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Tazaki T, Yamada H, Sato R, Ishii H, Sugita S, Yanagihara H, Nakamura D, Takashio O, Inamoto A, Iwanami A. Constipation-associated factors in outpatients with schizophrenia: A multicenter questionnaire survey. Neuropsychopharmacol Rep 2024. [PMID: 38957048 DOI: 10.1002/npr2.12464] [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: 05/19/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
Constipation is a prevalent gastrointestinal disorder that affects people globally, decreasing their quality of life and life expectancy. Individuals with schizophrenia often suffer from constipation, which could be a result of the illness itself or the side effects of psychotropic medications. However, little research has been conducted on factors contributing to constipation in individuals with schizophrenia. To address this issue, we conducted a survey using self-administered questionnaires and medical records to identify factors associated with constipation in psychiatric outpatients. This study included 399 patients with schizophrenia, resulting in a high prevalence of constipation (43.4%). The analysis suggested that female gender, the doses of antiparkinsonian medications, and benzodiazepine sleeping pills may be associated with constipation.
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Affiliation(s)
- Taro Tazaki
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Hiroki Yamada
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tokyo, Japan
- Shinrin Koen Mental Clinic, Tokyo, Japan
| | - Ryotaro Sato
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Hiroki Ishii
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Shutaro Sugita
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Haruka Yanagihara
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Dan Nakamura
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Osamu Takashio
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Atsuko Inamoto
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tokyo, Japan
| | - Akira Iwanami
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
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Froehner Junior I, Jorge JMN, Marques CFS, Santos VLCDG, Jukemura J. CONSTIPATION SCORING SYSTEM VALIDATED FOR THE PORTUGUESE LANGUAGE (ÍNDICE DE GRAVIDADE DA CONSTIPAÇÃO INTESTINAL): IS IT RELIABLE IN ASSESSING THE SEVERITY OF INTESTINAL CHRONIC CONSTIPATION IN OUR POPULATION? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 36:e1785. [PMID: 38511799 PMCID: PMC10949929 DOI: 10.1590/0102-672020230067e1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/08/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.
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Affiliation(s)
- Ilario Froehner Junior
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - José Marcio Neves Jorge
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | | | - José Jukemura
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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He M, Ding G, Yang Y, Zhong J. Bowel habits were associated with mortality in chronic kidney disease: results from a nationwide prospective cohort study. Ren Fail 2023; 45:2292150. [PMID: 38093521 PMCID: PMC10732187 DOI: 10.1080/0886022x.2023.2292150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Bowel habits may affect the prognosis in the chronic kidney disease (CKD) patients. This study aimed to explore the association of bowel habits with cardiovascular and all-cause mortality in CKD. METHODS 2460 CKD patients in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2010 without missing data for bowel habits and mortality were enrolled. Bowel habits including bowel movements (BMs) per week and stools consistency were obtained by standard interview. Mortality status and cause of death were determined by NHANES-linked National Death Index records through 31 December 2015. Cox proportional hazard models and Kaplan-Meier analysis were used to evaluate the association of bowel habits with cardiovascular and all-cause mortality. RESULTS A total of 2460 CKD patients with an average age of 60.80 ± 0.57 years were enrolled. During an average follow-up of 87.47 ± 0.98 months, 144 cardiovascular and 669 all-cause deaths were documented. Reporting 3 or fewer BMs per week was associated with cardiovascular (HR = 1.83, 95% CI: 1.06, 3.17) and all-cause mortality (HR = 1.71, 95% CI: 1.20, 2.43). More than 10 BMs per week also increased the risk of all-cause mortality (HR = 1.21, 95% CI: 1.01, 1.45). Hard stools consistency increased the risk of all-cause mortality (HR= 2.00, 95% CI: 1.48, 2.70) compared with those reporting normal stools. CONCLUSION Low stool frequency and hard stool consistency were associated with an increased risk of mortality in patients with CKD.
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Affiliation(s)
- Meng He
- Department of Nephrology, Mingguang People’s Hospital, Chuzhou, China
| | - Guanggui Ding
- Department of Nephrology, Mingguang People’s Hospital, Chuzhou, China
| | - Yongbiao Yang
- Department of Nephrology, Mingguang People’s Hospital, Chuzhou, China
| | - Jie Zhong
- Department of Nephrology, Mingguang People’s Hospital, Chuzhou, China
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Ghosh DK, Sarkar DK, Nath M, Ullah P, Khondaker MFA, Chowdhury SAM, Mahmuduzzaman M. Symptoms and Prevalence of Constipation among Adult Population of Bangladesh. Euroasian J Hepatogastroenterol 2023; 13:45-49. [PMID: 38222951 PMCID: PMC10785132 DOI: 10.5005/jp-journals-10018-1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/09/2023] [Indexed: 01/16/2024] Open
Abstract
Background Constipation is one of the most common gastrointestinal disorders. The prevalence of constipation is rapidly increasing globally. It has adverse effects on the patient's quality of life including productivity and results in a high financial hardship on the healthcare system. The aim of the study was to estimate the symptoms and prevalence of constipation among the adult population of Bangladesh. Materials and methods It was a cross-sectional observational study based on a structured questionnaire and a checklist. In this study, three criteria were used for the diagnosis of chronic constipation (self-reported perception, Rome III criteria, and Bristol's criteria). The study was conducted among 1,550 population between July 2019 and December 2019. Result The study population consisted of 1,550 respondents, among them 41.61% male and 58.39% female, and the mean age was 32.71 ± 9.72 years. In the study, 12.2% of the population was categorized to have constipation according to self-reported perception, 11.2% according to Rome III, and 10.3% reported to have been suffering from constipation according to Bristol chart.Female gender tends to have a greater prevalence than male. In multivariate analysis for constipation, betel nut chewer, alcohol consumer, diabetes mellitus, hypertension, GI surgery, and bronchial asthma were significantly (p < 0.001) associated with constipation. According to Bristol's criteria, the most common stool form was Type III (sausage-shaped with cracked surface) among the Bangladeshi population in this study. Conclusion Chronic constipation is a common problem worldwide. The findings of this study suggest that there is a high prevalence of constipation among the general population of Bangladesh. Decreasing modifiable risk factors of constipation can reduce its prevalence and burden of the disease. Bangladesh is markedly deficient in literature citing constipation prevalence and determinants. These findings may commence a call for setting priority as one of the major public health problems and demanding attention for both at the clinical and community levels. How to cite this article Ghosh DK, Sarkar DK, Nath M, et al. Symptoms and Prevalence of Constipation among Adult Population of Bangladesh. Euroasian J Hepato-Gastroenterol 2023;13(2):45-49.
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Affiliation(s)
- Dilip Kumar Ghosh
- Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
| | - Debashis Kumar Sarkar
- Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
| | - Mukta Nath
- Department of Anatomy, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Parash Ullah
- Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
| | | | | | - Mohammad Mahmuduzzaman
- Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
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Li Q, Shen H. Shengjing Runchang Decoction ameliorates spleen deficiency-induced constipation in children: An observational study. Medicine (Baltimore) 2022; 101:e32341. [PMID: 36595853 PMCID: PMC9794210 DOI: 10.1097/md.0000000000032341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Traditional Chinese medicines (TCM) are often used for the treatment of spleen-deficiency (SD) syndrome in China. This study evaluated the curative effects of TCM Shengjing Runchang Decoction on SD-induced constipation children. From July 2019 to April 2020, a total of 70 children with constipation due to spleen deficiency who were admitted to our hospital were selected and randomly divided into control group (n = 35) and treatment group (n = 35). Both groups were treated with standard western medicine, and the treatment group was combined with TCM Shengjing Runchang Decoction at the same time. The clinical efficacy and neurocytokines including 5-hydroxytryptamine (5-HT), vasoactive intestinal peptide (VIP), children's colonic transit time (CTT), glial cell line-derived neurotrophic factor, colonic estrogen receptor before and after treatment were analyzed and compared between the 2 groups. The curative effect, total effective rate of TCM syndromes, CTT, 5-HT and plasma VIP levels, glial cell-derived nerve effects of trophic factor levels, immune function IgG, IgGA, CD4/CD8 in the treatment group were significantly promoted in comparison with the control group (P > .05). The TCM Shengjing Runchang Decoction is effective in treatment with children with SD-induced constipation, which can effectively improve immune function, reduce neurotrophic factor secretion and maintain normal secretion and improve colonic motor function.
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Affiliation(s)
- Qi Li
- Department of Traditional Chinese Medicine, Beijing Kyoto Children’s Hospital, Beijing, China
- * Correspondence: Qi Li, Department of Traditional Chinese Medicine, Beijing Kyoto Children’s Hospital, 308 Huilongguan East Street, Changping District, Beijing 102208, China (e-mail: )
| | - Huizhen Shen
- Beijing Shunyi District Maternal and Child Health Hospital, Beijing, China
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Recognizing and Defining Occasional Constipation: Expert Consensus Recommendations. Am J Gastroenterol 2022; 117:1753-1758. [PMID: 35971230 DOI: 10.14309/ajg.0000000000001945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022]
Abstract
Constipation is a common problem, affects 15% of the population, and is often self-diagnosed and self-managed. Over the past 3 decades, there have been significant advances in our understanding and management of chronic constipation, with the emerging recognition that occasional constipation (OC) is another subtype that falls outside current classifications. The purpose of this review was to describe the process of developing and proposing a new definition for OC based on expert consensus and taking into consideration the multifactorial nature of the problem such as alterations in bowel habit that include stool frequency and difficulty with stool passage, perception of the sufferer, duration of symptoms, and potential responsiveness to treatment. Leading gastroenterologists from 5 countries met virtually on multiple occasions through an online digital platform to discuss the problem of OC and recommended a practical, user-friendly definition: "OC can be defined as intermittent or occasional symptomatic alteration(s) in bowel habit. This includes a bothersome reduction in the frequency of bowel movements and/or difficulty with passage of stools but without alarming features. Bowel symptoms may last for a few days or a few weeks, and episodes may require modification of lifestyle, dietary habits and/or use of over-the-counter laxatives or bulking agents to restore a satisfactory bowel habit." Prospective studies are required to validate this definition and determine OC prevalence in the community. This review highlights current knowledge gaps and could provide impetus for future research to facilitate an improved understanding of OC and development of evidence-based management guidelines.
