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Baidoo N, Sanger GJ. The human colon: Evidence for degenerative changes during aging and the physiological consequences. Neurogastroenterol Motil 2024:e14848. [PMID: 38887160 DOI: 10.1111/nmo.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/16/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The incidence of constipation increases among the elderly (>65 years), while abdominal pain decreases. Causes include changes in lifestyle (e.g., diet and reduced exercise), disease and medications affecting gastrointestinal functions. Degenerative changes may also occur within the colo-rectum. However, most evidence is from rodents, animals with relatively high rates of metabolism and accelerated aging, with considerable variation in time course. In humans, cellular and non-cellular changes in the aging intestine are poorly investigated. PURPOSE To examine all available studies which reported the effects of aging on cellular and tissue functions of human isolated colon, noting the region studied, sex and age of tissue donors and study size. The focus on human colon reflects the ability to access full-thickness tissue over a wide age range, compared with other gastrointestinal regions. Details are important because of natural human variability. We found age-related changes within the muscle, in the enteric and nociceptor innervation, and in the submucosa. Some involve all regions of colon, but the ascending colon appears more vulnerable. Changes can be cell- and sublayer-dependent. Mechanisms are unclear but may include development of "senescent-like" and associated inflammaging, perhaps associated with increased mucosal permeability to harmful luminal contents. In summary, reduced nociceptor innervation can explain diminished abdominal pain among the elderly. Degenerative changes within the colon wall may have little impact on symptoms and colonic functions, because of high "functional reserve," but are likely to facilitate the development of constipation during age-related challenges (e.g., lifestyle, disease, and medications), now operating against a reduced functional reserve.
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Affiliation(s)
- Nicholas Baidoo
- School of Life Sciences, University of Westminster, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gareth J Sanger
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abu Baker F, Mari A, Taher R, Nicola D, Gal O, Zeina AR. The Yield of Colonoscopy in the Evaluation of Constipation: An Age-Based Analysis of Outcome. J Clin Med 2024; 13:2910. [PMID: 38792451 PMCID: PMC11122582 DOI: 10.3390/jcm13102910] [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: 04/08/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Chronic constipation, a prevalent gastrointestinal complaint, exhibits rising incidence and diverse clinical implications, especially among the aging population. This study aims to assess colonoscopy performance in chronic constipation across age groups, comprehensively evaluating diagnostic yield and comparing results with average-risk controls. Methods: A retrospective analysis was conducted on 50,578 colonoscopy procedures performed over 12 years, including 5478 constipated patients. An average-risk control group (n = 4100) was included. Data extracted from electronic medical records covered demographics, operational aspects, and colonoscopy findings. The primary outcome measures included the diagnosis rate of colorectal cancer (CRC), polyp detection rate (PDR), and inflammatory bowel disease (IBD) diagnoses in constipated patients versus controls, with age-based and multivariate analyses. Results: Constipated patients exhibiting lower rates of adequate bowel preparation (92.7% vs. 85.3%; p < 0.001) and a lower cecal intubation rate. No significant variances between CRC and PDR were observed between constipated and controls, except for a potential of a slightly elevated CRC risk in constipated patients older than 80 (2.50% vs. 0% in controls; p = 0.07). Multivariate analysis demonstrated, across all age groups, that constipation did not confer an increased risk for CRC or polyp detection. Younger constipated patients exhibited a higher rate of IBD diagnoses (1.7% vs. 0.1% in controls; p < 0.001). Conclusions: Constipation did not confer an increased risk for CRC or polyps, among any age groups, except for a potential signal of elevated CRC risk in patients older than 80; additionally, it was associated with higher rates of IBD in younger patients.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; (F.A.B.); (R.T.); (D.N.); (O.G.)
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Nazareth 1613101, Israel;
| | - Randa Taher
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; (F.A.B.); (R.T.); (D.N.); (O.G.)
| | - Dorin Nicola
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; (F.A.B.); (R.T.); (D.N.); (O.G.)
| | - Oren Gal
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; (F.A.B.); (R.T.); (D.N.); (O.G.)
| | - Abdel-Rauf Zeina
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; (F.A.B.); (R.T.); (D.N.); (O.G.)
- Department of Radiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
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Amiri M, Hassanzadeh A, Rahimi M. A survey on functional constipation and its risk factors in older people in Shahreza, Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:118. [PMID: 38726080 PMCID: PMC11081462 DOI: 10.4103/jehp.jehp_345_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/28/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Functional constipation is prevalent among older people. It has major effects on the quality of life of them, as well as the high costs of treatment. This study investigated functional constipation and risk factors affecting older people living in Shahreza, Iran. MATERIALS AND METHODS This cross-sectional study was performed on 200 older people in Shahreza. They were selected by simple random sampling. We used the Rome III Criteria, the Elderly Physical Activity Questionnaire (PASE), and related questions from the SIB system (integrated health system). After completing the questionnaires, the data were analyzed using the mean and standard deviation, Chi-square test, independent-samples t-test, Fisher's exact test, and Mann-Whitney test. RESULTS The prevalence of functional constipation was 45%. There are significant relationships between functional constipation with dental problems (P = 0.02), intake of fluid (P = 0.001), fruits (P = 0.001), and vegetables (P < 0.001), polypharmacy (P = 0.003), and antidepressants (P = 0.008), history of colon (P = 0.003) and anal (P = 0.001) diseases, stroke or mobility disabilities (P = 0.002), the level of physical activity (P = 0.002), and gender (P = 0.04) in older people living in Shahreza. CONCLUSIONS According to the high prevalence of functional constipation in the studied older people, it is necessary to focus on controlling risk factors and planning to prevent the destructive effects of social restrictions on older people during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Mina Amiri
- Department of Health Education and HealthPromotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, Health Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rahimi
- Department of Health Education and HealthPromotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Rao SS, Manabe N, Karasawa Y, Hasebe Y, Nozawa K, Nakajima A, Fukudo S. Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: a systematic literature review with meta-analysis and number needed to treat/harm. BMC Gastroenterol 2024; 24:12. [PMID: 38166671 PMCID: PMC10759335 DOI: 10.1186/s12876-023-03104-8] [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: 06/14/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To comprehensively evaluate the efficacy, safety, patient symptoms, and quality-of-life (QoL) of lubiprostone, linaclotide, and elobixibat as treatment for chronic constipation (CC). DESIGN Systematic literature review (SLR) and meta-analysis (MA). Literature searches were conducted on PubMed and Embase using the Ovid platform. METHODS SLR including randomized controlled trials (RCTs) and observational studies was conducted to identify the overall efficacy and safety of lubiprostone, linaclotide, and elobixibat. Thereafter, MA was performed using only RCTs. The number needed to treat (NNT) and number needed to harm (NNH) analyses were additionally conducted. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was efficacy regarding change in spontaneous bowel movements. Secondary outcomes included safety, constipation-related symptoms, and QoL. RESULTS Twenty-four studies met the inclusion criteria for the SLR: 17 RCTs, 4 observational studies, and 3 single-arm trials. Feasibility assessment for the MA resulted in 14 studies available for safety data analysis, and 8 available for efficacy analysis, respectively. Three drugs showed similar efficacy in the MA and NNT analysis. However, the NNH analysis revealed distinct safety profiles: lubiprostone, linaclotide, and elobixibat were linked to the highest risk of nausea, diarrhea, and abdominal pain, respectively. CONCLUSION The current study provides an updated overview of the efficacy, safety, patient symptoms, and QoL of the three drugs with different mechanisms of action for CC treatment.The findings could help physicians adopt an individualized approach for treating patients with CC in clinical practice.
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Affiliation(s)
- Satish S Rao
- Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yusuke Karasawa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan.
| | - Yuko Hasebe
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan
| | - Kazutaka Nozawa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Camilleri E, Blundell R, Cuschieri A. Deciphering the anti-constipation characteristics of palm dates ( Phoenix dactylifera): a review. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2023. [DOI: 10.1080/10942912.2022.2153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Emma Camilleri
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Imsida, Malta
| | - Renald Blundell
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Imsida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Andrea Cuschieri
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Imsida, Malta
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Kang J, Lee M, Park M, Lee J, Lee S, Park J, Koyanagi A, Smith L, Nehs CJ, Yon DK, Kim T. Slow gut transit increases the risk of Alzheimer's disease: An integrated study of the bi-national cohort in South Korea and Japan and Alzheimer's disease model mice. J Adv Res 2023:S2090-1232(23)00397-1. [PMID: 38097171 DOI: 10.1016/j.jare.2023.12.010] [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: 09/17/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 01/02/2024] Open
Abstract
INTRODUCTION Although the association between Alzheimer's disease (AD) and constipation is controversial, its causality and underlying mechanisms remain unknown. OBJECTIVES To investigate the potential association between slow gut transit and AD using epidemiological data and a murine model. METHODS We conducted a bi-national cohort study in South Korea (discovery cohort, N=3,130,193) and Japan (validation cohort, N=4,379,285) during the pre-observation period to determine the previous diagnostic history (2009-2010) and the follow-up period (2011-2021). To evaluate the causality, we induced slow gut transit using loperamide in 5xFAD transgenic mice. Changes in amyloid-beta (Aβ) and other markers were examined using ELISA, qRT-PCR, RNA-seq, and behavioral tests. RESULTS Constipation was associated with an increased risk of AD in the discovery cohort (hazard ratio, 2.04; 95% confidence interval [CI], 2.01-2.07) and the validation cohort (hazard ratio; 2.82; 95% CI, 2.61-3.05). We found that loperamide induced slower gut transit in 5xFAD mice, increased Aβ and microglia levels in the brain, increased transcription of genes related to norepinephrine secretion and immune responses, and decreased the transcription of defense against bacteria in the colonic tissue. CONCLUSION Impaired gut transit may contribute to AD pathogenesis via the gut-brain axis, thus suggesting a cyclical relationship between intestinal barrier disruption and Aβ accumulation in the brain. We propose that gut transit or motility may be a modifiable lifestyle factor in the prevention of AD, and further clinical investigations are warranted.
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Affiliation(s)
- Jiseung Kang
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Mincheol Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jibeom Lee
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Sunjae Lee
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Christa J Nehs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea.
