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Blokhuis AM, Tytgat K, Groothuis JT, Houwen-van Opstal S. Severe gastrointestinal problems in Duchenne muscular dystrophy: A case series. Neuromuscul Disord 2024; 40:31-37. [PMID: 38823288 DOI: 10.1016/j.nmd.2024.05.006] [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: 02/13/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024]
Abstract
Due to improved supportive care, survival of patients with Duchenne muscular dystrophy (DMD) has increased significantly. Consequently, new challenges emerge in adult patients with DMD. In clinical practice we increasingly see patients with serious, even life-threatening, gastrointestinal (GI) problems in advanced disease stages. Little is known about the longitudinal course of GI problems and the appropriate management. We present a case-series of six adult patients with DMD with (recurrent) GI problems that required hospital admission. The most prevalent reported serious GI symptoms were gastrointestinal pseudo-obstruction, (sub)ileus and gastric dilatation. Besides, an overview is presented of the therapeutic options for GI problems in DMD. The current study provides insight in possible treatment options, however, there is a clear need for more research and an integral guideline on treatment of GI problems in adult patients with DMD in order to reduce associated morbidity and mortality.
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Affiliation(s)
- A M Blokhuis
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Kmaj Tytgat
- Department of Gastroenterology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center of Expertise for neuromuscular disorders (Radboud-NMD), Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD)
| | - Sls Houwen-van Opstal
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Postbus 9101, Huispostnr 898 HB, Nijmegen 6500, the Netherlands; Radboudumc Center of Expertise for neuromuscular disorders (Radboud-NMD), Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD).
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Ramu SK, Oblizajek NR, Savica R, Chunawala ZS, Deb B, Bharucha AE. Defecatory disorders are a common cause of chronic constipation in Parkinson disease. Neurogastroenterol Motil 2024; 36:e14767. [PMID: 38376243 PMCID: PMC11061800 DOI: 10.1111/nmo.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS Up to 50% of patients with Parkinson disease have constipation (PD-C), but the prevalence of defecatory disorders caused by rectoanal dyscoordination in PD-C is unknown. We aimed to compare anorectal function of patients with PD-C versus idiopathic chronic constipation (CC). METHODS Anorectal pressures, rectal sensation, and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry (HR-ARM) in patients with PD-C and control patients with CC, matched for age and sex. RESULTS We identified 97 patients with PD-C and 173 control patients. Eighty-six patients with PD-C (89%) had early PD, and 39 (40%) had a defecatory disorder, manifest by a prolonged rectal balloon expulsion time (37 patients) or a lower rectoanal pressure difference during evacuation (2 patients). PD-C patients with a prolonged BET had a greater anal resting pressure (p = 0.02), a lower rectal pressure increment (p = 0.005), greater anal pressure (p = 0.047), and a lower rectoanal pressure difference during evacuation (p < 0.001). Rectal sensory thresholds were greater in patients with abnormal BET. In the multivariate model comparing CC and PD-C (AUROC = 0.76), PD-C was associated with a lower anal squeeze increment (odds ratio [OR] for PD-C, 0.93 [95% CI, 0.91-0.95]), longer squeeze duration (OR, 1.05 [95% CI, 1.03-1.08]), lower rectal pressure increment (OR per 10 mm Hg, 0.72 [95% CI, 0.66-0.79]), and negative rectoanal gradient during evacuation (OR per 10 mm Hg, 1.16 [95% CI, 1.08-1.26]). CONCLUSIONS Compared with CC, PD-C was characterized by impaired squeeze pressure, longer squeeze duration, lower increase in rectal pressure, and a more negative rectoanal gradient during evacuation.
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Affiliation(s)
| | - Nicholas R Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Division of Movement Disorders, Mayo Clinic, Rochester, Minnesota, USA
| | - Zainali S Chunawala
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Brototo Deb
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Olson J, Mo KC, Schmerler J, Harris AB, Lee JS, Skolasky RL, Kebaish KM, Neuman BJ. AM-PAC Mobility Score <13 Predicts Development of Ileus Following Adult Spinal Deformity Surgery. Clin Spine Surg 2024:01933606-990000000-00279. [PMID: 38490976 DOI: 10.1097/bsd.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To determine whether the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score is associated with the development of postoperative ileus. SUMMARY OF BACKGROUND DATA Adult spinal deformity (ASD) surgery has a high complication rate. One common complication is postoperative ileus, and poor postoperative mobility has been implicated as a modifiable risk factor for this condition. METHODS Eighty-five ASD surgeries in which ≥5 levels were fused were identified in a single institution database. A physical therapist/physiatrist collected patients' daily postoperative AM-PAC scores, for which we assessed first, last, and daily changes. We used multivariable linear regression to determine the marginal effect of ileus on continuous AM-PAC scores; threshold linear regression with Bayesian information criterion to identify a threshold AM-PAC score associated with ileus; and multivariable logistic regression to determine the utility of the score thresholds when controlling for confounding variables. RESULTS Ten of 85 patients (12%) developed ileus. The mean day of developing ileus was postoperative day 3.3±2.35. The mean first and last AM-PAC scores were 16 and 18, respectively. On bivariate analysis, the mean first AM-PAC score was lower in patients with ileus than in those without (13 vs. 16; P<0.01). Ileus was associated with a first AM-PAC score of 3 points lower (Coef. -2.96; P<0.01) than that of patients without ileus. Patients with an AM-PAC score<13 had 8 times greater odds of developing ileus (P=0.023). Neither the last AM-PAC score nor the daily change in AM-PAC score was associated with ileus. CONCLUSIONS In our institutional cohort, a first AM-PAC score of <13, corresponding to an inability to walk or stand for more than 1 minute, was associated with the development of ileus. Early identification of patients who cannot walk or stand after surgery can help determine which patients would benefit from prophylactic management. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Jarod Olson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Abdelbaky AM, Elmasry WG, Awad AH. Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54136. [PMID: 38487150 PMCID: PMC10939480 DOI: 10.7759/cureus.54136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Enteral feeding is a crucial aspect of nutritional support for critically ill patients. However, the optimal feeding approach, whether bolus or continuous, remains a subject of debate. This systematic review and meta-analysis aimed to compare the outcomes of bolus feeding and continuous enteral feeding in critically ill patients. A systemic search was carried out in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate, Web of Science, Scopus, and Google Scholar to identify relevant studies. To ensure that we obtain the latest evidence on the topic, the search was limited to the last five years. Risk of bias assessments and meta-analyses were performed for relevant clinical outcomes. A total of nine randomized controlled trials (RCTs) were included, involving a total of 863 patients. All the studies were published between 2020 and 2023. High-risk performance bias was observed in seven studies, with unclear risk in two studies. In terms of clinical outcomes, no statistically significant differences were found between bolus and continuous enteral feeding in terms of diarrhea (odds ratio {OR} 0.60, 95% CI 0.27 to 1.30, p=0.20), constipation (OR 1.52, 95% CI 0.91 to 2.53, p=0.11), vomiting (OR 0.74, 95% CI 0.36 to 1.49, p=0.39), distention (OR 0.70, 95% CI 0.14 to 3.58, p=0.66), aspiration (OR 0.61, 95% CI 0.16 to 2.73, p=0.48), and gastric residual volume (GRV) (OR 0.80, 95% CI 0.30 to 2.15, p=0.66). Furthermore, no significant differences between bolus and continuous feeding were observed in terms of intensive care unit (ICU) mortality (OR 0.66, 95% CI 0.42 to 1.04, p=0.07), hospital mortality (OR 0.57, 95% CI 0.31 to 1.03, p=0.06), ICU length of stay (OR 0.70, 95% CI 0.50 to 1.90, p=0.25), and hospital length of stay (OR -0.86, 95% CI -3.04 to 1.33, p=0.44). This systematic review and meta-analysis suggest that bolus and continuous enteral feeding methods exhibit comparable outcomes in critically ill patients. However, both ICU mortality and hospital mortality outcomes were close to achieving statistical significance, which favored the continuous feeding approach.
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Affiliation(s)
| | - Wael G Elmasry
- Intensive Care Unit, Rashid Hospital - Dubai Health, Dubai, ARE
| | - Ahmed H Awad
- Intensive Care Unit, Rashid Hospital - Dubai Health, Dubai, ARE
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Vu NTH, Quach DT, Miyauchi S, Luu MN, Yoshida M, Nguyen DTN, Yoshino A, Miyaka Y, Okamoto Y, Oka S, Hiyama T. Prevalence and associated factors of chronic constipation among Japanese university students. Front Public Health 2024; 12:1258020. [PMID: 38292906 PMCID: PMC10824902 DOI: 10.3389/fpubh.2024.1258020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Chronic constipation (CC) is one of the most frequently reported gastrointestinal disorders in the general population and a prominent problem among university students. The study aimed to evaluate the prevalence and the associated factors of CC among Japanese university students. Methods This cross-sectional study was conducted among university students at Hiroshima University, Japan. Students answered the web questionnaire when making a web reservation for the health checkup (April 1 to May 31, 2023). The web questionnaire consisted of four sections, including baseline characteristics, lifestyle factors, family history of CC, and three scales to assess depression and eating disorders: the Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26 and Bulimic Investigatory Test (BITE). CC was diagnosed using Rome IV criteria. The multivariate logistic regression model was used to determine CC-related factors. Results Out of 10,500 individuals who participated in the annual health checkup, 7,496 participants answered the web questionnaire, of whom 5,386 answered all the survey questions. The mean age of the students was 21.1 ± 4.1 years. The male-to-female ratio was 1:1.17. The prevalence of CC was 13.7%. Factors significantly associated with CC in the multivariate model were first-degree family members with CC [Odd ratio (OR): 2.77, 95% confidence interval (CI): 2.31-3.31], severe depression according to BDI scale (OR: 2.59, 95% CI: 1.96-3.43), female sex (OR: 2.00, 95% CI: 1.69-2.36), and short sleep duration of 6 hours or less per day (OR: 1.28, 95% CI: 1.09-1.50). Lack of physical exercise tended to be associated with CC (OR: 1.19, 95% CI: 1.00-1.40). Conclusions CC is prevalent among Japanese university students. Significant risk factors for CC included the first-degree family history of CC, severe depression, female sex, and short sleep duration. Lack of physical exercise tended to be associated with CC. This may contribute to implementing suitable education health programs, health care professionals, and public health policies to identify individuals at risk for CC to prevent and treat CC effectively.
