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Tran DL, Sintusek P. Functional constipation in children: What physicians should know. World J Gastroenterol 2023; 29:1261-1288. [PMID: 36925458 PMCID: PMC10011959 DOI: 10.3748/wjg.v29.i8.1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 02/16/2023] [Indexed: 02/28/2023] Open
Abstract
Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.
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Affiliation(s)
- Duc Long Tran
- Thailand and Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Bangkok, Thailand
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 9000, Viet Nam
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Thai Red Cross, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Wang JK, Yao SK. Roles of Gut Microbiota and Metabolites in Pathogenesis of Functional Constipation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5560310. [PMID: 34603471 PMCID: PMC8481049 DOI: 10.1155/2021/5560310] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/09/2021] [Indexed: 02/05/2023]
Abstract
Functional constipation (FC), a condition characterized by heterogeneous symptoms (infrequent bowel movements, hard stools, excessive straining, or a sense of incomplete evacuation), is prevalent over the world. It is a multifactorial disorder and can be categorized into four subgroups according to different pathological mechanisms: normal transit constipation (NTC), slow transit constipation (STC), defecatory disorders (DD), and mixed type. Recently, growing evidence from human and animals has pointed that there was a strong association between gut microbiota and FC based on the brain-gut-microbiome axis. Studies have reported that the main characteristics of gut microbiota in FC patients were the relative decrease of beneficial bacteria such as Lactobacillus and Bifidobacterium, the relative increase of potential pathogens, and the reduced species richness. Gut microbiota can modulate gut functions through the metabolites of bacterial fermentation, among which short-chain fatty acids (SCFAs), secondary bile salts (BAs), and methane occupied more important positions and could trigger the release of gut hormones from enteroendocrine cells (EECs), such as 5-hydroxytryptamine (5-HT), peptide YY (PYY), and glucagon-like peptide-1 (GLP-1). Subsequently, these gut hormones can influence gut sensation, secretion, and motility, primarily through activating specific receptors distributed on smooth muscle cells, enteric neurons, and epithelial cells. However, research findings were inconsistent and even conflicting, which may be partially due to various confounding factors. Future studies should take the associated confounders into consideration and adopt multiomics research strategies to obtain more complete conclusions and to provide reliable theoretical support for exploring new therapeutic targets.
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Affiliation(s)
- Jun-Ke Wang
- Department of Gastroenterology, Peking Union Medical College and Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shu-Kun Yao
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
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Luo Y, Feng X, Wu D, Wang J, Lyv Z, Zheng J, Lim KT, Li Y. A randomized controlled trial of Chinese traditional medicine Dachengqi Decoction in the treatment of postoperative intestinal function recovery. Transl Cancer Res 2020; 9:4498-4506. [PMID: 35117815 PMCID: PMC8797330 DOI: 10.21037/tcr-19-2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intestinal dysfunction is not conducive to the recovery of patients after surgery. It is particularly important to restore the intestinal function as soon as possible. In recent years, ultrasonic drug penetration therapy as a new type of non-invasive therapy has been used to solve this problem, but its efficacy has not been confirmed. METHODS Single-centre, parallel, randomized controlled clinical trial in China that included 184 patients undergoing laparoscopic gastrointestinal surgery. Ninety-one participants were randomly assigned to low-frequency ultrasound and electric pulses for transdermal drug delivery with Dachengqi Decoction (DCQD) (intervention group), and 90 were assigned to the control group after laparoscopic gastrointestinal surgery. The primary outcome was time to first flatus after surgery (by patient's subjective feeling). Secondary outcomes assessed the recovery time of bowel movement, time of the first defecation, postoperative gastrointestinal complications (e.g., nausea, vomit, and bloating), days of hospitalization and treatment costs. RESULTS Of 184 patients, 181 (98.4%) completed the trial. The sociodemographic characteristics and efficiency data were comparable in the two groups at baseline. The intervention group had a shorter mean time of bowel movement recovery than the control group [29.4 h (IQR, 22.0-35.0 h) vs. 33.7 h (IQR, 24.0-40.0 h; P=0.005)] and a shorter mean time to first flatus after surgery [35.8 h (IQR, 23.1-46.6 h) vs. 46.7 h (IQR, 25.9-61.3 h; P=0.012)]. Postoperative gastrointestinal reactions (e.g., nausea, vomit, and bloating) occurred in 28.6% in the intervention group and 43.3% in the control group (P=0.038). Two patients in the intervention group had electrical tingling sensations, and one patient had a skin rash during the treatment. There were no significant differences in the occurrence rates of AEs or SAE, days of hospitalization and treatment costs between the two groups. CONCLUSIONS Low-frequency ultrasound and electric pulses for transdermal drug delivery with DCQD can shorten the time of bowel movement recovery and accelerate first anal exhaust after laparoscopic gastrointestinal surgery. TRAIL REGISTRATION Chictr.org.cn Identifier: ChiCTR-IPR-17013630.
