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 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
AIM： To evaluate the efficacy and safety of tegaserod, 6 mg twice daily （b.i.d.）, in men and women with chronic constipation （CC） from China. METHODS： This was a multicenter, double-blind, placebo-controlled stu...AIM： To evaluate the efficacy and safety of tegaserod, 6 mg twice daily （b.i.d.）, in men and women with chronic constipation （CC） from China. METHODS： This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatmentfree baseline period, patients were randomized to receive either tegaserod （6 mg b.i.d.） or placebo （b.i.d.） for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements （CSBMs） during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients＇ daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events （AEs）. RESULTS： A total of 607 patients were randomized to receive either tegaserod （n = 304） or placebo （n = 303）. Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo （1.39 vs 0.91, P = 0.0002）. A statistically significant difference in favor of tegaserod was also observed for a mean increase ≥ 1 CSBM/wk over wk 1-4 （47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018） and for the absolute number of≥ 3 CSBMs/wk over wk 1-4 （25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021）. Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod （3.6%） compared with placebo （1.7%）. CONCLUSION： Tecjaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.展开更多
AIM:To evaluate the possible relationship between varicocele and chronic constipation.METHODS:Between April 2009 and May 2010,a total of 135 patients with varicocele or constipation and 120 healthy controls were evalu...AIM:To evaluate the possible relationship between varicocele and chronic constipation.METHODS:Between April 2009 and May 2010,a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated.Patients were divided into two groups.In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist.All of them were evaluated by color Doppler ultrasonography.All patients with constipation,except for the healthy controls of the second group,underwent a colonoscopy to identify the etiology of the constipation.In the first group,we determined the rate of chronic constipation in patients with varicocele and in the second group,the rate of varicocele in patients with chronic constipation.In both groups,the rate of the disease was compared with age-matched healthy controls.In the second group,the results of colonoscopies in the patients with chronic constipations were also evaluated.RESULTS:In the first group,mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years,respectively(P < 0.05).In the second group,mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years,respectively(P < 0.05).In the first group,chronic constipation was observed in 8 of the 69 patients with varicocele(11.6%) and 3 out of 60 in healthy controls(5%),respectively.In this regard,there was no statistical significance between varicocele patients and the healthy control(P = 0.37).In the second group,varicocele was observed in 16 of the 66 patients with chronic constipation(24.24%) and 12 out of 60 in healthy controls(20%) respectively.Similarly,there was no statistical significance between chronic constipation and healthy controls(P = 0.72).Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele,in the second group.In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids.In this regard,there was no statistical significance between chronic constipation and healthy controls(P = 0.80).CONCLUSION:Chronic constipation may not be a major predictive factor for the development of varicocele,but it may be a facilitator factor for varicocele.展开更多
AIM: To investigate the potential oxidative stress in children with -chronic constipation and to explore its mechanisms.METHODS: Seventy children with chronic constipation and 70 age- and sex-matched healthy children ...AIM: To investigate the potential oxidative stress in children with -chronic constipation and to explore its mechanisms.METHODS: Seventy children with chronic constipation and 70 age- and sex-matched healthy children were enrolled in a randomized controlled study. Plasma levels of vitamins C and E, activities of superoxide dismutase and catalase and lipoperoxide level in erythrocytes were determined by spectrophotometry.RESULTS: Compared with healthy children whose vitamin C,vitamin E, superoxide dismutase, catalase and lipoperoxide were 58.35±14.42 μmol/L, 27.15±6.55 μmol/L, 2 206±171U/(g· Hb), 327.3±82.2 K/(g·Hb) and 19.18±4.27 nmol/(g·Hb)respectively, the levels of vitamin C, vitamin E, the activity of superoxide dismutase, and catalase in the children with chronic constipation significantly decreased [46.59±11.51 μmol/L,20.65±4.80 μmol/L, 1943±147 U/(g·Hb) and 269.3±67.8 K/(g·Hb),respectively P＜0.01], while the lipoperoxide significantly increased [25.22±5.01 nmol/(g·Hb), P＜0.01]. With a prolonged course of disease, the levels of vitamin C, vitamin E, the activity of superoxide dismutase and catalase in the children with chronic constipation gradually decreased,while the level of lipoperoxide gradually increased.CONCLUSION: Chronic constipation can cause potential oxidative stress in children.展开更多
Intestinal neuronal dysplasia type B(IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung's disease(HD...Intestinal neuronal dysplasia type B(IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung's disease(HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation.展开更多