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HUANG X, XIA Y, HAN K, QI W, LINGHU Q, ZHANG Q, XUE J. Hetong decoction relieves loperamide-induced constipation in rats by regulating expression of aquaporins. J TRADIT CHIN MED 2023; 43:1160-1167. [PMID: 37946478 PMCID: PMC10623261 DOI: 10.19852/j.cnki.jtcm.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate whether Hetong decoction (, HTT) alleviates constipation via regulating AQPs expression. METHODS Constipation in rats was induced by loperamide, and rats were randomly assigned into model (saline), HHT-low (95 g/kg), HTT-medium (190 g/kg), HTT-high (380 g/kg) and positive control (mosapride) groups. Then the defecation function, the concentration of serum arginine vasopressin (AVP) and cyclic adenosine monophosphate (cAMP), and the expression of AQP3 and AQP8 in colon tissues were assessed. NCM460 colon cells with AQP3 and AQP8 knockdown or overexpression were exposed to serum from rats that received low or high dose of HTT, followed by detection of AQP3 and AQP8 expression. RESULTS The model group showed lower fecal weight and water content, weaker intestinal transit, higher serum concentration of AVP and cAMP, increased proximal and distal AQP8 expression, increased proximal but decreased distal AQP3 expression. However, these trends were reversed in both the HTT group (low, medium and high dose) and the positive control group. In NCM460 cells, HTT dose-dependently stabilized AQP3 and AQP8 expression under AQP3/8 plasmid interference or overexpression. CONCLUSIONS HTT relieves constipation in rats through regulating AQP3 and AQP8 expression.
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Affiliation(s)
- Xi HUANG
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Youguang XIA
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Kai HAN
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Weiwei QI
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Qing LINGHU
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Qing ZHANG
- 2 Department of Pathology, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
| | - Jingbo XUE
- 1 Department of Anorectal, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
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Zhao T, Lu J, Qin J, Chen Y, Shi Z, Wei W, Xiong P, Ma D, Song X. Altered intestinal barrier contributes to cognitive impairment in old mice with constipation after sevoflurane anesthesia. Front Nutr 2023; 10:1117028. [PMID: 37771755 PMCID: PMC10523324 DOI: 10.3389/fnut.2023.1117028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Elderly patients have a high risk of developing postoperative cognitive dysfunction (POCD). Gastrointestinal disorders, such as constipation, in the elderly population may be involved in the pathogenesis of neurological disorders by promoting inflammatory responses due to a 'leaky gut'. General anesthetic sevoflurane may impair gastrointestinal function in elderly patients to trigger neurological complications following surgery. Therefore, we hypothesized that elderly individuals with gastrointestinal dysfunction may be more vulnerable to sevoflurane and consequently develop POCD. Methods Aged mice were randomly divided into four groups: control (CTRL), CTRL+sevoflurane (Sev), slow transit constipation (STC), and STC + Sev. Mice in the STC and STC + Sev groups were intra-gastrically administrated loperamide (3 mg/kg, twice a day for 7 days) to induce a slow transit constipation (STC) model determined with fecal water content and the time of first white fecal pellet, whereas mice in the other groups received the similar volume of saline. One week later, mice in the CTRL+Sev group and STC + Sev group received 2% sevoflurane for 2 h. The gut permeability evaluated with 4-kDa fluorescein isothiocyanate (FITC)-dextran, serum cytokines, microglia density, TLR4/NF-κB signaling expression, and POCD-like behavioral changes were determined accordingly. Results The loperamide-induced STC mice had decreased fecal water content and prolonged time of first white fecal pellet. Sevoflurane exposure caused significantly increased gut permeability and serum cytokines, as well as the activation of microglia and the TLR4/NF-κB signaling pathway in the prefrontal cortex of the aged STC mice. Sevoflurane also caused cognitive impairment and emotional phenotype abnormality in aged STC mice. Conclusion Aged STC mice were more vulnerable to sevoflurane anesthesia and consequently developed POCD-like behavioral changes. Our data suggest that gastrointestinal disorders including constipation may contribute to the development of POCD.
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Affiliation(s)
- Tianyun Zhao
- The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Junming Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingwen Qin
- Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanxin Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziwen Shi
- Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Wei
- Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
- National Clinical Research Center for Child Health, Zhejiang, China
| | - Xingrong Song
- The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
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Zheng C, Yang Z, Kong L, Gao Z, Lu T, Zhang H. Psychometric evaluation of the Chinese version of the Elderly-Constipation Impact Scale: a translation and validation study. BMC Public Health 2023; 23:1345. [PMID: 37438713 DOI: 10.1186/s12889-023-16231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE The objective of this study was to translate the Elderly-Constipation Impact Scale into Chinese and to examine its reliability and validity in a population of older people suffering from chronic constipation. METHODS In this study, the scale was paraphrased, back-translated, cross-culturally adapted and pre-experimented using the Brislin double translation-back-translation method to create the initial Chinese version of the Elderly-Constipation Impact Scale. A convenience sampling method was used to select 564 study participants who met the inclusion and exclusion criteria in Liaoning and Shanxi, China, to evaluate the reliability and validity of the scale. General information about the study population was using descriptive statistics; item analysis was used to screen the items of the scale. Content validity, exploratory factor analysis, and validation factor analysis were chosen to validate the scales; internal consistency, spilt-half reliability and retest reliability were used determine the reliability of the measurement scales. RESULTS The Chinese version of the Elderly-Constipation Impact Scale contains 7 dimensions and 21 items. The Cronbach's alpha coefficient for the total scale was 0.901 and the range of Cronbach's alpha values for each dimension was 0.707 to 0.918. The split-half reliability of the scale was 0.736 and the retest reliability was 0.763. The exploratory factor analysis showed a KMO value of 0.873 and a Bartlett's spherical test X2 value of 3499.978 (p < 0.001). A total of seven common factors were extracted, namely daily activities, treatment satisfaction, lack of control of bodily function, diet restriction, symptom intensity, anxiety and preventive actions, with a cumulative variance contribution of 77.813%. Each item had a loading value > 0.4 on its common factor. In the validation factor analysis, the model fit results were X2 / df = 1.886, GFI = 0.910, AGFI = 0.874, PGFI = 0.654, IFI = 0.955, TLI = 0.942, CFI = 0.954, RMSEA = 0.056 and PNFI = 0.718. The model fit indicators were all within acceptable limits. CONCLUSION The Chinese version of the E-CIS has good reliability and validity in the chronic constipation population of elderly individuals. The results of the questionnaire can effectively and comprehensively reflect the impact of chronic constipation on the quality of life of elderly individuals. It provides a meaningful reference for identifying targets for intervention.
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Affiliation(s)
- Chen Zheng
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Zhen Yang
- School of Nursing, China Medical University, 77 Puhe Road, Shenyang New District, Shenyang, Liaoning Province, P.R. China
| | - Linghui Kong
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Ziyun Gao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Tingting Lu
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Huijun Zhang
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China.
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OKADA K, TAKAMI D, MAKIZAKI Y, TANAKA Y, NAKAJIMA S, OHNO H, SAGAMI T. Effects of Bifidobacterium longum CLA8013 on bowel movement improvement: a placebo-controlled, randomized, double-blind study. BIOSCIENCE OF MICROBIOTA, FOOD AND HEALTH 2023; 42:213-221. [PMID: 37404567 PMCID: PMC10315193 DOI: 10.12938/bmfh.2022-066] [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: 10/07/2022] [Accepted: 03/18/2023] [Indexed: 07/06/2023]
Abstract
A placebo-controlled, randomized, double-blind study was conducted to evaluate the effect of taking 25 billion colony-forming units of heat-killed Bifidobacterium longum CLA8013 over 2 weeks on bowel movements in constipation-prone healthy individuals. The primary endpoint was the change in defecation frequency between the baseline and 2 weeks after the intake of B. longum CLA8013. The secondary endpoints were the number of days of defecation, stool volume, stool consistency, straining during defecation, pain during defecation, feeling of incomplete evacuation after defecation, abdominal bloating, fecal water content, and the Japanese version of the Patient Assessment of Constipation Quality of Life. A total of 120 individuals were assigned to two groups, 104 (control group, n=51; treatment group, n=53) of whom were included in the analysis. After 2 weeks of consuming the heat-killed B. longum CLA8013, defecation frequency increased significantly in the treatment group compared with that in the control group. Furthermore, compared with the control group, the treatment group showed a significant increase in stool volume and significant improvement in stool consistency, straining during defecation, and pain during defecation. No adverse events attributable to the heat-killed B. longum CLA8013 were observed during the study period. This study revealed that heat-killed B. longum CLA8013 improved the bowel movements of constipation-prone healthy individuals and confirmed that there were no relevant safety issues.
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Affiliation(s)
- Keisuke OKADA
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Daisuke TAKAMI
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Yutaka MAKIZAKI
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Yoshiki TANAKA
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Shunji NAKAJIMA
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Hiroshi OHNO
- R&D Center, Biofermin Pharmaceutical Co., Ltd., 7-3-4
Higashi-machi, Ibukidai, Nishi-ku, Kobe, Hyogo 651-2242, Japan
| | - Toru SAGAMI
- Shinagawa Season Terrace Health Care Clinic, 5F, Shinagawa
Season Terrace, 1-2-70 Konan, Minato-ku, Tokyo 108-0075, Japan
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11
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Wang X, Sun Y, Yan S, Shi H, Zhu L, Gao S, Liu Z. Effectiveness of electroacupuncture versus prucalopride for women with severe chronic constipation: secondary analysis of a randomized controlled trial. Int J Colorectal Dis 2023; 38:20. [PMID: 36662303 DOI: 10.1007/s00384-023-04313-z] [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] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Electroacupuncture (EA) is a component alternative therapy for severe chronic constipation (SCC). Women are more vulnerable to SCC and gender might impact the response of patients with functional gastrointestinal disorders to therapy. We performed this secondary analysis to explore the effectiveness and safety of EA compared with prucalopride among women with SCC. METHODS Based on a multicenter, randomized, noninferiority trial, 446 female patients were randomly assigned to receive 28-session EA (n = 222) over 8 weeks with 24-week follow-up without treatment or to receive prucalopride (n = 224) over 32 consecutive weeks. The primary outcome was the proportion of overall complete spontaneous bowel movements (CSBMs) responders over weeks 1-8, defined as at least three CSBMs per week, and more than an increase of one CSBM from baseline meanwhile for at least 6 weeks during an 8-week treatment period. Secondary outcomes measure sustained CSBM responder, weekly responders, change from baseline in mean weekly CSBMs and SBMs, straining and stool consistency, quality of life, and adverse events (AEs). RESULTS The proportion of overall responders was 25.23% in the EA group, similar to 25.89% in the prucalopride group, with a between-group difference of - 0.67% (95% CI, - 8.80 to 7.40%; P = 0.872) during an 8-week treatment. In the secondary outcomes, EA and prucalopride groups had no significant difference, except that EA was inferior to prucalopride in improving SBMs. The AEs were less in the EA group than the prucalopride group. CONCLUSION EA may be a promising and safe treatment for women with SCC; its effect could sustain 24 weeks after treatment stopped.
