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Okawa Y. The Impact of Nutritional Therapy on Gastrointestinal Motility in Older Adults. Healthcare (Basel) 2023; 11:2829. [PMID: 37957974 PMCID: PMC10647505 DOI: 10.3390/healthcare11212829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Japan is becoming a superaged society, and nutrition therapy for the elderly population is very important. Elderly individuals often have multiple diseases and are prone to malnutrition. Furthermore, functional constipation, diarrhoea, faecal incontinence, etc., may occur despite no organic abnormality of digestive tract function. Due to these disabilities, the resulting malnutrition, and the slow recovery, it is often difficult for elderly individuals to reintegrate into society. Secondary or incorrect nutritional management increases complications, decreases physical function and worsens the prognosis. Previous statistical research suggests that in-hospital mortality is significantly higher among hospitalised patients aged ≥65 years who ingest less than half of their caloric needs. Therefore, appropriate nutritional management from an early stage is essential for elderly individuals. Moreover, functional excretion disorders, dementia, and sarcopenia (muscle-wasting disease) are attracting attention as pathological conditions unique to elderly individuals, and it is essential to undergo rehabilitation early with nutritional management. Being elderly does not preclude nutritional management, and it is necessary to reconsider appropriate nutritional therapy even in the terminal stage and in advanced physical and mental illnesses. This review explores the relationship between dietary intake and FGIDs, with a focus on elderly adults.
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Affiliation(s)
- Yohei Okawa
- Department of Psychosomatic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai 980-8575, Miyagi, Japan
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Song H, Guo R, Sun X, Kou Y, Ma X, Chen Y, Song L, Yuan C, Wu Y. Xylooligosaccharides from corn cobs alleviate loperamide-induced constipation in mice via modulation of gut microbiota and SCFA metabolism. Food Funct 2023; 14:8734-8746. [PMID: 37694718 DOI: 10.1039/d3fo02688d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This study aimed to optimize the structure and efficacy of xylooligosaccharides (XOSs) from corn cobs in constipated mice. Structural analysis revealed that XOSs from corn cobs were composed of β-Xyl-(1 →4)-[β-Xyl-(1→4)]n-α/β-Xyl (n = 0-5) without any other substituents. XOS administration significantly reduced the defecation time, increased the gastrointestinal transit rate, restored the gastrointestinal neurotransmitter imbalance, protected against oxidative stress, and reversed constipation-induced colonic inflammation. Fecal metabolite and microbiota analysis showed that XOS supplementation significantly increased short chain fatty acid (SCFA) levels and improved the gut microbial environment. These findings highlighted the potential of XOSs from corn cobs as an active ingredient for functional foods or as a therapeutic agent in constipation therapy.
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Affiliation(s)
- Hong Song
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Rui Guo
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xianbao Sun
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yuxing Kou
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xuan Ma
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yinan Chen
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Lihua Song
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Chunmei Yuan
- Yunnan Maoduoli Group Food Co., Ltd., Yuxi 653100, China
| | - Yan Wu
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
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Zheng KX, Yuan SL, Dong M, Zhang HL, Jiang XX, Yan CL, Ye RC, Zhou HQ, Chen L, Jiang R, Cheng ZY, Zhang Z, Wang Q, Jin WZ, Xie W. Dihydroergotamine ameliorates liver fibrosis by targeting transforming growth factor β type II receptor. World J Gastroenterol 2023; 29:3103-3118. [PMID: 37346154 PMCID: PMC10280794 DOI: 10.3748/wjg.v29.i20.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/01/2023] [Accepted: 04/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The transforming growth factor β (TGFβ) signaling pathway plays a crucial role in the development of liver fibrosis by activating TGFβ type II receptor (TGFβR2), followed by the recruitment of TGFβR1 finally triggering downstream signaling pathway.
AIM To find drugs targeting TGFβR2 that inhibit TGFβR1/TGFβR2 complex formation, theoretically inhibit TGFβ signaling pathway, and thereby ameliorate liver fibrosis.
METHODS Food and Drug Administration-approved drugs were screened for binding affinity with TGFβR2 by virtual molecular docking. We identified 6 candidates and further explored their potential by Cell Counting Kit-8 (CCK-8) cell cytotoxic experiment to validate toxicity and titrated the best cellular working concentrations. Next, we further demonstrated the detailed molecular working mechanisms using mutagenesis analysis. Finally, we used a mouse model to investigate its potential anti-liver fibrosis effect.
RESULTS We identified 6 drug candidates. Among these 6 drugs, dihydroergotamine (DHE) shows great ability in reducing fibrotic gene expressions such as collagen, p-SMAD3, and α-SMA in TGFβ induced cellular model of liver fibrosis in LX-2 cells. Furthermore, we demonstrated that DHE binds to TGFβR2. Moreover, mutation of Leu27, Phe30, Thr51, Ser52, Ile53, and Glu55 of TGFβR2 disrupted the binding of TGFβR2 with DHE. In addition, DHE significantly improved liver fibrosis, as evidenced by Masson’s trichrome staining of liver sections. This is further supported by the width and the velocity of the portal vein, and serum markers of liver function. In line with those observations, DHE also decreased macrophages infiltration and extracellular matrix deposition in the liver.
CONCLUSION DHE alleviates liver fibrosis by binding to TGFβR2 thereby suppressing TGFβ signaling pathway. We show here that as far as drug repurposing, DHE has great potential to treat liver fibrosis.
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Affiliation(s)
- Ke-Xin Zheng
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shou-Li Yuan
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Meng Dong
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Han-Lin Zhang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Xiao-Xiao Jiang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Chun-Long Yan
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, Agriculture College of Yanbian University, Yanji 133002, Jilin Province, China
| | - Rong-Cai Ye
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Hui-Qiao Zhou
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Li Chen
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Rui Jiang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Zi-Yu Cheng
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Zhi Zhang
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- Graduate School, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Qi Wang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wan-Zhu Jin
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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A Discussion of Whether Various Lifestyle Changes can Alleviate the Symptoms of Irritable Bowel Syndrome. Healthcare (Basel) 2022; 10:healthcare10102011. [PMID: 36292457 PMCID: PMC9602372 DOI: 10.3390/healthcare10102011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022] Open
Abstract
Irritable bowel syndrome (IBS) causes abdominal pain during bowel movements and is diagnosed according to the Rome IV international diagnostic criteria. Patients diagnosed as having IBS experience abdominal pain at least 1 day/week, on average, over a 3-month period and not 3 days per month. A diagnosis of IBS is confirmed if symptoms have persisted for more than 6 months. IBS symptoms negatively affect daily life. First, improving daily habits are important to ameliorating IBS symptoms. IBS symptoms can be alleviated by staying active, sleeping, resting and staying stress-free. In addition, it is important to eat three, balanced meals a day on a regular basis and avoid overeating, especially at night. Spicy foods, high-fat foods, and alcohol can exacerbate symptoms. Researchers found, in a literature review, that IBS symptoms can be ameliorated by improving daily habits, thus relieving abdominal pain and the defecation symptoms of IBS.