Introduction: Constipation is the infrequent emission of hard stools. It is common, most often of functional origin, with a prevalence ranging from 0.7% to 29.6%. The aim of our study was to investigate the prevalence...Introduction: Constipation is the infrequent emission of hard stools. It is common, most often of functional origin, with a prevalence ranging from 0.7% to 29.6%. The aim of our study was to investigate the prevalence of constipation in children undergoing paediatric gastroenterology. Methodology: This was a bi-centric retrospective study carried out at the Albert Royer Children’s Hospital and the Dalal Jamm Hospital Pediatrics Department. Children followed in the pediatric gastroenterology consultation during the period from January 1, 2013 to February 29, 2020 were included. Results: A total of 337 children (205 boys;60.83%) were included, representing a prevalence of 25%. The median age was 3 years 6 months. The 13 - 24 months age group was the most frequent (27.6%). Rare stools were the main reason for consultation (92.8%). Rare stools were noted in 92.88% of cases. Bristol types 1 and 2 accounted for 6.53% and 54.60% respectively. The main associated signs were abdominal pain (29.4%), followed by abdominal bloating (20.96%). Abdominal pain was functional in 73.58% of cases. Under treatment, 90.19% of children had a favorable outcome. Conclusion: Constipation is common in Senegalese children with a prevalence close to that reported in Western countries. In most case, it is functional with good prognostic.展开更多
Objectives To explore the value of performing a modified colonic transit test in the diagnosis of chronic constipation.Methods we retrospectively analyzed the results in 101 patients admitted to the MDT Outpatient Cli...Objectives To explore the value of performing a modified colonic transit test in the diagnosis of chronic constipation.Methods we retrospectively analyzed the results in 101 patients admitted to the MDT Outpatient Clinic of Subei People’s Hospital,Jiangsu Province,China,from July 1,2019,to July 31,2021.Patients were prohibited from using drugs and stimulant foods that could affect bowel motility for three days before and during the examination.We performed two abdominal X-rays at 6 and 72 hours after oral ingestion of the barium suspension to observe the residual condition of barium in the patient's colon.We then gave specific treatments based on the different types of constipation detected in the patients.Results Compared with patients with normal transit,patients with slow transit(P<0.001)and patients with rectal evacuation disorders had a significantly reduced stool frequency(P<0.05).The kappa coefficient of the modified colonic transit test compared to anorectal manometry in the diagnosis of functional defecation disorders(FDDs)was 0.649,indicating substantial consistency between the two methods.Conclusion The modified colonic transit test not only assesses colonic transit function and provides an initial determination of the type of constipation,but also shows the colon morphology,providing a reference for possible subsequent treatments.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
Chronic constipation is a common gastrointestinal disease severely affecting the patient's quality of life. The traditional treatment of constipation is the use of laxatives. Recently, several new drugs including ...Chronic constipation is a common gastrointestinal disease severely affecting the patient's quality of life. The traditional treatment of constipation is the use of laxatives. Recently, several new drugs including lubiprostone, linaclotide and prucalopride have been approved for treatment of chronic constipation. However, a significant unmet medical need still remains, particularly among those patients achieving poor results by current therapies. The 5-EF1'1 receptor modulators velusetrag and naronapride, the guanylate cy-clase C agonist plecanatide and die deal bile acid transporter inhibitor elobixibat are recognized as the most promising drugs under investigation. Herein, we give a comprehensive review on the pharmacological therapeutics for the treatment of chronic constipation, with the purpose of reflecting the drug development trends in this field. (C) 2015 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.orgicenses/by-ne-rid/4.0/).展开更多
BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the ...BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.METHODS We performed a prospective case-control study,from May-June to November2017.Glucose/lactulose breath tests,radiopaque markers(multiple capsule techniques)and wireless motility capsule analysis were used to assess colonicand oro-cecal transit time,after excluding small-intestinal bacterial overgrowth condition.Then,we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires,the Irritable Bowel Syndrome Quality of life(IBS-QOL),the Short Form Health Survey 12,and the Hospital Anxiety and Depression Scale 14(HADS-14 A and HADS-14 D).RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects.Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels(P<0.001),and they showed a significant impairment of all health-related quality of life and psychological tests(IBS-QOL,Short Form Health Survey 12-Physical Component Summary,Short Form Health Survey 12-Mental Component Summary,HADS-14 A and HADS-14 D),as compared to the control group(P<0.001),which significantly correlated with low vitamin D levels(r=-0.57,P<0.001;r=0.21,P=0.01;r=-0.48,P<0.001;r=-0.57,P<0.001;r=-0.29,P<0.001,respectively).At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder(odds ratio=1.19;95%confidence interval:1.14-1.26,P<0.001).CONCLUSION Vitamin D deficiency,anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders.Vitamin D serum levels should be routinely measured in these patients.展开更多
Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）...Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）, 6）, Shemgjfuxu （上巨虚 ST 37）, etc. （2）Zhongliao （中髎 BL 33）, Xiadiao （下髎 BL 34）, Dachangshu （大肠俞 BL 25）, etc. Electroacupuncture was applied in combination at Zhongliao （中髎 BL 33）, Xialiao （下髎 BL 34）, Tianshu（天枢 ST 25） and Shamgjuxu （上巨虚 ST 37）, once a day, 10 treatments made one session. By constipation diary of patients, frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, stool quality, a sense of defecation and the Patient Assessment of Constipation Quality of Life questionnaire （PAC-QOL）, as well as the changes before and after treatment were observed. Results After treatment, the apparent improvements were achieved in frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, a sense of defecation and score of PAC-QOL as compared with those before treatment （all P〈0.01）. The total effective rate was 67.7% （61/70）. The acupuncture effieacies were various on CFC of different dynamic mechanisms. The efficacy on slow transit constipation （STC） was superior to that caused by spastic pelvic floor syndrome （SPFS-C） （P〈0.05）, the efficacy on constipation caused by irritable bowel syndrome （IBS-C） was superior to that on either SPFS-C or constipation caused by relaxant pelvic floor syndrome （RPFS-C） （both P〈0.05）. Of 52 eases in effective follow-up, 1 month after treatment, 3 eases were cured, 6 eases markedly effective, 23 eases effective, and 20 cases failed; 3 months after treatment, 3 eases were cured, 5 eases markedly effective, 16 cases effective and 28 cases failed. Conclusion Acupuncture has definite efficacy on CFC with definite etiology, loci and diagnostic classification. But, the efficacies are different due to various dynamic mechanisms. A further optimized treatment program is required to improve the efficacy on SPFS-C and RPFS-C.展开更多
BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and const...BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.展开更多
Objective To investigate whether chronic childhood constipation (CCC) may cause oxidative stress and potential free radical damage to children, and to explore the mechanisms by which CCC may cause oxidative stress an...Objective To investigate whether chronic childhood constipation (CCC) may cause oxidative stress and potential free radical damage to children, and to explore the mechanisms by which CCC may cause oxidative stress and potential free radical damage to chronic constipation patients (CCPs). Methods Sixty CCPs and sixty healthy child volunteers (HCVs) whose ages, gender and others were matched for the CCPs were enrolled in a randomized controlled study, in which levels of vitamin C (VC) and vitamin E (VE) in plasma as well as activities of superoxide dismutase (SOD) and catalase (CAT) in erythrocytes were determined by spectrophotometric analytical methods. Results Compared with average values of the above biochemical parameters in the HCVs group, the average values of VC and VE in plasma as well as those of SOD and CAT in erythrocytes in the CCPs group were significantly decreased (P<0.0001). Linear regression and bivariate correlation analysis showed that with prolonged course of the CCPs, the levels of VC and VE in plasma as well as the activities of SOD and CAT in erythrocytes in the CCPs were decreased gradually (P<0.0001). Conclusion The findings in the present study suggest that chronic childhood constipation causes oxidative stress and potential free radical damage to children with chronic constipation.展开更多
Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of cons...Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of constipation were randomly divided into an acupuncture-moxibustion group and a simple acupuncture group with 50 cases for each group. Two groups of acupoints were adopted every other day alternatively for both groups. Point group 1： Tiansha （天枢ST 25）, Daheng （大横 SP 15）, Qihai （气海 CV 6）, Guanyuan （关元 CV 4）, Ztisanli （足三里 ST 36）, Shangjhxu （上巨虚 ST 37） and Sanyinjiao （三阴交 SP 6）. Point group 2： Zhsngliao （中髎 BL 33）, Xiatliao （下髎 BL 34）, Dachangsha （大肠俞 BL 25）, Shenshu （肾俞 BL 23） and Pisha （脾俞 BL 20）. Acupuncture was the only therapy adopted for acupuncture group on all the above mentioned points. While, for acupuncture-moxibustion group, moxibustion with grain-shaped moxa cones was applied on Qihai （所海 CV 6）, Zusatnli （足三里 ST 36）, Datchangshu （大肠俞 BL 25） and Pishu （脾俞 BL 20）, and acupuncture was applied on the rest points. Clinical therapeutic effect, clinical score of constipation, quality of life and score of psychological symptoms were observed before and after the treatment. Results The total effective rate in acupuncture-moxihustion group was 74.0%（37/50）, which was superior to that （52.0%, 26/50） in acupuncture group （P〈0.05）. The clinical scores of constipation, quality of life and scores of psychological symptoms of both groups improved after the treatment. For clinical scores of constipation, degree of difficulty in bowel movement, duration of defecation, abdominal pain, difficulty in exsufflation, incomplete sensation after defecation, obstruction sense of anus, purgative prescription dependence, score of life quality and psychological symptoms of acupuneture-moxibustion group were all better than those of simple acupuncture group （P〈0.05, P〈0.01）. Conclusion The combined therapy of both moxibustion with grain-shaped moxa cones and acupuncture is safe and effective in treatment of chronic functional constipation, and the effect is superior to simple therapy of acupuncture.展开更多
