Effectiveness and safety of lactobacilli in children with functional constipation: Study protocol for a meta-analysis and systematic review

Associations between functional constipation and non-IgE-mediated food allergy in infants and children

BACKGROUND

The non-IgE-mediated food allergy (non-IgE-FA) is less prevalent than IgE-mediated food allergy, and their relationship with functional constipation (FC) needs to be clarified.

METHODS

A total of 305 infants and children with constipation treated in the Department of Pediatric Gastroenterology, Children's Hospital of Nanjing Medical University, from July 2020 to December 2021 were included in this study. Four cases with organic lesions were excluded. Among 301 diagnosed with FC, according to ROME IV criteria, 81 cases with allergy-related indicators were further evaluated for food allergy by food-specific IgG antibody test, allergen- specific IgE antibody detection, skin prick test, and food avoidance and reintroduction.

RESULTS

A total of 45 cases with FC were diagnosed with food allergy, and the incidence rate was 15%. Among the 45 patients, 35 cases (77.8%) had FC with non-IgE-FA. The main clinical symptoms or signs included anal fissure, abdominal pain, and pain during defecation. The most prevalent allergic foods were cow's milk, eggs, fish, and shrimp. Ten (22.2%) cases reported FC with mixed food allergy, including both non-IgE-mediated and IgE-mediated food allergy. This study focused on non-IgE-mediated food allergy-related FC.

CONCLUSION

Our results showed that the incidence of food allergy in infants and children with FC was 15%, which was mainly mediated by non-IgE-FA. The main clinical symptoms or signs in these cases included anal fissure, abdominal pain, and pain during defecation, and the main allergens included milk, eggs, fish, and shrimp.

Efficacy and Safety of Probiotics in Geriatric Patients with Constipation: Systematic Review and Meta-Analysis

BACKGROUND

Probiotics may be an effective alternative to traditional drug therapy for constipation in the elderly.

OBJECTIVE

To assess the efficacy and safety of probiotics in managing constipation among the elderly.

METHODS

Eight databases were queried for randomized controlled trials (RCTs) investigating probiotics' efficacy in addressing constipation among the elderly until January 2023. The meta-analysis was conducted employing R software version 4.2.2. The Cochrane risk of bias tool was utilized to evaluate the risk of bias, and the GRADE approach was employed to assess the credibility of the evidence concerning the efficacy of probiotics in treating constipation in older individuals.

RESULTS

A total of six RCTs involving 444 patients were included. Two studies were rated as low risk of bias. The meta-analysis findings revealed that probiotics, when compared to a placebo, led to an increase in stool frequency (MD = 1.02,95% CI [0.21, 2.07], p<0.05, very low quality), the probiotic group exhibited a notable impact on ameliorating symptoms associated with constipation (OR = 11.28, 95%CI [7.21, 17.64], p < 0.05, very low quality), no significant disparities were observed in terms of efforts to evacuate, manual maneuvers, and the incidence of adverse events (p>0.05).

CONCLUSION

The available evidence indicates a degree of uncertainty, ranging from low-to-very low, suggesting the efficacy of probiotics in augmenting bowel frequency and ameliorating constipation-related symptoms among elderly patients with constipation. Nevertheless, given the quality of the studies included, it is advisable to conduct further well-designed investigations with substantial sample sizes to substantiate the findings of this study.

Effects of Astragalus, Epimedium, and Fructus Ligustri Lucidi extractive on antioxidant capacity, production performance, and immune mechanism of breeding pigeons under stress

With the large-scale and intensive development of pigeon breeding industry and the improvement of production level, stress factors have an important impact on the immune, antioxidant capacity, and productivity of pigeons. In this study, the extenuating effect of Astragalus, Epimedium, and Ligustrum lucidum (AEF) on the antioxidant, production performance, and immune mechanism was investigated in breeding pigeons. Eighty pairs of 11-month-old healthy breeding pigeons with the same egg production batch were randomly divided into 4 groups: control group (C group), treated with AEF (AEF group), in restraint stress (S group) and treated with AEF and in restraint stress (S+AEF group). Results showed that AEF reduces weight loss during lactation and increases spleen weight, increased IgA, IgG, T4, GSH-Px, and SOD in serum and decreased T3 and MDA (P < 0.05). Furthermore, treatment with AEF declined HSP60, HSP70, HSP90, GR levels in liver and cFOS, GR mRNA levels in the Hypothalamus, GR mRNA levels in the pituitary (P < 0.05). Meanwhile, the results of the intestine studies showed that AEF promoted relative abundances of Firmicutes and relieve intestinal injury in the colon of pigeons. These results indicated AEF enhanced stress resistance, immunity, production performance and antioxidant capacity of pigeons.