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Affiliation(s)
- Xinlu Wang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanjie Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hangyu Shi
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lili Zhu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Gao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:80-87. [PMID: 36548108 DOI: 10.1097/spv.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population. OBJECTIVES The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction. STUDY DESIGN This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used. RESULTS One hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction. CONCLUSIONS Polypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.
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Gao YY, Tang Q, Liu YC, Liu XH, Qian BX, Chai YF, Wang LJ. Unexplained hyperammonemia and encephalopathy in the emergency department: Abernethy malformation in elderly patients. World J Emerg Med 2023; 14:69-71. [PMID: 36713341 PMCID: PMC9842458 DOI: 10.5847/wjem.j.1920-8642.2023.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/12/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Yan-ying Gao
- Department of Hepatology, the Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
| | - Qing Tang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yan-cun Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiao-he Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bao-xin Qian
- Department of Hepatology, the Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
| | - Yan-fen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China,Yan-fen Chai,
| | - Li-jun Wang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China,Corresponding Authors: Li-jun Wang, ;
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Šola KF, Vladimir-Knežević S, Hrabač P, Mucalo I, Saso L, Verbanac D. The effect of multistrain probiotics on functional constipation in the elderly: a randomized controlled trial. Eur J Clin Nutr 2022; 76:1675-1681. [PMID: 35927504 PMCID: PMC9708599 DOI: 10.1038/s41430-022-01189-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Constipation is one of the most common gastrointestinal conditions, particularly among older individuals. This study aimed to evaluate the efficacy and safety of selected multistrain probiotics on functional constipation and laboratory blood parameters in the elderly living in a nursing home. SUBJECTS AND METHODS Sixty participants (42 females and 18 males) aged 77.9 ± 8.84 years with functional constipation, who met the eligibility criteria, completed the study. In a double-blind, placebo-controlled, parallel design, each participant was randomized to receive either the selected probiotic mixture (N = 28) or placebo (N = 32) for 12 weeks as an adjunct to their usual diet and medications. The liquid probiotic formulation containing Bifidobacterium animalis subsp. lactis BLC1, Lactobacillus acidophilus LA3 and Lactobacillus casei BGP93 was tested for the first time. RESULTS Supplementation of selected probiotics resulted in a slight but nonsignificant increase in cumulative stool frequency compared with placebo. However, after the 71st day of the treatment, the cumulative number of stools was significantly higher in the probiotic group (P < 0.05) when the influence of laxative was excluded. The trend towards an increase in the difference between the two groups, which began 1 week after the probiotic intervention, pointed out to their prolonged effect. There were no significant dependent or independent effects of treatment and time on most of the 27 laboratory blood parameters tested. CONCLUSIONS Multistrain probiotic supplementation was found to be efficacious, safe and well tolerated in the elderly with functional constipation.
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Affiliation(s)
| | | | - Pero Hrabač
- Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Iva Mucalo
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Luciano Saso
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Donatella Verbanac
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
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15
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Association between Depression, Anxiety Symptoms and Gut Microbiota in Chinese Elderly with Functional Constipation. Nutrients 2022; 14:nu14235013. [PMID: 36501044 PMCID: PMC9740187 DOI: 10.3390/nu14235013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to investigate the relationship between anxiety, depression, and gut microbiota in elderly patients with FC. METHODS in this cross-sectional study, a total of 198 elderly participants (85 male and 113 female) aged over 60 years were recruited. The study was conducted in Changsha city, China. The participants completed an online questionnaire, including The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), The Patient Assessment of Symptoms (PAC-SYM), and The Patient Assessment of Quality of Life (PAC-QoL). We selected the 16S rDNA V3 + V4 region as the amplification region and sequenced the gut microbiota using the Illumina Novaseq PE250 high-throughput sequencing platform. RESULTS in total, 30.3% of patients with constipation had depression, while 21.3% had anxiety. The relative abundance of intestinal microbiota in the normal group was higher than that in the anxiety and depression group. According to LEfSe analysis, the relative abundance of g_Peptoniphilus and g_Geobacter in the people without depression and anxiety was higher. The relative abundance of g_Pseudoramibacter-Eubacterium and g_Candidatus-Solibacter in the depression group was lower, and the relative abundance of g_Bacteroides and g_Paraprevotella, g_Cc_115 in the anxiety group was higher. In addition, according to the correlation analysis, g_Aquicella and g_Limnohabitans were negatively correlated with constipation symptoms, anxiety, and depression. CONCLUSIONS this study found that gut microbiota composition may be associated with a higher incidence of anxiety and depression in patients with FC, thus providing insight into the mechanisms that ameliorate mood disorders in patients with FC.
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16
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Carmona-González M, Flores-Garnica A, Sánchez-Ramos MÁ, Ortiz-Rodríguez MA, Arenas-Ocampo ML, García-Serrano LA, Camacho-Díaz BH. Impact of the COVID-19 pandemic on the quality of life of older adults. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.37468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted unevenly across nations and population groups. Older adults were considered a high-risk group because of their high susceptibility to infection and potential for clinical complications and death. Long periods of home confinement and social distancing foster changes in daily life that impact the mobility, health and quality of life of older adults. This study aims to assess the quality of life of older adults during the COVID-19 pandemic, adherence to prevention measures, self-perceived impaired mobility, relating to others, daily activities, eating habits and constipation-patterns. Methods A cross-sectional study with a mixed approach was implemented, with 114 participants completing an online survey. Findings The participants with poorer quality of life had older age, had less schooling, were unemployed, had no partner, were ill and experienced chronic functional constipation. The intimacy dimension had the lowest score. Mobility, relating to others and activities of daily living were rated by most participants as strongly affected by the pandemic. Conclusions The COVID-19 pandemic impacted the quality of life of older adults by fostering social isolation and physical inactivity. To ameliorate this, public health interventions are needed.
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Affiliation(s)
| | | | | | | | | | - Luz A. García-Serrano
- Instituto Politécnico Nacional – Centro Interdisciplinario de Investigaciones y Estudios sobre Medio Ambiente y Desarrollo
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Du X, Liu S, Jia P, Wang X, Gan J, Hu W, Zhu H, Song Y, Niu J, Ji Y. Epidemiology of Constipation in Elderly People in Parts of China: A Multicenter Study. Front Public Health 2022; 10:823987. [PMID: 35784241 PMCID: PMC9240593 DOI: 10.3389/fpubh.2022.823987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the epidemiological characteristics of constipation in people aged 65 years and older in several regions of China. Patients and Methods A cross-sectional study based on a cluster sampling design was conducted in four cities of China: Tianjin, Xiamen, Cangzhou and Harbin. A total of 5,222 cases (age ≥ 65 years) were recruited, and the survey was conducted via centralized and household questionnaires that included the following: basic demographic characteristics such as sex, age, education, marital status, living status and occupation; social activities; duration of sleep at night; duration of menstruation and delivery times (in females); and if the participant had constipation symptoms, the severity of constipation. Constipation was diagnosed according to the Rome IV criteria. Results Of the 5,222 participants, 919 were diagnosed with constipation. The prevalence of constipation was 17.60% in elderly people ≥65 years old. Prevalence increased with age and was significantly higher in females than males (P < 0.05). Prevalence was lower in the manual compared to the non-manual worker group, and significantly increased with decreasing duration of night sleep (P < 0.05). Older age, female sex and shorter sleep duration at night were risk factors for constipation in elderly people. Conclusion The prevalence of constipation in the elderly people in four cities of China was 17.60%, and was significantly affected by age, sex and sleep duration at night.
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Affiliation(s)
- Xiaoshan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Peifei Jia
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Xiaodan Wang
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Jinghuan Gan
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenzheng Hu
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Han Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Yehua Song
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Jianping Niu
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
- *Correspondence: Yong Ji
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Jianping Niu
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18
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Effect of Fresh Dendrobe Juice Consumption on Senile Habitual Constipation for Older People: A Four-Week Randomized Controlled Trial. SUSTAINABILITY 2022. [DOI: 10.3390/su14063656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: In Chinese medicine, it is believed that fresh dendrobe juice, which is mild in nature, can relieve the symptom of constipation. Methods: A pilot research design was conducted. Fifty-six older people with senile habitual constipation were recruited and randomly enrolled into control or experimental groups, each with 28 people. The control group was offered water routinely in a day. In addition, the experimental group received 125 mL of dendrobe juice twice a day for four weeks. Quality of life for the old people was evaluated by the Patient Assessment of Constipation Quality of Life (PAC-QOL) Score and the symptom of constipation was assessed by Wexner score. Results: The four-week intervention brought significant performance improvement in all the measured parameters in the experimental group in comparison with the control group. These included significantly more frequency and shorter durations of defecation (p < 0.01, respectively), improved quality of life based on constipation score (PAC-QOL) (experimental group: 50.41 ± 3.46 vs. control group: 70.25 ± 2.35; p < 0.05), and improved score on the Wexner constipation scale (experimental group: 6.56 ± 0.89 vs. control group: 15.50 ± 0.64; p < 0.05). Conclusions: Fresh dendrobe beverage therapy is effective in improving stool frequency, reducing duration of defecation, and enhancing quality of life.