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Caetano AC, Costa D, Silva-Mendes S, Correia-Pinto J, Rolanda C. Constipation: Prevalence in the Portuguese community using Rome IV-Associated factors, toilet behaviours and healthcare seeking. United European Gastroenterol J 2022; 10:376-384. [PMID: 35315232 PMCID: PMC9103370 DOI: 10.1002/ueg2.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chronic constipation (CC) is a major public health condition and CC management remains challenging. Objective We aimed to evaluate the CC (and subtypes) prevalence in a Southern Europe Mediterranean country using Rome IV criteria, and to assess related factors, toilet and healthcare seeking behaviours. Methods Cross‐sectional epidemiological survey, conducted in general community and representing the Portuguese population according to sex and age. The questionnaire covered bowel habits, factors potentially associated with CC (demographic, health/lifestyle, toilet behaviours) and data regarding healthcare seeking. Results From the study data of 1950 individuals were analyzed. The answer rate was 68% and 1335 questionnaires were available for calculation. The CC prevalence was 17.8%, with respectively 9.3% of Functional Constipation (FC) and 8.5% of Irritable Bowel Syndrome – subtype constipation (IBS‐C). The likelihood of constipation was significantly higher in younger (OR 1.01; 95% confidence interval [CI], 1.007–1.031), solo (OR 2.48; 95% CI, 1.7–3.47) and low‐income (OR 2.40; 95% CI, 1.77–3.47) individuals. Constipated individuals spent more time at defecation, longer than 5 min (p = 0.001), and had particular toilet behaviours (absence of a morning pattern [p = 0.008], the use of triggers [p = 0.001] and reading/technological material [p = 0.006]) to facilitate the evacuation. Only 39% of affected individuals sought medical advice, mainly IBS‐C patients (p = 0.018). Conclusion Chronic constipation seems to impact 1 in each 5 Portuguese. Constipated patients are younger, solo, less active and with low income. They develop a clear toilet behaviour profile. FC and IBS‐C patients assume particular behaviours.
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Affiliation(s)
- Ana Célia Caetano
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Dalila Costa
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sofia Silva-Mendes
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Correia-Pinto
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carla Rolanda
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães, Portugal
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Effect of Prebiotics and Synbiotics Carried by Food over Irritable Bowel Syndrome Symptoms: A Systematic Review. DAIRY 2022. [DOI: 10.3390/dairy3010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic condition that affects 11.2% of the world’s population. The management of gut microbiota using probiotic and synbiotic agents might be a valid alternative to assist in the treatment of IBS. The focus of this study was to evaluate the effects of prebiotic and synbiotic compounds carried by different foods on major symptoms of IBS through a systematic literature review. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS were accessed during July 2021. The studies included in this review were the ones that tested volunteers older than 16 years of age and were conducted using a randomized, controlled clinical trial. The risk of bias was assessed by using the Cochrane risk-of-bias tool for randomized trials (RoB2). Furthermore, the data found were qualitatively evaluated due to the studies’ differences. Two papers were able to fit the criteria, with a total sample size of 280 participants. No datum was found regarding the use of prebiotics in the treatment of IBS. Synbiotic agents, however, had a positive effect on gastrointestinal symptoms and the participants’ overall bowel satisfaction; however, it was not possible to reach a consensus on which effects. Further studies regarding the use of synbiotics and prebiotics must be carried out to determine which effects are the most significant in the treatment of IBS.
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Clinical assessment and cytokines level in constipation-predominant irritable bowel syndrome participants treated with Lactobacillus-containing cultured milk drink. Acta Gastroenterol Belg 2021; 84:585-591. [PMID: 34965040 DOI: 10.51821/84.4.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Gut dysbiosis is linked with the pathophysiology of irritable bowel syndrome (IBS). Manipulation of intestinal microbiota using cultured milk drinks may stimulate the immune system, hence providing beneficial support in IBS treatment. This study aimed to investigate the effects of cultured milk drink on clinical symptoms, intestinal transit time (ITT), fecal pH and cytokines in constipation-predominant IBS (IBS-C) as compared to non-IBS participants. METHODS Each recruited participant was given three bottles of 125 ml cultured milk drink containing 109 cfu Lactobacillus acidophilus LA-5 and Lactobacillus paracasei L. CASEI-01 consumed daily for 30 days. At pre- and post-30-day consumption, fecal pH, ITT, clinical symptoms, IL-6, IL-8 and TNF-α levels were assessed. Seventy-seven IBS-C and 88 non-IBS were enrolled. RESULTS Post-consumption, 97.4% of IBS-C experienced improvements in constipation-related symptoms supported by the significant reduction of ITT and decreased fecal pH (p<0.05). All pro-inflammatory cytokines were significantly lower in post as compared to pre-consumption of cultured milk drinks in IBS-C (p<0.05). There was significant reduction in the IL-8 and TNF-α levels in post- as compared to pre-consumption for the non-IBS (p<0.05). CONCLUSION Cultured milk drink taken daily improved clinical symptoms and reduced cytokines, hence should be considered as an adjunctive treatment in IBS-C individuals.
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van Gruting IM, Stankiewicz A, Thakar R, Santoro GA, IntHout J, Sultan AH. Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome. Cochrane Database Syst Rev 2021; 9:CD011482. [PMID: 34553773 PMCID: PMC8459393 DOI: 10.1002/14651858.cd011482.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obstructed defaecation syndrome (ODS) is difficulty in evacuating stools, requiring straining efforts at defaecation, having the sensation of incomplete evacuation, or the need to manually assist defaecation. This is due to a physical blockage of the faecal stream during defaecation attempts, caused by rectocele, enterocele, intussusception, anismus or pelvic floor descent. Evacuation proctography (EP) is the most common imaging technique for diagnosis of posterior pelvic floor disorders. It has been regarded as the reference standard because of extensive experience, although it has been proven not to have perfect accuracy. Moreover, EP is invasive, embarrassing and uses ionising radiation. Alternative imaging techniques addressing these issues have been developed and assessed for their accuracy. Because of varying results, leading to a lack of consensus, a systematic review and meta-analysis of the literature are required. OBJECTIVES To determine the diagnostic test accuracy of EP, dynamic magnetic resonance imaging (MRI) and pelvic floor ultrasound for the detection of posterior pelvic floor disorders in women with ODS, using latent class analysis in the absence of a reference standard, and to assess whether MRI or ultrasound could replace EP. The secondary objective was to investigate differences in diagnostic test accuracy in relation to the use of rectal contrast, evacuation phase, patient position and cut-off values, which could influence test outcome. SEARCH METHODS We ran an electronic search on 18 December 2019 in the Cochrane Library, MEDLINE, Embase, SCI, CINAHL and CPCI. Reference list, Google scholar. We also searched WHO ICTRP and clinicaltrials.gov for eligible articles. Two review authors conducted title and abstract screening and full-text assessment, resolving disagreements with a third review author. SELECTION CRITERIA Diagnostic test accuracy and cohort studies were eligible for inclusion if they evaluated the test accuracy of EP, and MRI or pelvic floor ultrasound, or both, for the detection of posterior pelvic floor disorders in women with ODS. We excluded case-control studies. If studies partially met the inclusion criteria, we contacted the authors for additional information. DATA COLLECTION AND ANALYSIS Two review authors performed data extraction, including study characteristics, 'Risk-of-bias' assessment, sources of heterogeneity and test accuracy results. We excluded studies if test accuracy data could not be retrieved despite all efforts. We performed meta-analysis using Bayesian hierarchical latent class analysis. For the index test to qualify as a replacement test for EP, both sensitivity and specificity should be similar or higher than the historic reference standard (EP), and for a triage test either specificity or sensitivity should be similar or higher. We conducted heterogeneity analysis assessing the effect of different test conditions on test accuracy. We ran sensitivity analyses by excluding studies with high risk of bias, with concerns about applicability, or those published before 2010. We assessed the overall quality of evidence (QoE) according to GRADE. MAIN RESULTS Thirty-nine studies covering 2483 participants were included into the meta-analyses. We produced pooled estimates of sensitivity and specificity for all index tests for each target condition. Findings of the sensitivity analyses were consistent with the main analysis. Sensitivity of EP for diagnosis of rectocele was 98% (credible interval (CrI)94%-99%), enterocele 91%(CrI 83%-97%), intussusception 89%(CrI 79%-96%) and pelvic floor descent 98%(CrI 93%-100%); specificity for enterocele was 96%(CrI 93%-99%), intussusception 92%(CrI 86%-97%) and anismus 97%(CrI 94%-99%), all with high QoE. Moderate to low QoE showed a sensitivity for anismus of 80%(CrI 63%-94%), and specificity for rectocele of 78%(CrI 63%-90%) and pelvic floor descent 83%(CrI 59%-96%). Specificity of MRI for diagnosis of rectocele was 90% (CrI 79%-97%), enterocele 99% (CrI 96%-100%) and intussusception 97% (CrI 88%-100%), meeting the criteria for a triage test with high QoE. MRI did not meet the criteria to replace EP. Heterogeneity analysis showed that sensitivity of MRI performed with evacuation phase was higher than without for rectocele (94%, CrI 87%-98%) versus 65%, CrI 52% to 89%, and enterocele (87%, CrI 74%-95% versus 62%, CrI 51%-88%), and sensitivity of MRI without evacuation phase was significantly lower than EP. Specificity of transperineal ultrasound (TPUS) for diagnosis of rectocele was 89% (CrI 81%-96%), enterocele 98% (CrI 95%-100%) and intussusception 96% (CrI 91%-99%); sensitivity for anismus was 92% (CrI 72%-98%), meeting the criteria for a triage test with high QoE. TPUS did not meet the criteria to replace EP. Heterogeneity analysis showed that sensitivity of TPUS performed with rectal contrast was not significantly higher than without for rectocele(92%, CrI 69%-99% versus 81%, CrI 58%-95%), enterocele (90%, CrI 71%-99% versus 67%, CrI 51%-90%) and intussusception (90%, CrI 69%-98% versus 61%, CrI 51%-86%), and was lower than EP. Specificity of endovaginal ultrasound (EVUS) for diagnosis of rectocele was 76% (CrI 54%-93%), enterocele 97% (CrI 80%-99%) and intussusception 93% (CrI 72%-99%); sensitivity for anismus was 84% (CrI 59%-96%), meeting the criteria for a triage test with very low to moderate QoE. EVUS did not meet the criteria to replace EP. Specificity of dynamic anal endosonography (DAE) for diagnosis of rectocele was 88% (CrI 62%-99%), enterocele 97% (CrI 75%-100%) and intussusception 93% (CrI 65%-99%), meeting the criteria for a triage test with very low to moderate QoE. DAE did not meet the criteria to replace EP. Echodefaecography (EDF) had a sensitivity of 89% (CrI 65%-98%) and specificity of 92% (CrI 72%-99%) for intussusception, meeting the criteria to replace EP but with very low QoE. Specificity of EDF for diagnosis of rectocele was 89% (CrI 60%-99%) and for enterocele 97% (CrI 87%-100%); sensitivity for anismus was 87% (CrI 72%-96%), meeting the criteria for a triage test with low to very low QoE. AUTHORS' CONCLUSIONS In a population of women with symptoms of ODS, none of the imaging techniques met the criteria to replace EP. MRI and TPUS met the criteria of a triage test, as a positive test confirms diagnosis of rectocele, enterocele and intussusception, and a negative test rules out diagnosis of anismus. An evacuation phase increased sensitivity of MRI. Rectal contrast did not increase sensitivity of TPUS. QoE of EVUS, DAE and EDF was too low to draw conclusions. More well-designed studies are required to define their role in the diagnostic pathway of ODS.