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Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature. CHILDREN 2022; 9:children9071024. [PMID: 35884008 PMCID: PMC9322125 DOI: 10.3390/children9071024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 12/27/2022]
Abstract
Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.
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Okawa Y. Development of colonic transit time and ultrasound imaging tools as objective indicators for assessing abnormal defecation associated with food intake: a narrative review based on previous scientific knowledge. Biopsychosoc Med 2021; 15:20. [PMID: 34742336 PMCID: PMC8572427 DOI: 10.1186/s13030-021-00222-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background Functional gastrointestinal disorders (FGIDs) involve chronic or persistent gastrointestinal symptoms. Laboratory tests show no organic lesions, and the symptoms are due to dysfunction. The most typical FGID is irritable bowel syndrome (IBS). In IBS patients, defecation disorders are common and have adverse effects on daily life. The proper evaluation and analysis of colonic transit are important for the management of defecation disorders in IBS patients. In addition, dietary intake and lifestyle affect colonic transit. An accurate assessment of such factors can guide management, leading to improvements in colonic transit and the resolution of defecation disorders. Main topic The Rome IV diagnostic criteria for IBS are based on subjective symptoms, which must be communicated and explained by the patient, limiting their application. Colonic transit time and ultrasonography are objective tools that can be used to diagnose IBS. In particular, previous studies used colonic transit to accurately distinguish between constipation and normal stool passage and to assess delayed gastrointestinal motility. Diet and lifestyle modifications can improve colonic transit and ameliorate bowel dysfunction. Conclusion Colonic transit can be improved by modifying lifestyle factors. Defecation disorders in IBS patients may be resolved by focusing on such factors. In the future, methods of visualizing defecation disorders due to impaired gastrointestinal motility and objective indicators of the associated abdominal symptoms need to be investigated.
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Affiliation(s)
- Yohei Okawa
- Department of Behavioural Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
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Cho HM, Kim H, Yoo R, Kim G, Kye BH. Effect of Biofeedback Therapy during Temporary Stoma Period in Rectal Cancer Patients: A Prospective Randomized Trial. J Clin Med 2021; 10:5172. [PMID: 34768692 PMCID: PMC8584867 DOI: 10.3390/jcm10215172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This prospective randomized controlled study was designed to evaluate the effect of biofeedback therapy (BFT) during temporary stoma period to prevent defecation dysfunction after sphincter-preserving surgery (SPS). METHODS Following SPS with temporary stoma, patients were divided according to whether (BFT group) or not (Control group) they received BFT. BFT was performed once or twice a week during the temporary stoma period. Kegel exercise were advised to all the patients. Subjective defecation symptoms were evaluated according to Cleveland Clinic Incontinence Score (CCIS) as primary outcome at 12 months postoperatively. Manometric data of five time-points were also analyzed. RESULTS Twenty-one patients in the BFT group and 23 patients in the control group received anorectal physiologic testing. The incidence of CCIS of more than 9 points, which is the primary end point in this study, was not statistically different between BFT group and control group (p = 1.000). The liquid stool incontinence in the BFT group showed a better tendency (p = 0.06) at 12 months post-SPS. Time-dependent serial changes in maximal sensory threshold (Max RST) was significantly different between the BFT and control groups (p = 0.048). Also, the change of mean resting pressure (MRP) tended to be more stable in the BFT group (p = 0.074). CONCLUSIONS The BFT in the period of temporary stoma may be related to liquid stool incontinence at 12 months post-SPS and lead to stable MRP and better Max RST. Therefore, BFT during temporary stoma might be helpful for preventing and minimizing defecation dysfunction in high risk patients after SPS, NCT01661829).
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Affiliation(s)
- Hyeon-Min Cho
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (H.-M.C.); (R.Y.); (G.K.)
| | - Hyungjin Kim
- Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - RiNa Yoo
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (H.-M.C.); (R.Y.); (G.K.)
| | - Gun Kim
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (H.-M.C.); (R.Y.); (G.K.)
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (H.-M.C.); (R.Y.); (G.K.)
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Wibowo DA, Nailufar F, Tjandrawinata RR. Antidiarrheal Effect of DLBS1Y62, a Bioactive Fraction of Uncaria gambir Roxb. Dried Sap Extract, in Wistar Rats. J Exp Pharmacol 2021; 13:669-675. [PMID: 34290534 PMCID: PMC8289365 DOI: 10.2147/jep.s299001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Diarrhea is a common health problem worldwide, especially in developing countries. It is the second leading cause of mortality for children. Uncaria gambir Roxb. extract has been used to treat diarrhea and dysentery, and as an astringent medicine, in Asian countries. Here, we investigated the antidiarrheal effect of DLBS1Y62, which is the bioactive fraction of dried sap extract from U. gambir, using castor oil-induced diarrhea and castor oil-induced enteropooling in rats. Methods DLBS1Y62 was obtained by crushing and milling the dried sap extract of U. gambir leaves. Male Wistar rats, 2–3 months old, weighing 200–250 g (n=30), were used for this study. Negative controls received 0.05 mL purified water. Positive controls were treated with 2 mg/kg BW loperamide orally as a suspension. Groups I, II, and III received 6.25, 12.5, and 25 mg/kg BW DLBS1Y62, respectively. Group IV received a combination of 6.25 mg/kg BW DLBS1Y62 and 20 mg/kg BW attapulgite. Diarrheal onset and frequency were observed; then, the weight and volume of intestinal contents were measured. Results DLBS1Y62 at all dose levels and in combination with attapulgite could inhibit the formation of further fecal forms of diarrhea, without delaying the onset of diarrhea. The rats that received DLBS1Y62 25 mg/kg BW had the lowest frequency of diarrhea and average intestinal contents compared with the treatment and negative control groups. DLBS1Y62 at a dose of 25 mg/kg BW also gave similar results to 2 mg/kg BW loperamide as a positive control in reducing diarrheal frequency and intestinal content. Conclusion The results of this study suggest that DLBS1Y62, particularly at a dose of 25 mg/kg BW, containing tannin as a compound, may become an alternative treatment for diarrhea.