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Affiliation(s)
- Nhu Thi Hanh Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shunsuke Miyauchi
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Mahoko Yoshida
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Doan Thi Nha Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Atsuo Yoshino
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Yoshie Miyaka
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Yuri Okamoto
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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Chowdhury K, Sinha S, Kumar S, Haque M, Ahmad R. Constipation: A Pristine Universal Pediatric Health Delinquent. Cureus 2024; 16:e52551. [PMID: 38249647 PMCID: PMC10797657 DOI: 10.7759/cureus.52551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/23/2024] Open
Abstract
Constipation suffered by children is a global public health problem. Functional constipation (FC) brings about deteriorating effects in the children's lives who suffer from it. The risk factors for the development of constipation include the consumption of a diet low in fiber and high in calories (such as the consumption of fast food), a sedentary lifestyle with a lack of exercise, a family history of constipation, and emotional and psychological stress endured by children in their families. It is one of the most common causes of stomachaches in children. FC may lead to fecal incontinence (FI), anal fissures, recurrent urinary tract infections (RUTI), and enuresis in children. Severe constipation may result in stool becoming rock-hard and inflexible in the rectum, which is clinically identified as fecal impaction. It is imperative to perform clinical evaluation and treatment, including pharmacological (the use of stimulant and osmotic laxatives) and non-pharmacological (education, changes in diet, intervention to promote positive behavior and address any emotional issues, toilet training, and physiotherapy for the pelvic floor) interventions. In the case of refractory patients, neuromodulation, the irrigation of the anal canal, and surgical management may be needed. It is essential to lead a healthy, stress-free lifestyle with plenty of exercise and a balanced diet rich in fiber (such as fruits and vegetables) so children can have regular bowel habits and thrive.
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Affiliation(s)
- Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, BGD
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Ramos-Nascimento A, Grenga L, Haange SB, Himmelmann A, Arndt FS, Ly YT, Miotello G, Pible O, Jehmlich N, Engelmann B, von Bergen M, Mulder E, Frings-Meuthen P, Hellweg CE, Jordan J, Rolle-Kampczyk U, Armengaud J, Moeller R. Human gut microbiome and metabolite dynamics under simulated microgravity. Gut Microbes 2023; 15:2259033. [PMID: 37749878 PMCID: PMC10524775 DOI: 10.1080/19490976.2023.2259033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
The Artificial Gravity Bed Rest - European Space Agency (AGBRESA) study was the first joint bed rest study by ESA, DLR, and NASA that examined the effect of simulated weightlessness on the human body and assessed the potential benefits of artificial gravity as a countermeasure in an analog of long-duration spaceflight. In this study, we investigated the impact of simulated microgravity on the gut microbiome of 12 participants during a 60-day head-down tilt bed rest at the :envihab facilities. Over 60 days of simulated microgravity resulted in a mild change in the gut microbiome, with distinct microbial patterns and pathway expression in the feces of the countermeasure group compared to the microgravity simulation-only group. Additionally, we found that the countermeasure protocols selectively increased the abundance of beneficial short-chain fatty acids in the gut, such as acetate, butyrate, and propionate. Some physiological signatures also included the modulation of taxa reported to be either beneficial or opportunistic, indicating a mild adaptation in the microbiome network balance. Our results suggest that monitoring the gut microbial catalog along with pathway clustering and metabolite profiling is an informative synergistic strategy to determine health disturbances and the outcome of countermeasure protocols for future space missions.
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Affiliation(s)
- Ana Ramos-Nascimento
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Lucia Grenga
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI, Bagnols sur Cèze, France
| | - Sven-Bastiaan Haange
- Department of Metabolomics, UFZ-Helmholtz Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Alexandra Himmelmann
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Franca Sabine Arndt
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Yen-Tran Ly
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Guylaine Miotello
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI, Bagnols sur Cèze, France
| | - Olivier Pible
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI, Bagnols sur Cèze, France
| | - Nico Jehmlich
- Department of Metabolomics, UFZ-Helmholtz Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Beatrice Engelmann
- Department of Metabolomics, UFZ-Helmholtz Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Martin von Bergen
- Department of Metabolomics, UFZ-Helmholtz Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | | | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
| | - Ulrike Rolle-Kampczyk
- Department of Metabolomics, UFZ-Helmholtz Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Jean Armengaud
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI, Bagnols sur Cèze, France
| | - Ralf Moeller
- Institute of Aerospace Medicine, German Aerospace Center (DLR e.V.), Cologne, Germany
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Zhang JJ, Sun R, Guo S, Yang S. Incidence of constipation and associated factors in the period of lockdown during COVID-19 pandemic: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e069614. [PMID: 37775294 PMCID: PMC10546134 DOI: 10.1136/bmjopen-2022-069614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 08/16/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The lifestyle and habit changes that have emerged as a result of quarantine measures may have had a negative impact on defecation habits. However, there is a lack of data on combined estimates of its occurrence and prevalence. METHODS AND ANALYSIS We will conduct a systematic search for observational studies on PubMed/MEDLINE, Web of Science, Cochrane Library, EMBASE, CNKI, SinoMed, VIP China Science and Technology Journal database, Chinese Biomedical Databases and Wanfang Data. The search will include literature published from the inception of the databases to September 2022. Two authors will independently screen articles and extract data based on predefined inclusion and exclusion criteria. The risk of bias in the included studies will be evaluated using the Newcastle-Ottawa Scale for observational studies. Statistical analysis will be performed using Review Manager software V.5.4 and STATA V.16.0 software. Heterogeneity among studies will be assessed using the Q statistical test and I2 statistical tests. In case of significant heterogeneity, subgroup analysis and sensitivity analysis will be conducted to explore the source of heterogeneity. Sensitivity analyses will also be performed to assess the reliability of the study findings. If feasible, a meta-analysis will be conducted. Otherwise, a descriptive synthesis will be performed using a best-evidence synthesis approach. The primary outcome of interest will be the prevalence of constipation. The secondary outcomes will involve examining the association of risk factors. To evaluate potential publication bias, we will use both the Begg funnel plot and Egger's weighted regression statistics. Furthermore, to accurately assess the quality of evidence for our primary outcome, we will employ the Grading of Recommendations Assessment, Development and Evaluation system. ETHICS AND DISSEMINATION This systematic review protocol will only consider published studies available in databases and will not include individual patient data. Therefore, ethical approval is not required, and the findings will be published in a peer-reviewed journal. PROSPER REGISTRATION NUMBER CRD42022366176.
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Affiliation(s)
- Juan Juan Zhang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ran Sun
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sha Guo
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sha Yang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu, China
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Šlosar L, Peskar M, Pišot R, Marusic U. Environmental enrichment through virtual reality as multisensory stimulation to mitigate the negative effects of prolonged bed rest. Front Aging Neurosci 2023; 15:1169683. [PMID: 37674784 PMCID: PMC10477372 DOI: 10.3389/fnagi.2023.1169683] [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: 02/19/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Prolonged bed rest causes a multitude of deleterious physiological changes in the human body that require interventions even during immobilization to prevent or minimize these negative effects. In addition to other interventions such as physical and nutritional therapy, non-physical interventions such as cognitive training, motor imagery, and action observation have demonstrated efficacy in mitigating or improving not only cognitive but also motor outcomes in bedridden patients. Recent technological advances have opened new opportunities to implement such non-physical interventions in semi- or fully-immersive environments to enable the development of bed rest countermeasures. Extended Reality (XR), which covers augmented reality (AR), mixed reality (MR), and virtual reality (VR), can enhance the training process by further engaging the kinesthetic, visual, and auditory senses. XR-based enriched environments offer a promising research avenue to investigate the effects of multisensory stimulation on motor rehabilitation and to counteract dysfunctional brain mechanisms that occur during prolonged bed rest. This review discussed the use of enriched environment applications in bedridden patients as a promising tool to improve patient rehabilitation outcomes and suggested their integration into existing treatment protocols to improve patient care. Finally, the neurobiological mechanisms associated with the positive cognitive and motor effects of an enriched environment are highlighted.
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Affiliation(s)
- Luka Šlosar
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Alma Mater Europaea – ECM, Department of Health Sciences, Maribor, Slovenia
| | - Manca Peskar
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Biological Psychology and Neuroergonomics, Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universität Berlin, Berlin, Germany
| | - Rado Pišot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Uros Marusic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Alma Mater Europaea – ECM, Department of Health Sciences, Maribor, Slovenia
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10
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Qu J, Xu X, Xu C, Ding X, Zhang K, Hu L. The effect of intermittent versus continuous enteral feeding for critically ill patients: a meta-analysis of randomized controlled trials. Front Nutr 2023; 10:1214774. [PMID: 37671198 PMCID: PMC10475573 DOI: 10.3389/fnut.2023.1214774] [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: 04/30/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
Objectives The appropriate strategy for enteral feeding in critically ill patients still remains controversial. Therefore, we conducted this meta-analysis to compare the effect of intermittent versus continuous enteral feeding method for critically ill patients. Methods Electronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched up to April 10th, 2023 for randomized controlled trials evaluating the effect of intermittent versus continuous enteral feeding for critically ill patients. The primary outcomes were feeding intolerances, including diarrhea, vomiting, distension, constipation, gastric retention, and aspiration pneumonia. The secondary outcomes were mortality in intensive care unit (ICU), length of stay in ICU, and achievement of nutritional goal. Results Thirteen studies with a total of 884 patients were analyzed in this meta-analysis. Overall, the use of intermittent enteral feeding was associated with higher incidence of diarrhea (OR 1.66, 95%CI 1.13 to 2.43, I2 = 16%) and distension (OR 2.29, 95%CI 1.16 to 4.51, I2 = 0%), lower incidence of constipation (OR 0.58, 95%CI 0.37 to 0.90, I2 = 0%), and longer length of ICU stay (MD 1.09, 95%CI 0.53 to 1.64, I2 = 0%). Moreover, no significant difference was identified for other outcome measures. Conclusion In critically ill patients, the implementation of intermittent enteral feeding was associated with higher incidence of diarrhea and distension, longer length of ICU stay, but lower occurrence of constipation. Nevertheless, the absence of sufficient high-quality randomized controlled clinical trials precludes any definitive conclusions regarding the optimal approach to enteral feeding in this population. There is an imperative need for more studies to further assess the efficacy of the two enteral feeding strategies.