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Affiliation(s)
- Isabelle Ma van Gruting
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, Netherlands
| | | | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, UK
| | - Giulio A Santoro
- Section of Anal Physiology and Ultrasound, Department of Surgery, Regional Hospital, Treviso, Italy
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, UK
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11
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Werth BL, Christopher SA. Potential risk factors for constipation in the community. World J Gastroenterol 2021; 27:2795-2817. [PMID: 34135555 PMCID: PMC8173388 DOI: 10.3748/wjg.v27.i21.2795] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Constipation is a common community health problem. There are many factors that are widely thought to be associated with constipation but real-world evidence of these associations is difficult to locate. These potential risk factors may be categorised as demographic, lifestyle and health-related factors. This review presents the available evidence for each factor by an assessment of quantitative data from cross-sectional studies of community-dwelling adults published over the last 30 years. It appears that there is evidence of an association between constipation and female gender, residential location, physical activity and some health-related factors such as self-rated health, some surgery, certain medical conditions and certain medications. The available evidence for most other factors is either conflicting or insufficient. Therefore, further research is necessary to determine if each factor is truly associated with constipation and whether it can be regarded as a potential risk factor. It is recommended that studies investigating a broad range of factors are conducted in populations in community settings. Multivariate analyses should be performed to account for all possible confounding factors. In this way, valuable evidence can be accumulated for a better understanding of potential risk factors for constipation in the community.
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Affiliation(s)
- Barry L Werth
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
| | - Sybele-Anne Christopher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
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12
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Barberio B, Judge C, Savarino EV, Ford AC. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:638-648. [PMID: 34090581 DOI: 10.1016/s2468-1253(21)00111-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs. FINDINGS Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used. INTERPRETATION Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability. FUNDING None.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Ciaran Judge
- Department of Gastroenterology, St James's University Hospital, Dublin, Ireland
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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13
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Silveira EA, Santos ASEADC, Ribeiro JN, Noll M, Dos Santos Rodrigues AP, de Oliveira C. Prevalence of constipation in adults with obesity class II and III and associated factors. BMC Gastroenterol 2021; 21:217. [PMID: 33980157 PMCID: PMC8114515 DOI: 10.1186/s12876-021-01806-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Constipation and obesity have common risk factors. However, little is known about the occurrence of constipation in individuals with severe obesity and the associated factors. OBJECTIVE To evaluate the prevalence of intestinal constipation and its associated factors in adults with obesity class II and III. METHOD This study analyzed baseline data from a randomized clinical trial with adults aged 18-64 with a Body Mass Index (BMI) ≥ 35 kg/m2, living in the metropolitan region of Goiânia, Brazil. Data were collected using a questionnaire containing sociodemographic, lifestyle, level of obesity, presence of comorbidities, water intake and food consumption variables. The outcome variable was constipation assessed by the Rome III criteria and the Bristol Stool Form Scale. Multiple Poisson regression analysis was used to assess the association between explanatory variables and the outcome. RESULTS Among the 150 participants, the prevalence of constipation was 24.67% (95% CI: 17.69-31.64). After multiple regression analyses constipation was associated with polypharmacy (adjusted PR: 2.99, 95% CI: 1.18-7.57, p = 0.021), younger age group i.e. 18-29 years (adjusted PR: 3.12, 95% CI: 1.21-8.06, p = 0.019) and former smoking (adjusted PR: 3.24, 95% CI: 1.28-9.14, p = 0.014). There was no statistically significant association between constipation and daily consumption of fiber-rich foods, however, the non-consumption of whole grains was borderline significant (adjusted PR: 2.92, 95% CI: 1.00 to 8.49, p = 0.050). CONCLUSION A high prevalence of constipation was found in adults with obesity class II and III. Constipation was significantly associated with the simultaneous use of five or more medications, younger age group and being a former smoker.
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Affiliation(s)
- Erika Aparecida Silveira
- Faculty of Medicine, Postgraduate Program in Health Sciences, Federal University of Goias, Goiania, Brazil.
- Affiliate Academic, Department of Epidemiology and Public Health, University College London, London, UK.
| | | | | | - Matias Noll
- Faculty of Medicine, Postgraduate Program in Health Sciences, Federal University of Goias, Goiania, Brazil
- Federal Institute Goiano, Ceres, Brazil
| | | | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, London, UK
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14
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Neyrinck AM, Rodriguez J, Taminiau B, Amadieu C, Herpin F, Allaert FA, Cani PD, Daube G, Bindels LB, Delzenne NM. Improvement of gastrointestinal discomfort and inflammatory status by a synbiotic in middle-aged adults: a double-blind randomized placebo-controlled trial. Sci Rep 2021; 11:2627. [PMID: 33514774 PMCID: PMC7846804 DOI: 10.1038/s41598-020-80947-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Several studies suggest that microbial alterations (dysbiosis) are intimately linked to chronic inflammation occurring upon aging. The aim of this study was to investigate the potential interest of a synbiotic approach (co-administration of a probiotic bacteria and a prebiotic dietary fibre) to improve gastrointestinal wellness and inflammatory markers in middle-aged people. Middle-aged subjects were randomized to take synbiotic (Bifidobacterium animalis lactis and fructo-oligosaccharides (FOS)) or placebo for 30 days. Stool frequency and consistency were improved in both placebo and synbiotic-treated volunteers while the synbiotic treatment significantly decreased the number of days with abdominal discomfort. Synbiotic treatment had no impact on mood dimensions, quality of life scores or the overall composition of the gut microbiota (16S rRNA gene sequencing of DNA extracted from stool). Importantly, plasma proinflammatory cytokines (interleukin (IL)-6, IL-8, IL-17a and interferon-gamma (IFNγ)) were significantly lower after 30 days of synbiotic supplementation. This effect appears to be independent of the gut barrier function. This study demonstrates that a combination of B. animalis lactis and the well-known prebiotic FOS could be a promising synbiotic strategy to decrease inflammatory status with improvement of gut disorders in middle-aged people.
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Affiliation(s)
- Audrey M Neyrinck
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium
| | - Julie Rodriguez
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium
| | - Bernard Taminiau
- Fundamental and Applied Research for Animal and Health (FARAH), Faculty of Veterinary Medicine, University of Liège, 4000, Liège, Belgium
| | - Camille Amadieu
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium
| | | | | | - Patrice D Cani
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium.,WELBIO-Walloon Excellence in Life Sciences and BIOtechnology, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Georges Daube
- Fundamental and Applied Research for Animal and Health (FARAH), Faculty of Veterinary Medicine, University of Liège, 4000, Liège, Belgium
| | - Laure B Bindels
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium
| | - Nathalie M Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Avenue E. Mounier, Box B1.73.11, 1200, Brussels, Belgium.
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15
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Ibrahim A, Ali RAR, Manaf MRA, Ahmad N, Tajurruddin FW, Qin WZ, Desa SHM, Ibrahim NM. Multi-strain probiotics (Hexbio) containing MCP BCMC strains improved constipation and gut motility in Parkinson's disease: A randomised controlled trial. PLoS One 2020; 15:e0244680. [PMID: 33382780 PMCID: PMC7774928 DOI: 10.1371/journal.pone.0244680] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/13/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We determined the effectiveness of a multi-strain probiotic (Hexbio®) containing microbial cell preparation MCP®BCMC® on constipation symptoms and gut motility in PD patients with constipation. METHODS PD patients with constipation (ROME III criteria) were randomized to receive a multi-strain probiotic (Lactobacillus sp and Bifidobacterium sp at 30 X 109 CFU) with fructo-oligosaccaride or placebo (fermented milk) twice daily for 8 weeks. Primary outcomes were changes in the presence of constipation symptoms using 9 items of Garrigues Questionnaire (GQ), which included an item on bowel opening frequency. Secondary outcomes were gut transit time (GTT), quality of life (PDQ39-SI), motor (MDS-UPDRS) and non-motor symptoms (NMSS). RESULTS Of 55 recruited, 48 patients completed the study: 22 received probiotic and 26 received placebo. At 8 weeks, there was a significantly higher mean weekly BOF in the probiotic group compared to placebo [SD 4.18 (1.44) vs SD 2.81(1.06); (mean difference 1.37, 95% CI 0.68, 2.07, uncorrected p<0.001)]. Patients in the probiotic group reported five times higher odds (odds ratio = 5.48, 95% CI 1.57, 19.12, uncorrected p = 0.008) for having higher BOF (< 3 to 3-5 to >5 times/week) compared to the placebo group. The GTT in the probiotic group [77.32 (SD55.35) hours] reduced significantly compared to placebo [113.54 (SD 61.54) hours]; mean difference -36.22, 95% CI -68.90, -3.54, uncorrected p = 0.030). The mean change in GTT was 58.04 (SD59.04) hour vs 20.73 (SD60.48) hours respectively (mean difference 37.32, 95% CI 4.00, 70.63, uncorrected p = 0.028). No between-groups differences were observed in the NMSS, PDQ39-SI, MDS-UPDRS II and MDS-UPDRS III scores. Four patients in the probiotics group experienced mild reversible side effects. CONCLUSION This study showed that consumption of a multi-strain probiotic (Hexbio®) over 8 weeks improved bowel opening frequency and whole gut transit time in PD patients with constipation.
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Affiliation(s)
- Azliza Ibrahim
- Faculty of Medicine, Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Raja Affendi Raja Ali
- Faculty of Medicine, Gastroenterology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Rizal Abdul Manaf
- Faculty of Medicine, Department of Community Health, Hospital Canselor Tuanku Muhriz UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Faculty of Medicine, Department of Community Health, Hospital Canselor Tuanku Muhriz UKM Medical Centre, Kuala Lumpur, Malaysia
| | | | - Wong Zhi Qin
- Faculty of Medicine, Gastroenterology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Siti Hajar Md Desa
- Department of Nursing, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Faculty of Medicine, Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Kuala Lumpur, Malaysia
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16
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De Aquino FDM, Costa CR, De Aguiar DX, Costa NM. Prevalência da constipação intestinal em acadêmicos de medicina de uma instituição particular do estado de Tocantins, Brasil. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i2.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivos: Analisar a prevalência e características da constipação intestinal (CI) em acadêmicos de medicina de uma instituição particular do Estado do Tocantins, Brasil. Métodos: Estudo transversal e quantitativo, com aplicação de questionário a acadêmicos de medicina do 1º, 3º e 6º período. Foi realizada a coleta de dados gerais e específicos, de agosto a setembro de 2018, para a caracterização da CI, seguido de estatística descritiva. Resultados: A maioria dos 142 entrevistados era do 1º semestre do curso (n = 73; 51,4%), tinham até 28 anos (n = 133; 94%) e eram mulheres (n = 90; 63,4%). A maioria fazia suas refeições em casa (n = 106; 74,6%) e 84 (59,1%) realizavam quatro ou mais refeições ao dia. A maioria (n = 54, 38%) fazia uso de folhas verdes e frutas uma a duas vezes por dia. A presença de CI autoreferida ocorreu em 22 acadêmicos (15,5%) enquanto a CI funcional, caracterizada como esforço ao evacuar ou fezes endurecidas, ocorreu em 38 (26,7%). A minoria (n = 27; 19%) referiu frequência evacuatória até três vezes por semana. Além do esforço ao evacuar e fezes endurecidas, o sintoma mais prevalente foi a sensação de evacuação incompleta (n = 32; 22,5%). Conclusão: A constipação intestinal apresenta-se como um quadro pouco frequente entre os acadêmicos do curso de medicina estudado. O esforço evacuatório e fezes endurecidas foram os achados mais prevalentes.