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Affiliation(s)
- Dicky A Wibowo
- Animal Pharmacology Section, Dexa Laboratories of Biomolecular Sciences (DLBS), PT Dexa Medica, Cikarang, 17550, Indonesia
| | - Florensia Nailufar
- Animal Pharmacology Section, Dexa Laboratories of Biomolecular Sciences (DLBS), PT Dexa Medica, Cikarang, 17550, Indonesia
| | - Raymond R Tjandrawinata
- Dexa Laboratories of Biomolecular Sciences (DLBS), PT Dexa Medica, Cikarang, 17550, Indonesia
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Maeda K, Yamana T, Takao Y, Mimura T, Katsuno H, Seki M, Tsunoda A, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version. J Anus Rectum Colon 2021; 5:52-66. [PMID: 33537501 PMCID: PMC7843140 DOI: 10.23922/jarc.2020-057] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
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Beyond pregnancy, women's health in inflammatory bowel disease. Curr Opin Gastroenterol 2019; 35:288-295. [PMID: 33216483 DOI: 10.1097/mog.0000000000000552] [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] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Women's health includes comprehensive physical, mental and preventive care. This section will provide an overview of some of the most common disorders that can impact the health and quality of life (QOL) of women with inflammatory bowel diseases (IBDs). RECENT FINDINGS Women with IBD are at higher risk for cervical dysplasia compared to healthy controls with most cases preventable with vaccination. Current rates of cervical cancer screening and human papilloma virus vaccination remain low. Irritable bowel syndrome is highly prevalent among women with IBD and may present with similar symptoms. In addition, gastrointestinal symptoms may worsen during the menstrual cycle. Evaluation for active inflammation and infection should be undertaken prior to changing IBD medications. Fecal incontinence is prevalent but highly underreported in women with IBD. Further, sexual dysfunction is ubiquitous in women with IBD. Many aspects of IBD impact sexual function, including side-effects of medications, changes in body image and surgical interventions. SUMMARY Understanding other disorders that may cause symptoms in women with IBD is important for providers to obtain a clear history, provide the appropriate treatment and improve QOL. Caring for women with IBD involves more comprehensive care beyond the treatment of active luminal inflammation.
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Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 2018; 22:589-596. [DOI: 10.1007/s10151-018-1830-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
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de Sousa HA, da Silva MDG, Barbosa KDP, Vianna LMDS, Pacheco YG, de Godoy JRP, Kuckelhaus SAS. Electrical stimulation structurally affects the tissues of the rectum and anus of nulliparous rats. J Anat 2017; 231:398-404. [PMID: 28547814 PMCID: PMC5554829 DOI: 10.1111/joa.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
Considering that the muscles of the anus perform a critical role in maintaining continence, losses in their structure can negatively affect the physiological control of the intestinal contents. Anorectal electro-stimulation (ARES) has been reported to have a positive effect on the functionality of treated patients, but how ARES affects the structural tissues of the anorectal segment remains unknown. Because the study of how ARES structurally affects human tissues is not possible, this study aimed to clarify these effects in a murine model, which has a similar anorectal segment (structure and physiology) to humans. For the descriptive and comparative study, randomly selected nulliparous adult Wistar rats (n = 5) were submitted to 30 anorectal sessions of ARES with a biphasic current (700 μs, 50 Hz from 2 to 4 mA). After treatment, the animals were euthanized, and the anorectal segments were dissected and processed for histopathological analysis. Our results showed that ARES increased the widths of the mucosal, submucosal and muscle layers of the rectum, as well as the number of leukocytes in the mucosa. ARES also caused hyperplasia of the smooth muscle of the internal anal sphincter and hypertrophy of the external anal sphincter muscle. In conclusion, our results showed that ARES had not only a positive effect on the structure (morphology) of all tissues associated with the rectum and anus but, more importantly, on the structural gain of the muscles (hyperplasia and hypertrophy), which could point to a functional gain of the anal sphincter, reinforcing the applicability of ARES as a non-invasive treatment for anal incontinence.
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Affiliation(s)
- Hugo Alves de Sousa
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - Maria da Glória da Silva
- Laboratory of HistologyArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | | | | | - Yolanda Galindo Pacheco
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - José Roberto Pimenta de Godoy
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - Selma Aparecida Souza Kuckelhaus
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
- Laboratory of Cell ImmunologyArea of PathologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
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Luo D, Qu C, Lin G, Zhang Z, Xie J, Chen H, Liang J, Li C, Wang H, Su Z. Character and laxative activity of polysaccharides isolated from Dendrobium officinale. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Luo D, Qu C, Zhang Z, Xie J, Xu L, Yang H, Li C, Lin G, Wang H, Su Z. Granularity and Laxative Effect of Ultrafine Powder of Dendrobium officinale. J Med Food 2017; 20:180-188. [DOI: 10.1089/jmf.2016.3827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- DanDan Luo
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chao Qu
- Guangdong Province Forestry Science and Technology Extension Station, Guangzhou, China
| | - ZhenBiao Zhang
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianHui Xie
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - LieQiang Xu
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - HongMei Yang
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - CaiLan Li
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - GuoSheng Lin
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - HongFeng Wang
- Guangdong Provincial Key Laboratory of Bio-Control for the Forest Disease and Pest, Guangzhou, China
- Biotechnology Division, Guangdong Academy of Forestry, Guangzhou, China
| | - ZiRen Su
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, China
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15
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McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K. Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments. Front Pharmacol 2016; 7:414. [PMID: 27857691 PMCID: PMC5093116 DOI: 10.3389/fphar.2016.00414] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal (GI) side-effects of chemotherapy are a debilitating and often overlooked clinical hurdle in cancer management. Chemotherapy-induced constipation (CIC) and Diarrhea (CID) present a constant challenge in the efficient and tolerable treatment of cancer and are amongst the primary contributors to dose reductions, delays and cessation of treatment. Although prevalence of CIC is hard to estimate, it is believed to affect approximately 16% of cancer patients, whilst incidence of CID has been estimated to be as high as 80%. Despite this, the underlying mechanisms of both CID and CIC remain unclear, but are believed to result from a combination of intersecting mechanisms including inflammation, secretory dysfunctions, GI dysmotility and alterations in GI innervation. Current treatments for CIC and CID aim to reduce the severity of symptoms rather than combating the pathophysiological mechanisms of dysfunction, and often result in worsening of already chronic GI symptoms or trigger the onset of a plethora of other side-effects including respiratory depression, uneven heartbeat, seizures, and neurotoxicity. Emerging treatments including those targeting the enteric nervous system present promising avenues to alleviate CID and CIC. Identification of potential targets for novel therapies to alleviate chemotherapy-induced toxicity is essential to improve clinical outcomes and quality of life amongst cancer sufferers.