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Wang F, Fei M, Hu WZ, Wang XD, Liu S, Zeng Y, Zhang JH, Lv Y, Niu JP, Meng XL, Cai P, Li Y, Gang BZ, You Y, Lv Y, Ji Y. Prevalence of Constipation in Elderly and Its Association With Dementia and Mild Cognitive Impairment: A Cross-Sectional Study. Front Neurosci 2022; 15:821654. [PMID: 35140587 PMCID: PMC8819140 DOI: 10.3389/fnins.2021.821654] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background Constipation and dementia have similar epidemiological characteristics. Changes in intestinal flora and characteristics of the brain-gut axis play roles in the pathogeneses of the two diseases, suggesting that there may be a close connection between the two. Most of the studies on constipation in dementia patients have focused on the population with α-synucleinopathies [Parkinson’s disease dementia (PDD), dementia with Lewy bodies (DLB)]. Few studies have reported the prevalence of constipation in all-cause dementia and mild cognitive impairment (MCI) populations. Objective To assess the prevalence of constipation in patients with all-cause dementia and MCI subtypes and to explore the association between constipation with dementia and MCI subtypes. Methods From May 2019 to December 2019, we conducted a population-based cross-sectional survey. A total of 11,743 participants aged 65 or older from nine cities in China were surveyed. Participants underwent a series of clinical examinations and neuropsychological measurements. Constipation, dementia, MCI and MCI subtype were diagnosed according to established criteria through standard diagnostic procedures. Results The overall age- and sex-adjusted prevalence of constipation in individuals aged 65 years and older was 14.8% (95% CI, 14.6–15.0). The prevalence rates of constipation were19.2% (95% CI, 17.3–21.0), 19.1% (95% CI, 16.8–21.5), 14.4% (95% CI, 12.8–15.9), and 13.8% (95% CI, 13.0–14.6) in the dementia, non-amnestic (na)-MCI, amnestic (a)-MCI and normal cognition populations, respectively. Multivariate logistic regression analysis showed that higher prevalence of constipation was associated with dementia (p = 0.0.032, OR = 1.18, 95% CI: 1.02–1.38) and na-MCI (p = 0.003, OR = 1.30, 95% CI: 1.09–1.54). Conclusion The present study found a high prevalence of constipation in elderly individuals in China, and higher in patients with dementia and na-MCI.
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Affiliation(s)
- Fei Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, China
| | - Min Fei
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, China
| | - Wen-Zheng Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Yan Zeng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
| | - Jin-Hong Zhang
- Department of Neurology, Cangzhou People’s Hospital, Cangzhou, China
| | - Yang Lv
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian-ping Niu
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xin-ling Meng
- Department of Neurology, Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, China
| | - Pan Cai
- Dementia Clinic, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yang Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bao-zhi Gang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong You
- Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yan Lv
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
- *Correspondence: Yong Ji,
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Enhanced Recovery after Surgery Protocol Accelerates Recovery of Lumbar Disc Herniation among Elderly Patients Undergoing Discectomy via Promoting Gastrointestinal Function. Pain Res Manag 2021; 2021:3573460. [PMID: 34853625 PMCID: PMC8629654 DOI: 10.1155/2021/3573460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
This study aimed to analyze the effect of the enhanced recovery after surgery (ERAS) protocol on the recovery of gastrointestinal function in patients with lumbar disc herniation after discectomy. A total of 179 patients with lumbar disc herniation were randomly divided into the ERAS and non-ERAS groups. The non-ERAS group received routine nursing, and the ERAS group received ERAS strategy. The two groups were compared for general recovery indicators such as postoperative hemoglobin and prealbumin, satisfaction, and length of hospital stay. Gastrointestinal function was also evaluated, such as postoperative feeding time, intestinal chirping recovery time, intestinal exhaust gas recovery time, and complications such as ileus, nausea, and vomiting. The satisfaction of patients in the ERAS group (86.15 ± 2.43) was significantly higher than that in the non-ERAS group (77.19 ± 3.32), and the difference was statistically significant (P < 0.05). The average time of eating in the ERAS group was 2.27 h after surgery. In addition, the amount of eating in the ERAS group was significantly better than that in the non-ERAS group, and the difference was statistically significant. In the ERAS group, intestinal chirping recovery time recovered to normal time, and exhaust recovery time and average defecation time were significantly shorter than those in the non-ERAS group. In the ERAS group, the average amount of hemoglobin and prealbumin decreased 3 days after operation, which was significantly lower than that in the non-ERAS group. To sum up, ERAS has an evident effect on the recovery of gastrointestinal function after discectomy of disc herniation, which can promote the recovery of patients.
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21
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Kang SJ, Cho YS, Lee TH, Kim SE, Ryu HS, Kim JW, Park SY, Lee YJ, Shin JE. Medical Management of Constipation in Elderly Patients: Systematic Review. J Neurogastroenterol Motil 2021; 27:495-512. [PMID: 34642269 PMCID: PMC8521458 DOI: 10.5056/jnm20210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Constipation is a common gastrointestinal problem in the elderly. Because of the limitations of life style modifications and the comorbidity, laxative use is also very common. Therefore, this study reviews the latest literature on the effect and safety of laxative in the elderly. Methods A systematic review of randomized controlled trials investigating the effectiveness and safety of laxatives for constipation in elderly patients over 65 years old were performed using the following databases PubMed, EMBASE, and the Cochrane Library. Results Twenty-three randomized controlled trials were included in this review. Among the selected studies, 9 studies compared laxative with placebo and 5 studies compared laxatives of the same type. Four studies compared different types of laxatives or compared combination agents. Five studies compared novel medications such as prucalopride, lubiprostone, and elobixibat with placebo. Psyllium, calcium polycarbophil, lactulose syrup, lactitol, polyethylene glycol, magnesium hydroxide, stimulant laxative with or without fiber, and other medications were more effective than placebo in elderly constipation patients in short-term. Generally, the frequency and severity of adverse effects of laxative were similar between the arms of studies. Conclusions Bulk laxative, osmotic laxative, stimulant laxative with or without fiber, and other medications can be used in elderly patients in short-term within 3 months with reasonable safety. However, the quality of included studies was not high and most of studies was conducted in a small number of patients. Among these laxatives, polyethylene glycol seems to be safe and effective in long-term use of about 6 months in elderly patients.
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Affiliation(s)
- Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Young Sin Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Soonchunhyang University, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Han Seung Ryu
- Department of Internal Medicine and Digestive Diseases Research Institute, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea
| | - Jung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea
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22
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Wang Q, Qi Y, Shen W, Xu J, Wang L, Chen S, Hou T, Si J. The Aged Intestine: Performance and Rejuvenation. Aging Dis 2021; 12:1693-1712. [PMID: 34631215 PMCID: PMC8460310 DOI: 10.14336/ad.2021.0202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Owing to the growing elderly population, age-related problems are gaining increasing attention from the scientific community. With senescence, the intestine undergoes a spectrum of changes and infirmities that are likely the causes of overall aging. Therefore, identification of the aged intestine and the search for novel strategies to rescue it, are required. Although progress has been made in research on some components of the aged intestine, such as intestinal stem cells, the comprehensive understanding of intestinal aging is still limited, and this restricts the in-depth search for efficient strategies. In this concise review, we discuss several aspects of intestinal aging. More emphasis is placed on the appraisal of current and potential strategies to alleviate intestinal aging, as well as future targets to rejuvenate the aged intestine.
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Affiliation(s)
- Qiwen Wang
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yadong Qi
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Weiyi Shen
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jilei Xu
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Lan Wang
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Shujie Chen
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Tongyao Hou
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jianmin Si
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.,2Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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23
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Axelrod L, Axelrod S, Navalgund A, Triadafilopoulos G. Pilot Validation of a New Wireless Patch System as an Ambulatory, Noninvasive Tool That Measures Gut Myoelectrical Signals: Physiologic and Disease Correlations. Dig Dis Sci 2021; 66:3505-3515. [PMID: 33063188 DOI: 10.1007/s10620-020-06663-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Limited means exist to assess gastrointestinal activity in a noninvasive, objective way that is highly predictive of underlying motility disorders. The aim of this paper is to demonstrate the feasibility of recording myoelectric gastrointestinal activity by cutaneous patches and to correlate myoelectric signals with gastrointestinal function in various clinical settings. METHODS A novel wireless patch system (WPS) (G-Tech Medical) that acquires gastrointestinal myoelectrical signals was placed on the patients' anterior abdomens. Data were transmitted wirelessly to a mobile device with a user interface and forwarded to a cloud server where processing algorithms identified episodes of motor activity, quantified their parameters, and nominally assigned them to specific gastrointestinal organs based on their frequencies. RESULTS The inherent reproducibility of the WPS measurement technique itself and from the underlying gut activity, coupled with source validation and sensitivity to changes in gut activity in several physiologic and pathologic states, demonstrates its feasibility, safety, and performance in clinical settings. CONCLUSIONS The novel WPS technology, measuring myoelectric intestinal activity noninvasively and continuously over multiple days, is feasible in a wide range of clinical settings, highlighting its promise in the diagnosis and management of motility disorders. Further research is required for more extensive validation and to determine how best to employ this information to optimize patient care.
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Affiliation(s)
- Lindsay Axelrod
- G-Tech Medical, Fogarty Institute for Innovation, 2495 Hospital Drive, Suite 300, Mountain View, CA, 94040, USA
| | - Steve Axelrod
- G-Tech Medical, Fogarty Institute for Innovation, 2495 Hospital Drive, Suite 300, Mountain View, CA, 94040, USA
| | - Anand Navalgund
- G-Tech Medical, Fogarty Institute for Innovation, 2495 Hospital Drive, Suite 300, Mountain View, CA, 94040, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.
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24
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Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC. Questionnaire Survey of Bowel Habit in Japanese Medical Personnel. J Anus Rectum Colon 2021; 5:297-305. [PMID: 34395943 PMCID: PMC8321588 DOI: 10.23922/jarc.2021-014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aims to clarify the bowel habit, change of bowel movement throughout the cycle of menstruation, and toilet use in Japanese medical personnel. METHODS A questionnaire survey was completed by Japanese medical personnel after listening to lectures on bowel disorders. Constipation was defined according to Rome III criteria, whereas diarrhea was defined as Bristol stool form scale type 6 and 7. RESULTS In total, 463 persons (mean age, 35.6 years, range 20-91, male/female/no answer: 132/324/7) have completed the questionnaire. Constipation was significantly more often observed in females (male/female: 3%/31%, p > 0.001, Chi-squared test), while diarrhea was noted to be less in females (male/female: 1%/7%). Constipation was observed in 20% of participants in their 20s, and the constipation rate was observed to gradually increase with age. It was observed in 45% of participants in their 70s or older. Bowel movement changed to constipation around menstruation in 18% of females and changed to diarrhea in 43% of females. Constipation often occurred before menstruation and diarrhea during menstruation. Only 2% of participants used a Japanese-style toilet, and 5% of participants claimed that they were unable to pass a stool on a Japanese-style toilet. CONCLUSIONS Constipation was significantly more frequent in females and increased with age among female Japanese medical personnel. Change of bowel movement occurred in 61% of females around menstruation. Five percent of participants were unable to pass stools on a Japanese-style toilet.