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17
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Yurtdaş G, Acar-Tek N, Akbulut G, Cemali Ö, Arslan N, Beyaz Coşkun A, Zengin FH. Risk Factors for Constipation in Adults: A Cross-Sectional Study. J Am Coll Nutr 2020; 39:713-719. [PMID: 32077808 DOI: 10.1080/07315724.2020.1727380] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: The objective of this study was to determine associations between physical activity, dietary fiber intake, water and fluid intake, and constipation as well as other possible risk factors for constipation in adults.Method: A cross-sectional study was conducted in 4561 (1812 male and 2749 female) adults, aged between 18-65 years, living in Ankara, Turkey. Participants having three or fewer bowel movements per week were considered constipated. Dietary fiber and fluid intake data were ascertained from a 62-item food frequency questionnaire (FFQ). The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to evaluate participant physical activity.Results: Of the total cohort, 16.6% were diagnosed with constipation (13.6% males, 18.5% females). Logistic regression analysis showed a significantly greater risk of constipation in participants with female gender, advancing age, being obese. Participants who were moderately active (OR: 0.77, 95% CI: 0.62-0.91) and active (OR: 0.74, 95% CI: 0.59-0.90) had a decreased likelihood of constipation, when compared with inactive participants (p < 0.05). Participants in the middle upper quartile for water intake (OR: 0.71, 95% CI: 0.57-0.88), had a decreased likelihood of constipation, when compared with participants in the lowest quartile. Participants in the middle upper quartile (OR: 0.74, 95% CI: 0.58-0.92) and the highest quartile for dietary fiber intake (OR: 0.66, 95% CI: 0.52-0.84), had a decreased likelihood of constipation, when compared with participants in the lowest quartile (p < 0.05).Conclusion: Constipation is common in the Turkish adult population. Insufficient physical activity, decreasing fiber and water intake, obesity, advancing age and female gender were associated with increased constipation risks. Combining regular physical activity and increasing fiber and water intake may protect from constipation, and relieve constipation symptoms.
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Affiliation(s)
- Gamze Yurtdaş
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey.,Faculty of Health Sciences, Department of Nutrition and Dietetics, İzmir Katip Çelebi University, İzmir, Turkey
| | - Nilüfer Acar-Tek
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Gamze Akbulut
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Özge Cemali
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Neslihan Arslan
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Ayfer Beyaz Coşkun
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Fatmanur Humeyra Zengin
- Department of Nutrition and Dietetics, Ankara Training and Research Hospital, Ankara, Turkey
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Bahrudin MF, Abdul Rani R, Tamil AM, Mokhtar NM, Raja Ali RA. Effectiveness of Sterilized Symbiotic Drink Containing Lactobacillus helveticus Comparable to Probiotic Alone in Patients with Constipation-Predominant Irritable Bowel Syndrome. Dig Dis Sci 2020; 65:541-549. [PMID: 31209720 PMCID: PMC6995448 DOI: 10.1007/s10620-019-05695-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aimed to objectively investigate whether the addition of polydextrose to sterilized probiotic containing Lactobacillus helveticus will confer benefits to constipation-predominant irritable bowel syndrome patients. METHODS A total of 163 patients were randomized into two groups: Group A to consume 350 mL of sterilized probiotic with 5.85 g polydextrose daily for 1 week and Group B without polydextrose. Intestinal transit time, fecal pH, fecal weight, and modified Garrigues questionnaires for pre- and post-consumption were assessed. RESULTS Median intestinal transit time was significantly reduced from 58 (IQR 43-72) to 45 (IQR 24-59) hours and 48 (IQR 31-72) to 30 (IQR 24-49) hours for Groups A and B, respectively (p < 0.01). Fecal pH for Groups A and B was significantly reduced from 6.57 ± 0.96 to 6.13 ± 0.95 (p = 0.003) and 6.58 ± 1.0 to 5.87 ± 0.83 (p < 0.001), respectively. Fecal weight for Group A was significantly increased from 8 g ± 6.4 g to 9.8 g ± 7.6 g (p = 0.003), but it was reduced for Group B from 13.3 g ± 19.4 g to 11.2 g ± 6.6 g (p = 0.308). Constipation-related symptoms were significantly improved for both groups. CONCLUSIONS The addition of polydextrose to sterilized probiotic containing L. helveticus did not show significant benefits to constipation-predominant irritable bowel syndrome patients. However, daily consumption of sterilized probiotic containing L. helveticus with or without polydextrose for a week alleviated constipation-related symptoms and objectively reduced both fecal pH and intestinal transit time.
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Affiliation(s)
- Mohd Fyzal Bahrudin
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia
| | - Azmi Mohd Tamil
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Norfilza Mohd Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Raja Affendi Raja Ali
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
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19
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Ghafar MYA, Yaakup H, Ali RAR, Shah SA. Evaluation of the Efficacy of Probiotics (MCP® BCMC® Strains) Treating Constipation in Elderly Patients with Multiple Chronic Co-Morbidities: A Randomized Control Trial. J Nutr Health Aging 2020; 24:1066-1072. [PMID: 33244562 DOI: 10.1007/s12603-020-1494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the impact of a microbial cell preparation (MCP®) (Hexbio®; comprising MCP® BCMC® strains) on stool frequency, consistency, and constipation-related symptoms in elderly patients with multiple chronic medical conditions. DESIGN Randomised control trial. SETTING Medical outpatient and medical/surgical in-patient unit in single tertiary center. PARTICIPANT Patients aged ≥ 60 years who experience constipation and have multiple chronic medical conditions. METHODS Participants with constipation were blindly randomized into either a treatment (MCP® BCMC® strains) or a placebo group. The treatment was administered twice daily. MEASUREMENT Gastrointestinal symptoms and stool habits were assessed over a week during the intervention via the use of a questionnaire and stool diary. RESULTS Stool frequency was seen to be higher and the improvement in stool consistency was more significant in the treatment group than in the placebo group (p =<0.001). A significant improvement in symptoms was demonstrated in patients who received MCP® BCMC® strains,specifically with respect to straining (p = < 0.001) and a sensation of incomplete evacuation (p = < 0.001). reduction in anorectal blockage symptoms and the need for manual stool evacuation was also demonstrated, but this finding was not statistically significant. Significant adverse events were not observed. CONCLUSIONS An improvement in stool frequency and consistency was reported in elderly patients with chronic medical conditions following the administration of MCP® BCMC® strains.
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Affiliation(s)
- M Y A Ghafar
- Dr. Hayati Yaakup, Palliative Care Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia, Tel: +60391456074, Fax: +60391456692,
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20
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Werth BL, Williams KA, Fisher MJ, Pont LG. Defining constipation to estimate its prevalence in the community: results from a national survey. BMC Gastroenterol 2019; 19:75. [PMID: 31113366 PMCID: PMC6528208 DOI: 10.1186/s12876-019-0994-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. METHODS The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. RESULTS Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). CONCLUSIONS The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.
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Affiliation(s)
- Barry L Werth
- Sydney Nursing School, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Kylie A Williams
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Murray J Fisher
- Sydney Nursing School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Lisa G Pont
- Sydney Nursing School, University of Sydney, Sydney, NSW, 2006, Australia.,Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
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21
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McClurg D, Harris F, Goodman K, Doran S, Hagen S, Treweek S, Norton C, Coggrave M, Norrie J, Rauchhaus P, Donnan P, Emmanuel A, Manoukian S, Mason H. Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT. Health Technol Assess 2019; 22:1-134. [PMID: 30375324 DOI: 10.3310/hta22580] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments. DESIGN A randomised controlled trial with process evaluation and health economic components. Outcome analysis was undertaken blind. SETTING The trial took place in 12 UK hospitals. PARTICIPANTS PwMS who had 'bothersome' NBD. INTERVENTION Following individualised training, abdominal massage was undertaken daily for 6 weeks (intervention group). Advice on good bowel management as per the Multiple Sclerosis Society advice booklet was provided to both groups. All participants received weekly telephone calls from the research nurse. MAIN OUTCOME MEASURES The primary outcome was the difference between the intervention and control groups in change in the NBD score from baseline to week 24. Secondary outcomes were measured via a bowel diary, adherence diary, the Constipation Scoring System, patient resource questionnaire and the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). RESULTS A total of 191 participants were finalised, 189 of whom were randomised (two participants were finalised in error) (control group, n = 99; intervention group, n = 90) and an intention-to-treat analysis was performed. The mean age was 52 years (standard deviation 10.83 years), 81% (n = 154) were female and 11% (n = 21) were wheelchair dependent. Fifteen participants from the intervention group and five from the control group were lost to follow-up. The change in NBD score by week 24 demonstrated no significant difference between groups [mean difference total score -1.64, 95% confidence interval (CI) -3.32 to 0.04; p = 0.0558]; there was a significant difference between groups in the change in the frequency of stool evacuation per week (mean difference 0.62, 95% CI 0.03 to 1.21; p = 0.039) and in the number of times per week that participants felt that they emptied their bowels completely (mean difference 1.08, 95% CI 0.41 to 1.76; p = 0.002), in favour of the intervention group. Of participant interviewees, 75% reported benefits, for example less difficulty passing stool, more complete evacuations, less bloated, improved appetite, and 85% continued with the massage. A cost-utility analysis conducted from a NHS and patient cost perspective found in the imputed sample with bootstrapping a mean incremental outcome effect of the intervention relative to usual care of -0.002 quality-adjusted life-years (QALYs) (95% CI -0.029 to 0.027 QALYs). In the same imputed sample with bootstrapping, the mean incremental cost effect of the intervention relative to usual care was £56.50 (95% CI -£372.62 to £415.68). No adverse events were reported. Limitations include unequal randomisation, dropout and the possibility of ineffective massage technique. CONCLUSION The increment in the primary outcome favoured the intervention group, but it was small and not statistically significant. The economic analysis identified that the intervention was dominated by the control group. Given the small improvement in the primary outcome, but not in terms of QALYs, a low-cost version of the intervention might be considered worthwhile by some patients. FUTURE WORK Research is required to establish possible mechanisms of action and modes of massage delivery. TRIAL REGISTRATION Current Controlled Trials ISRCTN85007023 and NCT03166007. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 58. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Doreen McClurg
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Selina Doran
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Shaun Treweek
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Anton Emmanuel
- National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
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22
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Meinds RJ, Timmerman MEW, van Meegdenburg MM, Trzpis M, Broens PMA. Reproducibility, feasibility and validity of the Groningen Defecation and Fecal Continence questionnaires. Scand J Gastroenterol 2018; 53:790-796. [PMID: 29703095 DOI: 10.1080/00365521.2018.1465993] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Current questionnaires on defecation disorders are often brief and fail to include questions considering causative factors. Furthermore, adult and pediatric questionnaires differ, which makes it impossible to monitor defecation disorders during the transition from childhood to adulthood. With these points in mind, we developed the Groningen Defecation and Fecal Continence (DeFeC) questionnaire and its pediatric equivalent, the P-DeFeC. The aim of this paper is to introduce the questionnaires and to assess their feasibility, reproducibility and validity. MATERIALS AND METHODS Various Rome IV criteria and scoring tools for constipation and fecal incontinence were incorporated, resulting in nine categories. Feasibility and reproducibility were assessed by performing a test-retest survey in 100 adult participants. Concurrent validity was assessed in 27 patients and 18 healthy volunteers by comparing questionnaire-based diagnoses of constipation and fecal incontinence to final diagnoses based on anorectal function tests. RESULTS There were no remarks on the understandability of any questions. The Cohen's kappa coefficient of all main questions ranged from 0.26 to 1.00, with an average of 0.57. All but one category showed moderate agreement or higher. The sensitivity of the questionnaire-based diagnosis of constipation was 75%; specificity was 100%. The sensitivity of the questionnaire-based diagnosis of fecal incontinence was 77%; specificity was 94%. CONCLUSIONS Overall reproducibility of the Groningen DeFeC questionnaire is acceptable and its validity is good. This makes it a feasible screening tool for defecation disorders and, equally important, with these questionnaires defecation disorders can now be monitored during the transition from childhood to adulthood.