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Affiliation(s)
- Rachel M McQuade
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne VIC, Australia
| | - Vanesa Stojanovska
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne VIC, Australia
| | - Raquel Abalo
- Área de Farmacología y Nutrición, Universidad Rey Juan CarlosMadrid, Spain; Grupo de Excelencia Investigadora URJC, Banco de Santander Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Universidad Rey Juan CarlosMadrid, Spain; Unidad Asociada al Instituto de Química Médica del Consejo Superior de Investigaciones CientíficasMadrid, Spain; Unidad Asociada al Instituto de Investigación en Ciencias de la Alimentación del Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | - Joel C Bornstein
- Department of Physiology, University of Melbourne, Melbourne VIC, Australia
| | - Kulmira Nurgali
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne VIC, Australia
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Kye BH, Kim HJ, Kim G, Yoo RN, Cho HM. The Effect of Biofeedback Therapy on Anorectal Function After the Reversal of Temporary Stoma When Administered During the Temporary Stoma Period in Rectal Cancer Patients With Sphincter-Saving Surgery: The Interim Report of a Prospective Randomized Controlled Trial. Medicine (Baltimore) 2016; 95:e3611. [PMID: 27149496 PMCID: PMC4863813 DOI: 10.1097/md.0000000000003611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We evaluated the effect of biofeedback therapy (BFT) on anorectal function after stoma closure when administered during the interval of temporary stoma after sphincter-preserving surgery for rectal cancer.Impaired anorectal function is common after lower anterior resections, though no specific treatment options are currently available to prevent this adverse outcome.Fifty-six patients who underwent neoadjuvant chemoradiation therapy after sphincter-preserving surgery with temporary stoma were randomized into 2 groups: group 1 (received BFT during the temporary stoma period) and group 2 (did not receive BFT). To evaluate anorectal function, anorectal manometry was performed in all patients and subjective symptoms were evaluated using the Cleveland Clinic Incontinence Score. The present study is a report at 6 months after rectal resection.Forty-seven patients, including 21 in group 1 and 26 in group 2, were evaluated by anorectal manometry. Twelve patients (57.1%) in group 1 and 13 patients (50%) in group 2 were scored above 9 points of Cleveland Clinic Incontinence Score, which is the reference value for fecal incontinence (P = 0.770). With time, there was a significant difference (P = 0.002) in the change of mean resting pressure according to time sequence between the BFT and control groups.BFT during the temporary stoma interval had no effect on preventing anorectal dysfunction after temporary stoma reversal at 6 months after rectal resection. However, BFT might be helpful for maintaining resting anal sphincter tone (NCT01661829).
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Affiliation(s)
- Bong-Hyeon Kye
- From the Department of Surgery, St Vincent's Hospital, The Catholic University of Korea, Korea
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17
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Managing Chronic Diarrhea With Colorectal Cancer. J Hosp Palliat Nurs 2015. [DOI: 10.1097/njh.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Sjödahl J, Walter SA, Johansson E, Ingemansson A, Ryn AK, Hallböök O. Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women - a randomized controlled trial. Scand J Gastroenterol 2015; 50:965-74. [PMID: 25892434 DOI: 10.3109/00365521.2014.999252] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Biofeedback and medical treatments have been extensively used for moderate fecal incontinence (FI). There is limited data comparing and combining these two treatments. The objective of this study was to evaluate the effect of biofeedback and medical treatments, separately and in combination. MATERIAL AND METHODS Sixty-four consecutive female patients, referred to a tertiary centre for FI, were included. The patients were randomized to start with either biofeedback (4-6 months) or medical treatment with loperamide and stool-bulking agents (2 months). Both groups continued with a combination of treatments, i.e. medical treatment was added to biofeedback and vice versa. A two-week prospective bowel symptom diary and anorectal physiology were evaluated at baseline, after single- and combination treatments. RESULTS Fifty-seven patients completed the study. Median number of leakage episodes during two weeks decreased from 6 to 3 (p < 0.0001) from baseline to completion. The patients showed a significant (1) decrease in number of leakages without forewarning (p = 0.04); (2) decrease in number of stools with urgency (p = 0.001); (3) decrease in number of loose stool consistency; and (4) an increase in rectal sensory thresholds, both for maximum tolerable rectal pressure and first sensation (<0.01). The combination treatment was superior to both single treatments in terms of symptoms and functions. There was no significant difference between the two groups at any time point. CONCLUSIONS The combination therapy with biofeedback and medical treatment is effective for symptom relief in FI. The symptom improvement was associated with improved fecal consistency, reduced urgency, and increased rectal sensory thresholds.
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Affiliation(s)
- Jenny Sjödahl
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden
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19
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Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G, Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P. Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists. Dig Liver Dis 2015; 47:628-45. [PMID: 25937624 DOI: 10.1016/j.dld.2015.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/08/2015] [Accepted: 03/28/2015] [Indexed: 02/06/2023]
Abstract
Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders. The aim was to develop a position paper on the diagnostic and therapeutic aspects of faecal incontinence, to provide practical recommendations for a cost-effective diagnostic work-up and a tailored treatment strategy. The recommendations were defined and graded on the basis of levels of evidence in accordance with the criteria of the Oxford Centre for Evidence-Based Medicine, and were based on currently published scientific evidence. Each statement was drafted through constant communication and evaluation conducted both online and during face-to-face working meetings. A brief recommendation at the end of each paragraph allows clinicians to find concise responses to each diagnostic and therapeutic issue.
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Affiliation(s)
| | - Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Italy.
| | | | - Giuseppe Dodi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Ezio Falletto
- I Division of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Alvise Frasson
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Iacopo Giani
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | - Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | | | - Guido Sciaudone
- General and Geriatric Surgery Unit, School of Medicine, Second University of Naples, Italy
| | | | - Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology - AORN "A. Cardarelli", Naples, Italy
| | - Renato Bocchini
- Gastrointestinal Physiopathology, Gastroenterology Department, Malatesta Novello Private Hospital, Cesena, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Italy
| | - Pietro Alduini
- Digestive Endoscopy Unit, San Luca Hospital, Lucca, Italy
| | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy
| | | | - Piera Rossitti
- Gastroenterology Unit, S.M. della Misericordia University Hospital, Udine, Italy
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20
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Jun H, Han MR, Kang NG, Park JH, Park JH. Use of hollow microneedles for targeted delivery of phenylephrine to treat fecal incontinence. J Control Release 2015; 207:1-6. [PMID: 25828366 DOI: 10.1016/j.jconrel.2015.03.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/19/2022]
Abstract
A hollow microneedle (HM) was prepared to deliver a phenylephrine (PE) solution into the anal sphincter muscle as a method for treating fecal incontinence. The goal of this study was the local targeted delivery of PE into the sphincter muscle through the perianal skin with minimal pain using hollow microneedles, resulting in the increase of resting anal sphincter pressure. PE was administered on the left and the right sides of the anus of a rat through the perianal skin using 1.5mm long HM. An in vivo imaging system study was conducted after injection of Rhodamine B, and a histological study was performed after injection of gentian violet. The resting anal sphincter pressure in response to various drug doses was measured by using an air-charged catheter. Anal pressure change produced by HM administration was compared with change produced by intravenous injection (IV), subcutaneous (SC) injection and intramuscular (IM) injection. The change in mean blood pressure produced by HM administration as a function of PE dose was compared with change produced by PBS injection. A pharmacokinetic study of the new HM administration method was performed. A model drug solution was localized in the muscle layer under the perianal skin at the injection site and then diffused out over time. HM administration of PE induced significant contraction of internal anal sphincter pressure over 12h after injection, and the maximum anal pressure was obtained between 5 and 6h. Compared to IV, SC and IM treatments, HM treatment produced greater anal pressure. There was no increase in blood pressure after HM administration of PE within the range of predetermined concentration. Administration of 800μg/kg of PE using HM produced 0.81±0.38h of tmax. Our study suggests that HM administration enables local delivery of a therapeutic dose of PE to the anal sphincter muscle layer with less pain. This new treatment has great potential as a clinical application because of the ease of the procedure, minimal pain, and dose-dependent response.
