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Zhong LLD, Cheng CW, Kun W, Dai L, Hu DD, Ning ZW, Xiao HT, Lin CY, Zhao L, Huang T, Tian K, Chan KH, Lam TW, Chen XR, Wong CT, Li M, Lu AP, Wu JCY, Bian ZX. Efficacy of MaZiRenWan, a Chinese Herbal Medicine, in Patients With Functional Constipation in a Randomized Controlled Trial. Clin Gastroenterol Hepatol 2019; 17:1303-1310.e18. [PMID: 29654915 DOI: 10.1016/j.cgh.2018.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The Chinese herbal medicine, MaZiRenWan (MZRW), has been used for more than 2000 years to treat constipation, but it has not been tested in a randomized controlled trial. We performed a trial to evaluate the efficacy and safety of MZRW, compared with the stimulant laxative senna or placebo, for patients with functional constipation (FC). METHODS We performed a double-blind, double-dummy, trial of 291 patients with FC based on Rome III criteria, seen at 8 clinics in Hong Kong from June 2013 through August 2015. Patients were observed for 2 weeks and then assigned randomly (1:1:1) to groups given MZRW (7.5 g, twice daily), senna (15 mg daily), or placebo for 8 weeks. Patients were then followed for 8 weeks and evaluated at baseline and weeks 4, 8 (end of treatment), and 16 (end of follow up). Participants recorded information on stool form and frequency, feeling of complete evacuation, and research medication taken. Data on individual bowel symptoms, global symptom improvement, and adverse events were collected. A complete response was defined as an increase ≥1 complete spontaneous bowel movement (CSBM)/week from baseline (the primary outcome). Secondary outcomes included response during the follow-up period, colonic transit, individual and global symptom assessments, quality of life measured with 36-item short form Chinese version, and adverse events. RESULTS Although there was no statistically significant difference in proportions of patients with a complete response to MZRW (68%) vs. senna (57.7%) (P = .14) at week 8, there was a statistically significant difference vs. placebo (33.0%) (P < .005). At the 16-week timepoint (after the 8-week follow-up period), 47.4% of patients had a complete response to MZRW, 20.6% had a complete response to senna, and 17.5% had a complete response to placebo (P < .005 for MZRW vs. placebo). The group that received MZRW group also had significant increases in colonic transit and reduced severity of constipation, straining, incomplete evacuation, and global constipation symptoms compared with the groups that received placebo or senna in (P < .05 for all comparisons). CONCLUSIONS In a randomized controlled trial of 291 patients with FC, we found MZRW to be well-tolerated and effective in increasing CSBM/week. MZRW did not appear to be more effective than senna and might be considered as an alternative to this drug. ClincialTrials.gov no: NCT01695850.
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Affiliation(s)
- Linda L D Zhong
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Chung-Wah Cheng
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Wai Kun
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Liang Dai
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Dong-Dong Hu
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Zi-Wan Ning
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Hai-Tao Xiao
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Cheng-Yuan Lin
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Ling Zhao
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Tao Huang
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Ke Tian
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - King-Hong Chan
- Department of Family Medicine & General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Kowloon City, Hong Kong, P. R. China
| | - Ting-Wa Lam
- Department of Medicine, Queen Elizabeth Hospital, Hospital Authority, Hong Kong, P. R. China
| | - Xiao-Rui Chen
- Department of Family Medicine & General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Kowloon City, Hong Kong, P. R. China
| | - Chi-Tak Wong
- Department of Family Medicine & General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Kowloon City, Hong Kong, P. R. China
| | - Min Li
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Ai-Ping Lu
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China
| | - Justin C Y Wu
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, P. R. China.
| | - Zhao-Xiang Bian
- Hong Kong Chinese Medicine Study Centre, Hong Kong Baptist University, Hong Kong, P. R. China.