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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25
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Arco S, Saldaña E, Serra-Prat M, Palomera E, Ribas Y, Font S, Clavé P, Mundet L. Functional Constipation in Older Adults: Prevalence, Clinical Symptoms and Subtypes, Association with Frailty, and Impact on Quality of Life. Gerontology 2021; 68:397-406. [PMID: 34265780 DOI: 10.1159/000517212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Functional constipation (FC) is very prevalent in older adults, especially in women, but its relationship with frailty is not fully understood. The aims were to assess FC prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life (QoL) in older people. METHODS This epidemiological study included 384 individuals aged over 70 years recruited from the community, a hospital, and a nursing home and stratified into robust, pre-frail, and frail groups (Fried criteria). The following criteria were evaluated: frailty, FC (Rome III criteria), stool consistency (Bristol Stool Chart), comorbidities (Charlson), dependency (Barthel), QoL (EQ5D), and clinical and sociodemographic data. Defined by symptom aggregation were 2 main clinical subtypes as follows: slow colonic transit time (CTT) and functional defecation disorder (FDD). RESULTS Mean age was 79.11 ± 6.43 years. Overall FC prevalence was 26.8%, higher in women (32.4% women vs. 21.8% men; p = 0.019) and highest in frail patients (41.7% frail vs. 33.9% pre-frail vs. 24.2% robust; p < 0.001). Straining and hard stools (Bristol 1-2) were the most prevalent symptoms (89.3 and 75.7%, respectively). Frailty and benzodiazepine intake were independently associated with FC. Patients with FC obtained poorer QoL scores in the EQ5D (perceived health 66.09 ± 17.8 FC patients vs. 56.4 ± 19.03 non-FC patients; p < 0.05). The FDD subtype became significantly more prevalent as frailty increased (6.5, 25.8, and 67.7% for robust, pre-frail, and frail patients, respectively); the slow CTT subtype was significantly more frequent in robust patients (38.5% robust vs. 30.5% pre-frail vs. 23.1% frail), p = 0.002. DISCUSSION/CONCLUSION FC prevalence in older adults was high, especially in women, and was associated with frailty and poor QoL. Clinical subtypes as related to frailty phenotypes reflect specific pathophysiological aspects and should lead to more specific diagnoses and improved treatment.
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Affiliation(s)
- Sandra Arco
- Badalona Serveis Assistencials, Badalona, Spain.,Escola Superior de Ciències de la Salut, Tecnocampus, Mataró, Spain
| | - Esther Saldaña
- Pelvic Floor Unit, Clínica Sagrada Familia, Barcelona, Spain
| | - Mateu Serra-Prat
- Department of Biostatistics and Epidemiology, Hospital de Mataró, Mataró, Spain
| | - Elisabet Palomera
- Department of Biostatistics and Epidemiology, Hospital de Mataró, Mataró, Spain
| | - Yolanda Ribas
- Department of Surgery Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Sergi Font
- Department of Surgery, Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Mataró, Spain
| | - Pere Clavé
- Pelvic Floor Unit, Clínica Sagrada Familia, Barcelona, Spain.,Department of Surgery, Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Mataró, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Lluís Mundet
- Department of Surgery, Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Mataró, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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26
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Hong JT. Current Opinion on Prucalopride in Gastroparesis and Chronic Constipation Treatment: A Focus on Patient Selection and Safety. Ther Clin Risk Manag 2021; 17:601-615. [PMID: 34135588 PMCID: PMC8197617 DOI: 10.2147/tcrm.s269330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Prucalopride is a third-generation, highly selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist. Many recent studies indicate prucalopride may play an important role in various motility disorders. The aim of this study was to investigate safety and patient selection considerations when using prucalopride as gastroparesis and chronic constipation treatment. We systematically searched PubMed, Embase, the Cochrane Central Register and ClinicalTrials.gov, and we reviewed all studies that evaluated prucalopride for the treatment of gastroparesis and chronic idiopathic constipation in adults. Prucalopride is an effective and safe option based on all the studies currently conducted. Thus, it may be the first-line treatment in the future. Prucalopride has the potential to be useful in the treatment of functional constipation and other forms of gastrointestinal diseases (eg, gastroparesis). Through the research on this potential, prucalopride is expected to be a useful and versatile option for treating gastrointestinal diseases in the future.
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Affiliation(s)
- Ji Taek Hong
- Division of Gastroenterology, Department of Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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27
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Mehershahi S, Ghazanfar H, Ashraf S, Shaikh DH, Patel H. Colitis Induced by Colon-Cleansing Agent. Case Rep Gastroenterol 2021; 15:621-625. [PMID: 34616266 PMCID: PMC8454223 DOI: 10.1159/000514440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
Constipation is one of the most common functional gastrointestinal disorders and affects 20% of the general population. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that affects the large intestine and is characterized by chronic abdominal pain and altered bowel habits. We report a case of a 35-year-old African American man with a past medical history of IBS who presented to the clinic with a chief complaint of abdominal pain and bloody diarrhea for 1 week. The patient stated that he used a colon-cleansing agent because of persistent constipation. Computed tomography scan of the patient's abdomen and pelvis with contrast was performed which showed diffuse contiguous segmental mural thickening and nodularity seen along the distal transverse, descending, and sigmoid colon. Colonoscopy showed moderate diffuse inflammation characterized by altered vascularity, erythema, and granularity from the rectum to the descending colon, and localized mild inflammation characterized by erythema was found at the ileocecal valve. The patient's clinical condition improved with symptomatic management over 10 days. Patients with IBS should be advised to restrain from using a colon-cleansing agent without advice from their primary doctor as it can lead to various complications.
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Affiliation(s)
| | - Haider Ghazanfar
- Department of Medicine, Bronxcare Health System, Bronx, New York, USA
- *Haider Ghazanfar,
| | - Shoaib Ashraf
- Department of Medicine, Bronxcare Health System, Bronx, New York, USA
| | - Danial H. Shaikh
- Department of Gastroenterology, Bronxcare Health System, Bronx, New York, USA
| | - Harish Patel
- Department of Gastroenterology, Bronxcare Health System, Bronx, New York, USA
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28
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Patel S, Doerfler B, Boutros K, Ng S, Manuel M, DeSimone E. Review of Treatment Options for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation. Int J Gen Med 2021; 14:1457-1468. [PMID: 33907450 PMCID: PMC8071080 DOI: 10.2147/ijgm.s274568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are two common disorders of gut-brain interaction. Affected patients often first present to their primary care providers seeking care for symptoms of constipation, abdominal pain, and bloating, which have a significant impact on their health-related quality of life. These patients often require extensive counseling and reassurance, and knowledge of reliable diagnostic criteria and treatment options is imperative to managing their conditions. Family medicine practitioners, including nurse practitioners and physician assistants, are uniquely qualified to provide a diagnosis and safe, effective management of these disorders. This article reviews the latest evidence and provides practical advice related to diagnosis and management of IBS-C and CIC.
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Affiliation(s)
- Sarah Patel
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
- Rutgers University, Piscataway, NJ, USA
| | - Bethany Doerfler
- Division of Gastroenterology, Northwestern Medicine, Chicago, IL, USA
| | - Katerine Boutros
- Global Medical Affairs Gastroenterology & Hepatology, AbbVie Inc, Madison, NJ, USA
| | - Samson Ng
- Global Medical Affairs Gastroenterology & Hepatology, AbbVie Inc, Madison, NJ, USA
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29
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Gao CC, Li GW, Wang TT, Gao L, Wang FF, Shang HW, Yang ZJ, Guo YX, Wang BY, Xu JD. Rhubarb extract relieves constipation by stimulating mucus production in the colon and altering the intestinal flora. Biomed Pharmacother 2021; 138:111479. [PMID: 33774313 DOI: 10.1016/j.biopha.2021.111479] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Constipation, mainly characterized by the difficulty in defecation, is a clinical symptom caused by a variety of factors. It can be manifested as normal or slow colonic transport abnormalities, which can occur alone or concurrently with defecation disorders. As there is not uniform definition and assessment standard, no clear plan could be used for the treatment of constipation. Although rhubarb, a traditional Chinese medicine, plays a therapeutic role in diseases involving constipation symptoms, the detailed mechanism of it in treating constipation remains unclear. METHODS A model of constipation-induced by diphenoxylate was prepared. Immunofluorescent staining was used to detect the expression of mucin 2 (MUC2), calnexin and chymase in colon. Western blotting was used to detect changes of tryptase and calnexin in the colon. And real-time polymerase chain reaction (PCR) was utilized to detect the changes of immunoglobulin-binding protein (Bip), X-box binding protein 1 (Xbp1) and C/EBP homologous protein (CHOP) of colonic goblet cells in mRNA levels. ELISA and biochemical kits were utilized to detect the changes of MUC2, Trefoil factor 3 (TFF3), acetylcholine, histamine and C-C motif chemokine ligand 5 (CCL5) in the colon. And the changes of colonic mucosa and intestinal flora of constipation model mice caused by rhubarb extract (RE) were analyzed to identify the mechanism of RE on the treatment of constipation. RESULTS RE promotes the secretion of colonic mucus by recruiting mast cells and enhancing the content of histamine and Ach in the mice colon. In the process, RE causes up-regulation of Bip and CHOP mRNA expression and down-regulation of Xbp1 and Xbp1s mRNA expression that induces ER stress of colonic epithelium associated with changes in the intestinal flora diversity and short-chain fatty acids content. CONCLUSION RE could relieve constipation by promoting the secretion of colonic mucus via mast cells activation and improving the intestinal microenvironment.