Advancement of Traditional Chinese Medicine in Regulation of Intestinal Flora: Mechanism-based Role in Disease Management

Intestinal microecology is the largest and most complex human microecology. The intestinal microflora plays an important role in human health. Imbalance of intestinal microflora contributes to the occurrence and development of many diseases. Recently, the treatment of human diseases by regulating intestinal microflora has become a research topic of interest. Traditional Chinese medicine considers the whole human body as the central concept in disease treatment strategies. It advocates maintaining the coordination and balance of the functions of various organs and systems of the human body, including the intestinal microflora. Traditional Chinese medicine improves the metabolism and immune function of the human body by regulating the intestinal microflora. The intestinal microflora could trigger pharmacological activity or reduce toxicity of drugs through regulating metabolism, which enables traditional Chinese medicine formulations to exert their best therapeutic effects. This review summarized the relationship between the intestinal microflora and digestive system, tumors, and other diseases. Furthermore, the role of traditional Chinese medicine in the treatment of tumors, and other diseases is discussed. The relationship among traditional Chinese medicine and the common intestinal microflora, pathogenesis of human diseases, and effective intervention methods were elaborated. In addition, we explored the research progress of traditional Chinese medicine in the treatment of various human diseases by regulating intestinal microflora to provide new treatment concepts. There is a close relationship between traditional Chinese medicine and the intestinal microflora. Traditional Chinese medicine formulations contribute to maintain the natural balance of the intestinal tract and the intestinal microflora to achieve treatment effects. This paper summarizes the mechanism of action of traditional Chinese medicine formulations in regulating the intestinal microflora in the prevention and treatment of various diseases. Furthermore, it summarizes information on the application of the interaction between traditional Chinese medicine preparations and the regulation of intestinal microflora in the treatment of common human diseases. Intestinal microflora plays a key role in traditional Chinese medicine in maintaining the natural balance of physiology and metabolism of human body. It will provide a theoretical basis for the traditional Chinese medicine preparations in the prevention and treatment of common human diseases, and simulate future research on this aspect.

Different Bifidobacterium bifidum strains change the intestinal flora composition of mice via different mechanisms to alleviate loperamide-induced constipation

Constipation is a condition with a high prevalence rate worldwide and may occur in men and women of any age. Bifidobacterium bifidum has been shown to have a relieving effect on constipation, but the underlying mechanism is still unknown. This study explored the effects of gavage of three strains of B. bifidum (CCFM668, FHNFQ25M12 and FXJCJ32M2) from different sources in mice with loperamide-induced constipation. After 38 days of intervention, B. bifidum CCFM668, FHNFQ25M12 and FXJCJ32M2 showed the ability to modify the levels of gastrointestinal active peptides and promote the expression of 5-hydroxytryptamine (5-HT or serotonin) receptor 4 (5-HT4R), thereby promoting small intestinal peristalsis. The strains could also effectively increase the thickness of the colonic mucosa. However, what was different from previous studies was that these results were independent of the levels of short-chain fatty acids (SCFAs) and 5-HT. Further analysis of the intestinal flora revealed that the relative abundances of the genera Faecalibaculum and Ruminococcaceae_UCG_014 in the constipated mice increased significantly, whereas that of Erysipelatoclostridium decreased. A correlation analysis between the intestinal flora and evaluated gastrointestinal indicators demonstrated that the relative abundances of the genera Anaerotruncus, Angelakisella, Erysipelatoclostridium and Ruminococcaceae_UCG_014 were negatively correlated with the levels of gastrointestinal active peptides. B. bifidum FXJCJ32M2 can increase the relative abundances of Turicibacter and Dubosiella, and this was positively correlated with the expression of aquaporin 8 and vasoactive intestinal peptide receptor 1 but could not effectively alleviate faecal dryness or promote colonic motility. These findings suggest that B. bifidum shows significant intraspecific differences in the remission mechanism and provides a theoretical basis for subsequent population experiments and personalised treatment for constipation.

Paediatrics: how to manage functional constipation

BACKGROUND

Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation.

METHODS

A PubMed search was performed with Clinical Queries using the key term 'functional constipation'. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch 'red flags' suggestive of organic causes of constipation. These 'red flags' include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success.

CONCLUSION

Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.