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Affiliation(s)
- Jing Qu
- Department of General Surgery, Lishui People’s Hospital, Lishui, China
| | - Xiaoya Xu
- Department of General Surgery, Lishui People’s Hospital, Lishui, China
| | - Chaobo Xu
- Department of General Surgery, Lishui People’s Hospital, Lishui, China
| | - Xuzhong Ding
- Department of General Surgery, Lishui People’s Hospital, Lishui, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Leshuang Hu
- Department of General Surgery, Lishui People’s Hospital, Lishui, China
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11
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Al Nou'mani J, Al Alawi AM, Al-Maqbali JS, Al Abri N, Al Sabbri M. Prevalence, Recognition, and Risk Factors of Constipation among Medically Hospitalized Patients: A Cohort Prospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1347. [PMID: 37512158 PMCID: PMC10385149 DOI: 10.3390/medicina59071347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Background and Objective: Constipation is a prevalent gastrointestinal condition that has a substantial impact on individuals and healthcare systems. This condition adversely affects health-related quality of life and leads to escalated healthcare expenses due to an increase in office visits, referrals to specialists, and hospital admission. This study aimed to evaluate the prevalence, recognition, risk factors, and course of constipation among hospitalized patients in medical wards. Materials and Methods: A prospective study was conducted, including all adult patients admitted to the General Medicine Unit between 1 February 2022 and 31 August 2022. Constipation was identified using the Constipation Assessment Scale (CAS), and relevant factors were extracted from the patients' medical records. Results: Among the patients who met the inclusion criteria (n = 556), the prevalence of constipation was determined to be 55.6% (95% CI 52.8-58.4). Patients with constipation were found to be older (p < 0.01) and had higher frailty scores (p < 0.01). Logistic regression analysis revealed that heart failure (Odds ratio (OR) 2.1; 95% CI 1.2-3.7; p = 0.01), frailty score (OR 1.4; 95% CI 1.2-1.5; p < 0.01), and dihydropyridines calcium channel blockers (OR 1.8; 95% CI 1.2-2.8; p < 0.01) were independent risk factors for constipation. Furthermore, the medical team did not identify constipation in 217 patients (64.01%). Conclusions: Constipation is highly prevalent among medically hospitalized patients. To ensure timely recognition and treatment, it is essential to incorporate a daily constipation assessment scale into each patient's medical records.
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Affiliation(s)
- Jawahar Al Nou'mani
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman
| | - Abdullah M Al Alawi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman
| | - Juhaina Salim Al-Maqbali
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat 123, Oman
- Department of Pharmacology and Clinical Pharmacy, Sultan Qaboos University, Muscat 123, Oman
| | - Nahid Al Abri
- College of Medicine and Health Science, Sultan Qaboos University, Muscat 123, Oman
| | - Maryam Al Sabbri
- College of Medicine and Health Science, Sultan Qaboos University, Muscat 123, Oman
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12
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Xiao Y, Xu L. Prevalence and Risk Factors of Enteral Feeding Intolerance in Critically Ill Patients and the Effectiveness of Preventive Treatments: A Prospective Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:135-142. [PMID: 37252021 PMCID: PMC10211412 DOI: 10.4103/sjmms.sjmms_384_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/02/2023] [Accepted: 03/12/2023] [Indexed: 05/31/2023]
Abstract
Background Feeding intolerance (FI) is a prevalent cause of enteral nutrition (EN) disruption. Factors that can prevent FI are poorly described. Objectives To determine the prevalence and risk factors associated with FI in critically ill patients and the effectiveness of preventive treatments. Patients and Methods This prospective observational study included critically ill patients admitted to the ICU of a general hospital who received EN through a nasogastric or nasointestinal tube from March 2020 to October 2021. Independent sample t-test, repeated measurement analysis of variance, and multivariate analysis were used to explore independent risk factors and the efficacy of preventive treatments. Results The study included 200 critically ill patients (mean age: 59.1 ± 17.8 years), of whom 131 were male. Most patients (58.50%) developed FI after a median EN duration of 2 days. The independent risk factors for FI were fasting for >3 days, high APACHE II score, and acute gastrointestinal injury (AGI) grade I before EN (P < 0.05). During EN, whole protein was found to be an independent preventive treatment that significantly decreased FI (P < 0.05), while before EN, early use of enema and gastric motility drugs in patients with abdominal distention/constipation significantly decreased FI (for both, P < 0.05). The preventive treatment group had significantly higher intake of the nutrient solution and significantly shorter invasive mechanical ventilation duration than the without preventive treatment group (for both, P < 0.05). Conclusion In ICU patients receiving nasogastric or nasointestinal tube feeding, FI was frequent, occurred early, and was more frequent in patients with fasting >3 days, a high APACHE II score, and an AGI grade before EN. Preventive treatments can reduce FI prevalence and result in patients consuming more nutrient solutions and having shorter invasive mechanical ventilation duration. Chinese Clinical Trial Registry Registration no ChiCTR-DOD-16008532.
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Affiliation(s)
- Yajuan Xiao
- School of Smart Healthcare Industry, Chongqing City Management College, No. 151, South 2 Road, University Town, Gao Xin District, Chongqing 401331, China
| | - Lei Xu
- Anesthesia and Operating Room, The 940 Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, No. 333 Nan Bing He Street, Qi Li He District, Lan Zhou 730000, China
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13
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Niu T, Zhou X, Li X, Liu T, Liu Q, Li R, Liu Y, Dong H. Development and validation of a dynamic risk prediction system for constipation in patients with amyotrophic lateral sclerosis. Front Neurol 2022; 13:1060715. [PMID: 36570448 PMCID: PMC9768031 DOI: 10.3389/fneur.2022.1060715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Although constipation is a common non-motor symptom in patients with amyotrophic lateral sclerosis (ALS), it is poorly valued. Moreover, there is a bidirectional effect between constipation and neuropsychiatric and sleep disturbances. Thus, these symptoms are better treated simultaneously. Therefore, this study aimed to develop and validate a model for predicting the risk of constipation in ALS patients, to help clinicians identify and treat constipation early. Methods Data of 118 ALS admissions from an observational prospective cohort, registered between March 2017 and December 2021, were analyzed. Demographic data were obtained. Constipation was assessed using the Knowles-Eccersley-Scott Symptom Questionnaire. The severity of ALS was assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). The Pittsburgh Sleep Quality Index (PSQI) was used to assess patients' sleep status. The least absolute shrinkage and selection operator (LASSO) regression model was used to select factors and construct a nomogram. Nomogram model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). The model was internally validated using bootstrap validation in the current cohort. Results Age, family history of constipation, total ALSFRS-R score, site of onset, total PSQI score, and depressed, were identified as significant predictors of the risk of constipation in ALS patients. The prediction model was validated to have good accuracy (Hosmer-Lemeshow test: χ2 = 11.11, P > 0.05) and discrimination (AUC = 0.856, 95% confidence interval: 0.784-0.928). DCA and CIC showed that the nomogram model had excellent clinical performance. Conclusions A web-based ALS constipation risk calculator with good predictive performance was constructed to identify patients at high risk of constipation and to allow early intervention in a clinical context.
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Affiliation(s)
- Tongyang Niu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xiaomeng Zhou
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xin Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Tingting Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Qi Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Rui Li
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Yaling Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China,*Correspondence: Yaling Liu
| | - Hui Dong
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China,Hui Dong
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Ding W, Luo F, Lin P, Tang Y, Liu Y. Effect of Nursing Outcome-Oriented Intervention on Airway Management in Elderly Long-Term Bedridden Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9557330. [PMID: 36267309 PMCID: PMC9578878 DOI: 10.1155/2022/9557330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
Objective This study intended to explore the nursing outcome-oriented intervention's effect on airway management in elderly long-term bedridden patients. Methods A total of 120 cases of elderly long-term bedridden patients admitted to our hospital from May 2018 to June 2020 were enrolled and randomly divided into the observation group (n = 60) and control group (n = 60). The control group received the routine nursing intervention, while the observation group received the nursing outcome-oriented intervention. Forced expiratory volume (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in the first second were compared between the two groups before and after the intervention. The pulmonary infection of the two groups was observed. Total protein, hemoglobin, albumin, and cholesterol levels were compared between the two groups. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the two groups' psychological status before and after the intervention. The Generic Quality of Life Inventory-74 (GQOLI-74) assessed the two groups' quality of life. Results After the intervention, the levels of FEV1, FVC, and MVV; total protein, hemoglobin, albumin, and cholesterol; and scores of physical function, psychological function, social function, and material life function in the observation group were higher than those in the control group. Pulmonary infection, secondary infection, the infection rate is more than 3%, HAMA, and HAMD scores, and the incidence of pressure ulcers, aspiration, constipation, and the falling bed was lower than those in the control group, with statistical significance (all P < 0.05). Conclusion Nursing outcome-oriented intervention can effectively improve lung function, pulmonary infection, nutritional status, negative mood, and quality of life of long-term bedridden elderly patients.
