BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been exa...BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.展开更多
BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD al...BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD alleviates STC by downregulating the nuclear factorκB(NF-κB)signaling pathway and restoring intestinal barrier function.METHODS KM mice were divided into control,model,and HQD treatment groups.Fresh colonic tissues were collected for single-cell RNA sequencing and spatial tra-nscriptome sequencing.The expressions of claudin-1,mucin 2,and NF-κB P65 proteins were detected by immunohistochemistry.In vitro experiments evaluated the effects of HQD on the LS174T cell line.RESULTS HQD improved intestinal motility,restored mucosal epithelium function and morphology.Single-cell RNA sequencing and spatial transcriptome sequencing data showed a reduction in goblet cells,decreased mucin 2 secretion,and activated apoptotic pathways in STC mice.The population of intestinal stem cells was reduced,and proliferation along with Wnt/β-catenin pathways were inhibited.STC also altered the distribution of intestinal cell states,increasing immune-associated Enterocyte_C3.Aberrant NF-κB pathway activation was noted across various cell types.After HQD treatment,NF-κB pathway activity was down-regulated,while cell proliferation pathways were up-regulated,alongside an increase in Enterocyte_C1 related to material transport.Immunocytochemical,Western blot,and immunohistochemistry analyses confirmed NF-κB pathway activation in goblet cells of STC mice,with HQD inhibiting this aberrant activation.CONCLUSION STC involves intestinal mucosal barrier damage.HQD may treat STC by suppressing NF-κB signaling in epithelial cells,restoring intestinal epithelial cell function,and promoting mucosal barrier repair.展开更多
Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiot...Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.展开更多
BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compar...BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compare the developed PEG-based formula(PEG-Chula)to the commercial formula for treating childhood FC.METHODS In this randomized controlled trial,we enrolled children aged<18 years with FC diagnosed by the Rome Ⅳ criteria to receive PEG-Chula[four flavors:(1)Strawberry;(2)Lychee;(3)Apple;and(4)Lychee-rose]or Forlax(orange-grapefruit flavor)for eight weeks.The primary outcomes included changes in stool frequency and consistency measured by the Bristol Stool scale.The secondary outcomes were constipation-related symptom improvement,adverse events,and palatability measured by the facial hedonic scale.RESULTS Fifty-two children diagnosed with FC[median age:4.21(2.33,7.88)years;35(67.31%)females]were enrolled.After the 8-week treatment,the mean weekly stool frequency increased in both groups,the mean change was 4.02(95%CI:3.09-4.95)in PEG-Chula and 3.78(95%CI:2.79-4.78)in commercial PEG compared to baseline(P<0.001).The extent of stool consistency improvement did not differ significantly.The most preferred PEG-Chula flavor was rated more palatable than the commercial PEG.Treatment compliance correlated with medication palatability(r=0.34,P=0.013).No significant differences in adverse events were found.CONCLUSION Both PEG-based formulas are effective and safe for managing pediatric FC.展开更多
BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to ...BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.展开更多
The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststr...The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststroke constipation,and to provide reference for clinical practice and scientific research.With the help of CiteSpace software,the related literatures published in the China National Knowledge Infrastructure database on the application of acupoint massage to constipation after stroke were analyzed,and scientific atlas for visual analysis was drawn.The hot keywords in the field of acupoint massage for post-stroke constipation are constipation,nursing intervention,and traditional Chinese medicine(TCM)nursing,indicating the great importance of TCM nursing for such patients.In mutation word detection,words such as constipation,nursing,stroke,and defecation reflex have earlier mutation times.Massage is the keyword with the longest mutation time,suggesting it is an effective intervention for post-stroke patients and is widely recognized.The commonly used acupoints for poststroke constipation are Tianshu(ST 25),Zhongwan(CV 12),and Qihai(CV 6).These acupoints can regulate qi and blood and enhance gastrointestinal peristalsis,providing guiding significance for formulating relevant clinical practice guidelines.The research of acupoint massage in the nursing of poststroke constipation is still in the stage of practice and exploration,and the specific definition of operation process,technique,acupoint,time,and intensity is still not clear.Multicenter,large-sample,in-depth intervention research,and cohort studies hold immense significance for the future development of this discipline.展开更多
BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unad...BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.展开更多
Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimenta...Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimental group and a control group,with 30 patients in each group.The control group received nasal feeding with a regular diet.The experimental group received nasal feeding with a regular diet plus inulin.The defecation status of the patients was observed and compared on the 3rd,5th,and 7th days.Results:Among the 30 patients in the experimental group and 30 patients in the control group,there was a statistically significant difference in treatment effect between the two groups(P<0.05).The treatment duration was(3.91±1.09)days in the experimental group and(5.78±1.52)days in the control group.Conclusion:Inulin has a significant effect in the treatment of constipation for critically ill patients in the ICU and is worthy of clinical promotion and application.展开更多
Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-respon...Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.展开更多
BACKGROUND Xuanshen decoction(XSD)is a traditional Chinese medicine formulation that is often applied in treating slow transit constipation(STC).However,its specific therapeutic mechanism remains to be characterized.A...BACKGROUND Xuanshen decoction(XSD)is a traditional Chinese medicine formulation that is often applied in treating slow transit constipation(STC).However,its specific therapeutic mechanism remains to be characterized.AIM To investigate the mechanism of XSD for STC,we combined network pharmacology prediction,molecular docking analysis,and in vivo studies.METHODS The therapeutic effects of XSD on loperamide-induced STC in rats were assessed through 24-hour fecal number,fecal moisture content,and intestinal propelling rate.Hematoxylin–eosin and Alcian blue/periodic acid-Schiff staining were applied to analyze colonic mucosa for histopathological presentation and mucin production.Next,the mechanism of action of XSD for STC was elucidated through network pharmacology and molecular docking analyses,and the findings were validated by the animal experiments.RESULTS XSD significantly alleviated the symptoms of STC in rats.Relative to the STC rats,in the medium-dose XSD and high-dose XSD rats,stem cell factor,C-kit,phosphophosphoinositide 3-kinase/phosphoinositide 3-kinase,phospho-protein kinase B/protein kinase B,catalase,and superoxide dismutase were substantially upregulated(P<0.01);nuclear factor erythroid 2-related factor 2(nuclear/cytoplasmic)and B-cell lymphoma 2(Bcl-2)were increased(P<0.05),while cleaved caspase-3,Bcl-2-associated X protein(Bax)/Bcl-2,and malondialdehyde were significantly reduced(P<0.01).Heme oxygenase-1 and glutathione peroxidase in the high-dose XSD group were significantly increased(P<0.01),and Bax was statistically lowered(P<0.01);glutathione peroxidase in the medium-dose XSD group was increased(P<0.05),while Bax was reduced(P<0.05).CONCLUSION XSD may inhibit oxidative-stress-induced apoptosis in interstitial cells of Cajal by stimulating the phosphoinositide 3-kinase/protein kinase B/nuclear factor erythroid 2-related factor 2 pathway,thereby effectively treating STC.展开更多
BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental healt...BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.展开更多
Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic com...Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.展开更多
BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The ...BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The use of electroacupuncture(EA)has demonstrated clinical efficacy in treating IBS-C and the gut-brain axis modulation,though its mechanisms remain unclear.AIM To investigate gut-brain-microbiota axis alteration and EA-associated microbial changes in IBS-C patients and treatment responders.METHODS This study consisted of two phases.The first phase was a cross-sectional study recruiting sixteen IBS-C patients and 16 healthy controls.Baseline fecal samples were collected to assess gut microbiota profiles between the two groups.The second phase was an observational longitudinal study in which the 16 IBS-C patients underwent nine EA sessions over one month.Gut microbiota profiles and clinical outcomes were assessed post-treatment course and at a one-month follow-up.RESULTS IBS-C patients exhibited significant gut dysbiosis,as indicated by altered beta diversity compared to healthy controls.EA significantly improved clinical outcomes and gut dysbiosis,with sustained therapeutic effects and normalization of neurotransmitter-related metabolic pathways observed at one-month follow-up.Notably,the gut bacterium Senegalimassilia was positively associated with symptom improvement,suggesting its potential as a predictive biomarker of EA responsiveness.CONCLUSION These findings support the integration of EA into IBS-C management and highlight Senegalimassilia as a candidate microbial biomarker for treatment response.展开更多
Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021...Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021.They were randomly divided into two groups using the envelope method:25 patients in the observation group and 25 patients in the control group.The control group received only lactulose,while the observation group received Denghuo moxibustion in addition to lactulose.The efficacy,quality of life(PAC-QOL scale),and laboratory indicators[serum substance P(SP)and vasoactive intestinal peptide(VIP)]were compared between the two groups.Results:The efficacy of the observation group was significantly better than that of the control group(P<0.05).After treatment,the PAC-QOL scores of both groups decreased significantly,and the improvement in the observation group was more significant(P<0.05).Changes in laboratory indicators showed that VIP decreased significantly and SP increased significantly in both groups,and the improvement of these two indicators in the observation group was significantly better than that in the control group(P<0.05).Conclusion:Denghuo moxibustion can enhance the efficacy of lactulose by regulating intestinal neuropeptides and is an effective treatment for post-stroke constipation.展开更多
Background:This study investigated the impacts and mechanisms of yunweiling in the management of Functional Constipation(FC)using network pharmacology and experimental research.Methods:Using the Traditional Chinese Me...Background:This study investigated the impacts and mechanisms of yunweiling in the management of Functional Constipation(FC)using network pharmacology and experimental research.Methods:Using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),Genecard,and Online Mendelian Inheritance in Man(OMIM)databases,a potential gene target for yunweiling in treating FC was found.A pharmacological network was built and viewed in Cytoscape.A protein interac-tion map was created with STRING and Cytoscape.‘clusterProfiler’helped uncover its mechanism.Molecular docking was done with AutoDock Vina.In a constipation mouse model,Western blot was used to assess yunweiling's effectiveness.Results:To investigate yunweiling's therapeutic effects on FC,we employed a loperamide-induced constipation model.Successful model establishment was con-firmed by first black stool time,reduced stool output,and impaired gastrointestinal motility.Yunweiling treatment,especially at high and medium doses,significantly al-leviated constipation symptoms by reducing first black stool time,increasing stool output,and enhancing gastrointestinal motility.HE staining revealed yunweiling's ability to restore colon tissue structure.Yunweiling modulated the expression of key proteins TP53,P-AKT,P-PI3K,RET,and Rai,implicating its involvement in the PI3K-Akt signaling pathway.Comparative analysis showed yunweiling to be more effective than its individual components(shionone,β-sitosterol,and daucosterol)in improving constipation.The combination of yunweiling with TP53 and PI3K-Akt inhibitors fur-ther enhanced its therapeutic effects,suggesting a synergistic mechanism.Conclusions:The integration of network pharmacology and experimental investiga-tions indicated the effectiveness of yunweiling in managing FC,offering essential theoretical support for clinical application.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical ex...Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.展开更多
BACKGROUND Constipation,a highly prevalent functional gastrointestinal disorder,induces a significant burden on the quality of patients'life and is associated with substantial healthcare expenditures.Therefore,ide...BACKGROUND Constipation,a highly prevalent functional gastrointestinal disorder,induces a significant burden on the quality of patients'life and is associated with substantial healthcare expenditures.Therefore,identifying efficient therapeutic modalities for constipation is of paramount importance.Oxidative stress is a pivotal contributor to colonic dysmotility and is the underlying pathology responsible for constipation symptoms.Consequently,we postulate that hydrogen therapy,an emerging and promising intervention,can serve as a safe and efficacious treatment for constipation.AIM To determine whether hydrogen-rich water(HRW)alleviates constipation and