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Affiliation(s)
- Hyesun Jun
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mee-Ree Han
- Department of Medicine, Chung Ang University, Dongjak-gu, Seoul 156-861, South Korea
| | - Nae-Gyu Kang
- LG Household & Health Care, Daejeon 305-343, South Korea.
| | - Jung-Hwan Park
- Department of BioNano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam, Geonggi-do 461-701, South Korea.
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital and College of Medicine, Sungkyunkwan University, Seoul, South Korea.
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21
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Lee D, Arora G. Medical management of fecal incontinence in challenging populations: a review. Clin Colon Rectal Surg 2014; 27:91-8. [PMID: 25320567 DOI: 10.1055/s-0034-1384661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fecal incontinence (FI) is a common and growing problem in the United States. Although there are multiple emerging novel interventions for the treatment of FI, the mainstay of initial therapy remains medical management. In this article, we review the available literature on the medical management of FI, with a special focus on patients with multiple sclerosis, diabetes mellitus, and the elderly.
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Affiliation(s)
- David Lee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gaurav Arora
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas ; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
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22
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Abstract
Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Israel
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23
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Holdstock JM, Dos Santos SJ, Harrison CC, Price BA, Whiteley MS. Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux. Phlebology 2014; 30:133-9. [PMID: 24755923 DOI: 10.1177/0268355514531952] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids. METHODS Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated. RESULTS Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved. CONCLUSION There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered.
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Affiliation(s)
- J M Holdstock
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK
| | - S J Dos Santos
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - C C Harrison
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK
| | - B A Price
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK
| | - M S Whiteley
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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24
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Kumpf VJ. Pharmacologic management of diarrhea in patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2014; 38:38S-44S. [PMID: 24463352 DOI: 10.1177/0148607113520618] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diarrhea associated with short bowel syndrome (SBS) can have multiple etiologies, including accelerated intestinal transit, gastric acid hypersecretion, intestinal bacterial overgrowth, and malabsorption of fats and bile salts. As a result, patients may need multiple medications to effectively control fecal output. The armamentarium of antidiarrheal drugs includes antimotility agents, antisecretory drugs, antibiotics and probiotics, bile acid-binding resins, and pancreatic enzymes. An antidiarrheal regimen must be individualized for each patient and should be developed using a methodical, stepwise approach. Treatment should be initiated with a single first-line medication at the low end of its dosing range. Dosage and/or dosing frequency can then be slowly escalated to achieve maximal effect while minimizing adverse events. If diarrhea remains poorly controlled, additional agents can be incorporated sequentially. If modification of the regimen is required, a single medication should be altered or exchanged at a time. After each adjustment of the regimen, sufficient time should be permitted to fully assess response (≥3-5 days) before initiating additional changes. SBS-associated malabsorption is a major obstacle to optimization of an antidiarrheal regimen because drug absorption is impaired. Patients may benefit from high dosages and/or frequent dosing intervals, liquid preparations, or nonoral routes of drug delivery. Although the diarrhea associated with SBS can be debilitating, effective pharmaceutical management has the potential to substantially improve health outcomes and quality of life for these patients.
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25
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Claudio Wainstein G, Rodrigo Quera P, Maria Isabel QG. Incontinencia fecal en el adulto: Un desafio permanente. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Functional diarrhea (FD), one of the functional gastrointestinal disorders, is characterized by chronic or recurrent diarrhea not explained by structural or biochemical abnormalities. The treatment of FD is intimately associated with establishing the correct diagnosis. First, FD needs to be distinguished from diarrhea-predominant irritable bowel syndrome (IBS), in which, unlike in FD, abdominal pain is a primary diagnostic criterion. Next, FD must be differentiated from the myriad organic causes of chronic diarrhea. Unlike IBS, in which a positive diagnosis can be made with an acceptable level of confidence using symptom-based criteria and minimal testing, the diagnosis of FD is still primarily a diagnosis of exclusion. Thus, the onus is on the physician to eliminate potential underlying causes, both common and uncommon, in the proper clinical setting. Once the diagnosis has been established, the clinician and patient should first focus on identifying, eliminating, and/or treating aggravating factors. These may include physiologic factors (eg, small bowel bacterial overgrowth), psychological factors (eg, stress and anxiety), and dietary factors (eg, carbohydrate malabsorption). Thereafter, appropriate treatment for functional diarrhea may be instituted. Treatment options include dietary and lifestyle modification, pharmacologic therapies, and alternative modalities. Although many of these strategies have been studied in IBS, almost none of them has been examined specifically in FD. Furthermore, given the poorly understood pathophysiologic basis of FD, these treatments primarily target a patient's symptoms and presumed altered physiology rather than underlying etiologic mechanisms. Therefore, we stress that treatment must be approached in an individualized manner and that dietary and pharmacologic therapies should be part of a comprehensive therapeutic approach in which education and reassurance form the foundation. In general, we attempt to remove dietary triggers and recommend increased fiber intake. We then add anticholinergic, antispasmodic, antimotility, and antidiarrheal agents as the first line of pharmacotherapy. Should a patient not respond to these, and for patients who have a significant degree of psychological dysfunction, central acting agents, including antidepressants and/or anxiolytics, may be beneficial. During the treatment period, we also recommend that physicians keep an open mind. If signs or symptoms that suggest an ongoing or previously unrecognized organic process develop, then a re-evaluation of the clinical picture is indicated.
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Affiliation(s)
- Evan S Dellon
- Department of Medicine, Division of Gastroenterology and Hepatology and Center for Functional GI and Motility Disorders, University of North Carolina School of Medicine, 4107 Bioinformatics Building, CB #7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7080, USA.
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27
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Li Z, Vaziri H. Treatment of chronic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26:677-87. [PMID: 23384811 DOI: 10.1016/j.bpg.2012.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/30/2012] [Accepted: 11/07/2012] [Indexed: 01/31/2023]
Abstract
The treatment of chronic diarrhoea can be challenging. While Oral Rehydration Solution is an important step in treating diarrhoeal illnesses, various medications can be used to alleviate the symptoms while the patient is undergoing diagnostic work up or to target the underlying mechanism responsible for their diarrhoea. Medications are also being prescribed in cases when there is a strong suspicious about a diagnosis or when there is no specific treatment for an underlying aetiology. This chapter discusses the treatment options for diarrhoeal disorders.