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Affiliation(s)
- Rob J Meinds
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Marjolijn E W Timmerman
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Maxime M van Meegdenburg
- b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Monika Trzpis
- b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Paul M A Broens
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.,b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
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Zhang T, Han Y, Wang J, Hou D, Deng H, Deng YL, Song Z. Comparative Epidemiological Investigation of Alzheimer's Disease and Colorectal Cancer: The Possible Role of Gastrointestinal Conditions in the Pathogenesis of AD. Front Aging Neurosci 2018; 10:176. [PMID: 30323761 PMCID: PMC6172982 DOI: 10.3389/fnagi.2018.00176] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that affects approximately 35 million people worldwide, and diet has been reported to influence the prevalence/incidence of AD. Colorectal cancer is among the most common cancers in Western populations, and the correlation between constipation and the occurrence of colorectal cancer has been identified in a number of studies, which show that a Westernized diet is a mutual risk factor. Constipation is a growing health problem, particularly in middle-aged and older adults. As the most common gastrointestinal disorder in adults, constipation affects 2-20% of the world population, and it is associated with several diseases, such as diabetes, Parkinson's disease, and others. Comparing the epidemiological data on colorectal cancer and AD, we find that colorectal cancer and AD have similar epidemiologic feature, which is both disease correlate with high prevalence of constipation. Therefore, we hypothesized that constipation may influence Alzheimer's disease in a similar way that it contributes to colorectal cancer. This review aimed to systemically elucidate the evidence that constipation contributes to Alzheimer's disease progression.
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Affiliation(s)
| | | | | | | | | | | | - Zhi Song
- Department of Neurology, Third Xiangya Hospital of Central South University, Changsha, China
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24
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Santacruz CC, López MO, García MV, Pérez CF, Miguel JC. Do bad habits bring a double constipation risk? THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:580-587. [PMID: 30260781 PMCID: PMC6284617 DOI: 10.5152/tjg.2018.17533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Good dietary habits, fluid intake, and regular exercise are considered to ease defecation although very few cases of chronic constipation can be managed through these approaches alone. Good defecation habits are recommended to avoid chronic constipation; however, the literature regarding this remains scarce. In this paper, we aimed to assess the association of bad habits concerning defecation, such as postponing, reluctance, or avoiding defecation anywhere but at home, with chronic constipation. MATERIALS AND METHODS This was a cross-sectional observational study including subjects from a tertiary hospital taskforce. In total, 415 of 910 eligible subjects were randomly selected. A cluster of questionnaires easy to understand and fill out was distributed. The questionnaires included queries regarding demographic data; past medical history; the presence of constipation; and dietary, other lifestyle, and defecation habits. The Rome III criteria for chronic constipation were also recorded. RESULTS In total, 24.3% of the subjects considered themselves constipated, and 26.5% fulfilled the Rome III criteria for constipation. There were obvious differences in constipation prevalence by sex (men 5% vs. women 31%). Fiber-rich diet, fluid intake, and exercise habits were not related to constipation. Defecation habits significantly correlated with the presence or absence of constipation: regular schedule (OR 0.39; CI 95% 0.23-0.67), persistently postponing defecation (OR 1.94; CI 95% 1.13-3.34), or avoiding defecation anywhere but at home (OR 2.38; CI 95% 1.4-4.1). CONCLUSION Compared with dietary habits, behavioral aspects surrounding defecation are more related to chronic constipation. Our results indicate that the modification of these bad habits may be the first step in chronic constipation treatment.
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Affiliation(s)
| | | | - Marta Vigara García
- Department of Geriatrics and Gerontology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Cristina Fernández Pérez
- Clinical Research and Methodology Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
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25
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Riezzo G, Orlando A, D’Attoma B, Linsalata M, Martulli M, Russo F. Randomised double blind placebo controlled trial on Lactobacillus reuteri DSM 17938: improvement in symptoms and bowel habit in functional constipation. Benef Microbes 2018; 9:51-60. [DOI: 10.3920/bm2017.0049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dysbiosis may contribute to constipation and its symptoms, therefore probiotic administration could improve significantly gut health and functions. The aim of the study was to investigate the effects of a long-lasting administration of Lactobacillus reuteri DSM 17938 (LR DSM 17938) on symptoms and quality of life (QoL) score in patients with functional constipation (FC). 56 FC patients with normal colonic transit time and without anorectal disorders and pelvic floor dysfunctions completed the study. LR DSM 17938 was administered for 105 days in a randomised double-blind clinical trial (28 patients per arm). Individual and cumulative scores including the Constipaq, a modified Constipation Scoring System (CSS) that considers the patient assessment of constipation-QoL (PAC-QoL), were calculated during the preliminary visit (V0), at day 15 (end of the induction period with a LR DSM 17938 double dosage, 4×108 cfu), day 60 (intermediate evaluation) and day 105 (V4) after a standard dosage (2×108 cfu). At the end of treatment, the beneficial effect of LR DSM 17938 compared to placebo was significantly evident for symptoms related to gas content and dysbiosis (abdominal discomfort, pain and bloating), incomplete defecation and helps for defecation (P<0.05). At the end of the whole LR DSM 17938 treatment, a marked and positive effect on both the CSS single and the cumulative items was evident with the exception of unfruitful attempt and Bristol score. Present findings indicate that LR DSM 17938 has an effect on symptoms different from stool consistency, and they suggest that this probiotic can effectively be used in association therapy rather than as single-drug therapy in the management of FC.
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Affiliation(s)
- G. Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
| | - A. Orlando
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
| | - B. D’Attoma
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
| | - M. Linsalata
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
| | - M. Martulli
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
| | - F. Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Digestive Diseases I.R.C.C.S. ‘Saverio de Bellis’, Via Turi 27, 70013 Castellana Grotte, Bari, Italy
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Trimingham C, McDonald S, Dansie K, Jesudason S, Faull R, Clayton P, Liew G, Le Leu R, Meade A. Bowel health in chronic kidney disease: Patient perceptions differ from clinical definitions. J Ren Care 2018; 44:65-72. [DOI: 10.1111/jorc.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Claire Trimingham
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
- ANZDATA; South Australian Health and Medical Research Institute; Adelaide South Australia
| | - Kathryn Dansie
- ANZDATA; South Australian Health and Medical Research Institute; Adelaide South Australia
| | - Shilpa Jesudason
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
| | - Randall Faull
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
| | - Phil Clayton
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
- ANZDATA; South Australian Health and Medical Research Institute; Adelaide South Australia
| | | | - Richard Le Leu
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
| | - Anthony Meade
- Central and Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
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27
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Pinheiro I, Robinson L, Verhelst A, Marzorati M, Winkens B, den Abbeele PV, Possemiers S. A yeast fermentate improves gastrointestinal discomfort and constipation by modulation of the gut microbiome: results from a randomized double-blind placebo-controlled pilot trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:441. [PMID: 28870194 PMCID: PMC5584023 DOI: 10.1186/s12906-017-1948-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/24/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Constipation and symptoms of gastrointestinal discomfort such as bloating are common among otherwise healthy individuals, but with significant impact on quality of life. Despite the recognized contribution of the gut microbiome to this pathology, little is known about which group(s) of microorganism(s) are playing a role. A previous study performed in vitro suggests that EpiCor® fermentate has prebiotic-like properties, being able to favorably modulate the composition of the gut microbiome. Therefore, the aim of this study was to investigate the effects of EpiCor fermentate in a population with symptoms of gastrointestinal discomfort and reduced bowel movements and to evaluate its effect at the level of the gut microbiome. METHODS This pilot study was performed according to a randomized, double-blind, placebo-controlled parallel design. Eighty subjects with symptoms of gastrointestinal discomfort and constipation were allocated to one of two trial arms (placebo or EpiCor fermentate). Randomization was done in a stratified manner according to symptom severity, resulting in two subgroups of patients: severe and moderate. Daily records of gastrointestinal symptoms were assessed on a 5-point scale, and also stool frequency and consistency were documented during a 2-week run-in and a 6-week intervention phases. Averages over two-week intervals were calculated. Constipation-associated quality of life and general perceived stress were assessed at baseline and after 3 and 6 weeks of intervention. Fecal samples were also collected at these same time points. RESULTS EpiCor fermentate led to a significant improvement of symptoms such as bloating/distension (p = 0.033 and p = 0.024 after 2 and 4 weeks of intervention, respectively), feeling of fullness (p = 0.004 and p = 0.023 after 2 and 4 weeks of intervention, respectively) and general daily scores (p = 0.046 after 2 weeks of intervention) in the moderate subgroup. A significant improvement in stool consistency was observed for the total population (p = 0.023 after 2 weeks of intervention) as well as for the severe subgroup (p = 0.046 after 2 weeks of intervention), and a nearly significant increase in stool frequency was detected for the total cohort (p = 0.083 and p = 0.090 after 2 and 4 weeks of intervention, respectively). These effects were accompanied by an improvement in constipation-associated quality of life and general perceived stress, particularly in the moderate subgroup. Members of the families Bacteroidaceae and Prevotellaceae, two groups of bacteria that have been previously reported to be deficient in constipated patients, were found to increase with EpiCor fermentate in the severe subgroup. In the moderate subgroup, a significant increase in Akkermansia muciniphila was observed. CONCLUSIONS Despite the relatively low dose administered (500 mg/day), particularly when comparing to the high recommended doses for prebiotic fibers, EpiCor fermentate was able to modulate the composition of the gut microbiome, resulting in improvement of constipation-associated symptoms. Conversely, the reported increase in bowel movements may have altered the gut microbial community by increasing those groups of bacteria that are better adapted to a faster gastrointestinal transit time. TRIAL REGISTRATION NCT03051399 at ClinicalTrials.gov. Retrospectively registered. Registration date: 13 February 2017.