Objective： To investigate the alternations of proteins in the colonic mucosa of chronic slow transit constipation （STC） rats with a 2-DE-based proteomic method and analyze the function of these down-regulated prote...Objective： To investigate the alternations of proteins in the colonic mucosa of chronic slow transit constipation （STC） rats with a 2-DE-based proteomic method and analyze the function of these down-regulated proteins so as to provide theoretical basis for the pathogenesis of intestinal mucosa of chronic STC rats. Methods： STC model was established by feeding rats with 8 mg/（kg＇d） diphenoxylate for 120 d. An experimental model of chronic STC rat was used for separation of proteomics from colonic mucosa using two-dimensional electrophoresis （2-DE）. Proteins altered in expressional level were identified by Image Master 2DElite, mass spectrometry, and bibliometrics were applied to identify the differential protein expression and their clinical s observed in the pathogenesis lgn of ificance and function were analyzed. Results： Obvious differential protein expression was STC, including mast cell protease （A1）, non-specific dipeptidase （A2） and chondrosome succinate dehydrogenase precursor （A3）. The expressions of A1, A2 and A3 were down-regulated in the gel graph of STC rats Conclusion： The down-regulation of chondrosome succinate dehydrogenase, mast cell protease as well as non-specific dipeptidase in rat colon suggests the functional impairment of the oxidoreduction of mitochondrion is very important in the genesis and development of STC. The immunological reaction of STC rats is weakened, and the function of digesting and absorbing protein may be damaged to some extent.展开更多
AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (ag...AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015).展开更多
AIM: To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. METHODS: Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the ...AIM: To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. METHODS: Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipation were excluded. All patients were given an explanation on the role of fiber in the gastrointestinal tract. They were then asked to go on a no fiber diet for 2 wk. Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable. Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 mo. RESULTS: The median age of the patients (16 male, 47 female) was 47 years (range, 20-80 years). At 6 mo, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons. Patients who stopped or reduced dietary fiber had significant improvement in their symp-toms while those who continued on a high fiber diet had no change. Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 d (± 1.59 d) to one motion in 1.0 d (± 0.0 d) (P < 0.001); those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 d (± 2.09 d) to one motion per 1.9 d (± 1.21 d) on a reduced fiber diet (P < 0.001); those who remained on a high fiber diet continued to have a mean of one motion per 6.83 d (± 1.03 d) before and after consultation. For no fiber, reduced fiber and high fiber groups, respectively, symptoms of bloating were present in 0%, 31.3% and 100% (P < 0.001) and straining to pass stools occurred in 0%, 43.8% and 100% (P < 0.001). CONCLUSION: Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.展开更多
OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patient...OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patients with stable COPD(according to defined criteria)in this cross-sectional study from four three-level class A Chinese medicine hospitals in China.We built an Epidata 3.0 database and performed statistical analysis with SPSS,version 17.0.We analyzed correlations between the frequency of lower gastrointestinal tract symptoms(constipation and abdominal distention)and scores for major pulmonary symptoms(cough,sputum and wheezing)based on the St.George's Respiratory Questionnaire(SGRQ),6-minute walking distance(6MWD)and frequency of acute exacerbations of COPD(AECOPD).RESULTS:In addition to their pulmonary symptoms,39.79%and 40.31%of study patients withstable COPD reported constipation and abdominal distention,respectively.Scores for major pulmonary symptoms(cough,sputum and wheezing),AECOPD and SGRQ values in patients with constipation and abdominal distention were significantly greater,and the 6MWD markedly shorter,than in those without them.According to Pearson's correlation analysis,there were strong correlations between these lower gastrointestinal tract symptoms and scores for pulmonary symptoms,SGRQ,6MWD and AECOPD.CONCLUSION:Lower gastrointestinal tract symptoms such as constipation and abdominal distention can adversely affect pulmonary symptoms,frequency of acute exacerbations and quality of life in patients with stable COPD.展开更多
BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary...BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary tract duplications.Based upon anatomic feature,colonic duplications can be classified as spherical(cystic)or tubular,with the latter being less common(approximately 20%).Symptoms of colonic duplication are dependent on the duplication site and extent,and patient age,etc.Usually,patients with colonic duplication manifest typical intestinal obstruction,potentially accompanied by recurrent dark or bright red bloody stool,varying degrees of anemia-related symptoms,and body wasting.CASE SUMMARY A young male patient was admitted to our hospital due to recurrent abdominal pain.No definite diagnosis was achieved by computed tomography(CT)or electronic colonoscopy,and the bowel preparation efficacy was suboptimal.Hirschsprung disease was suspected,and thus laparoscopic exploration was performed.An approximately 60-cm-long inverted duplicated colon with severe edema and dilation was identified.It originated from the mesenteric side of the transverse colon and ended in the terminal part of the descending colon with a blind end.The parallel native colon had a thickened colonic wall,became stiff,and was poor in peristalsis.The patient then underwent subtotal colectomy and was discharged 7 d after the surgery.From 3 mo post-surgery to date,the patient had regular bowel movement once daily and a steady increase in body weight.CONCLUSION Tubular colonic duplication is a rare type of alimentary tract duplication that can be detected by ultrasonography,CT,or magnetic resonance imaging based on the actual clinical situation.Surgical resection of aberrant colon(including the duplicated colonic segment and other potentially involved colonic segments)is the only approach to cure this medical condition.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.