its potential mechanism.METHODS Constipation models were established by orally loperamide to Sprague-Dawley rats.Rats freely consumed HRW,and were recorded their 24 h total stool weight,fecal water content,and charcoal propulsion rate.Fecal samples were subjected to 16S rDNA gene sequencing.Serum non-targeted metabolomic analysis,malondialdehyde,and superoxide dismutase levels were determined.Colonic tissues were stained with hematoxylin and eosin,Alcian blue-periodic acid-Schiff,reactive oxygen species(ROS)immunofluorescence,and immunohistochemistry for cell growth factor receptor kit(c-kit),PGP 9.5,sirtuin1(SIRT1),nuclear factor-erythroid-2-related factor 2(Nrf2),and heme oxygenase-1(HO-1).Quantitative real-time PCR and western blot analysis were conducted to determine the expression level of SIRT1,Nrf2 and HO-1.A rescue experiment was conducted by intraperitoneally injecting the SIRT1 inhibitor,EX527,into constipated rats.NCM460 cells were induced with H2O2 and treated with the metabolites to evaluate ROS and SIRT1 expression.RESULTS HRW alleviated constipation symptoms by improving the total amount of stool over 24 h,fecal water content,charcoal propulsion rate,thickness of the intestinal mucus layer,c-kit expression,and the number of intestinal neurons.HRW modulated intestinal microbiota imbalance and abnormalities in serum metabolism.HRW could also reduce intestinal oxidative stress through the SIRT1/Nrf2/HO-1 signaling pathway.This regulatory effect on oxidative stress was confirmed via an intraperitoneal injection of a SIRT1 inhibitor to constipated rats.The serum metabolites,β-leucine(β-Leu)and traumatic acid,were also found to attenuate H2O2-induced oxidative stress in NCM460 cells by up-regulating SIRT1.CONCLUSION HRW attenuates constipation-associated intestinal oxidative stress via SIRT1/Nrf2/HO-1 signaling pathway,modulating gut microbiota and serum metabolites.β-Leu and traumatic acid are potential metabolites that upregulate SIRT1 expression and reduce oxidative stress.展开更多
Functional constipation(FC)is a common disorder that is characterized by diffi-cult stool passage,infrequent bowel movement,or both.FC is highly prevalent,recurs often,accompanies severe diseases,and affects quality o...Functional constipation(FC)is a common disorder that is characterized by diffi-cult stool passage,infrequent bowel movement,or both.FC is highly prevalent,recurs often,accompanies severe diseases,and affects quality of life;therefore,safe and effective therapy with long-term benefits is urgently needed.Microbiota treatment has potential value for FC treatment.Microbiota treatments include modulators such as probiotics,prebiotics,synbiotics,postbiotics,and fecal micro-biota transplantation(FMT).Some probiotics and prebiotics have been adopted,and the efficacy of other microbiota modulators is being explored.FMT is con-sidered an emerging field because of its curative effects;nevertheless,substantial work must be performed before clinical implementation.展开更多
Constipation is a common intestinal disease.Kiwi berries can effectively prevent constipation.However,studies have yet to be done to determine how kiwi berries prevent constipation.For two weeks,mice in this study wer...Constipation is a common intestinal disease.Kiwi berries can effectively prevent constipation.However,studies have yet to be done to determine how kiwi berries prevent constipation.For two weeks,mice in this study were continually orally gavaged with kiwi berry,loperamide,or a combination of the 2.This study found that the kiwi group's feces had more water than the constipated mice.In addition,kiwi berries can speed up gastrointestinal transit(GI),shorten the time it takes to pass the first dark stool,and dramatically enhance body weight gain.In the interstitial cells of Caj al(ICC)cells and colon tissues,alterations in the protein expression of vasoactive intestinal peptide(VIP),cyclic adenosine monophosphate(cAMP),protein kinase A(PKA),and aquapcrin-3(AQP3)were found.At 3,6,and 12 h of ICC cells and mouse colon,the kiwi group's VIP,cAMP,PKA,and AQP3 protein expression levels were lower than those of the constipated mice.The kiwi berry can decrease the Firmicutes to Bacteroidetes ratio and boost the diversity and quantity of gut microbiota.By influencing the gut microbiota and VIP-cAMP-PKA-AQP3 signaling pathway,kiwi berries prevent constipation.展开更多
文摘BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.
基金Supported by the Natural Science Foundation of Guangdong Province for Distinguished Young Scholars,No.2022B1515020003the National Natural Science Foundation of China,No.82174369,No.82405397,No.82374442,and No.81973847+2 种基金Postdoctoral Fellowship Program of CPSF No.GZC20233247National Key Clinical Disciplineand the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004.