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Affiliation(s)
- Chen-Chen Gao
- Department of Physiology and Pathophysiology, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Guang-Wen Li
- Department of Physiology and Pathophysiology, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Tian-Tian Wang
- Department of Physiology and Pathophysiology, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Lei Gao
- Department of Bioinformatics, College of Bioengineering, Capital Medical University, Beijing 100069, China
| | - Fei-Fei Wang
- Department of Clinical Medicine, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Hong-Wei Shang
- Experimental Center for Morphological Research Platform, Capital Medical University, Beijing 100069, China
| | - Ze-Jun Yang
- Department of Clinical Medicine, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Yue-Xin Guo
- Department of Oral Medicine, Basic Medical College, Capital Medical University, Beijing 100069, China
| | - Bo-Ya Wang
- Undergraduate Student of 2018 Eight Program of Clinical Medicine, Peking University Health Science Center, Beijing 100081, China
| | - Jing-Dong Xu
- Department of Physiology and Pathophysiology, Basic Medical College, Capital Medical University, Beijing 100069, China.
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30
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Sugitani Y, Inoue R, Inatomi O, Nishida A, Morishima S, Imai T, Kawahara M, Naito Y, Andoh A. Mucosa-associated gut microbiome in Japanese patients with functional constipation. J Clin Biochem Nutr 2021; 68:187-192. [PMID: 33879972 PMCID: PMC8046005 DOI: 10.3164/jcbn.20-93] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
The number of patients with chronic constipation is increasing in Japan. We investigated the gut mucosa-associated microbiome in Japanese patients with functional constipation. Diagnosis was made according to the Rome IV criteria. Mucosal samples were obtained by gentle brushing of mucosa surfaces. The gut microbiome was analyzed using 16S rRNA gene sequencing. There were no significant differences in bacteria α-diversity such as richness and evenness. The PCoA indicated significant structural differences between the constipation group and healthy controls (p = 0.017 for unweighted and p = 0.027 for weighted). The abundance of the phylum Bacteroidetes was significantly higher in the constipation group. The abundance of the genera Streptococcus, Fusobacterium, Comamonas, and Alistipes was significantly higher in the constipation group. The abundance of the genera Acinetobacter, Oscillospilla, Mucispirillum, Propinibacterium, and Anaerotruncus was significantly lower in the constipation group. In the constipation group, the proportion of genes responsible for sulfur metabolism, selenocompound metabolism, sulfur relay system was significantly higher and the proportion of d-arginine and d-ornithine metabolism and flavonoid biosynthesis was significantly lower. In conclusion, we identified differences of the mucosa-associated microbiome between Japanese patients with functional constipation and healthy controls. The mucosa-associated microbiome of functional constipation was characterized by higher levels of Bacteroidetes (Alistipes).
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Affiliation(s)
- Yoshihiko Sugitani
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Ryo Inoue
- Laboratory of Animal Science, Department of Applied Biological Sciences, Faculty of Agriculture, Setsunan University, Nagaotoge-cho 45-1, Hirakata, Osaka 573-0101, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Atsushi Nishida
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - So Morishima
- Laboratory of Animal Science, Department of Applied Biological Sciences, Faculty of Agriculture, Setsunan University, Nagaotoge-cho 45-1, Hirakata, Osaka 573-0101, Japan
| | - Takayuki Imai
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Masahiro Kawahara
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
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31
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Mandovra P, Kalikar V, Patankar RV. Laparoscopic ventral mesh rectopexy for obstructive defecation syndrome: Follow-up in the Indian population. J Minim Access Surg 2021; 17:305-310. [PMID: 32964866 PMCID: PMC8270038 DOI: 10.4103/jmas.jmas_292_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Obstructive defecation syndrome (ODS) is a poorly understood cause of constipation. In selected patients not responding to conservative management, surgical options may be offered. Laparoscopic ventral mesh rectopexy (LVMR) is another surgical option which gained popularity in the past decade. Aim: This study aims to identify the efficacy of LVMR in the Indian population. Setting and Design: It is a retrospective analysis of prospectively collected data of patients who underwent LVMR from January 2015 to January 2017 at a tertiary centre in India. Subjects and Methods: Thirty patients fulfilled the inclusion criteria. Patients were periodically followed for 2 years. Pre- and post-operative modified Longo's ODS scores were recorded and compared. Furthermore, other complications were noted and evaluated. Statistical Analysis Used: Relevant statistical tests were used to analyse the collected data. Results: Thirty patients (28 females, 2 males, mean age: 52.4 years) underwent LVMR for ODS due to anatomical abnormality like rectorectal intussusceptions (RRIs) (36.7%), rectocele (13.3%), or combined RRI with rectocele (50%). The mean pre-operative modified Longo's ODS score was 23.17 ± 4.82 which decreased to 2.37 ± 1.59 at the end of 6 months and 1.23 ± 1.14 and 1.57 ± 1.14 at the end of 12 months and 2 years, respectively. The mean modified Longo's ODS score showed a significant fall of 94.7% at 12-month follow-up and 93.2% fall on 2-year follow-up. The mean operative time was 115 min and the average hospital stay of patients who underwent LVMR was 3.26 days. Conclusion: LVMR is a safe surgical procedure with minimal complications and good functional results for ODS patients due to rectal anatomical abnormality. Further larger studies are required to decide the best treatment modality for ODS.
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Affiliation(s)
- Pranav Mandovra
- Digestive Disease Centre, Zen Hospital, Mumbai, Maharashtra, India
| | - Vishakha Kalikar
- Digestive Disease Centre, Zen Hospital, Mumbai, Maharashtra, India
| | - Roy V Patankar
- Digestive Disease Centre, Zen Hospital, Mumbai, Maharashtra, India
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Sada H, Kajizono M, Ushio S, Esumi S, Kitamura Y, Sendo T. The Efficacy and Safety of Lubiprostone for Constipation in Cancer Patients Compared with Non-cancer Patients: A Retrospective Cohort Study. Biol Pharm Bull 2020; 43:1699-1706. [DOI: 10.1248/bpb.b20-00398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Hikaru Sada
- Department of Pharmacy, Okayama University Hospital
| | | | | | - Satoru Esumi
- Department of Pharmacy, Okayama University Hospital
| | - Yoshihisa Kitamura
- Department of Pharmacy, Okayama University Hospital
- Department of Pharmacotherapy, School of Pharmacy, Shujitsu University
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Di Martino E, Provenzani A, Polidori P. Evidence-based application of explicit criteria to assess the appropriateness of geriatric prescriptions at admission and hospital stay. PLoS One 2020; 15:e0238064. [PMID: 32841285 PMCID: PMC7446960 DOI: 10.1371/journal.pone.0238064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Background Inappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs). Objective The aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing. Methods A retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index. Results The Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled β2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index. Conclusion The prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.
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Affiliation(s)
- Enrica Di Martino
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
- * E-mail: ,
| | - Alessio Provenzani
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Piera Polidori
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study. Updates Surg 2020; 73:569-580. [PMID: 32648110 PMCID: PMC8005395 DOI: 10.1007/s13304-020-00845-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
Patients undergoing colon resection are often concerned about their functional outcomes after surgery. The primary aim of this prospective, multicentric study was to assess the intestinal activity and health-related quality-of-life (HRQL) after ileocecal valve removal. The secondary aim was to evaluate any vitamin B12 deficiency. The study included patients undergoing right colectomy, extended right colectomy and ileocecal resection for either neoplastic or benign disease. Selected items of GIQLI and EORTC QLQ-CR29 questionnaires were used to investigate intestinal activity and HRQL before and after surgery. Blood samples for vitamin B12 level were collected before and during the follow-up period. The empirical rule effect size (ERES) method was used to explain the clinical effect of statistical results. Linear mixed effect (LME) model for longitudinal data was applied to detect the most important parameters affecting the total score. A total of 158 patients were considered. Applying the ERES method, the analysis of both questionnaires showed clinically and statistically significant improvement of HRQL at the end of the follow-up period. Applying the LME model, worsening of HRQL was correlated with female gender and ileum length when using GIQLI questionnaire, and with female gender, open approach, and advanced cancer stage when using the EORTC QLQ-CR29 questionnaire. No significant deficiency in vitamin B12 levels was observed regardless of the length of surgical specimen. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory.
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Verkuijl SJ, Meinds RJ, Trzpis M, Broens PMA. The influence of demographic characteristics on constipation symptoms: a detailed overview. BMC Gastroenterol 2020; 20:168. [PMID: 32493265 PMCID: PMC7268616 DOI: 10.1186/s12876-020-01306-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diagnosing constipation remains difficult and its treatment continues to be ineffective. The reason may be that the symptom patterns of constipation differ in different demographic groups. We aimed to determine the pattern of constipation symptoms in different demographic groups and to define the symptoms that best indicate constipation. METHODS In this cross-sectional study the Groningen Defecation and Fecal Continence questionnaire was completed by a representative sample of the adult Dutch population (N = 892). We diagnosed constipation according to the Rome IV criteria for constipation. RESULTS The Rome criteria were fulfilled by 15.6% of the study group and we found the highest prevalence of constipation in women and young adults (19.7 and 23.5%, respectively). Symptom patterns differed significantly between constipated respondents of various ages, while we did not observe sex-based differences. Finally, we found a range of constipation symptoms, not included in the Rome IV criteria, that showed marked differences in prevalence between constipated and non-constipated individuals, especially failure to defecate (∆ = 41.2%). CONCLUSIONS Primarily, we found that certain symptoms of constipation are age-dependent. Moreover, we emphasize that symptoms of constipation not included in the Rome IV criteria, such as daily failure to defecate and an average duration of straining of more than five minutes, are also reliable indicators of constipation. Therefore, we encourage clinicians to adopt a more comprehensive approach to diagnosing constipation.