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.
文摘AIM： To evaluate the efficacy and safety of tegaserod, 6 mg twice daily （b.i.d.）, in men and women with chronic constipation （CC） from China. METHODS： This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatmentfree baseline period, patients were randomized to receive either tegaserod （6 mg b.i.d.） or placebo （b.i.d.） for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements （CSBMs） during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients＇ daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events （AEs）. RESULTS： A total of 607 patients were randomized to receive either tegaserod （n = 304） or placebo （n = 303）. Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo （1.39 vs 0.91, P = 0.0002）. A statistically significant difference in favor of tegaserod was also observed for a mean increase ≥ 1 CSBM/wk over wk 1-4 （47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018） and for the absolute number of≥ 3 CSBMs/wk over wk 1-4 （25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021）. Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod （3.6%） compared with placebo （1.7%）. CONCLUSION： Tecjaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.
文摘AIM:To evaluate the possible relationship between varicocele and chronic constipation.METHODS:Between April 2009 and May 2010,a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated.Patients were divided into two groups.In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist.All of them were evaluated by color Doppler ultrasonography.All patients with constipation,except for the healthy controls of the second group,underwent a colonoscopy to identify the etiology of the constipation.In the first group,we determined the rate of chronic constipation in patients with varicocele and in the second group,the rate of varicocele in patients with chronic constipation.In both groups,the rate of the disease was compared with age-matched healthy controls.In the second group,the results of colonoscopies in the patients with chronic constipations were also evaluated.RESULTS:In the first group,mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years,respectively(P < 0.05).In the second group,mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years,respectively(P < 0.05).In the first group,chronic constipation was observed in 8 of the 69 patients with varicocele(11.6%) and 3 out of 60 in healthy controls(5%),respectively.In this regard,there was no statistical significance between varicocele patients and the healthy control(P = 0.37).In the second group,varicocele was observed in 16 of the 66 patients with chronic constipation(24.24%) and 12 out of 60 in healthy controls(20%) respectively.Similarly,there was no statistical significance between chronic constipation and healthy controls(P = 0.72).Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele,in the second group.In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids.In this regard,there was no statistical significance between chronic constipation and healthy controls(P = 0.80).CONCLUSION:Chronic constipation may not be a major predictive factor for the development of varicocele,but it may be a facilitator factor for varicocele.
文摘AIM: To investigate the potential oxidative stress in children with -chronic constipation and to explore its mechanisms.METHODS: Seventy children with chronic constipation and 70 age- and sex-matched healthy children were enrolled in a randomized controlled study. Plasma levels of vitamins C and E, activities of superoxide dismutase and catalase and lipoperoxide level in erythrocytes were determined by spectrophotometry.RESULTS: Compared with healthy children whose vitamin C,vitamin E, superoxide dismutase, catalase and lipoperoxide were 58.35±14.42 μmol/L, 27.15±6.55 μmol/L, 2 206±171U/(g· Hb), 327.3±82.2 K/(g·Hb) and 19.18±4.27 nmol/(g·Hb)respectively, the levels of vitamin C, vitamin E, the activity of superoxide dismutase, and catalase in the children with chronic constipation significantly decreased [46.59±11.51 μmol/L,20.65±4.80 μmol/L, 1943±147 U/(g·Hb) and 269.3±67.8 K/(g·Hb),respectively P＜0.01], while the lipoperoxide significantly increased [25.22±5.01 nmol/(g·Hb), P＜0.01]. With a prolonged course of disease, the levels of vitamin C, vitamin E, the activity of superoxide dismutase and catalase in the children with chronic constipation gradually decreased,while the level of lipoperoxide gradually increased.CONCLUSION: Chronic constipation can cause potential oxidative stress in children.