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Affiliation(s)
- Weiwei Ding
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Fei Luo
- Department of Gastrointestinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Pingping Lin
- Department of Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Yu Tang
- College of Basic Medicine, Binzhou Medical University, Yantai, Shandong 264000, China
| | - Ying Liu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
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Iovino P, Neri MC, D'Alba L, Santonicola A, Chiarioni G. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction. Neurogastroenterol Motil 2022; 34:e14264. [PMID: 34532928 DOI: 10.1111/nmo.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The pathophysiology of bloating is partially understood. We investigated in patients with disorders of gut-brain interaction (DGBI) the relationship between severity of bloating, abdominal girth changes and defecation pattern, and the efficacy of pelvic floor biofeedback treatment on bloating. METHODS Disorders of gut-brain interaction patients with severe bloating as the main complaint were prescribed 2 weeks dietary advice and underwent abdominal girth measurements. At the first visit, all patients underwent a questionnaire on the subjective improvement of bloating, a (0-100) VAS abdominal bloating, and abdominal girth measurement. Patients reporting inadequate bloating relief underwent a standardized balloon expulsion test. Furthermore, they were invited to undergo pelvic floor electromyography and biofeedback treatment previously used for constipation due to dyssynergic defecation. The primary outcome was bloating improvement on a 5-point Likert scale. The secondary outcomes were the effect of diet intervention and pelvic floor biofeedback treatment on bloating severity and quality of life changes as well as the effect of pelvic floor biofeedback treatment on BET and EMG on straining. KEY RESULTS One hundred and fifty six patients (129 F, 39.3 ± 11.7 mean age) completed the 2-week run-in period. 105 patients were diet non-responder and underwent balloon expulsion test, with the vast majority (64%) failing the test. Patients who scored higher bloating on VAS had a significant association with failed balloon expulsion test (adjusted B 0.4 [95% CI 10.8-25.7], p < 0.0001). 63% agreed to perform pelvic floor biofeedback treatment at Verona center, 54% became responders reporting fair or major improvement/cure (ITT analysis, McNemar test, p < 0.0001), and all of them showed a 50% decrease in bloating severity. CONCLUSIONS AND INFERENCES Disordered defecation is a prevalent etiology in DGBI patients with bloating unresponsive to conservative measures; pelvic floor biofeedback treatment to improve the defecation effort significantly relieved bloating (http://www.isrctn.com, ISRCTN17004079).
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Affiliation(s)
- Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana , University of Salerno, Salerno, Italy
| | | | | | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana , University of Salerno, Salerno, Italy
| | - Giuseppe Chiarioni
- Division of Gastroenterology B, AOUI Verona, Verona, Italy
- UNC Center for Functional GI & Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Understanding the physiology of human defaecation and disorders of continence and evacuation. Nat Rev Gastroenterol Hepatol 2021; 18:751-769. [PMID: 34373626 DOI: 10.1038/s41575-021-00487-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
The act of defaecation, although a ubiquitous human experience, requires the coordinated actions of the anorectum and colon, pelvic floor musculature, and the enteric, peripheral and central nervous systems. Defaecation is best appreciated through the description of four phases, which are, temporally and physiologically, reasonably discrete. However, given the complexity of this process, it is unsurprising that disorders of defaecation are both common and problematic; almost everyone will experience constipation at some time in their life and many will develop faecal incontinence. A detailed understanding of the normal physiology of defaecation and continence is critical to inform management of disorders of defaecation. During the past decade, there have been major advances in the investigative tools used to assess colonic and anorectal function. This Review details the current understanding of defaecation and continence. This includes an overview of the relevant anatomy and physiology, a description of the four phases of defaecation, and factors influencing defaecation (demographics, stool frequency/consistency, psychobehavioural factors, posture, circadian rhythm, dietary intake and medications). A summary of the known pathophysiology of defaecation disorders including constipation, faecal incontinence and irritable bowel syndrome is also included, as well as considerations for further research in this field.
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17
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Chronic Constipation: Is a Nutritional Approach Reasonable? Nutrients 2021; 13:nu13103386. [PMID: 34684388 PMCID: PMC8538724 DOI: 10.3390/nu13103386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic constipation (CC) is one of the most common gastroenterological diagnoses in clinical practice. Treatment includes several steps, depending on the severity of symptoms. Lifestyle modifications and increased intake of fiber and water are suggested by most health professionals. Unfortunately, the recommendations in this regard are the most varied, often conflicting with each other and not always based on solid scientific arguments. This paper aims to clarify this topic by providing practical indications for the management of these patients in every day clinical practice. The literature available on this topic is scarce, and dietary studies have important methodological biases. However, fiber, mainly by binding water and acting as bulking agents and/or as prebiotics for the intestinal microbiota, and mineral water, especially if rich in magnesium and/or bicarbonate, are useful tools. An adequate, well-designed diet should be a cornerstone of any effective treatment for chronic constipation. High-quality studies on larger samples are mandatory to give scientific validity to the role of the food in CC therapy and to enable professionals to choose the best approach for their patients, combining nutritional and pharmacological agents.
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18
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Remes-Troche JM, Coss-Adame E, Amieva-Balmori M, Velarde-Ruiz Velasco JA, Gómez-Castaños PC, Flores-Rendón R, Gómez-Escudero O, Rodríguez-Leal MC, Durán-Rosas C, Pinto-Gálvez SM, Priego-Parra BA, Triana-Romero A. Incidence of 'new-onset' constipation and associated factors during lockdown due to the COVID-19 pandemic. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000729. [PMID: 34531245 PMCID: PMC8449841 DOI: 10.1136/bmjgast-2021-000729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/05/2021] [Indexed: 01/02/2023] Open
Abstract
Objective A minimum of physical activity and low liquid intake are factors that have been associated with constipation. The health emergency brought on by the COVID-19 pandemic has resulted in adopting behaviour, such as sheltering-in-place (less mobility) and dietary changes, creating a scenario we believe to be an adequate model for examining the appearance of symptoms of constipation and its associated factors. Design A cross-sectional and descriptive study was conducted on an open population, applying an electronic survey (4 weeks after lockdown due to COVID-19 in Mexico) to evaluate demographic characteristics, physical activity, water and fibre intake, appearance of constipation symptoms (including stool consistency), and quality of life. Results Out of 678 subjects evaluated, 170 (25%, 95% CI: 21.7 to 28.4) developed symptoms of ‘new-onset’ constipation, with a significant decrease in the number of daily bowel movements (p<0.05) and stool consistency (p<0.05) during lockdown. Furthermore, in the ‘new-onset’ constipation population there was a higher proportion of subjects (79 (47%) of 170) who stopped exercising during the pandemic compared with the subjects who did not develop constipation symptoms (187 (37%) of 508, p=0.03, OR: 1.49, 95% CI: 1.0 to 2.1). The multivariate analysis (logistic regression) showed that female sex (p=0.001), water intake (p=0.039), and physical activity (p=0.012) were associated with ‘new-onset’ constipation. Conclusions In our study on an open population in Mexico, we found that one-fourth of the population developed ‘new-onset’ constipation symptoms during the lockdown imposed due to the COVID-19 pandemic. A reduction of physical activity and less water consumption were associated factors.
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Affiliation(s)
| | - Enrique Coss-Adame
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Departamento de Gastroenterologia, Mexico City, Mexico
| | | | | | | | | | | | | | - Cristina Durán-Rosas
- Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | | | | | - Arturo Triana-Romero
- Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Mexico
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Lionarons JM, de Groot IJM, Fock JM, Klinkenberg S, Vrijens DMJ, Vreugdenhil ACE, Medici-van den Herik EG, Cuppen I, Jaeger B, Niks EH, Hoogerhuis R, Platte-van Attekum N, Feron FJM, Faber CG, Hendriksen JGM, Vles JSH. Prevalence of Bladder and Bowel Dysfunction in Duchenne Muscular Dystrophy Using the Childhood Bladder and Bowel Dysfunction Questionnaire. Life (Basel) 2021; 11:life11080772. [PMID: 34440515 PMCID: PMC8399211 DOI: 10.3390/life11080772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common in Duchenne muscular dystrophy (DMD), but not systematically assessed in regular care. We aimed to determine the prevalence of bladder and bowel dysfunction (BBD) in DMD patients compared with healthy controls (HC). Methods: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) based on the International Rome III criteria and the International Children’s Continence Society was filled out by 57 DMD patients and 56 HC. Additionally, possible associations of BBD with, for example, medication use or quality of life were evaluated in an additional questionnaire developed by experts. Results: In 74% of patients versus 56% of HC ≥ 1 LUTS (n.s.) were reported, 68% of patients versus 39% of HC reported ≥1 bowel symptom (p = 0.002) and 53% of patients versus 30% of HC reported combined LUTS and bowel symptoms (p = 0.019). A negative impact of BBD on daily life functioning was reported by 42% of patients. Conclusions: These data underscore that standard screening for BBD is needed and that the CBBDQ could be of added value to optimize DMD care.
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Affiliation(s)
- Judith M. Lionarons
- Department of Neurology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (S.K.); (C.G.F.)
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands;
- Correspondence: ; Tel.: +31-(0)43-3875058
| | - Imelda J. M. de Groot
- Department of Rehabilitation Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Duchenne Center Netherlands, 2333 ZA Leiden, The Netherlands; (E.H.N.); (J.G.M.H.)
| | - Johanna M. Fock
- Department of Neurology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (S.K.); (C.G.F.)
| | - Desiree M. J. Vrijens
- Department of Urology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Anita C. E. Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
- School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
| | | | - Inge Cuppen
- Department of Neurology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Bregje Jaeger
- Department of Neurology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Erik H. Niks
- Duchenne Center Netherlands, 2333 ZA Leiden, The Netherlands; (E.H.N.); (J.G.M.H.)
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Rinske Hoogerhuis
- Youth Healthcare Center South Limburg, 6411 TE Heerlen, The Netherlands; (R.H.); (N.P.-v.A.)
| | | | - Frans J. M. Feron
- Department of Social Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Catharina G. Faber
- Department of Neurology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (S.K.); (C.G.F.)
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Jos G. M. Hendriksen
- Duchenne Center Netherlands, 2333 ZA Leiden, The Netherlands; (E.H.N.); (J.G.M.H.)