文摘BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD alleviates STC by downregulating the nuclear factorκB(NF-κB)signaling pathway and restoring intestinal barrier function.METHODS KM mice were divided into control,model,and HQD treatment groups.Fresh colonic tissues were collected for single-cell RNA sequencing and spatial tra-nscriptome sequencing.The expressions of claudin-1,mucin 2,and NF-κB P65 proteins were detected by immunohistochemistry.In vitro experiments evaluated the effects of HQD on the LS174T cell line.RESULTS HQD improved intestinal motility,restored mucosal epithelium function and morphology.Single-cell RNA sequencing and spatial transcriptome sequencing data showed a reduction in goblet cells,decreased mucin 2 secretion,and activated apoptotic pathways in STC mice.The population of intestinal stem cells was reduced,and proliferation along with Wnt/β-catenin pathways were inhibited.STC also altered the distribution of intestinal cell states,increasing immune-associated Enterocyte_C3.Aberrant NF-κB pathway activation was noted across various cell types.After HQD treatment,NF-κB pathway activity was down-regulated,while cell proliferation pathways were up-regulated,alongside an increase in Enterocyte_C1 related to material transport.Immunocytochemical,Western blot,and immunohistochemistry analyses confirmed NF-κB pathway activation in goblet cells of STC mice,with HQD inhibiting this aberrant activation.CONCLUSION STC involves intestinal mucosal barrier damage.HQD may treat STC by suppressing NF-κB signaling in epithelial cells,restoring intestinal epithelial cell function,and promoting mucosal barrier repair.
文摘Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.
基金Supported by the 90th Anniversary of Chulalongkorn University Fund(Ratchadapiseksomphot Endowment Fund)Ratchadapiseksompotch Funds,Graduate Affairs,Faculty of Medicine,Chulalongkorn University,Bangkok,Thailand,No.GA68/028.
文摘BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compare the developed PEG-based formula(PEG-Chula)to the commercial formula for treating childhood FC.METHODS In this randomized controlled trial,we enrolled children aged<18 years with FC diagnosed by the Rome Ⅳ criteria to receive PEG-Chula[four flavors:(1)Strawberry;(2)Lychee;(3)Apple;and(4)Lychee-rose]or Forlax(orange-grapefruit flavor)for eight weeks.The primary outcomes included changes in stool frequency and consistency measured by the Bristol Stool scale.The secondary outcomes were constipation-related symptom improvement,adverse events,and palatability measured by the facial hedonic scale.RESULTS Fifty-two children diagnosed with FC[median age:4.21(2.33,7.88)years;35(67.31%)females]were enrolled.After the 8-week treatment,the mean weekly stool frequency increased in both groups,the mean change was 4.02(95%CI:3.09-4.95)in PEG-Chula and 3.78(95%CI:2.79-4.78)in commercial PEG compared to baseline(P<0.001).The extent of stool consistency improvement did not differ significantly.The most preferred PEG-Chula flavor was rated more palatable than the commercial PEG.Treatment compliance correlated with medication palatability(r=0.34,P=0.013).No significant differences in adverse events were found.CONCLUSION Both PEG-based formulas are effective and safe for managing pediatric FC.
基金Supported by National Natural Science Foundation of China,No.82174309and Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Siming Fund Special Project for Scientific Research,No.SGKJ-202304.
文摘BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.
文摘The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststroke constipation,and to provide reference for clinical practice and scientific research.With the help of CiteSpace software,the related literatures published in the China National Knowledge Infrastructure database on the application of acupoint massage to constipation after stroke were analyzed,and scientific atlas for visual analysis was drawn.The hot keywords in the field of acupoint massage for post-stroke constipation are constipation,nursing intervention,and traditional Chinese medicine(TCM)nursing,indicating the great importance of TCM nursing for such patients.In mutation word detection,words such as constipation,nursing,stroke,and defecation reflex have earlier mutation times.Massage is the keyword with the longest mutation time,suggesting it is an effective intervention for post-stroke patients and is widely recognized.The commonly used acupoints for poststroke constipation are Tianshu(ST 25),Zhongwan(CV 12),and Qihai(CV 6).These acupoints can regulate qi and blood and enhance gastrointestinal peristalsis,providing guiding significance for formulating relevant clinical practice guidelines.The research of acupoint massage in the nursing of poststroke constipation is still in the stage of practice and exploration,and the specific definition of operation process,technique,acupoint,time,and intensity is still not clear.Multicenter,large-sample,in-depth intervention research,and cohort studies hold immense significance for the future development of this discipline.
文摘BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.