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Affiliation(s)
| | - Larry Robinson
- Embria Health Sciences, 2105 SE Creekview Dr, Ankeny, IA 50021 USA
| | - An Verhelst
- ProDigest, Technologiepark 3, 9052 Ghent, Belgium
| | - Massimo Marzorati
- Center of Microbial Ecology and Technology (CMET), University of Ghent, Coupure Links 653, 9000 Ghent, Belgium
| | - Björn Winkens
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences, University of Maastricht, Maastricht, 6200 MD The Netherlands
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Bayer SB, Gearry RB, Drummond LN. Putative mechanisms of kiwifruit on maintenance of normal gastrointestinal function. Crit Rev Food Sci Nutr 2017; 58:2432-2452. [PMID: 28557573 DOI: 10.1080/10408398.2017.1327841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Kiwifruits are recognized as providing relief from constipation and symptoms of constipation-predominant irritable bowel syndrome (IBS-C). However, the underlying mechanisms, specifically in regards to gastrointestinal transit time and motility, are still not completely understood. This review provides an overview on the physiological and pathophysiological processes underlying constipation and IBS-C, the composition of kiwifruit, and recent advances in the research of kiwifruit and abdominal comfort. In addition, gaps in the research are highlighted and scientific studies of other foods with known effects on the gastrointestinal tract are consulted to find likely mechanisms of action. While the effects of kiwifruit fiber are well documented, observed increases in gastrointestinal motility caused by kiwifruit are not fully characterized. There are a number of identified mechanisms that may be activated by kiwifruit compounds, such as the induction of motility via protease-activated signaling, modulation of microflora, changes in colonic methane status, bile flux, or mediation of inflammatory processes.
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Affiliation(s)
- Simone Birgit Bayer
- a Department of Pathology , Center for Free Radical Research, University of Otago , 2 Riccarton Avenue, PO Box 4345, Christchurch , New Zealand
| | - Richard Blair Gearry
- b Department of Medicine , University of Otago , 2 Riccarton Avenue, PO Box 4345, Christchurch , New Zealand
| | - Lynley Ngaio Drummond
- c Drummond Food Science Advisory Ltd. , 1137 Drain Road, Killinchy RD 2, Leeston , New Zealand
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Abstract
The aims of this study were to estimate the prevalence of constipation and identify associated factors among adults living in an urban area in Londrina, Brazil. This was a secondary analysis of an epidemiological, population-based study on bowel habit performed in 2008 with 2,162 individuals selected through cluster sampling. Interviews were administered using a sociodemographic questionnaire and the adapted and validated Brazilian version of the "Bowel Function in the Community" tool. Variables from the original database were used to determine the prevalence of constipation (according to the Rome Criteria III) and associated factors. The chi-square test and multivariate logistic regression were used for data analysis. The overall prevalence of constipation (14.6%; n = 315) was higher among women than among men (21.9% vs. 5.3%), increased with age among men, and was inversely related to family income. Overall, female gender, low socioeconomic status, history of anal fissure, anorectal surgery, stroke, nervous system disease, fistulae, and hemorrhoids were factors significantly associated with constipation. The variables low social economic status, stroke, anal fissure history, and anorectal surgery were statistically significant in all three tested statistical models.
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30
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Gwee KA, Bergmans P, Kim J, Coudsy B, Sim A, Chen M, Lin L, Hou X, Wang H, Goh KL, Pangilinan JA, Kim N, Varannes SBD. Assessment of the Asian Neurogastroenterology and Motility Association Chronic Constipation Criteria: An Asian Multicenter Cross-sectional Study. J Neurogastroenterol Motil 2017; 23:262-272. [PMID: 27764907 PMCID: PMC5383121 DOI: 10.5056/jnm16095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/05/2016] [Accepted: 09/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background/Aims There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects. Methods This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator’s judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC. Results The primary analysis comprised of 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4%. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator’s judgment criteria (388 subjects [93.7%]) compared with the Rome III criteria. Conclusion This study demonstrates that the ANMA CC tool can be a useful for Asian patients with CC.
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Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Bergmans
- Biometrics Department, Janssen Cilag Benelux, Tilburg, The Netherlands
| | - JinYong Kim
- Regional Medical Affairs, Janssen Asia-Pacific, Singapore
| | | | - Angelia Sim
- Global Clinical Operations, Janssen, Selangor, Malaysia
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lin Lin
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University People's Hospital of Jiangsu Province, China
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huahong Wang
- Gastrointestinal Department, Peking University First Hospital, Beijing, China
| | | | - John A Pangilinan
- Department of Internal Medicine Section of Gastroenterology, St Luke's Medical Center, Institute of Digestive and Liver Diseases, Quezon, The Philippines
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Martínez-Martínez MI, Calabuig-Tolsá R, Cauli O. The effect of probiotics as a treatment for constipation in elderly people: A systematic review. Arch Gerontol Geriatr 2017; 71:142-149. [PMID: 28467916 DOI: 10.1016/j.archger.2017.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/07/2016] [Accepted: 04/09/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Treating constipation in elderly people remains a challenge; the administration of probiotics may be a valid therapy for this problem as an alternative to traditional drug-based treatments. The objective of this systematic review was to evaluate the efficiency of probiotics in treating constipation in elderly people. METHODS Articles related to this topic and published, without any time limitations, in the Medline, Embase, Scopus, Lilacs, or Cochrane databases were systematically reviewed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary search terms were 'constipation' and 'probiotics'. The main inclusion criteria were: 1) the article was original and the whole text was published in English or Spanish and 2) included the primary search terms in the title, summary, or body text; 3) the studies had to have included 60 or more participants defined as 'elderly' and 4) have specifically evaluated the effect of the administration of probiotics. RESULTS Of the 475 articles consulted, 9 met the inclusion criteria. Among the selected studies, there were four randomised and placebo-controlled trials and the remaining five reports were observational. Overall, our analysis of the randomised and placebo-controlled trials suggests that administration of probiotics significantly improved constipation in elderly individuals by 10-40% compared to placebo controls in which no probiotic was administered. The strain of bacteria most commonly tested was Bifidobacterium longum. However, caution is needed when interpreting these reports because of the heterogeneity of the original study designs, populations, and the risk of bias. Therefore, further placebo-controlled trials are necessary to determine the most efficient strains, doses, and the optimal treatment duration.
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Affiliation(s)
| | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
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Choopani R, Ghourchian A, Hajimehdipoor H, Kamalinejad M, Ghourchian F. Effect of Descurainia sophia (L.) Webb ex Prantl on Adult Functional Constipation: A Prospective Pilot Study. J Evid Based Complementary Altern Med 2017; 22:646-651. [PMID: 28401774 PMCID: PMC5871276 DOI: 10.1177/2156587217703018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic constipation is a common gastrointestinal disorder that effects an estimated 12% to 30% of general population worldwide. Descurainia sophia L. known commonly as flixweed acts as first-line medical treatment for constipation in Iranian traditional medicine. The aim of this study was to assess the efficacy and safety of this remedy for treating functional constipation by standard assessments. The Rome III criteria for functional constipation were the basis for diagnosis. All participants underwent a 4-week treatment. The primary end point was the proportion of patients achieving ≥3 complete spontaneous bowel movements per week. Secondary outcome measures included Patient Assessment of Constipation–Symptom items, Bristol Stool Form Scale, numbers of laxatives/week used by patients, and reported adverse effects. Thirty-five patients completed the program with no important adverse effect. Fifty-four (4%) patients had ≥3 complete spontaneous bowel movements per week. Descurainia sophia is safe and effective in the treatment of chronic functional constipation.
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Affiliation(s)
- Rasool Choopani
- 1 Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Serra J, Mascort-Roca J, Marzo-Castillejo M, Delgado Aros S, Ferrándiz Santos J, Rey Diaz Rubio E, Mearin Manrique F. Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.gastre.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Constipation is a frequent health problem leading to great discomfort to the person and affects his or her quality of life. It is considered to be highly prevalent in the general population, but there is little data supporting the findings. This study was undertaken with an objective to assess the prevalence of constipation and its associated factors among the general population of Dadu Majra Colony, UT, Chandigarh, India. A total of 505 individuals were interviewed through structured questionnaire based on ROME II criteria for constipation. Results revealed that the prevalence of self-reported constipation within the last 1 year was 24.8% whereas 16.8% of participants had constipation according to the Rome II criteria. Most of the subjects (83%) were within the age group of 18-59 years with mean age (years) of 38.64 ± 15.57. Constipation was significantly more frequent in females than in males (20% vs. 13%) and in nonworking population than in working population (20% vs. 12%). Poor dietary habits, lesser fluid intake per day, and lesser physical activity were found to be significant factors leading to the constipation. About 18% of constipated subjects reported physicians' consultation, whereas 8% reported the use of laxatives to relieve their constipation.
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Dimidi E, Dibley L, Cotterill N, Scott M, Whelan K, Knowles CH, Norton C. Validated constipation symptom and quality-of-life measures neither reflect patient and clinician concerns nor use words familiar to patients. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/gasn.2016.14.8.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Mark Scott
- Senior Clinical Scientist, Queen Mary University of London
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Neto IJFC, Maneira ALC, Teixeira NB, Vettorato BD, de Oliveira MC, Menezes TAT, Robles L. There is an agreement between constipation referred and that documented by objective criteria? JOURNAL OF COLOPROCTOLOGY 2016. [DOI: 10.1016/j.jcol.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction Chronic constipation is the most common digestive complaint at the doctor's office, with high prevalence in the population. However, many patients – and even those physicians not so familiar with pelvic floor disorders–define and consider constipation based on intestinal functionality and stool consistency. But symptoms of incomplete defecation, digital maneuvers, abdominal discomfort, and straining should not be overlooked.