- Center for Neurological Learning Disabilities, Kempenhaeghe, 5591 VE Heeze, The Netherlands
| | - Johan S. H. Vles
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands;
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De Giorgio R, Zucco FM, Chiarioni G, Mercadante S, Corazziari ES, Caraceni A, Odetti P, Giusti R, Marinangeli F, Pinto C. Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel. Adv Ther 2021; 38:3589-3621. [PMID: 34086265 PMCID: PMC8279968 DOI: 10.1007/s12325-021-01766-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022]
Abstract
The prescribing and use of opioid analgesics is increasing in Italy owing to a profusion in the number and types of opioid analgesic products available, and the increasing prevalence of conditions associated with severe pain, the latter being related to population aging. Herein we provide the expert opinion of an Italian multidisciplinary panel on the management of opioid-induced constipation (OIC) and bowel dysfunction. OIC and opioid-induced bowel dysfunction are well-recognised unwanted effects of treatment with opioid analgesics that can profoundly affect quality of life. OIC can be due to additional factors such as reduced mobility, a low-fibre diet, comorbidities, and concomitant medications. Fixed-dose combinations of opioids with mu (μ) opioid receptor antagonists, such as oxycodone/naloxone, have become available, but have limited utility in clinical practice because the individual components cannot be independently titrated, creating a risk of breakthrough pain as the dose is increased. A comprehensive prevention and management strategy for OIC should include interventions that aim to improve fibre and fluid intake, increase mobility or exercise, and restore bowel function without compromising pain control. Recommended first-line pharmacological treatment of OIC is with an osmotic laxative (preferably polyethylene glycol [macrogol]), or a stimulant laxative such as an anthraquinone. A second laxative with a complementary mechanism of action should be added in the event of an inadequate response. Second-line treatment with a peripherally acting μ opioid receptor antagonist (PAMORA), such as methylnaltrexone, naloxegol or naldemedine, should be considered in patients with OIC that has not responded to combination laxative treatment. Prokinetics or intestinal secretagogues, such as lubiprostone, may be appropriate in the third-line setting, but their use in OIC is off-label in Italy, and should therefore be restricted to settings such as specialist centres and clinical trials.
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Jaber A, Hemmer S, Klotz R, Ferbert T, Hensel C, Eisner C, Ryang YM, Obid P, Friedrich K, Pepke W, Akbar M. Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital. DER ORTHOPADE 2021; 50:425-434. [PMID: 33185695 DOI: 10.1007/s00132-020-04034-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury. OBJECTIVE The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated. MATERIAL AND METHODS An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included. RESULTS Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care. CONCLUSION Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.
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Affiliation(s)
- A Jaber
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - S Hemmer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - R Klotz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - T Ferbert
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Hensel
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Eisner
- Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Y M Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - P Obid
- Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Geisenheimer Straße 10, 65197, Wiesbaden, Germany
| | - K Friedrich
- Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Pepke
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Akbar
- MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany.
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22
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Lemay DG, Baldiviez LM, Chin EL, Spearman SS, Cervantes E, Woodhouse LR, Keim NL, Stephensen CB, Laugero KD. Technician-Scored Stool Consistency Spans the Full Range of the Bristol Scale in a Healthy US Population and Differs by Diet and Chronic Stress Load. J Nutr 2021; 151:1443-1452. [PMID: 33704458 DOI: 10.1093/jn/nxab019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prior studies of adults with constipation or diarrhea suggest that dietary intake, physical activity, and stress may affect stool consistency. However, the influence of these factors is unresolved and has not been investigated in healthy adults. OBJECTIVES We assessed the relations of technician-scored stool consistency in healthy adults with self-reported diet, objectively monitored physical activity, and quantifiable markers of stress. METHODS Stool consistency was scored by an independent technician using the Bristol Stool Form Scale (BSFS) to analyze samples provided by healthy adults, aged 18-65 y, BMI 18-44 kg/m2, in the USDA Nutritional Phenotyping Study (n = 364). A subset of participants (n = 109) were also asked to rate their sample using the BSFS. Dietary intake was assessed with two to three 24-h recalls completed at home and energy expenditure from physical activity was monitored using an accelerometer in the 7-d period preceding the stool collection. Stress was measured using the Wheaton Chronic Stress Inventory and allostatic load (AL). Statistical and machine learning analyses were conducted to determine which dietary, physiological, lifestyle, and stress factors differed by stool form. RESULTS Technician-scored BSFS scores were significantly further (P = 0.003) from the central score (mean ± SEM distance: 1.41 ± 0.089) than the self-reported score (1.06 ± 0.086). Hard stool was associated with higher (P = 0.005) intake of saturated fat (13.8 ± 0.40 g/1000 kcal) than was normal stool (12.5 ± 0.30 g/1000 kcal). AL scores were lower for normal stool (2.49 ± 0.15) than for hard (3.07 ± 0.18) (P = 0.009) or soft stool (2.89 ± 0.18) (P = 0.049). Machine learning analyses revealed that various dietary components, physiological characteristics, and stress hormones predicted stool consistency. CONCLUSIONS Technician-scored stool consistency differed by dietary intake and stress hormones, but not by physical activity, in healthy adults.This trial was registered at clincialtrials.gov as NCT02367287.
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Affiliation(s)
- Danielle G Lemay
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lacey M Baldiviez
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Chin
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA
| | - Sarah S Spearman
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA
| | - Eduardo Cervantes
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Leslie R Woodhouse
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA
| | - Nancy L Keim
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles B Stephensen
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Kevin D Laugero
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
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23
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Metabolic Dysfunction in Spinal Muscular Atrophy. Int J Mol Sci 2021; 22:ijms22115913. [PMID: 34072857 PMCID: PMC8198411 DOI: 10.3390/ijms22115913] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 12/11/2022] Open
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive genetic disorder leading to paralysis, muscle atrophy, and death. Significant advances in antisense oligonucleotide treatment and gene therapy have made it possible for SMA patients to benefit from improvements in many aspects of the once devastating natural history of the disease. How the depletion of survival motor neuron (SMN) protein, the product of the gene implicated in the disease, leads to the consequent pathogenic changes remains unresolved. Over the past few years, evidence toward a potential contribution of gastrointestinal, metabolic, and endocrine defects to disease phenotype has surfaced. These findings ranged from disrupted body composition, gastrointestinal tract, fatty acid, glucose, amino acid, and hormonal regulation. Together, these changes could have a meaningful clinical impact on disease traits. However, it is currently unclear whether these findings are secondary to widespread denervation or unique to the SMA phenotype. This review provides an in-depth account of metabolism-related research available to date, with a discussion of unique features compared to other motor neuron and related disorders.
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24
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Oliviero G, Ruggiero L, D’Antonio E, Gagliardi M, Nunziata R, Di Sarno A, Abbatiello C, Di Feo E, De Vivo S, Santonicola A, Iovino P. Impact of COVID-19 lockdown on symptoms in patients with functional gastrointestinal disorders: Relationship with anxiety and perceived stress. Neurogastroenterol Motil 2021; 33:e14092. [PMID: 33550640 PMCID: PMC7995091 DOI: 10.1111/nmo.14092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.
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Affiliation(s)
- Giovanni Oliviero
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Luigi Ruggiero
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Elvira D’Antonio
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Mario Gagliardi
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Rubino Nunziata
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Alessandro Di Sarno
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Carmelina Abbatiello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Elvira Di Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Simona De Vivo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoBaronissiItaly
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Kim HS, Park JH, Lee HS, Lee JY, Jung JW, Park SB, Hyun DJ, Park S, Yoon J, Lim H, Choi YY, Kim MJ. Effects of Wearable Powered Exoskeletal Training on Functional Mobility, Physiological Health and Quality of Life in Non-ambulatory Spinal Cord Injury Patients. J Korean Med Sci 2021; 36:e80. [PMID: 33783145 PMCID: PMC8007419 DOI: 10.3346/jkms.2021.36.e80] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients. METHODS Participants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timed-up-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale-International and the 36-Item Short-Form Health Survey version 2. RESULTS Ten participants finished 30 sessions of training and could ambulate independently. No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants. CONCLUSION In conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04055610.
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Affiliation(s)
- Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Ho Seok Lee
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Won Jung
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Si Bog Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Jin Hyun
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Sangin Park
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - JuYoung Yoon
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Hyunseop Lim
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea.
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26
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Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res 2021; 20:43-52. [PMID: 33472342 PMCID: PMC8831770 DOI: 10.5217/ir.2020.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/12/2020] [Indexed: 11/17/2022] Open
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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27
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Poola S, Jampala N, Tumin D, Ali E. Factors influencing inpatient colonoscopy bowel preparation quality. MINERVA GASTROENTERO 2020; 66:194-200. [PMID: 32218419 DOI: 10.23736/s1121-421x.20.02657-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Colonoscopy is highly sensitive for the visualization of the entire colon. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution. The purpose of this study was to identify factors that predict inadequate bowel preparation for inpatient colonoscopies. METHODS All patients ages >18 years of age undergoing inpatient colonoscopy in 2017-2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital length of stay (LOS). Outcomes were compared using multivariable regression with stepwise covariate selection. RESULTS The analysis included 315 patients (median age =67 years; 45% female). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization compared to adequate visualization (36% vs. 11%, P=0.014). There was no increased colonoscopy duration with poor visualization (P=0.075). There was no significant LOS with worse visualization quality (P=0.185). Factors predicting worse visualization quality included older age, history of congestive heart failure (CHF), cirrhosis, and motility disorders. CONCLUSIONS At our institution, patients who were older or had significant comorbid conditions (chronic artery disease, CHF, chronic obstructive pulmonary disease, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Bowel preparation type did not affect the duration, quality of visualization, or successful cecal intubation.
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Affiliation(s)
- Shiva Poola
- Department of Internal Medicine/Pediatrics, Vidant Medical Center/Brody School of Medicine, Greenville, NC, USA -
| | - Nannaya Jampala
- Deparment of Gastroenterology, Vidant Medical Center/Brody School of Medicine, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Vidant Medical Center/Brody School of Medicine, Greenville, NC, USA
| | - Eslam Ali
- Deparment of Gastroenterology, Vidant Medical Center/Brody School of Medicine, Greenville, NC, USA
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28
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Abstract
Bowel dysfunction, especially ileus, has been increasingly recognized in critically ill patients. Ileus is commonly associated to constipation, however abnormal motility can also concern the upper digestive tract, therefore impaired gastrointestinal transit (IGT) seems to be a more appropriate term. IGT, especially constipation, is common among patients under mechanical ventilation, occurring in up to 80% of the patients during the first week, and has been associated with worse outcome in intensive care unit (ICU). It is acknowledged that the most relevant definition for constipation in ICU is the absence of stool for the first six days after admission. Concerning the upper digestive intolerance (UDI), the diagnosis should rely only on vomiting and the systematic gastric residual volume (GRV) monitoring should be avoided. IGT results from a complex pathophysiology in which both the critical illness and its specific treatments may have a deleterious role. Both observational and experimental studies have shown the deleterious effect of sepsis, multiorgan failure, sedation (especially opioids) and mechanical ventilation on gut function. To date few studies have reported effect of treatment on IGT and the level of evidence is low. However, cholinesterase inhibitors seem safe and could probably be used in case of constipation but remains poorly prescribed. Prevention with bowel management protocol using osmotic laxatives appears to be safe but did not demonstrate its effectiveness. For patients treated with high posology of opioids during sedation, enteral opioid antagonists may be a promising strategy.