文摘Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimental group and a control group,with 30 patients in each group.The control group received nasal feeding with a regular diet.The experimental group received nasal feeding with a regular diet plus inulin.The defecation status of the patients was observed and compared on the 3rd,5th,and 7th days.Results:Among the 30 patients in the experimental group and 30 patients in the control group,there was a statistically significant difference in treatment effect between the two groups(P<0.05).The treatment duration was(3.91±1.09)days in the experimental group and(5.78±1.52)days in the control group.Conclusion:Inulin has a significant effect in the treatment of constipation for critically ill patients in the ICU and is worthy of clinical promotion and application.
基金supported by High-Level Chinese Medical Hospital Promotion ProjectHLCMHPP2023089.
文摘Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.
基金Supported by the 2024 Hospital Innovation Talent Cultivation Fund Project,No.2024YGKT12.
文摘BACKGROUND Xuanshen decoction(XSD)is a traditional Chinese medicine formulation that is often applied in treating slow transit constipation(STC).However,its specific therapeutic mechanism remains to be characterized.AIM To investigate the mechanism of XSD for STC,we combined network pharmacology prediction,molecular docking analysis,and in vivo studies.METHODS The therapeutic effects of XSD on loperamide-induced STC in rats were assessed through 24-hour fecal number,fecal moisture content,and intestinal propelling rate.Hematoxylin–eosin and Alcian blue/periodic acid-Schiff staining were applied to analyze colonic mucosa for histopathological presentation and mucin production.Next,the mechanism of action of XSD for STC was elucidated through network pharmacology and molecular docking analyses,and the findings were validated by the animal experiments.RESULTS XSD significantly alleviated the symptoms of STC in rats.Relative to the STC rats,in the medium-dose XSD and high-dose XSD rats,stem cell factor,C-kit,phosphophosphoinositide 3-kinase/phosphoinositide 3-kinase,phospho-protein kinase B/protein kinase B,catalase,and superoxide dismutase were substantially upregulated(P<0.01);nuclear factor erythroid 2-related factor 2(nuclear/cytoplasmic)and B-cell lymphoma 2(Bcl-2)were increased(P<0.05),while cleaved caspase-3,Bcl-2-associated X protein(Bax)/Bcl-2,and malondialdehyde were significantly reduced(P<0.01).Heme oxygenase-1 and glutathione peroxidase in the high-dose XSD group were significantly increased(P<0.01),and Bax was statistically lowered(P<0.01);glutathione peroxidase in the medium-dose XSD group was increased(P<0.05),while Bax was reduced(P<0.05).CONCLUSION XSD may inhibit oxidative-stress-induced apoptosis in interstitial cells of Cajal by stimulating the phosphoinositide 3-kinase/protein kinase B/nuclear factor erythroid 2-related factor 2 pathway,thereby effectively treating STC.
基金Suzhou Clinical Medical Center for Mood Disorders,No.Szlcyxzx202109Suzhou Key Laboratory,No.SZS2024016+1 种基金Multicenter Clinical Research on Major Diseases in Suzhou,No.DZXYJ202413General Program of Lianyungang Health Committee,No.202336.
文摘BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.
基金Supported by The Hubei Pediatric Alliance Medical Research Project,No.HPAMRP202117.
文摘Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.
文摘BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The use of electroacupuncture(EA)has demonstrated clinical efficacy in treating IBS-C and the gut-brain axis modulation,though its mechanisms remain unclear.AIM To investigate gut-brain-microbiota axis alteration and EA-associated microbial changes in IBS-C patients and treatment responders.METHODS This study consisted of two phases.The first phase was a cross-sectional study recruiting sixteen IBS-C patients and 16 healthy controls.Baseline fecal samples were collected to assess gut microbiota profiles between the two groups.The second phase was an observational longitudinal study in which the 16 IBS-C patients underwent nine EA sessions over one month.Gut microbiota profiles and clinical outcomes were assessed post-treatment course and at a one-month follow-up.RESULTS IBS-C patients exhibited significant gut dysbiosis,as indicated by altered beta diversity compared to healthy controls.EA significantly improved clinical outcomes and gut dysbiosis,with sustained therapeutic effects and normalization of neurotransmitter-related metabolic pathways observed at one-month follow-up.Notably,the gut bacterium Senegalimassilia was positively associated with symptom improvement,suggesting its potential as a predictive biomarker of EA responsiveness.CONCLUSION These findings support the integration of EA into IBS-C management and highlight Senegalimassilia as a candidate microbial biomarker for treatment response.