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Affiliation(s)
- Zhongzhen Li
- St. Vincent's Medical Center, Department of Medicine, 2800 Main St., Bridgeport, CT 06606, USA.
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28
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Sze EHM, Barker CD, Hobbs G. A cross-sectional survey of the relationship between fecal incontinence and constipation. Int Urogynecol J 2012; 24:61-5. [PMID: 22714998 DOI: 10.1007/s00192-012-1851-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 05/26/2012] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the prevalence of fecal incontinence between constipated and nonconstipated women and correlated its prevalence with the number of Rome III constipation symptoms. METHODS We performed a cross-sectional survey to evaluate the prevalence of fecal incontinence and constipation among women who presented to two gynecologic clinics for routine care over a 24-month period. Fecal incontinence was defined as loss of well-formed and/or loose stool beyond the patient's control that occurred at least once in the last 4 weeks, was bothersome, had been present for the past 3 or more months, and had affected the person's activities, relationships, or feelings. Constipation was diagnosed using the Rome III criteria. Our study was exempt from institutional review board approval because it was a survey and did not ask for information that could be used to identify the participant. RESULTS Mean age of the 2,319 participants was 50.1 ± 15 years and mean body mass index (BMI) was 28.7 ± 7. Seven hundred and twenty-five (31 %) women had constipation, and 233 (10 %) had fecal incontinence. One hundred and one (43 %) incontinent women had coexisting constipation. Logistic regression analysis identified white race (p = .013), menopause (p = .010), and constipation (p = .004) as risk factors for fecal incontinence. After controlling for these risk factors, constipated women were more likely to have fecal incontinence than nonconstipated women [relative risk (RR) 1.60, 95 % confidence interval (CI) 1.26-2.05]. In addition, the prevalence of fecal incontinence was strongly associated with the number of Rome III constipation symptoms (p < .001). CONCLUSION Constipation is an important risk factor for fecal incontinence.
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Affiliation(s)
- Eddie H M Sze
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506-9186, USA.
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Abstract
PURPOSE OF REVIEW Anorectal dysfunction constitutes a major problem in patients surviving rectal cancer. In this review, the current options for management of fecal incontinence after treatment for rectal cancer are discussed. RECENT FINDINGS First line therapy should be conservative measures aimed at symptomatic control. Dietary regiments, fibers, constipating agents and enemas may be tried. Biofeedback is an option to strengthen the external anal sphincter, improve rectal sensitivity and coordinate pelvic floor muscles. Colonic irrigation has been successful to reduce symptoms and improve quality of life. Surgical interventions may be considered if conservative management fails. Sacral nerve stimulation is a successful minimal invasive procedure for the treatment of fecal incontinence; however, evidence of the method after treatment for rectal cancer is still limited. Complex surgical procedures should be limited to only highly selected patients. A stoma should be considered when other treatment modalities have failed. SUMMARY Systematic evaluation of the postoperative anorectal function in patients treated for rectal cancer should be a standard practice at every follow-up. An individually tailored treatment should be offered to the severely affected patients to minimize their symptoms. The evidence on the most commonly used treatments is sparse, therefore, further randomized controlled studies are needed.
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Baek C, Han M, Min J, Prausnitz MR, Park JH, Park JH. Local transdermal delivery of phenylephrine to the anal sphincter muscle using microneedles. J Control Release 2011; 154:138-47. [PMID: 21586307 DOI: 10.1016/j.jconrel.2011.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 04/19/2011] [Accepted: 05/01/2011] [Indexed: 01/01/2023]
Abstract
We propose pretreatment using microneedles to increase perianal skin permeability for locally targeted delivery of phenylephrine (PE), a drug that increases resting anal sphincter pressure to treat fecal incontinence. Microneedle patches were fabricated by micromolding poly-lactic-acid. Pre-treatment of human cadaver skin with microneedles increased PE delivery across the skin by up to 10-fold in vitro. In vivo delivery was assessed in rats receiving treatment with or without use of microneedles and with or without PE. Resting anal sphincter pressure was then measured over time using water-perfused anorectal manometry. For rats pretreated with microneedles, topical application of 30% PE gel rapidly increased the mean resting anal sphincter pressure from 7±2 cm H(2)O to a peak value of 43±17 cm H(2)O after 1 h, which was significantly greater than rats receiving PE gel without microneedle pretreatment. Additional safety studies showed that topically applied green fluorescent protein-expressing E. coli penetrated skin pierced with 23- and 26-gauge hypodermic needles, but E. coli was not detected in skin pretreated with microneedles, which suggests that microneedle-treated skin may not be especially susceptible to infection. In conclusion, this study demonstrates local transdermal delivery of PE to the anal sphincter muscle using microneedles, which may provide a novel treatment for fecal incontinence.
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Affiliation(s)
- Changyoon Baek
- Department of Chemical and Biomolecular Engineering, Kyungwon University, Seongnam, Geonggi-do, 461-701, Republic of Korea
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Bharucha AE, Seide BM, Zinsmeister AR. The effects of clonidine on symptoms and anorectal sensorimotor function in women with faecal incontinence. Aliment Pharmacol Ther 2010; 32:681-8. [PMID: 20629973 PMCID: PMC2932810 DOI: 10.1111/j.1365-2036.2010.04391.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Women with faecal incontinence and rectal urgency have increased rectal stiffness and sensation. AIM To evaluate the effects of clonidine, an alpha(2) -adrenergic agonist, in faecal incontinence. METHODS In this open-label uncontrolled study, bowel symptoms and anorectal functions (anal pressures, rectal compliance, and sensation) were assessed before and during treatment with transdermal clonidine (0.2 mg daily, 4 weeks) in 12 women with urge-predominant faecal incontinence. RESULTS Clonidine reduced the frequency (17.8 +/- 3.1 before vs. 8.8 +/- 3.9 after, P = 0.03) and number of days with faecal incontinence (11.8 +/- 1.6 before vs. 6.1 +/- 1.8 after, P = 0.02), faecal incontinence symptom severity score (max = 13, 8.3 +/- 0.7 vs. 5.6 +/- 0.9, P < 0.01), and allowed patients to defer defecation for a longer duration (P = 0.03). Although overall effects on anorectal functions were not significant, the treatment-associated reduction in faecal incontinence episodes was associated with increased rectal compliance (r = -0.58, P < 0.05) and reduced rectal sensation. (r = -0.73, P = 0.007 vs. desire to defecate pressure threshold). CONCLUSIONS Clonidine improves symptoms in women with faecal incontinence; this improvement is associated with increased rectal compliance and reduced rectal sensitivity. A controlled study is necessary to confirm these observations.