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Affiliation(s)
- Philippe Ariès
- Clermont-Tonnerre Military Teaching Hospital, Brest, France.,Val-de-Grâce French Military Health Service Academy, Paris, France.,Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France - .,UFR of Medicine, University of Western Brittany, Brest, France
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29
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Chun A, Asselin PK, Knezevic S, Kornfeld S, Bauman WA, Korsten MA, Harel NY, Huang V, Spungen AM. Changes in bowel function following exoskeletal-assisted walking in persons with spinal cord injury: an observational pilot study. Spinal Cord 2020; 58:459-466. [PMID: 31822808 PMCID: PMC7145720 DOI: 10.1038/s41393-019-0392-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 01/15/2023]
Abstract
STUDY DESIGN Prospective, observational study. OBJECTIVE To explore the effects of exoskeletal-assisted walking (EAW) on bowel function in persons with spinal cord injury (SCI). SETTING Ambulatory research facility located in a tertiary care hospital. METHODS Individuals 18-65 years of age, with thoracic vertebrae one (T1) to T11 motor-complete paraplegia of at least 12 months duration were enrolled. Pre- and post-EAW training, participants were asked to report on various aspects of their bowel function as well as on their overall quality of life (QOL) as related to their bowel function. RESULTS Ten participants completed 25-63 sessions of EAW over a period of 12-14 weeks, one participant was lost to follow up due to early withdrawal after ten sessions. Due to the small sample size, each participant's results were presented descriptively in a case series format. At least 5/10 participants reported improvements with frequency of bowel evacuations, less time spent on bowel management per bowel day, fewer bowel accidents per month, reduced laxative and/or stool softener use, and improved overall satisfaction with their bowel program post-EAW training. Furthermore, 8/10 reported improved stool consistency and 7/10 reported improved bowel function related QOL. One participant reported worsening of bowel function post-EAW. CONCLUSION Between 50 and 80% of the participants studied reported improvements in bowel function and/or management post-EAW training. EAW training appeared to mitigate SCI-related bowel dysfunction and the potential benefits of EAW on bowel function after SCI is worthy or further study.
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Affiliation(s)
- Audrey Chun
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Pierre K Asselin
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Steven Knezevic
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Stephen Kornfeld
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - William A Bauman
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mark A Korsten
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Noam Y Harel
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vincent Huang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ann M Spungen
- VA Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, 10468, USA.
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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30
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Melanosis coli: A comprehensive review. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:266-272. [PMID: 32094046 DOI: 10.1016/j.gastrohep.2020.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 01/11/2023]
Abstract
Melanosis coli (MC) is a common condition characterized by a black or brown pigment deposited in the colorectal mucosa. It is a reversible condition that is influenced by many factors, such as living habits and bowel function. However, the epidemiology and etiology of MC are still unclear. Most studies show that there is a significant correlation between the use of anthraquinone laxatives and the occurrence of MC. At present, the mechanism of the apoptosis theory is widely recognized as regards the pathogenesis of MC. There is no specific clinical manifestation of MC, and its diagnosis is mainly based on a complimentary examination, such as endoscopic and histopathological tests. General treatment, such as changing living habits, is preferred, and medical or surgical treatment should not be considered in the absence of serious malignancy. The aim of this review is to systematically present and outline the concepts of the epidemiology, etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and treatment of MC, in order to improve the understanding of this condition.
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Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020; 17:21-39. [PMID: 31690829 DOI: 10.1038/s41575-019-0222-y] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Michael Camilleri
- C.E.N.T.E.R. Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Matsumoto-Miyazaki J, Asano Y, Takei H, Ikegame Y, Shinoda J. Acupuncture for Chronic Constipation in Patients with Chronic Disorders of Consciousness After Severe Traumatic Brain Injury. Med Acupunct 2019; 31:218-223. [PMID: 31456867 DOI: 10.1089/acu.2019.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Patients with chronic disorders of consciousness (DOC) frequently develop chronic constipation. This study evaluated the effects of acupuncture on bowel movements (BMs) in patients with DOC and chronic constipation resulting from severe traumatic brain injury (TBI). Materials and Methods: This retrospective observational study took place in the Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, of Kizawa Memorial Hospital, in Minokamo, Gifu, Japan. The study included 25 patients with chronic DOC resulting from TBI, who received acupuncture treatment. The patients received 2 sessions of acupuncture treatment per week. Information on frequency of defecation, number of days during which patients had BMs, and use of laxatives prior to the acupuncture treatment and after 10 weeks of treatment was extracted from medical records and compared. Results: The median (first quartile and third quartile) frequency of defecation increased significantly after 10 weeks of acupuncture from 3.0 (2.5, 3.5) to 3.5 (2.5, 4.5) times/week (P = 0.038). The number of days on which defecation occurred also increased significantly, from 2.0 (2.0, 2.5) to 2.5 (2.0, 3.5) days/week (P < 0.001). The use of bisacodyl suppositories decreased significantly from 1.5 (1.5, 2.0) to 1.5 (0.5, 2.0) times/week (P = 0.041). The mean ± standard error use of sodium picosulfate for 10 patients decreased significantly, from 20.4 ± 3.5 to 14.3 ± 3.3 drops/week (P = 0.004). Conclusions: Acupuncture treatment could be beneficial for chronic constipation in patients with DOC caused by TBI. A large prospective cohort study with a control group is warranted.
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Affiliation(s)
- Jun Matsumoto-Miyazaki
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Gifu, Japan
| | - Hiroaki Takei
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan
| | - Yuka Ikegame
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan
| | - Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Gifu, Japan
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Abstract
Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.
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The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents. GASTROENTEROLOGY REVIEW 2018; 13:299-304. [PMID: 30581504 PMCID: PMC6300848 DOI: 10.5114/pg.2018.79809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/25/2018] [Indexed: 01/06/2023]
Abstract
Introduction Constipation is one of the most frequent clinical and nursing problems both in palliative care patients and in nursing home residents. Aim To assess the occurrence of constipation and its risk factors in adult inpatient palliative care units versus nursing homes. Material and methods An epidemiological study was performed in an inpatient hospice and a nursing home. Results Fifty-one hospice patients and 49 nursing home residents were included in the study. Cancer was the main clinical condition in 90% of the palliative care patients (PCPs), and dementia or other psychotic disorders were predominant in the nursing home residents (NHRs). More PCPs had constipation than did NHRs (80% vs. 59%; p = 0.02), although none of the single constipation symptoms differed statistically between these two groups. The insufficient food intake was twice as severe in the hospice patients (p = 0.0001). 68.6% of PCPs took strong opioids, while none of the NHRs did. Three times more NHRs spent at least 50% of daytime in bed than did PCPs (73.5% vs. 23.5%; p < 0.0001). Conclusions Constipation is very frequent in both palliative care patients and nursing home residents, but PCPs are more prone to it. The NHR and PCR groups should not be treated uniformly as the end-of-life population, referring to prevention and treatment of constipation, therapy needs, and the means enrolled for optimal symptom control.
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Nakano J, Hashizume K, Fukushima T, Ueno K, Matsuura E, Ikio Y, Ishii S, Morishita S, Tanaka K, Kusuba Y. Effects of Aerobic and Resistance Exercises on Physical Symptoms in Cancer Patients: A Meta-analysis. Integr Cancer Ther 2018; 17:1048-1058. [PMID: 30352523 PMCID: PMC6247562 DOI: 10.1177/1534735418807555] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective. This study aimed to conduct a meta-analysis to
establish the effect of exercise interventions on physical symptoms, including
fatigue, nausea/vomiting, pain, dyspnea, insomnia, loss of appetite,
constipation, and diarrhea in cancer patients and survivors.
Methods. We searched articles published before April 2017
using the following databases: Cochrane Library, PubMed/MEDLINE, CINAHL, Scopus,
PEDro, Health & Medical Collection, and Psychology Database. Randomized
controlled trials (RCTs) of exercise intervention in cancer patients, which
evaluated cancer-related physical symptoms using the European Organization for
Research and Treatment of Cancer Quality of Life Questionnaire-C30, were
included. Symptom scale data were extracted for meta-analysis. Subgroup analyses
were performed for exercise types (aerobic, resistance, and mixed exercise
programs). Results. Of the 659 articles, 10 RCTs were included
in the meta-analysis, of which the mean PEDro score was 5.43 (SD = 1.28).
Fatigue, pain, dyspnea, and insomnia were significantly lower in the
intervention group than in the control group at postintervention in cancer
patients. However, exercise intervention did not promote or suppress
nausea/vomiting, loss of appetite, constipation, and diarrhea in cancer
patients. The effect of exercise type on each symptom was not different.
Conclusion. Exercise intervention was confirmed to improve
fatigue, pain, and insomnia and might have reduced dyspnea in cancer patients.
However, the benefits of exercise on nausea/vomiting, loss of appetite,
constipation, and diarrhea were not shown in any exercise type. Further research
is warranted to examine the effects of exercise interventions on physical
symptoms in cancer patients.
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Affiliation(s)
- Jiro Nakano
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kaori Hashizume
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuya Fukushima
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.,2 Nagasaki University Hospital, Nagasaki, Japan
| | - Kazumi Ueno
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Matsuura
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuta Ikio
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.,3 Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Shun Ishii
- 2 Nagasaki University Hospital, Nagasaki, Japan
| | | | - Koji Tanaka
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoko Kusuba
- 1 Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abstract
OBJECTIVE Most of the studies have defined constipation as a period without stool after ICU admission. We aimed to test the impact of both duration and timing of infrequent defecation in critical care patients. PATIENTS AND METHODS We performed a prospective, bi-center, observational study. Patients were divided into three subgroups: 'not constipated', '3-5 days', and 'at least 6 days' (longest period without stool passage, respectively, shorter than 3 days, 3-5 days, and ≥6 days). Furthermore, 'early' constipated patients were defined as those for whom the longest time to stool passage occurred just after ICU admission, whereas for 'late' constipated patients the longest period without stool occurred later during ICU stay. RESULTS A total of 182 patients were included: the mean age was 67.2 years (54.4-78.9 years), 80 were women, and simplified acute physiology score II was 42 (34-52). In all, 42 (23.1%), 82 (45.1%), and 58 (31.8%) belonged to the nonconstipated, 3-5 days, or greater than or equal to 6 days subgroup of patients, respectively. Time spent under mechanical ventilation and ICU length of stay was longer in the greater than or equal to 6 days subgroups as compared with both other subgroups. ICU stay was longer in the 3-5 days subgroup as compared with the not constipated patients. Furthermore, the late patients of the greater than or equal to 6 days subgroups exhibited worse survival as compared with all other patients. CONCLUSION Both timing and duration of infrequent defecation seem to have an impact on critical care patient's outcome, and should therefore be included in the diagnostic criteria.