基金Supported by Sao Paulo Research Foundation(FAPESP)No.2014/042271-1
文摘Intestinal neuronal dysplasia type B(IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung's disease(HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation.
文摘Introduction: Constipation is the infrequent emission of hard stools. It is common, most often of functional origin, with a prevalence ranging from 0.7% to 29.6%. The aim of our study was to investigate the prevalence of constipation in children undergoing paediatric gastroenterology. Methodology: This was a bi-centric retrospective study carried out at the Albert Royer Children’s Hospital and the Dalal Jamm Hospital Pediatrics Department. Children followed in the pediatric gastroenterology consultation during the period from January 1, 2013 to February 29, 2020 were included. Results: A total of 337 children (205 boys;60.83%) were included, representing a prevalence of 25%. The median age was 3 years 6 months. The 13 - 24 months age group was the most frequent (27.6%). Rare stools were the main reason for consultation (92.8%). Rare stools were noted in 92.88% of cases. Bristol types 1 and 2 accounted for 6.53% and 54.60% respectively. The main associated signs were abdominal pain (29.4%), followed by abdominal bloating (20.96%). Abdominal pain was functional in 73.58% of cases. Under treatment, 90.19% of children had a favorable outcome. Conclusion: Constipation is common in Senegalese children with a prevalence close to that reported in Western countries. In most case, it is functional with good prognostic.
基金supported by the Graduate ResearchInnovation Project in Jiangsu Province [Nos.SJCX21_1644and SJCX22_1816]the Academic Science and Technology Innovation Fund for College Students [No.202011117056Y]+2 种基金the Social Development-Health Care Project of YangzhouJiangsu Province [No.YZ2021075]the High-level Talent"Six One Projects"Top Talent Scientific Research Project of Jiangsu Province [No.LGY2019034]
文摘Objectives To explore the value of performing a modified colonic transit test in the diagnosis of chronic constipation.Methods we retrospectively analyzed the results in 101 patients admitted to the MDT Outpatient Clinic of Subei People’s Hospital,Jiangsu Province,China,from July 1,2019,to July 31,2021.Patients were prohibited from using drugs and stimulant foods that could affect bowel motility for three days before and during the examination.We performed two abdominal X-rays at 6 and 72 hours after oral ingestion of the barium suspension to observe the residual condition of barium in the patient's colon.We then gave specific treatments based on the different types of constipation detected in the patients.Results Compared with patients with normal transit,patients with slow transit(P<0.001)and patients with rectal evacuation disorders had a significantly reduced stool frequency(P<0.05).The kappa coefficient of the modified colonic transit test compared to anorectal manometry in the diagnosis of functional defecation disorders(FDDs)was 0.649,indicating substantial consistency between the two methods.Conclusion The modified colonic transit test not only assesses colonic transit function and provides an initial determination of the type of constipation,but also shows the colon morphology,providing a reference for possible subsequent treatments.
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 National Natural Science Foundation of China (No. 81072519)the "111 Project" from the Ministry of Education of China
文摘Chronic constipation is a common gastrointestinal disease severely affecting the patient's quality of life. The traditional treatment of constipation is the use of laxatives. Recently, several new drugs including lubiprostone, linaclotide and prucalopride have been approved for treatment of chronic constipation. However, a significant unmet medical need still remains, particularly among those patients achieving poor results by current therapies. The 5-EF1'1 receptor modulators velusetrag and naronapride, the guanylate cy-clase C agonist plecanatide and die deal bile acid transporter inhibitor elobixibat are recognized as the most promising drugs under investigation. Herein, we give a comprehensive review on the pharmacological therapeutics for the treatment of chronic constipation, with the purpose of reflecting the drug development trends in this field. (C) 2015 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.orgicenses/by-ne-rid/4.0/).
文摘BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.METHODS We performed a prospective case-control study,from May-June to November2017.Glucose/lactulose breath tests,radiopaque markers(multiple capsule techniques)and wireless motility capsule analysis were used to assess colonicand oro-cecal transit time,after excluding small-intestinal bacterial overgrowth condition.Then,we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires,the Irritable Bowel Syndrome Quality of life(IBS-QOL),the Short Form Health Survey 12,and the Hospital Anxiety and Depression Scale 14(HADS-14 A and HADS-14 D).RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects.Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels(P<0.001),and they showed a significant impairment of all health-related quality of life and psychological tests(IBS-QOL,Short Form Health Survey 12-Physical Component Summary,Short Form Health Survey 12-Mental Component Summary,HADS-14 A and HADS-14 D),as compared to the control group(P<0.001),which significantly correlated with low vitamin D levels(r=-0.57,P<0.001;r=0.21,P=0.01;r=-0.48,P<0.001;r=-0.57,P<0.001;r=-0.29,P<0.001,respectively).At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder(odds ratio=1.19;95%confidence interval:1.14-1.26,P<0.001).CONCLUSION Vitamin D deficiency,anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders.Vitamin D serum levels should be routinely measured in these patients.