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Affiliation(s)
- Sanne J. Verkuijl
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob J. Meinds
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
| | - Paul M. A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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The Efficacy and Safety of Elobixibat for the Elderly with Chronic Constipation: A Multicenter Retrospective Cohort Study. Gastroenterol Res Pract 2020; 2020:9656040. [PMID: 32411210 PMCID: PMC7204088 DOI: 10.1155/2020/9656040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
Materials and Methods This was a multicenter retrospective cohort study. The subjects were patients aged ≥20 years treated for chronic constipation from May 2018 to November 2019 at 12 related institutions. Patients were divided into ≤74 years and ≥75 years old. Elobixibat at 10 mg/day was prescribed for two weeks. We then analyzed the discontinuation due to ineffectiveness, change of spontaneous bowel movements (SBM), stool consistency, the time until the first SBM, adverse events, and effect-related factors. Results There were 140 cases (61 males) evaluated, with an average age of 72.1 ± 13.6 years (≤74 years: 71 cases; ≥75 years: 69 cases). The discontinuation rate was 7.9%. The SBM (times/week) increased from 2.86 to 6.08 (p < 0.001). The overall SBM improvement rate was 74.0% (≤74 years: 78.2% vs. ≥75 years: 68.9%, p = 0.31; male: 75.0% vs. female: 73.3%, p = 0.78). The overall improvement rate of stool consistency was 59.6% (≤74 years: 62.9%, ≥75 years: 56.1%, p = 0.42). The time until the first SBM (hours) for those ≤74 years and ≥75 years was 17.2 ± 14.3 and 11.2 ± 8.4 (p = 0.04). Adverse event rates for those ≤74 years and ≥75 years were 28.2% and 10.1% (p < 0.01). There were no significant effect-related factors for gender, age, and use of laxatives. Conclusions Short-period elobixibat is shown to be effective also for the elderly and male.
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Xu XH, Zhang MM, Wu X, Xu SB, Wang W, Zheng CH, Huang GY. Efficacy of Electro-acupuncture in Treatment of Functional Constipation: A Randomized Controlled Trial. Curr Med Sci 2020; 40:363-371. [PMID: 32337698 DOI: 10.1007/s11596-020-2188-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/12/2020] [Indexed: 02/06/2023]
Abstract
Functional constipation (FC) is a chronic disease that significantly affects the life quality of patients. Acupuncture has been used for the treatment of FC for many years, but its effectiveness has not been scientifically assessed. The present study aimed to evaluate the efficacy of electro-acupuncture (EA) in relieving the symptoms, mental states and quality of life (QOL) of FC patients. A total of 96 FC patients were randomly allocated into EA, mosapride & sham EA group (MS) and mosapride control group (MC). In the EA group, patients were treated with 16 sessions of needling at Quchi (LI11) and Shangjuxu (ST37) bilaterally, 5 times a week in the first 2 weeks, and 3 times a week in the last 2 weeks. In the MC group, patients were treated with 5 mg mosapride citrate three times a day for 4 weeks. In the MS group, patients underwent sham EA and the same mosapride citrate treatment as in the MC group. The primary outcome was the number of weekly spontaneous bowel movements (SBMs). The secondary outcomes included stool consistency, intensity of defecating difficulty, 36-Item Short-Form Health Survey (SF-36), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and the validated Patient Assessment of Constipation-Quality of Life (PAC-QOL). The results showed that as compared with the baseline, EA significantly improved the weekly SBMs, stool consistency and intensity of defecating difficulty (P<0.05). It also partly ameliorated the PAC-QOL, SF-36, SDS and SAS scores when compared with MC or MS group (P<0.05). However, no significant difference was observed between MS and MC groups in bowel function outcomes and QOL scores. It was concluded that EA could effectively improve bowel function, mental states and QOL of FC patients.
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Affiliation(s)
- Xiao-Hu Xu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ming-Min Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao Wu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sha-Bei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cui-Hong Zheng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Guang-Ying Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Abstract
Constipation is a common condition, affecting up to half of all older adults during their lifetime. Untreated constipation has significant impacts, decreasing quality of life and potentially leading to urinary and/or faecal incontinence, faecal impaction and, in severe cases, hospitalisation. The increased constipation prevalence among older populations is multifactorial, with a number of age-related factors contributing to the rise in prevalence with aging. Laxatives are the mainstay of constipation management and are commonly used among older populations for both treatment and prevention of constipation. A range of laxative types including bulk forming agents, softeners and emollients, osmotic agents, stimulants, and the newer prokinetic and secretory agents are available. Despite laxatives being freely available without prescription in many countries and commonly used by older individuals, evidence regarding the effectiveness or safety of most laxatives in older populations is lacking. Additionally, age-related changes increase the risk of adverse effects associated with laxatives, such as electrolyte disturbances, among older persons. Caution must be taken when extrapolating recommendations for general adult populations to older populations. Laxative choice for older individuals should be tailored after careful assessment and consideration of comorbid conditions, concomitant medications and the potential for adverse effects.
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The evaluation of GI-pill gastrointestinal electronic capsule for colonic transit test in patients with slow transit constipation. Int J Colorectal Dis 2020; 35:29-34. [PMID: 31758247 DOI: 10.1007/s00384-019-03422-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The evaluation of GI-pill gastrointestinal electronic capsule for colonic transit test in patients with slow transit constipation (STC) was studied. MATERIALS AND METHODS STC patients (n = 162) were randomly divided into experimental group (n = 84, orally taken GI-pill gastrointestinal electronic capsule and X-ray granule capsule) and control group (n = 78, orally taken X-ray granule capsule). Comparison of the time in colonic transit test between the two groups was conducted. The data of GI-pill gastrointestinal electronic capsule in vivo time, time of capsule passing through the colon, the number of high amplitude propagating contractions (HAPCs), and physiological response ratio were analyzed. RESULTS There were no significant differences in the whole colonic transit test time, right colonic transit time, left colonic transit time, and rectosigmoid colonic transit time between experimental group and control group (p > 0.05). All patients had no abdominal pain, nausea, vomiting, black stool, difficulty in electronic capsule excretion, or any other discomfort during the test. CONCLUSION GI-pill gastrointestinal electronic capsule can continuously evaluate the dynamic characteristics of digestive tract in STC patients and is consistent with X-ray granule capsule, which is meaningful to clinical application.
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Xu M, Zhang W, Wang L, Feng X, Li Y. The effect and safety of acupuncture on patients with functional constipation: Protocol for a systematic review and meta-analysis of high quality RCTs. Medicine (Baltimore) 2019; 98:e18125. [PMID: 31804322 PMCID: PMC6919459 DOI: 10.1097/md.0000000000018125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Functional constipation (FC) is a prevalent clinical disease that affects a considerable proportion of the population of all ages. Persistent FC significantly reduces quality of life and influences physical and emotional well-being, as well as consumes many substantial healthcare resources. Acupuncture originates from Traditional Chinese Medicine (TCM), and emerging evidence of several randomized controlled trials (RCTs) published suggest that acupuncture has positive effects for FC. Since 2019, several new results of high quality RCTs about acupuncture treatment for FC have been published. Thus a systematic review will be designed to appraise the effectiveness and safety of acupuncture for improvement of FC in patients based on high quality RCTs. METHODS We carried out a rigorous literature search in English and Chinese electronic database from inception to present. Two reviewers will identify relevant studies, extract and manage trial information, and then assess the risk of bias in included studies by the Cochrane risk of bias assessment tool. Only high quality RCTs will be included. Data will be synthesized by either fixed-effects or random-effects model regarding to a heterogeneity test. The primary outcome measurement will be the change from baseline in mean complete spontaneous bowel movements and stool form. The secondary outcomes involved disappearance rate of symptoms, proportion of responders, mean transit time, health-related quality of life, and safety of intervention. Meta-analysis will be performed by using Cochrane's RevMan software. RESULTS This systematic review will summarize high quality clinical evidence to assess and appraise the effectiveness and safety of acupuncture treatment for FC patient. EXPECTED CONCLUSION This systematic review and meta-analysis will provide evidence to determine whether acupuncture treatment is an effective and safe therapy for the prevention and treatment of FC compared with medication treatment.
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Affiliation(s)
- Mingmin Xu
- School of Acupuncture–Moxibustion and Tuina
| | - Wei Zhang
- Office of Educational Administration
| | - Lu Wang
- School of Acupuncture–Moxibustion and Tuina
| | | | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
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Chu JR, Kang SY, Kim SE, Lee SJ, Lee YC, Sung MK. Prebiotic UG1601 mitigates constipation-related events in association with gut microbiota: A randomized placebo-controlled intervention study. World J Gastroenterol 2019; 25:6129-6144. [PMID: 31686768 PMCID: PMC6824284 DOI: 10.3748/wjg.v25.i40.6129] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 09/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Constipation is a common functional gastrointestinal disorder and its etiology is multifactorial. Growing evidence suggests that intestinal dysbiosis is associated with the development of constipation. Prebiotics are subjected to bacterial fermentation in the gut to produce short-chain fatty acids (SCFAs), which can help relieve constipation symptoms. The prebiotic UG1601 consists of inulin, lactitol, and aloe vera gel, which are known laxatives, but randomized, controlled clinical trials that examine the effects of this supplement on gut microbiota composition are lacking.
AIM To assess the efficacy of the prebiotic UG1601 in suppressing constipation-related adverse events in subjects with mild constipation.
METHODS Adults with a stool frequency of less than thrice a week were randomized to receive either prebiotics or a placebo supplement for 4 wk. All participants provided their fecal and blood samples at baseline and at the end of intervention. Gastrointestinal symptoms and stool frequency were evaluated. The concentrations of serum endotoxemia markers and fecal SCFAs were determined. The relative abundance of SCFA-producing bacteria and the gut microbial community in the responders and non-responders in the prebiotics supplementation group were evaluated.
RESULTS There were no significant differences in gastrointestinal symptoms between groups, although the prebiotic group showed greater symptom improvement. However, after prebiotic usage, serum cluster of differentiation (CD) 14 and lipopolysaccharide (LPS) concentrations were significantly decreased (CD14, P = 0.012; LPS, P < 0.001). The change in LPS concentration was significantly larger in the prebiotic group than in the placebo group (P < 0.001). Fecal SCFAs concentrations did not differ between groups, while the relative abundance of Roseburia hominis, a major butyrate producer, was significantly increased in the prebiotic group (P = 0.045). The abundances of the phylum Firmicutes and the family Lachnospiraceae (phylum Firmicutes, class Clostridia) (P = 0.009) were decreased in the responders within the prebiotic group. In addition, the proportions of the phylum Firmicutes, the class Clostridia, and the order Clostridiales were inversely correlated with several fecal SCFAs (P < 0.05).
