULTS There were no significant differences in gastrointestinal symptoms between groups, although the prebiotic group showed greater symptom improvement. However, after prebiotic usage, serum cluster of differentiation (CD) 14 and lipopolysaccharide (LPS) concentrations were significantly decreased (CD14, P = 0.012; LPS, P < 0.001). The change in LPS concentration was significantly larger in the prebiotic group than in the placebo group (P < 0.001). Fecal SCFAs concentrations did not differ between groups, while the relative abundance of Roseburia hominis, a major butyrate producer, was significantly increased in the prebiotic group (P = 0.045). The abundances of the phylum Firmicutes and the family Lachnospiraceae (phylum Firmicutes, class Clostridia) (P = 0.009) were decreased in the responders within the prebiotic group. In addition, the proportions of the phylum Firmicutes, the class Clostridia, and the order Clostridiales were inversely correlated with several fecal SCFAs (P < 0.05).
CONCLUSION Alterations in gut microbiota composition, including a decrease in the phylum Firmicutes and an increase in butyrate-producing bacteria, following prebiotic UG1601 supplementation might help alleviate symptom scores and endotoxemia.
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Affiliation(s)
- Jae Ryang Chu
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Saem-Yi Kang
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Sung-Eun Kim
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Sol-Ji Lee
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | | | - Mi-Kyung Sung
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
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Mahassadi AK, Ebela PC, Bangoura AD, Attia AK. The burden of irritable bowel syndrome and chronic constipation on health-related quality of life in black Africans: a comparison with healthy control subjects in Côte d'Ivoire, West Africa. Clin Exp Gastroenterol 2019; 12:355-365. [PMID: 31447575 PMCID: PMC6684486 DOI: 10.2147/ceg.s192563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Although patients with irritable bowel syndrome (IBS) and chronic constipation (CC) have an impaired health-related quality of life (HRQoL), little is known in black African patients compared with control subjects. This study provided the magnitude and the influencing factors of HRQoL impairment in black African outpatients with IBS or CC compared with control subjects using the generic SF-36 questionnaire. Materials and methods: One hundred and four consecutive black African outpatients complaining with IBS (n=72, mean age=38.9 years, female=62.5%) and CC (n=32, mean age=37.4 years, female=75%) met Rome 3 criteria were compared with 210 control subjects (mean age=37.4 years, 63.8% male). The SF-36 scores in all domains of HRQoL with the corresponding physical (PCS) and mental (MCS) composite scores between groups were compared with post hoc analysis and multivariate linear regression analysis for the assessment of the influencing factors. Results: Overall, IBS and CC patients exhibited low SF-36 scores in the 8 domains of HRQoL in comparison with control subjects. IBS patients scored less in mental health (mean difference=-10.3, p=0.001), bodily pain (mean difference=-23.5, p≤0.0001), and social functioning domains (mean difference =-15.1, p=0.01) in comparison with CC patients. Post hoc analysis demonstrated a trend down of PCS (mean difference=-12.9, p<0.0001) and MCS (mean difference=-11.2, p=0.01) disfavoring IBS patients than those with CC in comparison with control subjects. In multivariate linear regression analysis, besides the negative impact of IBS and CC, factors influencing PCS were BMI (β=0.4; p=0.01) and comorbidities (β=-5.9; p=0.002). Those influencing MCS were the presence of remunerated activity (β=2.7, p=0.02), and patient living alone (β=9.4; p=0.04). Conclusion: IBS and CC impact negatively on the HRQoL in black African subjects and more importantly in those with IBS than CC.
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Affiliation(s)
- Alassan Kouamé Mahassadi
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Paulin Christian Ebela
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Aboubacar Demba Bangoura
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Alain Koffi Attia
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
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Song J, Bai T, Zhang L, Hou XH. Clinical features and treatment options among Chinese adults with self-reported constipation: An internet-based survey. J Dig Dis 2019; 20:409-414. [PMID: 31145540 DOI: 10.1111/1751-2980.12792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/15/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to investigate the clinical features, precipitating factors, bowel habits, bothersome symptoms and treatment strategies of individuals in China with self-reported constipation. METHODS An internet-based survey was conducted in China. The participants had self-reported chronic constipation (≥1 symptoms including straining, hard stools, time-consuming defecation, sensations of incomplete evacuation and anorectal blockage, using manual assistance, and fewer than three defecations per week, for over 6 months). Data on their sex, age and occupation, precipitating factors, bowel habit, main symptoms and treatment options were collected. RESULTS Overall, 6318 participants fulfilled the inclusion criteria for chronic constipation. More women (54.6%, n = 3450) than men reported constipation. The most common age group for constipation was 31 to 40 years (40.0%, n = 2520) and the most common occupation was office workers (43.6%, n = 2754). Disordered eating routines, consuming spicy food, and failure to defecate in time were the most common factors associated with constipation. Overall, 76.0% (n = 4804) participants did not defecate in the morning; 56.2% (n = 3548) spent 6 to 15 minutes in defecating. The most prevalent symptom was straining (39.4%, n = 2489). For preferred treatment options, 81.7% (n = 5160) selected changes in their lifestyle and diet, 51.1% (n = 3229) selected using traditional Chinese medicine, and 25.2% (n = 1590) selected using laxatives. CONCLUSIONS Constipation rates were higher in women, people aged 31 to 40 years old, and those working in offices. Having eating disorders, eating spicy food and withholding stools were the most common precipitating factors. Straining was the most prevalent symptom. Lifestyle changes were the most common action taken for managing constipation.