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Xu L, Wang T, Chen T, Yang WQ, Liang ZP, Zhu JC. Identification of risk factors for enteral feeding intolerance screening in critically ill patients. Saudi Med J 2018; 38:816-825. [PMID: 28762434 PMCID: PMC5556298 DOI: 10.15537/smj.2017.8.20393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To identify risk factors for enteral feeding intolerance screening in critically ill patients, thereby, provide some reference for healthcare staff to assess the risk of feeding intolerance, and lay the foundation for future scale development. Methods: This study used a mixed methodology, including a literature review, semi-structured interviews, the Delphi technique, and the analytic hierarchy process. We used the literature review and semi-structured interviews (n=22) to draft a preliminarily item pool for feeding intolerance, Delphi technique (n=30) to screen and determine the items, and the analytic hierarchy process to calculate the weight of each item. The study was conducted between June 2014 and September 2015 in Daping Hospital, Third Military Medical University, Chongqing, China. Results: Twenty-three risk factors were selected for the scale, including 5 dimensions. We assigned a weight to each item according to their impact on the feeding intolerance, with a higher score indicating a greater impact. The weight of each dimension was decreasing as follows: patient conditions, weight score equals 42; general conditions, weight score equals 23; gastrointestinal functions, weight score equals 15; biochemical indexes, weight score equals 14; and treatment measures, weight score equals 6. Conclusion: Developed list of risk factors based on literature review, survey among health care professionals and expert consensus should provide a basis for future studies assessing the risk of feeding intolerance in critically ill patients.
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Affiliation(s)
- Lei Xu
- School of Nursing, Third Military Medical University, Chongqing, China. E-mail.
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Abstract
PURPOSE Variations in the caliber of human large intestinal tract causes changes in pressure and the velocity of its contents, depending on flow volume, gravity, and density, which are all variables of Bernoulli's principle. Therefore, it was hypothesized that constipation and diarrhea can occur due to changes in the colonic transit time (CTT), according to Bernoulli's principle. In addition, it was hypothesized that high amplitude peristaltic contractions (HAPC), which are considered to be involved in defecation in healthy subjects, occur because of cecum pressure based on Bernoulli's principle. METHODS A virtual healthy model (VHM), a virtual constipation model and a virtual diarrhea model were set up. For each model, the CTT was decided according to the length of each part of the colon, and then calculating the velocity due to the cecum inflow volume. In the VHM, the pressure change was calculated, then its consistency with HAPC was verified. RESULTS The CTT changed according to the difference between the cecum inflow volume and the caliber of the intestinal tract, and was inversely proportional to the cecum inflow volume. Compared with VHM, the CTT was prolonged in the virtual constipation model, and shortened in the virtual diarrhea model. The calculated pressure of the VHM and the gradient of the interlocked graph were similar to that of HAPC. CONCLUSION The CTT and HAPC can be explained by Bernoulli's principle, and constipation and diarrhea may be fundamentally influenced by flow dynamics.
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The Mexican consensus on chronic constipation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The Mexican consensus on chronic constipation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:168-189. [PMID: 29555103 DOI: 10.1016/j.rgmx.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/08/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Significant advances have been made in the knowledge and understanding of the epidemiology, pathophysiology, diagnosis, and treatment of chronic constipation, since the publication of the 2011 guidelines on chronic constipation diagnosis and treatment in Mexico from the Asociación Mexicana de Gastroenterología. AIMS To present a consensus review of the current state of knowledge about chronic constipation, providing updated information and integrating the new scientific evidence. METHODS Three general coordinators reviewed the literature published within the time frame of January 2011 and January 2017. From that information, 62 initial statements were formulated and then sent to 12 national experts for their revision. The statements were voted upon, using the Delphi system in 3 voting rounds (2 electronic and one face-to-face). The statements were classified through the GRADE system and those that reached agreement >75% were included in the consensus. RESULTS AND CONCLUSIONS The present consensus is made up of 42 final statements that provide updated knowledge, supplementing the information that had not been included in the previous guidelines. The strength of recommendation and quality (level) of evidence were established for each statement. The current definitions of chronic constipation, functional constipation, and opioid-induced constipation are given, and diagnostic strategies based on the available diagnostic methods are described. The consensus treatment recommendations were established from evidence on the roles of diet and exercise, fiber, laxatives, new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, and surgery.
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Welch C, K Hassan-Smith Z, A Greig C, M Lord J, A Jackson T. Acute Sarcopenia Secondary to Hospitalisation - An Emerging Condition Affecting Older Adults. Aging Dis 2018; 9:151-164. [PMID: 29392090 PMCID: PMC5772853 DOI: 10.14336/ad.2017.0315] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022] Open
Abstract
There has been increasing interest and research into sarcopenia in community-dwelling older adults since the European Working Group on Sarcopenia in Older People (EWGSOP) agreed a consensus definition in 2010. Sarcopenia has been defined as loss of muscle mass with loss of muscle function (strength or physical performance), with measurements two Standard Deviations (SDs) below the mean of a young reference population. This definition does not necessitate longitudinal measurements, or the absence of acute illness and diagnosis can be made from single measurements. We hypothesise that hospitalisation, due to a combination of acute inflammatory burden and muscle disuse, leads to an acute decline in muscle mass and function and may lead to some individuals meeting criteria for sarcopenia, acutely, based on the EWGSOP definition. This may be partially recoverable or may lead to increased risk of developing sarcopenia long-term. We have denoted the term “acute sarcopenia” to refer to acute loss of muscle mass and function associated with hospitalisation. This review discusses some of the current available research in this context and also identifies some of the knowledge gaps and potential areas for future research.
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Affiliation(s)
- Carly Welch
- 1Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,2Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham: B15 2WB, UK
| | - Zaki K Hassan-Smith
- 2Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham: B15 2WB, UK.,3Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,4Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Carolyn A Greig
- 5School of Sport, Exercise & Rehabilitation Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,6MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Janet M Lord
- 1Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,6MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Thomas A Jackson
- 1Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,2Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham: B15 2WB, UK
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Weatherly DL, Szymanski KM, Whittam BM, Bennett WE, King S, Misseri R, Kaefer M, Rink RC, Cain MP. Comparing inpatient versus outpatient bowel preparation in children and adolescents undergoing appendicovesicostomy. J Pediatr Urol 2018; 14:50.e1-50.e6. [PMID: 28917602 DOI: 10.1016/j.jpurol.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/08/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric urology has come under scrutiny, secondary to literature demonstrating little benefit regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive procedures at our institution no longer underwent IBP. We hypothesized that outpatient bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative complications after appendicovesicostomy surgery. MATERIALS AND METHODS An institutional database of patients undergoing lower urinary tract reconstruction between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty or continent ileovesicostomy were excluded because of insufficient numbers undergoing OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013. Cost data were obtained from the Pediatric Health Information System. RESULTS Sixty-seven patients met the inclusion criteria, with 30 (44.8%) undergoing IBP. There were no differences with respect to gender, age, presence of ventriculoperitoneal shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified as Clavien-Dindo grade 1-2, with no statistical difference (IBP 20.0% vs. OBP 5.4%, p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel obstruction, or shunt infection. DISCUSSION This is the first analysis of hospitalization costs and IBP, showing a higher median cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar to a previous report. Similar complication rates between the groups add to the growing body of literature that avoidance of IBP is safe in pediatric lower urinary tract reconstruction. Being a retrospective review of a practice change, differences in care that influenced cost and LOS may be missing. Also, as the surgeons do not know if a usable appendix is initially present, our data may not extrapolate to all patients. Despite these potential limitations, our data support the safety of utilizing OBP in patients with a high likelihood of a usable appendix, including those undergoing a synchronous Malone antegrade continence enema via a split-appendix technique. CONCLUSION In patients undergoing an appendicovesicostomy, preoperative IBP led to longer LOS and higher costs of hospitalization. OBP was not associated with increased risks of postoperative complications.
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Affiliation(s)
- David L Weatherly
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
| | - Benjamin M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - William E Bennett
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Shelly King
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Baffy N, Foxx-Orenstein AE, Harris LA, Sterler S. Intractable Constipation in the Elderly. ACTA ACUST UNITED AC 2017; 15:363-381. [PMID: 28801825 DOI: 10.1007/s11938-017-0142-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Chronic constipation is a common gastrointestinal disorder disproportionately affecting the elderly. Immobility, polypharmacy, and physiologic changes contribute to its increased prevalence in this population. Unidentified and undertreated constipation leads to a significant negative impact on quality of life and an increase in healthcare spending. Careful physical examination and exploration of the clinical history can unmask primary and secondary forms of constipation, guiding diagnostic and therapeutic considerations. Non-pharmacologic treatment options include bowel training and biofeedback as well as the addition of fiber. Laxatives are safe and can be used long term; thus, they remain the mainstay of therapy. Newer agents with specific physiologic targets have proven to be effective in adults with chronic constipation, but data is lacking for safety profile in the elderly. Consideration for surgery in medically refractory cases should be entertained, while use of neuromodulation is not ready for prime time. This is a review of the currently available treatment options for chronic constipation in adults and specifically tailored towards the elderly.