CONCLUSION Alterations in gut microbiota composition, including a decrease in the phylum Firmicutes and an increase in butyrate-producing bacteria, following prebiotic UG1601 supplementation might help alleviate symptom scores and endotoxemia.
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Affiliation(s)
- Jae Ryang Chu
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Saem-Yi Kang
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Sung-Eun Kim
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | - Sol-Ji Lee
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
| | | | - Mi-Kyung Sung
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, South Korea
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Biomarkers of Parkinson's disease: 20 years later. J Neural Transm (Vienna) 2019; 126:803-813. [PMID: 30949837 DOI: 10.1007/s00702-019-02001-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
Despite intensive effort, biomarker research for the detection of prodromal stage, diagnosis and progression of Parkinson's disease (PD) falls short of expectations. This article reviews the attempts in the last 20 years to find a biomarker, addresses challenges along the biomarker search and suggests the steps that should be taken to overcome these challenges. Although several biomarkers are currently available, none of them is specific enough for diagnosis, prediction of future PD or disease progression. The main reason for the failure finding a strong biomarker seems to be drastic heterogeneity of PD, which exhibits itself in all domains; from the clinic to pathophysiology or genetics. The diversity in patient selection, assessment methods or outcomes in biomarker studies also limit the interpretation and generalizability of the data. In search of a reliable biomarker, consideration of novel approaches encompassing individual demographic, clinical, genetic, epigenetic and environmental differences, employment of strategies enabling marker combinations, designing multicenter studies with compatible assessment methods, integration of data from preclinical domains and utilization of novel technology-based assessments are necessary.
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Khan O, Shankar PR, Parikh AD, Cohan RH, Keshavarzi N, Khalatbari S, Saad RJ, Davenport MS. Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects. Abdom Radiol (NY) 2019; 44:821-827. [PMID: 30552438 DOI: 10.1007/s00261-018-1869-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients. METHOD This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess "fecal loading" [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess "renal stones" [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann's method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients. RESULTS Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: - 0.4 [90% CI - 0.7, - 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)]. CONCLUSION Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.
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Alikiaii B, Majedi MA, Hashemi ST, Kiani M. Comparing the Efficacy of Two Drugs Senalin and Bisacodyl in Treatment of Constipation in Intensive Care Units' Patients. Adv Biomed Res 2019; 8:17. [PMID: 30993087 PMCID: PMC6425743 DOI: 10.4103/abr.abr_165_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Constipation is an intestinal syndrome that can be created alone or in the context of another disease in patients admitted to intensive care units (ICUs). Given the role of sennosides in increasing the transfer rate of materials from the large intestine, we aimed to compare the effect of senalin with bisacodyl on the treatment of constipation in patients admitted to ICUs. Materials and Methods In this randomized, double-blind study, 70 patients admitted to the ICU were divided into two groups. The senalin recipient group received senalin with a dose of 500 mg daily for 3 days. The bisacodyl recipient group received bisacodyl with a dose of 10 mg daily for 3 days. Results The mean of defecation frequency during the 2nd day of treatment of constipation was significantly higher in the group receiving bisacodyl than in the senalin group (P < 0.01). There was no significant difference between the two groups in terms of fecal consistency in any of the study days (P < 0.05). The prevalence of complications in the 3rd day of treatment was significantly higher in bisacodyl group than in the senalin group (P = 0.04). Conclusion Given the lack of difference in the efficacy of two drugs, fecal consistency, daily defecation frequency and fewer complications of senalin compared to bisacodyl, it s eems that this drug can be used as an appropriate treatment for constipation in patients admitted to ICUs.
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Affiliation(s)
- Babak Alikiaii
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Azad Majedi
- Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Seyed Taghi Hashemi
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kiani
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Gustafsson M, Lämås K, Isaksson U, Sandman PO, Lövheim H. Constipation and laxative use among people living in nursing homes in 2007 and 2013. BMC Geriatr 2019; 19:38. [PMID: 30736737 PMCID: PMC6368797 DOI: 10.1186/s12877-019-1054-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. METHODS In 2007 and 2013, two surveys were performed in the county of Västerbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. RESULTS The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. CONCLUSIONS The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden.
| | - Kristina Lämås
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Arctic Research Centre at Umeå University, 901 87, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 901 87, Umeå, Sweden
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Zheng S, Yao J. Expert consensus on the assessment and treatment of chronic constipation in the elderly. Aging Med (Milton) 2018; 1:8-17. [PMID: 31942474 PMCID: PMC6880707 DOI: 10.1002/agm2.12013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 12/11/2022] Open
Abstract
It is of significant importance to scientifically assess and efficiently address chronic constipation in the elderly population. Therefore, organizing some domestic experts of geriatrics and gastroenterology, we have formulated this consensus to reference for clinical staff.
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Abstract
BACKGROUND Chronic constipation is described as a common complication determined by difficult and/or rare passage of stool or both. The difference in definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviors, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms. METHODS A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. Better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.In this study, some of the old and new therapies in the treatment of chronic constipation have been studied based on the controlled studies and strong evidence. We are trying to address some of the controversial issues to manage the disease and to provide appropriate diagnostic options in an efficient and cost-effective way. RESULTS The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION To our knowledge, our study will provide an overall estimate of chronic constipation to assess controversial issues, available diagnostic and therapeutic strategies of chronic constipation. ETHICS AND DISSEMINATION Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.
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Affiliation(s)
- Mojgan Forootan
- Department of Gastroenterology, Gastrointestinal, and liver Diseases Research Center (RCGLD)
| | - Nazila Bagheri
- Department of Nephrology, Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences
| | - Mohammad Darvishi
- Department of Aerospace and Subaquatic Medicine, Infectious Diseases and Tropical Medicine Research Center (IDTMRC), AJA University of Medical Sciences, Tehran, Iran
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Al-Momani LA, Arikapudi S, Gaddam S, Treece J, Rashid S, Baumrucker S. Home-Based Treatment for Chronic Constipation. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822317746403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Saima Rashid
- East Tennessee State University, Johnson City, TN, USA
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Inoh Y, Kanoshima K, Ohkuma K, Fuyuki A, Uchiyama S, Ohkubo H, Higurashi T, Iida H, Nonaka T, Fujita K, Kusakabe A, Inamori M, Hiroishi K, Nagase H, Nakajima A, Takahara T. Assessment of colonic contents in patients with chronic constipation using MRI. J Clin Biochem Nutr 2018; 62:277-280. [PMID: 29892169 PMCID: PMC5990404 DOI: 10.3164/jcbn.17-104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022] Open
Abstract
Although chronic constipation is common, colonic functional evaluating tests are uncommon. This study examines whether chronic constipation and gastrointestinal symptoms are correlated with the lateral diameter of the colon measured from MRI images. We included chronic constipation patients in a prospective, cross-sectional study using MRI at three centers. We divided 3D MRI colorectal images into 6 segments using with specified sequences and selected the maximum luminal diameter from each segment. We used the GSRS questionnaire to evaluate gastrointestinal symptoms. We evaluated the correlation between luminal diameters and GSRS scores. We found the following positive correlations: descending colon and unsatisfactory defecation symptoms; sigmoid colon and diarrhea; and rectum and constipation. The sum and ratio of the ascending and sigmoid colon diameters correlated with nausea and diarrhea. The sum of the transvers to the sigmoid colon diameter also correlated with nausea and diarrhea. The sum of all segment diameters correlated with nausea and constipation. In conclusion, we showed cross-sectional study of colonic MRI correlate with gastrointestinal symptoms. MRI might be useful for colonic motility evaluations to determine appropriate constipation treatments (Clinical trial registry number UMIN 000021274).
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Affiliation(s)
- Yumi Inoh
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Kenji Kanoshima
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Kanji Ohkuma
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Akiko Fuyuki
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Shiori Uchiyama
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Kanagawa 222-0036, Japan
| | - Hidenori Ohkubo
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Takuma Higurashi
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Hiroshi Iida
- Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Takashi Nonaka
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Koji Fujita
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Akihiko Kusakabe
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Kazumasa Hiroishi
- Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa 215-0026, Japan
| | - Hajime Nagase
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Kanagawa 222-0036, Japan
| | - Atushi Nakajima
- Department of Hepatology and Gastroenterology, Yokohama City University School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Taro Takahara
- Department of Biological Engineering, Tokai University, School of Biological Engineering, Isehara, Kanagawa 259-1193, Japan
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Nishikawa M, Shimada N, Kanzaki M, Ikegami T, Fukuoka T, Fukushima M, Asano K. The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis. Acute Med Surg 2018; 5:222-229. [PMID: 29988705 PMCID: PMC6028801 DOI: 10.1002/ams2.334] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2022] Open
Abstract
Aim This study aimed to clarify the characteristics of patients who presented with severe hypermagnesemia and subsequently underwent emergency hemodialysis. Methods We investigated the age, gender, complications, clinical symptoms, causal drugs, electrocardiogram findings, and laboratory data of 15 patients. Results Magnesium oxide had been administered in all cases and 14 patients were over 65 years old. The male : female ratio was 6:9. Chief complaints included a disturbance of consciousness, hypotension, bradycardia, and respiratory failure. The median serum magnesium value before hemodialysis was 6.0 (3.7–18.6) mg/dL. The daily dosage of magnesium oxide was ≤ 2.0 g in 12 cases. The median serum creatinine value before hemodialysis was 5.39 (0.54–10.29) mg/dL. However, in two cases, the creatinine value was not elevated. Complications of acute kidney injury exacerbated the hypermagnesemia in nine cases. Conclusions We recommend that the serum magnesium value should be measured in older patients who are taking magnesium oxide and are showing signs and symptoms of a disturbance of consciousness, hypotension, bradycardia, and respiratory failure of an uncertain etiology, even if the serum creatinine value is not elevated or the dosage of magnesium oxide is within recommended levels.
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Affiliation(s)
- Mana Nishikawa
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Noriaki Shimada
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Motoko Kanzaki
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Tetsunori Ikegami
- Department of Emergency Medicine Kurashiki Central Hospital Kurashiki Japan
| | - Toshio Fukuoka
- Department of General Medicine Kurashiki Central Hospital Kurashiki Japan
| | - Masaki Fukushima
- Department of Internal Medicine Shigei Research Institute Hospital Okayama Japan
| | - Kenichiro Asano
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
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