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Affiliation(s)
- A. E. Bharucha
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - B. M. Seide
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - A. R. Zinsmeister
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
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Btaiche IF, Chan LN, Pleva M, Kraft MD. Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutr Clin Pract 2010; 25:32-49. [PMID: 20130156 DOI: 10.1177/0884533609357565] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Critically ill patients who are subjected to high stress or with severe injury can rapidly break down their body protein and energy stores. Unless adequate nutrition is provided, malnutrition and protein wasting may occur, which can negatively affect patient outcome. Enteral nutrition (EN) is the mainstay of nutrition support therapy in patients with a functional gastrointestinal (GI) tract who cannot take adequate oral nutrition. EN in critically ill patients provides the benefits of maintaining gut functionality, integrity, and immunity as well as decreasing infectious complications. However, the ability to provide timely and adequate EN to critically ill patients is often hindered by GI motility disorders and complications associated with EN. This paper reviews the GI complications and intolerances associated with EN in critically ill patients and provides recommendations for their prevention and treatment. It also addresses the role of commonly used medications in the intensive care unit and their impact on GI motility and EN delivery.
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Affiliation(s)
- Imad F Btaiche
- University of Michigan Hospitals and Health Centers, Pharmacy Services, UHB2D301, 1500 E. Med. Center Drive, Ann Arbor, MI 48109-0008, USA.
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Affiliation(s)
- Darleen Chien
- Gerontology Nurse Practitioner Program at the University of Pennsylvania School of Nursing, Philadelphia, Pa, USA
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Fecal incontinence in an inpatient population: a not uncommon finding. Dig Dis Sci 2009; 54:2215-9. [PMID: 19058001 DOI: 10.1007/s10620-008-0592-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 10/17/2008] [Indexed: 01/03/2023]
Abstract
The prevalence of fecal incontinence (FI) in hospitalized patients was determined, as well as the frequency with which physicians query about FI. Using a standardized questionnaire, subjects admitted to general medicine services at three university hospitals were questioned about FI. Investigators also reviewed the subjects' charts to determine if presence or absence of FI was documented. One hundred ninety-nine patients were enrolled, and 46% (92/199) reported ongoing FI. Advanced age, looser stools, symptoms of fecal urgency, urinary incontinence, and history of forceps delivery were found to be potential predictors of FI. Only 6% (6/92) with FI had documentation of FI in the medical chart and only 3% (6/199) of the entire sample were queried about FI. Fecal incontinence is an extremely common condition in hospitalized patients. Physician history-taking is severely deficient in this area. Methods to improve FI detection in the hospitalized patient population need to be developed.
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Talley NJ, Lasch KL, Baum CL. A gap in our understanding: chronic constipation and its comorbid conditions. Clin Gastroenterol Hepatol 2009; 7:9-19. [PMID: 18829389 DOI: 10.1016/j.cgh.2008.07.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/24/2008] [Accepted: 07/11/2008] [Indexed: 02/07/2023]
Abstract
Constipation is one of the most common digestive disorders in the United States; however, the association of this condition with related comorbidities, both gastrointestinal and extraintestinal, is poorly documented. Here, we have reviewed the association of constipation with specific comorbidities. The data suggest that there are considerable clinical consequences associated with constipation. Ultimately, realization of the disease risks associated with chronic constipation may provide the impetus needed to direct new research, and shift attention on the part of patients and practitioners to methods for preventing significant and potentially costly comorbid medical problems.
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Affiliation(s)
- Nicholas J Talley
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.
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36
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Elía Guedea M, Gracia Solanas JA, Royo Dachary P, Ramírez Rodríguez JM, Aguilella Diago V, Martínez Díez M. [Prevalence of anal diseases after Scopinaro's biliopancreatic bypass for super-obese patients]. Cir Esp 2008; 84:132-7. [PMID: 18783671 DOI: 10.1016/s0009-739x(08)72154-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department. MATERIAL AND METHOD We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded. RESULTS There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula. CONCLUSIONS Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence.
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Affiliation(s)
- Manuela Elía Guedea
- Servicio de Cirugía General B, Hospital Clínico Universitario, Zaragoza, España
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37
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Faucheron JL. [Anal incontinence]. Presse Med 2008; 37:1447-62. [PMID: 18555639 DOI: 10.1016/j.lpm.2008.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 01/26/2008] [Accepted: 04/21/2008] [Indexed: 12/15/2022] Open
Abstract
Anal incontinence today is more frequent than current estimates indicate. When a patient seeks care for this condition, its cause and severity are assessed by a careful history and clinical examination. Two essential atraumatic examinations are decision-support tools: transrectal ultrasound and anal manometry. Treatment should always be proposed. Surgery is necessary in some cases: obvious rupture of the external sphincter, if possible confirmed by transrectal ultrasound, should be directly repaired. Should this treatment fail, a repeated repair or a sphincter replacement (graciloplasty or artificial sphincter) is called for. Neuromodulation therapy is often indicated in the absence of obvious rupture, especially in cases of pudendal neuropathy.
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Affiliation(s)
- Jean-Luc Faucheron
- Unité de chirurgie colorectale, Clinique universitaire de chirurgie digestive et de l'urgence, Hôpital Albert Michallon, F-38043 Grenoble cedex 9, France.
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38
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Affiliation(s)
- Jorge G Avila
- Department of Pharmacy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Abstract
Fecal incontinence is a common clinical problem that often is frustrating to the patient and treating physician. Nonsurgical management for fecal incontinence includes dietary manipulation, Kegel exercises, perianal skin care, and biofeedback therapy. Pharmacotherapies often are used to assist in management of fecal incontinence. A variety of pharmacotherapies have been utilized for the management of fecal incontinence; limited data from randomized, placebo-controlled trials are available. This is a review of the existing literature on clinical trials of several classes of drugs and other medical therapies that may be beneficial for patients with fecal incontinence. The information in this article was obtained by a MEDLINE search for all clinical trials of drug therapy for fecal incontinence. These treatments and the existing data on their use are summarized. Treatments reviewed include stool bulking agents, with an emphasis on the most promising effect obtained with calcium polycarbophil, constipating agents, including loperamide, codeine, amitriptyline, atropine, and diphenoxylate agents injected into the anal sphincter, drugs to enhance anal sphincter function, including topical phenylepherine and oral sodium valproate, and trials of fecal disimpaction. A new classification to easily remember the treatment categories for this condition, based on the "ABCs of treatment for fecal incontinence," has been introduced into the structure of this review.
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Affiliation(s)
- Eli D Ehrenpreis
- Division of Gastroenterology, Rush Medical Center, Chicago, Illinois, USA.