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Affiliation(s)
- Noemi Baffy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA
| | - Amy E Foxx-Orenstein
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
| | - Lucinda A Harris
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA
| | - Susan Sterler
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA
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Tantawy SA, Kamel DM, Abdelbasset WK, Elgohary HM. Effects of a proposed physical activity and diet control to manage constipation in middle-aged obese women. Diabetes Metab Syndr Obes 2017; 10:513-519. [PMID: 29276399 PMCID: PMC5734236 DOI: 10.2147/dmso.s140250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Obesity is very common worldwide and is related to critical morbidity and mortality. It has a large number of impacts on the human body. Constipation has a prevalence from 4% to 29% in various parts of the world and is considered to be a major health problem, with an estimated incidence of 5% in males and 15% in females. There is a strong association between obesity and constipation. This study aimed to investigate the effect of physical activity and a low-calorie diet on constipation in middle-aged obese women. METHODS This study included 125 obese women (age 20-40 years) who had chronic constipation. Participants were randomly assigned to two groups. Group A included 62 women who received a suggested protocol of physical activity, a low-calorie diet, and the routine standard care for constipation, whereas Group B included 63 women who received only the standard medical care for constipation and a low-calorie diet. Both groups followed the program for 12 weeks. Changes in the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment Quality of Life (PAC-QOL) scores, and in the body mass index (BMI) were recorded in study subjects, both at baseline and at the end of the study program. RESULTS There were no statistically significant differences in the baseline characteristics of patients in the two groups. After 12 weeks of intervention, both groups showed significant intra-group differences (p < 0.05) in all of the measured variables, except the BMI which showed a nonsignificant difference (p > 0.05) in Group B. Between-groups comparison showed significant differences (p < 0.05) in all of the measured parameters in favor of Group A. CONCLUSION Physical activity and weight reduction improve PAC-SYM and PAC-QOL scores in middle-aged, premenopausal women with constipation in the short term (up to 12 weeks).
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Affiliation(s)
- Sayed A Tantawy
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine, Cairo University, Giza, Egypt
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Correspondence: Sayed A Tantawy, Department of Physiotherapy, College of Medical Health and Sciences, Ahlia University, P.O. Box 10878 Manama, Kingdom of Bahrain, Tel +973 3688 3977, Fax +973 1729 0083, Email
| | - Dalia M Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy of Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Cairo, Egypt
| | - Hany M Elgohary
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Lim YJ, Rosita J, Chieng JY, Hazizi AS. The Prevalence and Symptoms Characteristic of Functional Constipation Using Rome III Diagnostic Criteria among Tertiary Education Students. PLoS One 2016; 11:e0167243. [PMID: 27997551 PMCID: PMC5172545 DOI: 10.1371/journal.pone.0167243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Functional constipation is very common with heterogeneous symptoms that have substantial impact on patient quality of life as well as medical resources which are rarely reported as life-threatening. The aim of this study is to examine the prevalence and symptoms characteristic of functional constipation (FC) by using Rome III diagnostic criteria among tertiary education students with an intention to introduce treatment in the future. METHODS Demographic, socio-economics characteristics and symptoms of FC using the Rome III criteria were sought using a questionnaire administered to Malaysian students in a tertiary education setting. Other data obtained were the general health status, lifestyle factors and anthropometric measurements. Using a simple random sampling method, a total of 1662 students were recruited in the study with a response rate of 95.0%. Sampled data are presented as frequency and percentage and stratified accordingly into categories for Chi-square analysis. RESULTS The prevalence of functional constipation among the students was 16.2%, with a significantly higher prevalence among women (17.4%) than men (12.5%). Hard or lumpy stool, incomplete evacuation, anorectal obstruction and straining were reported as the commonest symptoms experienced. Type 3 was the most frequent stool consistency experienced among the constipated individuals (35.2%). Only 4.4% of individuals reported having less than three defecations per week. Using univariable analysis, FC was significantly associated with sex (odds ratio: 1.48, 95% CI: 1.06-2.06) and age group (odds ratio: 1.34, 95% CI: 1.01-1.79) with P value < 0.05 significance level. In multivariate logistic regression analysis, only sex was found significantly associated with FC (adjusted odds ratio: 1.53, 95% CI: 1.08-2.17, P < 0.05). CONCLUSIONS Based on the prevalence rate, constipation is a common problem among tertiary education students (16.2%), with significantly more prevalence among the female respondents. Early detection of symptoms and further intervention studies focusing on treatment recommendation in improving the symptoms are essential.
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Affiliation(s)
- Ying Jye Lim
- Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia
| | - Jamaluddin Rosita
- Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia
| | - Jin Yu Chieng
- Department of Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia
| | - Abu Saad Hazizi
- Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia
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Wiklund M, Sundqvist E, Fagevik Olsén M. Physical Activity in the Immediate Postoperative Phase in Patients Undergoing Roux-en-Y Gastric Bypass-a Randomized Controlled Trial. Obes Surg 2016; 25:2245-50. [PMID: 25910983 DOI: 10.1007/s11695-015-1690-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study is to register the number of steps taken during the first postoperative week by patients who underwent laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) and evaluate whether goals for steps taken per day could affect the patients' physical activity level, time to first flatus and stool, days at hospital, and recovery. METHODS Fifty-five patients undergoing LRYGB surgery carried a step counter on the first postoperative week and recorded the number of steps taken. They also registered hours spent sitting, lying down and sleeping, assessed their level of recovery, and noted the first day of flatus and defecation. The intervention group was informed to try to reach a daily goal regarding the number of steps to be taken. RESULTS The patients took 2000-3000 steps/day on the first postoperative days. There were significant differences between the groups in numbers of steps taken in favor of the intervention group on four of the postoperative days. The patients in the intervention group found that the goals were set at the right level, except for the second day, where they thought 1300 steps were too few. There were no significant differences between the groups in the mean time spent sitting or lying. Neither were there any differences in time for first flatus, stool, days at hospital, nor degree of recovery. CONCLUSIONS Goals set for steps taken per day increase the amount of steps walked in patients undergoing gastric bypass surgery. Step counters and predefined goals can be used to facilitate mobilization after obesity surgery.
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Affiliation(s)
- Malin Wiklund
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ellen Sundqvist
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastroenterol 2015; 15:130. [PMID: 26467668 PMCID: PMC4604730 DOI: 10.1186/s12876-015-0366-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/04/2015] [Indexed: 02/07/2023] Open
Abstract
Constipation is a frequently reported bowel symptom in the elderly with considerable impact on quality of life and health expenses. Disease-related morbidity and even mortality have been reported in the affected frail elderly. Although constipation is not a physiologic consequence of normal aging, decreased mobility, medications, underlying diseases, and rectal sensory-motor dysfunction may all contribute to its increased prevalence in older adults. In the elderly there is usually more than one etiologic mechanism, requiring a multifactorial treatment approach. The majority of patients would respond to diet and lifestyle modifications reinforced by bowel training measures. In those not responding to conservative treatment, the approach needs to be tailored addressing all comorbid conditions. In the adult population, the management of constipation continues to evolve as well as the understanding of its complex etiology. However, the constipated elderly have been left behind while gastroenterology consultations for this common conditions are at a rise for the worldwide age increment. Aim of this review is to provide an update on epidemiology, quality of life burden, etiology, diagnosis, current approaches and limitations in the management of constipation in the older ones to ease the gastroenterologists’ clinic workload.
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Affiliation(s)
- Roberto De Giorgio
- Department of Medical and Surgical Sciences/Digestive system, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Eugenio Ruggeri
- Department of Medical and Surgical Sciences/Digestive system, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences/Digestive system, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Leonardo H Eusebi
- Department of Medical and Surgical Sciences/Digestive system, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences/Digestive system, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, AOUI Verona, Verona, Italy. .,UNC Center for Functional GI & Motility Disorder, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Division of Gastroenterology of the University of Verona, Ospedale Policlinico GB Rossi, Piazzale LA Scuro, 10, 37134, Verona, Italy.
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48
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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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Gombash SE, Cowley CJ, Fitzgerald JA, Iyer CC, Fried D, McGovern VL, Williams KC, Burghes AHM, Christofi FL, Gulbransen BD, Foust KD. SMN deficiency disrupts gastrointestinal and enteric nervous system function in mice. Hum Mol Genet 2015; 24:3847-60. [PMID: 25859009 DOI: 10.1093/hmg/ddv127] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/07/2015] [Indexed: 12/19/2022] Open
Abstract
The 2007 Consensus Statement for Standard of Care in Spinal Muscular Atrophy (SMA) notes that patients suffer from gastroesophageal reflux, constipation and delayed gastric emptying. We used two mouse models of SMA to determine whether functional GI complications are a direct consequence of or are secondary to survival motor neuron (Smn) deficiency. Our results show that despite normal activity levels and food and water intake, Smn deficiency caused constipation, delayed gastric emptying, slow intestinal transit and reduced colonic motility without gross anatomical or histopathological abnormalities. These changes indicate alterations to the intrinsic neural control of gut functions mediated by the enteric nervous system (ENS). Indeed, Smn deficiency led to disrupted ENS signaling to the smooth muscle of the colon but did not cause enteric neuron loss. High-frequency electrical field stimulation (EFS) of distal colon segments produced up to a 10-fold greater contractile response in Smn deficient tissues. EFS responses were not corrected by the addition of a neuronal nitric oxide synthase inhibitor indicating that the increased contractility was due to hyperexcitability and not disinhibition of the circuitry. The GI symptoms observed in mice are similar to those reported in SMA patients. Together these data suggest that ENS cells are susceptible to Smn deficiency and may underlie the patient GI symptoms.
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Affiliation(s)
| | | | | | - Chitra C Iyer
- Department of Molecular & Cellular Biochemistry, Wexner Medical Center and
| | - David Fried
- Department of Physiology, Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA and
| | - Vicki L McGovern
- Department of Molecular & Cellular Biochemistry, Wexner Medical Center and
| | - Kent C Williams
- Division of Pediatric Gastroenterology, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Arthur H M Burghes
- Department of Molecular & Cellular Biochemistry, Wexner Medical Center and
| | - Fedias L Christofi
- Department of Anesthesiology, The Ohio State University, Columbus, OH 43210, USA
| | - Brian D Gulbransen
- Department of Physiology, Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA and
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Iovino P, Bucci C, Tremolaterra F, Santonicola A, Chiarioni G. Bloating and functional gastro-intestinal disorders: Where are we and where are we going? World J Gastroenterol 2014; 20:14407-14419. [PMID: 25339827 PMCID: PMC4202369 DOI: 10.3748/wjg.v20.i39.14407] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.
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