基金Supported by Nanjing Provincial Science and Education Health Project:HL 07061
文摘Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）, 6）, Shemgjfuxu （上巨虚 ST 37）, etc. （2）Zhongliao （中髎 BL 33）, Xiadiao （下髎 BL 34）, Dachangshu （大肠俞 BL 25）, etc. Electroacupuncture was applied in combination at Zhongliao （中髎 BL 33）, Xialiao （下髎 BL 34）, Tianshu（天枢 ST 25） and Shamgjuxu （上巨虚 ST 37）, once a day, 10 treatments made one session. By constipation diary of patients, frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, stool quality, a sense of defecation and the Patient Assessment of Constipation Quality of Life questionnaire （PAC-QOL）, as well as the changes before and after treatment were observed. Results After treatment, the apparent improvements were achieved in frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, a sense of defecation and score of PAC-QOL as compared with those before treatment （all P〈0.01）. The total effective rate was 67.7% （61/70）. The acupuncture effieacies were various on CFC of different dynamic mechanisms. The efficacy on slow transit constipation （STC） was superior to that caused by spastic pelvic floor syndrome （SPFS-C） （P〈0.05）, the efficacy on constipation caused by irritable bowel syndrome （IBS-C） was superior to that on either SPFS-C or constipation caused by relaxant pelvic floor syndrome （RPFS-C） （both P〈0.05）. Of 52 eases in effective follow-up, 1 month after treatment, 3 eases were cured, 6 eases markedly effective, 23 eases effective, and 20 cases failed; 3 months after treatment, 3 eases were cured, 5 eases markedly effective, 16 cases effective and 28 cases failed. Conclusion Acupuncture has definite efficacy on CFC with definite etiology, loci and diagnostic classification. But, the efficacies are different due to various dynamic mechanisms. A further optimized treatment program is required to improve the efficacy on SPFS-C and RPFS-C.
文摘BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.
文摘Objective To investigate whether chronic childhood constipation (CCC) may cause oxidative stress and potential free radical damage to children, and to explore the mechanisms by which CCC may cause oxidative stress and potential free radical damage to chronic constipation patients (CCPs). Methods Sixty CCPs and sixty healthy child volunteers (HCVs) whose ages, gender and others were matched for the CCPs were enrolled in a randomized controlled study, in which levels of vitamin C (VC) and vitamin E (VE) in plasma as well as activities of superoxide dismutase (SOD) and catalase (CAT) in erythrocytes were determined by spectrophotometric analytical methods. Results Compared with average values of the above biochemical parameters in the HCVs group, the average values of VC and VE in plasma as well as those of SOD and CAT in erythrocytes in the CCPs group were significantly decreased (P<0.0001). Linear regression and bivariate correlation analysis showed that with prolonged course of the CCPs, the levels of VC and VE in plasma as well as the activities of SOD and CAT in erythrocytes in the CCPs were decreased gradually (P<0.0001). Conclusion The findings in the present study suggest that chronic childhood constipation causes oxidative stress and potential free radical damage to children with chronic constipation.
基金Supported by National Program on Key Basic Research Project (973 Program): 2009 CB 522905
文摘Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of constipation were randomly divided into an acupuncture-moxibustion group and a simple acupuncture group with 50 cases for each group. Two groups of acupoints were adopted every other day alternatively for both groups. Point group 1： Tiansha （天枢ST 25）, Daheng （大横 SP 15）, Qihai （气海 CV 6）, Guanyuan （关元 CV 4）, Ztisanli （足三里 ST 36）, Shangjhxu （上巨虚 ST 37） and Sanyinjiao （三阴交 SP 6）. Point group 2： Zhsngliao （中髎 BL 33）, Xiatliao （下髎 BL 34）, Dachangsha （大肠俞 BL 25）, Shenshu （肾俞 BL 23） and Pisha （脾俞 BL 20）. Acupuncture was the only therapy adopted for acupuncture group on all the above mentioned points. While, for acupuncture-moxibustion group, moxibustion with grain-shaped moxa cones was applied on Qihai （所海 CV 6）, Zusatnli （足三里 ST 36）, Datchangshu （大肠俞 BL 25） and Pishu （脾俞 BL 20）, and acupuncture was applied on the rest points. Clinical therapeutic effect, clinical score of constipation, quality of life and score of psychological symptoms were observed before and after the treatment. Results The total effective rate in acupuncture-moxihustion group was 74.0%（37/50）, which was superior to that （52.0%, 26/50） in acupuncture group （P〈0.05）. The clinical scores of constipation, quality of life and scores of psychological symptoms of both groups improved after the treatment. For clinical scores of constipation, degree of difficulty in bowel movement, duration of defecation, abdominal pain, difficulty in exsufflation, incomplete sensation after defecation, obstruction sense of anus, purgative prescription dependence, score of life quality and psychological symptoms of acupuneture-moxibustion group were all better than those of simple acupuncture group （P〈0.05, P〈0.01）. Conclusion The combined therapy of both moxibustion with grain-shaped moxa cones and acupuncture is safe and effective in treatment of chronic functional constipation, and the effect is superior to simple therapy of acupuncture.