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Affiliation(s)
- Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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The Impact of EMG Biofeedback on Evacuation Difficulty Level and Pain Grade During Defecation in Chronically Constipated Elderly Female Patients Due to Dyssynergic Defecation. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1030026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the impact of biofeedback therapy on evacuation difficulty level and the pain grade during defecation of elderly female patients with dyssynergic defecation. With this aim, after one month of initial assessment, 16 chronically constipated female patients with dyssynergic defecation were randomized to either a electromyographic biofeedback group (n = 8) or to a conventional treatment group (n = 8). The results showed a significant decrease in the evacuation difficulty level and pain grade during defecation following behavioral treatment through biofeedback. At the same time, the treatment produced significant improvements in the weekly stool frequency and a decrease in the mean electromyographic (EMG) activity (µV) of the external anal sphincter during straining to defecate. Clinical gains were maintained during the follow-up carried out six months later.
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48
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Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilisation by patients and healthcare professionals. Proc Nutr Soc 2019; 79:147-157. [PMID: 31262376 DOI: 10.1017/s0029665119000934] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this narrative review is to assess and present evidence on the mechanisms of action of probiotics in constipation, their effectiveness and their utilisation by patients and healthcare professionals. Chronic constipation is a common bothersome disorder that has a considerable impact on patients' quality of life. Probiotics have been increasingly investigated for their effectiveness in various disorders, including chronic constipation. Probiotics may affect gut motility and constipation through their impact on the gut microbiota and fermentation, the central and enteric nervous system and the immune system. However, evidence for the effectiveness of probiotics in the management of constipation remains varied, with some strains demonstrating improvements, while others show no effect. Despite the uncertainty in evidence and the fact that the majority of healthcare professionals do not recommend probiotics for constipation, an increased prevalence of probiotic use by people with constipation has been shown. Therefore, there is a need for public health strategies to inform the public about where strong evidence of probiotic effectiveness exist, and where evidence is still weak. Education of healthcare professionals on the increased utilisation of probiotics for constipation by the public and on current evidence for the effectiveness of specific strains is also required.
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49
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Yin T, He Z, Ma P, Hou L, Chen L, Xie K, Tian Z, Wang F, Xiong J, Yang Y, Sun R, Zeng F. Effect and cerebral mechanism of acupuncture treatment for functional constipation: study protocol for a randomized controlled clinical trial. Trials 2019; 20:283. [PMID: 31126315 PMCID: PMC6534837 DOI: 10.1186/s13063-019-3410-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Acupuncture is effective in functional constipation (FC) treatment, but the central mechanism has not been well investigated. This trial will combine functional magnetic resonance imaging (fMRI) and positron emission tomography-computed tomography (PET-CT) to investigate the potential central mechanism of acupuncture treatment for FC. Methods This is a multimodal neuroimaging randomized controlled trial. In total, 140 FC patients will be randomly allocated into four groups: the verum acupuncture group; the sham acupuncture group; the PEG 4000 group; and the waiting-list group. This trial will include a two-week baseline period and a two-week treatment period. Patients will receive 10 sessions of acupuncture, sham acupuncture, PEG 4000, or no intervention during the treatment period. The stool diary, Cleveland Constipation Score (CCS), Patient Assessment of Constipation Symptom (PAC-SYM), and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QoL) will be used to assess the clinical efficacy of different interventions. The MRI and PET-CT scans will be performed to detect cerebral functional changes in 15 patients in each group at baseline and at the end of treatment/waiting. Multimodal imaging data will be associated with clinical data to investigate possible correlation between brain activity changes elicited by different interventions and symptoms improvement. Discussion We hypothesize that acupuncture can treat FC through normalizing the pathological alteration of the cerebral activity. The results of this trial will allow us to re-testify the therapeutic effects of acupuncture treating for FC and to investigate the potential central mechanism of acupuncture treatment for FC from direct (cerebral glucose metabolism) and indirect (contrast of oxyhemoglobin and deoxyhemoglobin) approaches. Trial registration Chinese Clinical Trial Registry, ChiCTR1800016658. Registered on 14 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3410-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Zhaoxuan He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture-Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Peihong Ma
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Likai Hou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Li Chen
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Kunnan Xie
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Zilei Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Fumin Wang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Jing Xiong
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Yi Yang
- Acupuncture-Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.,School of Administration, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ruirui Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China. .,Acupuncture-Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China. .,Acupuncture-Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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50
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Dimidi E, Cox C, Scott SM, Whelan K. Probiotic use is common in constipation, but only a minority of general and specialist doctors recommend them and consider there to be an evidence base. Nutrition 2019; 61:157-163. [DOI: 10.1016/j.nut.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/20/2018] [Accepted: 11/17/2018] [Indexed: 01/06/2023]
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