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Zhong LLD, Cheng CW, Chan Y, Chan KH, Lam TW, Chen XR, Wong CT, Wu JCY, Bian ZX. Chinese herbal medicine (Ma Zi Ren Wan) for functional constipation: study protocol for a prospective, double-blinded, double-dummy, randomized controlled trial. Trials 2013; 14:366. [PMID: 24180235 PMCID: PMC4228394 DOI: 10.1186/1745-6215-14-366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 10/22/2013] [Indexed: 01/15/2023] Open
Abstract
Background Functional constipation is a common clinical complaint. Although the effectiveness of Ma Zi Ren Wan for alleviating functional constipation symptoms has been proven in a previous randomized placebo-controlled study, further evidence is needed to make clinical recommendations about Chinese herbal medicine. In particular, a comparison with conventional western medicine for functional constipation patients is needed. Methods/Design This is a prospective, double-blinded, double dummy, randomized, controlled trial. After a 2-week run-in period, eligible patients (Rome III) with excessive traditional Chinese medicine syndrome will randomly be assigned to the Chinese medicine arm (Ma Zi Ren Wan and western medicine placebo), western medicine arm (senna and Chinese medicine placebo) or placebo arm (Chinese medicine placebo and western medicine placebo). Patients will undergo an 8-week treatment and an 8-week follow-up. The primary outcome is the responder rate for complete spontaneous bowel movement (CSBM) during treatment. Patients with a mean increase of CSBM ≧1/week in comparison with their baselines are defined as responders. The secondary outcomes include responder rate during follow-up, changes of colonic transit as measured with radio-opaque markers, individual and global symptom assessments, and reported adverse effects. Discussion This study is the first study to compare a Chinese Herbal Medicine (Ma Zi Ren Wan) with a laxative that is commonly used in the clinical practice of western medicine, and with a placebo. This study will complete the investigation of Ma Zi Ren Wan for functional constipation, and should, therefore, suggest recommendations for clinical practice. Furthermore, the process of first conducting a systematic review, then implementing a dose determination study followed by a placebo-control trial, and finally, comparing traditional Chinese medicine with an active conventional medicine in a controlled trial can be a reference to other researches on Chinese medicine interventions in the future. Trial registration NCT01695850
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Affiliation(s)
| | | | | | | | | | | | | | - Justin C Y Wu
- School of Chinese Medicine, Hong Kong Baptist University, 1/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong, SAR, China.
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Deiteren A, Camilleri M, Bharucha AE, Burton D, McKinzie S, Rao A, Zinsmeister AR. Performance characteristics of scintigraphic colon transit measurement in health and irritable bowel syndrome and relationship to bowel functions. Neurogastroenterol Motil 2010; 22:415-23, e95. [PMID: 20025675 PMCID: PMC2852474 DOI: 10.1111/j.1365-2982.2009.01441.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The inter- and intra-subject variations of scintigraphy, which are used to identify colonic transit disturbances in irritable bowel syndrome (IBS), are unclear. The relationship between colonic transit and bowel functions is incompletely understood. To assess inter- and intra-subject variations of scintigraphic colonic transit measurements in 86 IBS patients and 17 healthy subjects and to quantify the relationship between colonic transit and bowel symptoms in 147 IBS patients and 46 healthy subjects. METHODS Data from participants with multiple colonic transit measurements were analysed. Primary end points were colonic filling at 6 h (CF6h) and geometric center (GC) at 24 and 48 h for colonic transit. Bowel functions were assessed by daily stool diaries. KEY RESULTS Inter- and intra-subject variations were greater for small intestinal than colonic transit. Overall, inter- and intra-subject variations were relatively narrow for colonic transit (both GC24h and GC48h, with lower COV at 48 h); there was little intra-subject variation in health and IBS-constipation over a period of <or=3 weeks and over 2.0 years (median, range 0.1, 11.0 years). Significant intra-individual differences in GC24h were observed only in IBS-D patients. Colonic transit was significantly associated with stool form (accounting for 19-27% of the variance), frequency (19%), and ease of stool passage (12%). CONCLUSIONS & INFERENCES Despite inter-subject variation in scintigraphic colonic transit results, the intra-subject measurements are reproducible over time in healthy volunteers and patients with IBS; significant changes in colonic transit at 24 h were observed only in IBS-D. Colonic transit is associated with stool form, frequency and ease of passage.
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Affiliation(s)
| | | | | | | | | | | | - Alan R. Zinsmeister
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota
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Manabe N, Cremonini F, Camilleri M, Sandborn WJ, Burton DD. Effects of bisacodyl on ascending colon emptying and overall colonic transit in healthy volunteers. Aliment Pharmacol Ther 2009; 30:930-6. [PMID: 19678812 PMCID: PMC2862903 DOI: 10.1111/j.1365-2036.2009.04118.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The mechanism of action of bisacodyl in the unprepared human colon remains unclear. AIM To evaluate the effect of oral bisacodyl on the overall and regional colonic transit in humans. METHODS In a double-blind, randomized, placebo-controlled study of 25 healthy participants, effects of oral bisacodyl (5 mg p.o. per day) and placebo on colonic transit were compared. A validated scintigraphy method was used to measure colonic transit. The primary transit endpoints, ascending colon emptying t(1/2) and geometric centre of colon isotope at 24 h (overall transit), were compared (Wilcoxon rank sum test). RESULTS There were significant treatment effects on ascending colon t(1/2), with the bisacodyl group demonstrating accelerated emptying [median 6.5 h, interquartile range 5.0-8.0 h] relative to the placebo group [11.0 h (7.0-17.1); P = 0.03]. Numerical differences in colonic geometric centre 24 h [bisacodyl median 3.0 (2.2-3.8), placebo 4.0 (3.1-4.6)] were not significant (P = 0.19). There were no significant differences observed in geometric centre 4 h. CONCLUSION Oral 5 mg bisacodyl accelerates ascending colon in the unprepared colon in healthy adults; this action may contribute to the drug's efficacy in constipation.
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Affiliation(s)
- N Manabe
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN 55905, USA
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