基金Honghuagang District Science and Technology Plan Project of Zunyi City(Project No.:Zun Hong Ke He She Zi 202103)。
文摘Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021.They were randomly divided into two groups using the envelope method:25 patients in the observation group and 25 patients in the control group.The control group received only lactulose,while the observation group received Denghuo moxibustion in addition to lactulose.The efficacy,quality of life(PAC-QOL scale),and laboratory indicators[serum substance P(SP)and vasoactive intestinal peptide(VIP)]were compared between the two groups.Results:The efficacy of the observation group was significantly better than that of the control group(P<0.05).After treatment,the PAC-QOL scores of both groups decreased significantly,and the improvement in the observation group was more significant(P<0.05).Changes in laboratory indicators showed that VIP decreased significantly and SP increased significantly in both groups,and the improvement of these two indicators in the observation group was significantly better than that in the control group(P<0.05).Conclusion:Denghuo moxibustion can enhance the efficacy of lactulose by regulating intestinal neuropeptides and is an effective treatment for post-stroke constipation.
基金funded by the TCM Spleen and Stomach Discipline Leader Project of High-level Talents in Yunnan Province (no grant number)TCM Joint Project of Yunnan Provincial Science and Technology Department (grant number 202101AZ070001-209).
文摘Background:This study investigated the impacts and mechanisms of yunweiling in the management of Functional Constipation(FC)using network pharmacology and experimental research.Methods:Using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),Genecard,and Online Mendelian Inheritance in Man(OMIM)databases,a potential gene target for yunweiling in treating FC was found.A pharmacological network was built and viewed in Cytoscape.A protein interac-tion map was created with STRING and Cytoscape.‘clusterProfiler’helped uncover its mechanism.Molecular docking was done with AutoDock Vina.In a constipation mouse model,Western blot was used to assess yunweiling's effectiveness.Results:To investigate yunweiling's therapeutic effects on FC,we employed a loperamide-induced constipation model.Successful model establishment was con-firmed by first black stool time,reduced stool output,and impaired gastrointestinal motility.Yunweiling treatment,especially at high and medium doses,significantly al-leviated constipation symptoms by reducing first black stool time,increasing stool output,and enhancing gastrointestinal motility.HE staining revealed yunweiling's ability to restore colon tissue structure.Yunweiling modulated the expression of key proteins TP53,P-AKT,P-PI3K,RET,and Rai,implicating its involvement in the PI3K-Akt signaling pathway.Comparative analysis showed yunweiling to be more effective than its individual components(shionone,β-sitosterol,and daucosterol)in improving constipation.The combination of yunweiling with TP53 and PI3K-Akt inhibitors fur-ther enhanced its therapeutic effects,suggesting a synergistic mechanism.Conclusions:The integration of network pharmacology and experimental investiga-tions indicated the effectiveness of yunweiling in managing FC,offering essential theoretical support for clinical application.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
基金Supported by the Ministry of Science,Technological Development and Innovations,Republic of Serbia,No.451-03-66/2024-03/200110.
文摘Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.
基金Supported by National Natural Science Foundation of China,No.82374449China Postdoctoral Science Foundation,No.2023M731782+1 种基金Jiangsu Funding Program for Excellent Postdoctoral Talent,No.2022ZB806Jiangsu Province Postgraduate Scientific Research and Innovation Plan,No.KYCX23_2136.