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Affiliation(s)
- Yuwen Luo
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xingyu Feng
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Deqing Wu
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junjiang Wang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zejian Lyv
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Zheng
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kheng Tian Lim
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yong Li
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Paknejad MS, Motaharifard MS, Barimani S, Kabiri P, Karimi M. Traditional, complementary and alternative medicine in children constipation: a systematic review. ACTA ACUST UNITED AC 2019; 27:811-826. [PMID: 31734825 DOI: 10.1007/s40199-019-00297-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. EVIDENCE ACQUISITION Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1-18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. RESULTS 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. CONCLUSION The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. Graphical abstract.
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Affiliation(s)
- Maryam Sadat Paknejad
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Monireh Sadat Motaharifard
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Shahdis Barimani
- Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Kabiri
- Department of Biostatics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran.
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Xu Z, Liu T, Zhou Q, Chen J, Yuan J, Yang Z. Roles of Chinese Medicine and Gut Microbiota in Chronic Constipation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:9372563. [PMID: 31239866 PMCID: PMC6556327 DOI: 10.1155/2019/9372563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/20/2019] [Accepted: 05/07/2019] [Indexed: 02/08/2023]
Abstract
Chronic constipation is a common gastrointestinal dysfunction, but its aetiology and pathogenesis are still unclear. Interestingly, the compositions of the gut microbiota in constipation patients and healthy controls are different. Various studies reported the different gut microbiota alterations in constipation patients, but most studies indicated that constipation patients showed the decreased beneficial bacteria and the reduced species richness of gut bacteria. Besides, the alterations in the gut microbiota may lead to constipation and constipation-related symptoms and the regulation of gut microbiota has a positive effect on gut functional diseases such as constipation. Microbial treatment methods, such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, can be used to regulate gut microbiota. Increasing evidences have suggested that Chinese medicine (CM) has a good therapeutic effect on chronic constipation. Chinese medicine is well known for its multitarget and multimode effects on diseases as well as less side effects. In previous studies, after the treatment of constipation with CM, the gut microbiota was restored, indicating that the gut microbiota might be the target or important way for CM to exert its efficacy. In this review, we summarized the effects of microbial treatment and CM on the gut microbiota of constipation patients and discussed the relationship between CM and gut microbiota.
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Affiliation(s)
- Zhenyuan Xu
- College of Basic Medical Sciences, Yunnan University of Chinese Medicine, 650500 Kunming, Yunnan, China
- Yunnan Key Laboratory of Molecular Biology of Chinese Medicine, 650500 Kunming, Yunnan, China
| | - Tianhao Liu
- College of Chinese Medicine, Jinan University, 510632 Guangzhou, Guangdong, China
| | - Qingli Zhou
- College of Basic Medical Sciences, Yunnan University of Chinese Medicine, 650500 Kunming, Yunnan, China
| | - Jing Chen
- College of Basic Medical Sciences, Yunnan University of Chinese Medicine, 650500 Kunming, Yunnan, China
- Yunnan Key Laboratory of Molecular Biology of Chinese Medicine, 650500 Kunming, Yunnan, China
| | - Jiali Yuan
- Yunnan Key Laboratory of Molecular Biology of Chinese Medicine, 650500 Kunming, Yunnan, China
| | - Zhongshan Yang
- College of Basic Medical Sciences, Yunnan University of Chinese Medicine, 650500 Kunming, Yunnan, China
- Yunnan Key Laboratory of Molecular Biology of Chinese Medicine, 650500 Kunming, Yunnan, China
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Corrigendum to "A Randomized Controlled Trial of Chinese Patent Medicine Xiao'er Biantong Granules in the Treatment of Functional Constipation in Children". EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2018:3616345. [PMID: 30622596 PMCID: PMC6304614 DOI: 10.1155/2018/3616345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 12/05/2022]
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