Objectives To investigate the correlation between constipation referred and documented through objective criteria in patients admitted on a daytime-nursing ward basis at the Hospital Santa Marcelina, São Paulo.
Methodology This is a prospective study of a random sample of patients admitted on a daytime-ward hospitalization basis at Santa Marcelina Hospital to perform minor surgical procedures not related to functional disorders of the gastrointestinal tract in the period from September 2014 to June 2015; the only exclusion criterion was “not agreed to participate in the interview conducted by students of medicine at Santa Marcelina Medical School”.
Results 102 patients were randomly analyzed in the period considered (51% female) with a mean overall age of 48.6 (19–82) years. Constipation has been reported spontaneously by 17.6% of participants and denied by 82.4%. With the implementation of the Cleveland Clinic's criteria for the diagnosis of constipation, the compliance with the referred symptomatology was 88.9%; the same value was found with the use of the Rome III criteria (Kappa = 0.665). In addition, a higher incidence of constipation was observed in female patients (p = 0.002).
Conclusion A higher incidence of constipation was observed in female participants, with no statistical difference with respect to age. Furthermore, a substantial agreement was found between constipation referred and constipation documented through objective criteria.
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Affiliation(s)
- Isaac José Felippe Corrêa Neto
- Hospital Santa Marcelina, Departamento de Cirurgia Geral, Serviço de Coloproctologia, São Paulo, SP, Brazil
- Faculdade de Santa Marcelina, São Paulo, SP, Brazil
- Sociedade Brasileira de Coloproctologia, Brazil
| | | | | | | | | | | | - Laercio Robles
- Hospital Santa Marcelina, Departamento de Cirurgia Geral, Serviço de Coloproctologia, São Paulo, SP, Brazil
- Faculdade de Santa Marcelina, São Paulo, SP, Brazil
- Colégio Brasileiro de Cirurgiões, Brazil
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Comparación sobre la efectividad y seguridad del polietilenglicol con y sin electrolitos en el tratamiento del estreñimiento funcional. An Pediatr (Barc) 2016; 85:34-40. [DOI: 10.1016/j.anpedi.2015.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 12/12/2022] Open
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Comparison of the effectiveness and safety of polyethylene glycol with and without electrolytes in the treatment of chronic constipation. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, Steele SR. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum 2016; 59:479-92. [PMID: 27145304 DOI: 10.1097/dcr.0000000000000599] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lee A, Lambert K, Byrne P, Lonergan M. PREVALENCE OF CONSTIPATION IN PATIENTS WITH ADVANCED KIDNEY DISEASE. J Ren Care 2016; 42:144-9. [PMID: 27113374 DOI: 10.1111/jorc.12157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND For people on peritoneal dialysis (PD), constipation is associated with technique failure. For those on haemodialysis (HD), constipation has been associated with a reduction in quality of life. OBJECTIVES The objectives of this study were to (i) determine the prevalence of functional constipation; (ii) compare patient perception of constipation with Rome III criteria for functional constipation; (iii) describe the prevalence of constipation and stool form using Bristol Stool Form Scale (BSFS); (iv) determine differences in bowel habit and stool form between those on dialysis compared to pre-dialysis; and (v) determine the diagnostic accuracy of self-perception and the Rome III criteria against the BSFS. A cross-sectional group of pre-dialysis (eGFR < 15 ml/min) and dialysis patients were recruited. A total of 148 patients participated (98 HD, 21 PD and 21 pre-dialysis). PARTICIPANTS completed a questionnaire consisting of self-perception of the presence of constipation, simplified questions from the Rome III criteria for functional constipation, scored their stool form using the BSFS and reported laxative use. RESULTS The prevalence of constipation using the Rome III criteria was 12.3%; patient perception 46.3% and 25.7% using the BSFS. Prevalence differed according to the tool used. CONCLUSION No single method alone is sufficient for accurately determining if a patient is constipated. Relying on patients' self-perception may be unreliable. Ideally patient assessment of constipation should incorporate both the Rome III criteria and BSFS in a method such as the one designed as a result of this research. Further research is needed to assess its usability and practicality in clinical practice.
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Affiliation(s)
- Anna Lee
- Renal Service, Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Kelly Lambert
- Renal Service, Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Pauline Byrne
- Renal Service, Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Maureen Lonergan
- Renal Service, Illawarra Shoalhaven Local Health District, New South Wales, Australia
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Serra J, Mascort-Roca J, Marzo-Castillejo M, Delgado Aros S, Ferrándiz Santos J, Rey Diaz Rubio E, Mearin Manrique F. Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:132-141. [PMID: 27048918 DOI: 10.1016/j.gastrohep.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/05/2016] [Indexed: 02/07/2023]
Abstract
Clinical practice guidelines for the management of constipation in adults aim to generate recommendations on the optimal approach to chronic constipation in the primary care and specialized outpatient setting. Their main objective is to provide healthcare professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of this condition. They are intended for family physicians, primary care and specialist nurses, gastroenterologists and other health professionals involved in the treatment of these patients, as well as patients themselves. The guidelines have been developed in response to the high prevalence of chronic constipation, its impact on patient quality of life and recent advances in pharmacological management. The Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) system has been used to classify the scientific evidence and strengthen the recommendations.
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Affiliation(s)
- Jordi Serra
- Unitat de Motilitat i Trastorns Funcionals Digestius, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Juanjo Mascort-Roca
- Centro de Asitencia Primaria (CAP) Florida Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España; Departament de Ciències Clíniques, Campus Bellvitge, Facultat de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca- Institut d'Investigació d'Atenció Primària (IDIAP) Jordi Gol Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut; Científico de semFYC, Barcelona, España
| | - Silvia Delgado Aros
- Neuro-Enteric Translational Science (NETS) group coordinator, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-Parc de Salut Mar. Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, España
| | | | - Enrique Rey Diaz Rubio
- Hospital Clínico San Carlos, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Fermín Mearin Manrique
- Servicio de Aparato Digestivo, Instituto de Trastornos Funcionales y Motores Digestivos, Barcelona, España
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Drewes AM, Munkholm P, Simrén M, Breivik H, Kongsgaard UE, Hatlebakk JG, Agreus L, Friedrichsen M, Christrup LL. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction–Recommendations of the Nordic Working Group. Scand J Pain 2016; 11:111-122. [DOI: 10.1016/j.sjpain.2015.12.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/12/2015] [Indexed: 02/07/2023]
Abstract
Abstract
Background and aims
Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent. The current review describes the pathophysiology, clinical implications and treatment of OIBD.
Methods
The Nordic Working Group was formed to provide input for Scandinavian specialists in multiple, relevant areas. Seven main topics with associated statements were defined. The working plan provided a structured format for systematic reviews and included instructions on how to evaluate the level of evidence according to the GRADE guidelines. The quality of evidence supporting the different statements was rated as high, moderate or low. At a second meeting, the group discussed and voted on each section with recommendations (weak and strong) for the statements.
Results
The literature review supported the fact that opioid receptors are expressed throughout the gastrointestinal tract. When blocked by exogenous opioids, there are changes in motility, secretion and absorption of fluids, and sphincter function that are reflected in clinical symptoms. The group supported a recent consensus statement for OIC, which takes into account the change in bowel habits for at least one week rather than focusing on the frequency of bowel movements. Many patients with pain receive opioid therapy and concomitant constipation is associated with increased morbidity and utilization of healthcare resources. Opioid treatment for acute postoperative pain will prolong the postoperative ileus and should also be considered in this context. There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. Whilst opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient.
Conclusion and implications
It is the belief of this Nordic Working Group that increased awareness of adverse effects and OIBD, particularly OIC, will lead to better pain treatment in patients on opioid therapy. Subsequently, optimised therapy will improve quality of life and, from a socio-economic perspective, may also reduce costs associated with hospitalisation, sick leave and early retirement in these patients.
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Affiliation(s)
- Asbjørn M. Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology , Aalborg University Hospital , Hobrovej Denmark
| | - Pia Munkholm
- NOH (Nordsjællands Hospital) Gastroenterology , Hillerød Denmark
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Göteborg Sweden
| | - Harald Breivik
- Department of Pain Management and Research , Oslo University Hospital and University of Oslo , Rikshospitalet Norway
| | - Ulf E. Kongsgaard
- Department of Anaesthesiology, Division of Emergencies and Critical Care , Oslo University Hospital, Norway and Medical Faculty, University of Oslo , Rikshospitalet Norway
| | - Jan G. Hatlebakk
- Department of Clinical Medicine , Haukeland University Hospital , Bergen , Norway
| | - Lars Agreus
- Division of Family Medicine , Karolinska Institute , Stockholm , Sweden
| | - Maria Friedrichsen
- Department of Social and Welfare Studies , Faculty of Medicine and Health Sciences , Norrköping , Sweden
| | - Lona L. Christrup
- Department of Drug Design and Pharmacology , Faculty of Health Sciences, University of Copenhagen , københavn Denmark
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Chu H, Hou X. Understanding of Constipation Symptoms and the Diagnosis and Management of Constipation in Chinese Physicians. PLoS One 2016; 11:e0152801. [PMID: 27031865 PMCID: PMC4816533 DOI: 10.1371/journal.pone.0152801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/18/2016] [Indexed: 01/03/2023] Open
Abstract
Background and Aims Although a range of guidelines for the diagnosis and treatment of chronic constipation has been carried out, there was very little information about the understanding on constipation. The aim of the present study was to estimate the understanding of constipation symptoms and the diagnosis and management of constipation by clinical physicians in China. Methods Participants were physicians and researchers in the field of gastroenterology in China who were scheduled to attend the National Conference on gastrointestinal motility(Constipation). Based on the recommendation of the Rome Foundation Board, the self-reported questionnaire was constructed. Findings Although most of the opinions on symptoms of constipation were consistent, there were still some differences. Opinions on the Bristol stool form during constipation were discordant, 34% of the doctors thought that it was type 1 and type 2, while 46%of the doctors suggested that type 3 should also be considered constipation. There was no significant difference between them(P = 0.05); We investigated the interpretation on the duration of defecation prolonged, 27% of the doctors suggested it should be longer than 10 minutes, 22% of the doctors suggested it should be longer than 20 minutes, and other 22% of the doctors suggested it should be time of defecation became longer compared to previously bowel habits, there was no significant difference among them(P = 0.38).Only 36% of the doctors thought that psychotherapy was most important in the treatment of severe constipation, while 37% of the doctors thought that medication treatment was most important in the treatment of severe constipation, there was no significant difference between them(P = 0.895). Conclusion We were able to obtain valuable information about current views on symptoms of constipation and the diagnosis and treatment of constipation among Chinese doctors. Although most of the opinions were consistent there were still some differences. This study indicated that in practice in China there was a need for further study on the role of constipation symptoms and there may also be a need for better establishment of consensus guidelines for constipation.