文摘BACKGROUND Constipation,a highly prevalent functional gastrointestinal disorder,induces a significant burden on the quality of patients'life and is associated with substantial healthcare expenditures.Therefore,identifying efficient therapeutic modalities for constipation is of paramount importance.Oxidative stress is a pivotal contributor to colonic dysmotility and is the underlying pathology responsible for constipation symptoms.Consequently,we postulate that hydrogen therapy,an emerging and promising intervention,can serve as a safe and efficacious treatment for constipation.AIM To determine whether hydrogen-rich water(HRW)alleviates constipation and its potential mechanism.METHODS Constipation models were established by orally loperamide to Sprague-Dawley rats.Rats freely consumed HRW,and were recorded their 24 h total stool weight,fecal water content,and charcoal propulsion rate.Fecal samples were subjected to 16S rDNA gene sequencing.Serum non-targeted metabolomic analysis,malondialdehyde,and superoxide dismutase levels were determined.Colonic tissues were stained with hematoxylin and eosin,Alcian blue-periodic acid-Schiff,reactive oxygen species(ROS)immunofluorescence,and immunohistochemistry for cell growth factor receptor kit(c-kit),PGP 9.5,sirtuin1(SIRT1),nuclear factor-erythroid-2-related factor 2(Nrf2),and heme oxygenase-1(HO-1).Quantitative real-time PCR and western blot analysis were conducted to determine the expression level of SIRT1,Nrf2 and HO-1.A rescue experiment was conducted by intraperitoneally injecting the SIRT1 inhibitor,EX527,into constipated rats.NCM460 cells were induced with H2O2 and treated with the metabolites to evaluate ROS and SIRT1 expression.RESULTS HRW alleviated constipation symptoms by improving the total amount of stool over 24 h,fecal water content,charcoal propulsion rate,thickness of the intestinal mucus layer,c-kit expression,and the number of intestinal neurons.HRW modulated intestinal microbiota imbalance and abnormalities in serum metabolism.HRW could also reduce intestinal oxidative stress through the SIRT1/Nrf2/HO-1 signaling pathway.This regulatory effect on oxidative stress was confirmed via an intraperitoneal injection of a SIRT1 inhibitor to constipated rats.The serum metabolites,β-leucine(β-Leu)and traumatic acid,were also found to attenuate H2O2-induced oxidative stress in NCM460 cells by up-regulating SIRT1.CONCLUSION HRW attenuates constipation-associated intestinal oxidative stress via SIRT1/Nrf2/HO-1 signaling pathway,modulating gut microbiota and serum metabolites.β-Leu and traumatic acid are potential metabolites that upregulate SIRT1 expression and reduce oxidative stress.
基金Supported by the Project of the National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,No.NCRCGPLAGH-2023005.
文摘Functional constipation(FC)is a common disorder that is characterized by diffi-cult stool passage,infrequent bowel movement,or both.FC is highly prevalent,recurs often,accompanies severe diseases,and affects quality of life;therefore,safe and effective therapy with long-term benefits is urgently needed.Microbiota treatment has potential value for FC treatment.Microbiota treatments include modulators such as probiotics,prebiotics,synbiotics,postbiotics,and fecal micro-biota transplantation(FMT).Some probiotics and prebiotics have been adopted,and the efficacy of other microbiota modulators is being explored.FMT is con-sidered an emerging field because of its curative effects;nevertheless,substantial work must be performed before clinical implementation.
基金financially supported by National Natural Science Foundation of China (U21A20273)China Agriculture Research System of MOF and MARA (CARS-29)the First Batch of Liaoning“Unveiling Leader”Scientific and Technological Projects (2021JH1/10400036)。
文摘Constipation is a common intestinal disease.Kiwi berries can effectively prevent constipation.However,studies have yet to be done to determine how kiwi berries prevent constipation.For two weeks,mice in this study were continually orally gavaged with kiwi berry,loperamide,or a combination of the 2.This study found that the kiwi group's feces had more water than the constipated mice.In addition,kiwi berries can speed up gastrointestinal transit(GI),shorten the time it takes to pass the first dark stool,and dramatically enhance body weight gain.In the interstitial cells of Caj al(ICC)cells and colon tissues,alterations in the protein expression of vasoactive intestinal peptide(VIP),cyclic adenosine monophosphate(cAMP),protein kinase A(PKA),and aquapcrin-3(AQP3)were found.At 3,6,and 12 h of ICC cells and mouse colon,the kiwi group's VIP,cAMP,PKA,and AQP3 protein expression levels were lower than those of the constipated mice.The kiwi berry can decrease the Firmicutes to Bacteroidetes ratio and boost the diversity and quantity of gut microbiota.By influencing the gut microbiota and VIP-cAMP-PKA-AQP3 signaling pathway,kiwi berries prevent constipation.