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Abstract
BACKGROUND Intestinal complaints are a frequent health concern for elderly people and their care providers. AIMS To explore the distinction between constipation and the subjective complaints in elderly people and to review the diagnosis, causes and treatment of constipation, fecal impaction, and fecal incontinence. METHODS Review of studies that give information on prevalence, causes, symptoms, and treatment of bowel problems in the elderly, excluding uncontrolled clinical observations. RESULTS Self-reported constipation and laxative use increase with age and are more common among women, blacks and people of low socio-economic level. The patient's pharmacological history is fundamental, because medications are the cause of up to 40% of chronic constipation, and are often used inappropriately. The results of most laxative trials require cautious interpretation, but fiber and laxatives are more effective than placebo against constipation. Much additional research is needed to determine the most cost-effective method of treating intestinal complaints in the elderly. CONCLUSIONS Bowel problems in older people have a considerable impact on the quality of life and have many contributory causes that are often amenable to treatment and management. Results of therapy can be good, leading to alleviation of suffering and the ability to lead a fuller life.
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Affiliation(s)
- G C Spinzi
- Department of Gastroenterology, Ospedale Valduce, Como, Italy.
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Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal Disease: A Comprehensive Review. J Am Coll Surg 2007; 204:102-17. [PMID: 17189119 DOI: 10.1016/j.jamcollsurg.2006.08.022] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 08/24/2006] [Accepted: 08/25/2006] [Indexed: 12/11/2022]
Affiliation(s)
- Orit Kaidar-Person
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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42
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Maslekar S, Gardiner A, Maklin C, Duthie GS. Investigation and treatment of faecal incontinence. Postgrad Med J 2006; 82:363-71. [PMID: 16754704 PMCID: PMC2563743 DOI: 10.1136/pgmj.2005.044099] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 02/07/2006] [Indexed: 12/17/2022]
Abstract
Faecal incontinence is a debilitating condition affecting people of all ages, and significantly impairs quality of life. Proper clinical assessment followed by conservative medical therapy leads to improvement in more than 50% of cases, including patients with severe symptoms. Patients with advanced incontinence or those resistant to initial treatment should be evaluated by anorectal physiology testing to establish the severity and type of incontinence. Several treatment options with promising results exist. Patients with gross sphincter defects should undergo surgical repair. Those who fail to respond to sphincteroplasty and those with no anatomical defects have the option of either sacral nerve stimulation or other advanced procedures. Stoma formation should be reserved for patients who do not respond to any of the above procedures.
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Affiliation(s)
- S Maslekar
- University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK
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Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, Melton LJ. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol 2006; 101:1305-12. [PMID: 16771954 DOI: 10.1111/j.1572-0241.2006.00553.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In women with "idiopathic" fecal incontinence (FI), consensus guidelines recommend anal sphincter imaging and surgical repair, when feasible, of anal sphincter defects believed to cause FI. However, the relative contributions of obstetric trauma and bowel symptoms to FI in the community are unknown. METHODS To assess risk factors for FI during the past year, a previously validated questionnaire was mailed to an age-stratified random sample of 5,300 women residing in Olmsted County, Minnesota. RESULTS Altogether, 2,800 women (53%) responded. The risk of fecal incontinence increased with age (odds ratio [OR] per decade 1.3, 95% CI 1.2-1.4). The risk of fecal incontinence was higher among women with rectal urgency (OR 8.3, 95% CI 4.8-14.3) whether or not they also had other bowel disturbances (i.e., constipation, diarrhea, or abdominal pain) or had a vaginal delivery with forceps or stitches (OR 9.0, 95% CI 5.6-14.4). Among women with FI, rectal urgency and age were also risk factors for symptom severity. In contrast, obstetric risk factors for anorectal trauma did not increase the risk for FI. The risk for FI was not significantly different among women with cesarean section, vaginal delivery with or without forceps or stitches, or anorectal surgery, compared with nulliparous women without any of these risk factors. CONCLUSIONS Rectal urgency rather than obstetric injury is the main risk factor for FI in women. These observations reinforce the importance of behavioral, dietary, and pharmacological measures to ameliorate bowel disturbances before anal imaging in women with "idiopathic" FI.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Abstract
In recent years, obesity has been recognized as a form of malnutrition in older adults and a continuing risk factor for serious health problems. Weight reduction in older adults is not as reliable a recommendation as it is for younger adults; a decreased body mass index (BMI) seems to be associated with a higher incidence of stroke, and a normal or slightly elevated BMI has been linked to greater reserve capacity. Weight loss in older adults requires strategies that consider health status, functional ability, and rational targets. Strategies may include behavior modification, dietary alterations, exercise or physical activity, and reasonable goals that do not put the individual at nutritional risk. Studies that examine different approaches to weight reduction rarely include older subjects, so it is difficult to make judgments about various interventions (surgery, exercise, drugs, or diet) and their efficacy in this population. Fad diets may be lacking in essential nutrients and may prove to be risky for elderly people. Weight loss programs for older adults should focus on maintaining adequate intake of essential nutrients while reducing calories by controlling dietary fat intake.
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Affiliation(s)
- Ronni Chernoff
- Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, 4300 West 7th Street, Little Rock, AR 72205, USA.
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45
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Terra MP, Beets-Tan RGH, van Der Hulst VPM, Dijkgraaf MGW, Bossuyt PMM, Dobben AC, Baeten CGMI, Stoker J. Anal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging. Radiology 2005; 236:886-95. [PMID: 16014438 DOI: 10.1148/radiol.2363041162] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To prospectively compare external phased-array magnetic resonance (MR) imaging with endoanal MR imaging in depicting external and internal anal sphincter defects in patients with fecal incontinence and to prospectively evaluate observer reproducibility in the detection of external and internal anal sphincter defects with both MR imaging techniques. MATERIALS AND METHODS The medical ethics committees of both participating hospitals approved the study, and informed consent was obtained. Thirty patients (23 women, seven men; mean age, 58.7 years; range, 37-78 years) with fecal incontinence underwent MR imaging with both endoanal and external phased-array coils. MR images were evaluated by three radiologists with different levels of experience for external and internal anal sphincter defects. Measures of inter- and intraobserver agreement of both MR imaging techniques and of differences between both imaging techniques were calculated. RESULTS Both MR imaging techniques did not significantly differ in the depiction of external (P > .99) and internal (P > .99) anal sphincter defects. The techniques corresponded in 25 (83%) of 30 patients for the depiction of external anal sphincter defects and in 28 (93%) of 30 patients for the depiction of internal anal sphincter defects. Interobserver agreement was moderate to good for endoanal MR imaging and poor to fair for external phased-array MR imaging. Intraobserver agreement ranged from fair to very good for both imaging techniques. CONCLUSION External phased-array MR imaging is comparable to endoanal MR imaging in the depiction of clinically relevant anal sphincter defects. Because of the weak interobserver agreement, both MR imaging techniques can be recommended in the diagnostic work-up of fecal incontinence only if sufficient experience is available.
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Affiliation(s)
- Maaike P Terra
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Zhu L, Tang WF, Ren P, Huang X. [Research strategy and clinical significance of anorectum manometry]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2005; 3:240-2. [PMID: 15885181 DOI: 10.3736/jcim20050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Lin Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Huaxi Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
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