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Affiliation(s)
- Huikuan Chu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, China
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, China
- * E-mail:
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Bouchoucha M, Devroede G, Bon C, Mary F, Bejou B, Benamouzig R. Difficult defecation in constipated patients and its relationship to colonic disorders. Int J Colorectal Dis 2016; 31:685-91. [PMID: 26861636 DOI: 10.1007/s00384-016-2528-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The importance in constipated subjects of having difficult defecation is poorly known. According to the Rome III criteria, constipated patients are classified as having either irritable bowel syndrome with constipation or functional constipation, depending on the presence and characteristics of abdominal pain. But, the Rome III criteria also identify another group of patients, labeled as suffering from functional anorectal disorders. Within this group, two complaints are akin to being constipated, but not labeled so: having dyssynergic defecation or inadequate defecation. OBJECTIVE The aim of this study was to search for an association between difficult defecation and colonic transit abnormalities in constipated patients and, thus, shed some light on the definition of constipation according to the Rome III criteria. PATIENTS Four hundred four consecutive patients (81% female), aged 44.9 ± 16.6 years, with a BMI of 25.5 ± 6.4 kg/m(2) (mean ± SD), suffering from chronic constipation were included in the present study. After filling out a standard Rome III questionnaire, patients were classified as suffering from an irritable bowel syndrome with constipation or functional constipation. In addition, they were classified as complaining of difficult defecation or not. Patients completed the Bristol Stool Form Scale as well as visual analogue scales for constipation, bloating, and abdominal pain. The colonic transit time was measured using radiopaque markers and analyzed according to three sites: the right colon, the left colon, and the rectosigmoid area. RESULTS Difficult defecation is more frequent in patients with irritable bowel syndrome with constipation (84%) than in patients with functional constipation (68%). It is associated with an increase in constipation and abdominal pain scores on Likert scales, and a longer oroanal transit time, due to a delay in the left part of the colon. CONCLUSIONS This study demonstrates that difficult defecation is part of a more generalized colorectal dysfunction in both irritable bowel syndrome and in functional constipation patients with an overlap of symptomatology. It also demonstrates the relative inadequacy of the Rome III criteria to describe the relationship between constipation and difficult defecation.
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Affiliation(s)
- Michel Bouchoucha
- Université Paris V René Descartes, 15, rue de l'École de Médecine, 75270, Paris Cedex 06, France. .,Service de Gastroentérologie, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny Cedex, France.
| | - Ghislain Devroede
- Département de Chirurgie, Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,CHUS-Hôtel-Dieu, 580 rue Bowen Sud, Sherbrooke, Quebec, J1G2EB, Canada
| | - Cyriaque Bon
- Service de Gastroentérologie, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny Cedex, France
| | - Florence Mary
- Service de Gastroentérologie, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny Cedex, France
| | - Baktiar Bejou
- Service de Gastroentérologie, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny Cedex, France
| | - Robert Benamouzig
- Service de Gastroentérologie, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny Cedex, France
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Houghton LA, Heitkemper M, Crowell M, Emmanuel A, Halpert A, McRoberts JA, Toner B. Age, Gender and Women's Health and the Patient. Gastroenterology 2016; 150:S0016-5085(16)00183-9. [PMID: 27144622 DOI: 10.1053/j.gastro.2016.02.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
Abstract
Patients with functional gastrointestinal disorders (FGIDs) often experience distress, reduced quality of life, a perceived lack of validation, and an unsatisfactory experience with health care providers. A health care provider can provide the patient with a framework in which to understand and legitimize their symptoms, remove self-doubt or blame, and identify factors that contribute to symptoms that the patient can influence or control. This framework is implemented with the consideration of important factors that impact FGIDs, such as gender, age, society, and the patient's perspective. Although the majority of FGIDs, including globus, rumination syndrome, IBS, bloating, constipation, functional abdominal pain, sphincter of Oddi dyskinesia, pelvic floor dysfunction, and extra-intestinal manifestations, are more prevalent in women than men, functional chest pain, dyspepsia, vomiting, and anorectal pain do not appear to vary by gender. Studies suggest sex differences in somatic but not visceral pain perception, motility, and central processing of visceral pain; although further research is required in autonomic nervous system dysfunction, genetics and immunologic/microbiome. Gender differences in response to psychological treatments, antidepressants, fiber, probiotics, and anticholinergics have not been adequately studied. However, a greater clinical response to 5-HT3 antagonists but not 5-HT4 agonists has been reported in women compared with men.
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Affiliation(s)
- Lesley A Houghton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA; Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
| | | | - Michael Crowell
- Division of Gastroenterology and Hepatology Mayo Clinic, Scottsdale, Arizona, USA
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Abdullah MMH, Gyles CL, Marinangeli CPF, Carlberg JG, Jones PJH. Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis. Food Nutr Res 2015; 59:28646. [PMID: 26652739 PMCID: PMC4677277 DOI: 10.3402/fnr.v59.28646] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence-based research highlights beneficial impacts of dietary fibre on several aspects of the gut pathophysiology that are accompanied by a considerable financial burden in healthcare services. Recommended intakes of dietary fibre may thus associate with financial benefits at a population level. OBJECTIVE We sought to systematically assess the potential annual savings in healthcare costs that would follow the reduction in rates of functional constipation and irregularity with increased dietary fibre intakes among Canadian adults. DESIGN A cost-of-illness analysis was developed on the basis of current and recommended levels of fibre intake in Canada, constipation reduction per 1 g fibre intake, proportion of adults who are likely to consume fibre-rich diets, and population expected to respond to fibre intake. Sensitivity analyses covering a range of assumptions were further implemented within the economic simulation. RESULTS Our literature searches assumed a 1.8% reduction in constipation rates with each 1 g/day increase in fibre intake. With intakes corresponding to the Institute of Medicine's adequate levels of 38 g/day for men and 25 g/day for women, among 5 and 100% of the adult populations, anywhere between CAD$1.5 and CAD$31.9 million could be saved on constipation-related healthcare costs annually. Each 1 g/day increase in dietary fibre was estimated to result in total annual healthcare cost savings that ranged between CAD$0.1 and CAD$2.5 million. CONCLUSIONS The present research suggests an economic value of increasing dietary fibre intake beyond its well-known health benefits. Healthy-eating behaviours consistent with the recommended intakes of dietary fibre by the general public should hence be advocated as a practical approach for reducing costs associated with the management of constipation in Canada.
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Affiliation(s)
- Mohammad M H Abdullah
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
- Richardson Centre for Functional Foods and Nutraceuticals (RCFFN), University of Manitoba, Winnipeg, MB, Canada
| | - Collin L Gyles
- Department of Agribusiness & Agricultural Economics, University of Manitoba, Winnipeg, Manitoba
| | | | - Jared G Carlberg
- Department of Agribusiness & Agricultural Economics, University of Manitoba, Winnipeg, Manitoba
| | - Peter J H Jones
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
- Richardson Centre for Functional Foods and Nutraceuticals (RCFFN), University of Manitoba, Winnipeg, MB, Canada;
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Abstract
Aim To understand the prevalence of functional constipation in pregnant women and to analyze the impact of its risk factors. Methods We searched hospital databases for women who were 37–41 weeks pregnant (1698 cases) from July 2012 to January 2014 in four hospitals in Shanghai. We reviewed factors including general data, living and eating habits, psychological history, past history of defecation in the 6 months before pregnancy and defecation after pregnancy. Data were analyzed using SPSS software. Results Pregnant women who were more than 35 years old, with a pre-pregnancy body mass index >24, who were highly educated and employed in a sedentary occupation, showed a higher prevalence of functional constipation. Multivariate logistic regression analysis indicated that the prevalence of functional constipation among pregnant women was related to age, pre-pregnancy body mass index, diet, exercise, occupation, psychological factors, threatened abortion in early pregnancy and constipation history. Conclusion The prevalence rate of functional constipation in pregnant women was significantly higher than in the general population.
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Affiliation(s)
- Wenjun Shi
- The Medical School of Tongji University, Shanghai, China
- Huangpu District Maternity and Infant Hospital, Shanghai, China
| | - Xiaohang Xu
- The Medical School of Tongji University, Shanghai, China
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University, Shanghai, China
| | - Yi Zhang
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University, Shanghai, China
| | - Sa Guo
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University, Shanghai, China
| | - Jing Wang
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University, Shanghai, China
- * E-mail: (JJW); (JW)
| | - Jianjun Wang
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University, Shanghai, China
- * E-mail: (JJW); (JW)
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Constipation in specialized palliative care: factors related to constipation when applying different definitions. Support Care Cancer 2015; 24:691-698. [PMID: 26160464 DOI: 10.1007/s00520-015-2831-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied. OBJECTIVES The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation. METHODS Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios. RESULTS Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease. CONCLUSION There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.
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Schmidt FMQ, Santos VLCDG, Domansky RDC, Barros E, Bandeira MA, Tenório MADM, Jorge JMN. [Prevalence of self-reported constipation in adults from the general population]. Rev Esc Enferm USP 2015; 49:443-52. [PMID: 26107705 DOI: 10.1590/s0080-623420150000300012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/02/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of self-reported constipation and associated factors in the general population of a Brazilian city. METHOD Secondary analysis of an epidemiological study, population-based, cross-sectional study, about bowel habits of Brazilian population. A total of 2,162 individuals were interviewed using two instruments: sociodemographic data and the adapted and validated Brazilian version of the "Bowel Function in the Community" tool. RESULTS There was a prevalence of 25.2% for the self-reported constipation, 37.2% among women and 10.2% among men. Stroke and old age were associated with constipation in the three statistical models used. CONCLUSION The prevalence found showed to be similar to the findings in the literature, although some associated factors obtained here have never been investigated.
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Affiliation(s)
| | | | | | - Elaine Barros
- Servidor Público Estadual Hospital - HSPE, Sao Paulo, SP, Brazil
| | | | | | - José Marcio Neves Jorge
- School of Medicine, Departament of Gastroenterology, University of Sao Paulo, Sao Paulo, SP, Brazil
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Abstract
The aim of this study was to review current constipation assessment scales and clarify (a) the nature of extant measurements and (b) the criteria contained in the measures. A review of relevant literature from inception to 2011 was extracted from PubMed, CINHAL, Cochrane, and MEDLINE databases by searching for the following key words: constipation, scale, measurement, questionnaire, and assessment. Eight scales were reviewed. The scales under review measured constipation from a subjective viewpoint. All measurement criteria included in 8 of the scales were arranged into 51 items and divided into 5 categories. Categories used to measure the severity of constipation were defecation difficulties, abdominal symptoms, emotional effects of constipation, self-treatment strategies, and individual characteristics. Original and suitable scales for the measurement of the severity of constipation based on the review were the Patient-Assessment of Constipation Symptoms scale and the Constipation Assessment Scale. The Patient-Assessment of Constipation Symptoms scale and the Constipation Assessment Scale are reliable, valid, original, and suitable scales to measure the severity of constipation for subjects.
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