基金Supported by the Science Research Foundation of Janssen Pharmaceutical Ltd.(JRC14)
文摘Objective： To investigate the alternations of proteins in the colonic mucosa of chronic slow transit constipation （STC） rats with a 2-DE-based proteomic method and analyze the function of these down-regulated proteins so as to provide theoretical basis for the pathogenesis of intestinal mucosa of chronic STC rats. Methods： STC model was established by feeding rats with 8 mg/（kg＇d） diphenoxylate for 120 d. An experimental model of chronic STC rat was used for separation of proteomics from colonic mucosa using two-dimensional electrophoresis （2-DE）. Proteins altered in expressional level were identified by Image Master 2DElite, mass spectrometry, and bibliometrics were applied to identify the differential protein expression and their clinical s observed in the pathogenesis lgn of ificance and function were analyzed. Results： Obvious differential protein expression was STC, including mast cell protease （A1）, non-specific dipeptidase （A2） and chondrosome succinate dehydrogenase precursor （A3）. The expressions of A1, A2 and A3 were down-regulated in the gel graph of STC rats Conclusion： The down-regulation of chondrosome succinate dehydrogenase, mast cell protease as well as non-specific dipeptidase in rat colon suggests the functional impairment of the oxidoreduction of mitochondrion is very important in the genesis and development of STC. The immunological reaction of STC rats is weakened, and the function of digesting and absorbing protein may be damaged to some extent.
基金Supported by Grants from Conselho Nacional de Desenvolvi-mento Cientifico e TecnológicoFundaco de Amparo à Pesquisa do Estado de Minas Gerais
文摘AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015).
文摘AIM: To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. METHODS: Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipation were excluded. All patients were given an explanation on the role of fiber in the gastrointestinal tract. They were then asked to go on a no fiber diet for 2 wk. Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable. Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 mo. RESULTS: The median age of the patients (16 male, 47 female) was 47 years (range, 20-80 years). At 6 mo, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons. Patients who stopped or reduced dietary fiber had significant improvement in their symp-toms while those who continued on a high fiber diet had no change. Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 d (± 1.59 d) to one motion in 1.0 d (± 0.0 d) (P < 0.001); those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 d (± 2.09 d) to one motion per 1.9 d (± 1.21 d) on a reduced fiber diet (P < 0.001); those who remained on a high fiber diet continued to have a mean of one motion per 6.83 d (± 1.03 d) before and after consultation. For no fiber, reduced fiber and high fiber groups, respectively, symptoms of bloating were present in 0%, 31.3% and 100% (P < 0.001) and straining to pass stools occurred in 0%, 43.8% and 100% (P < 0.001). CONCLUSION: Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.
基金Supported by China National Key Basic Research Plan,(No.2009CB522704)
文摘OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patients with stable COPD(according to defined criteria)in this cross-sectional study from four three-level class A Chinese medicine hospitals in China.We built an Epidata 3.0 database and performed statistical analysis with SPSS,version 17.0.We analyzed correlations between the frequency of lower gastrointestinal tract symptoms(constipation and abdominal distention)and scores for major pulmonary symptoms(cough,sputum and wheezing)based on the St.George's Respiratory Questionnaire(SGRQ),6-minute walking distance(6MWD)and frequency of acute exacerbations of COPD(AECOPD).RESULTS:In addition to their pulmonary symptoms,39.79%and 40.31%of study patients withstable COPD reported constipation and abdominal distention,respectively.Scores for major pulmonary symptoms(cough,sputum and wheezing),AECOPD and SGRQ values in patients with constipation and abdominal distention were significantly greater,and the 6MWD markedly shorter,than in those without them.According to Pearson's correlation analysis,there were strong correlations between these lower gastrointestinal tract symptoms and scores for pulmonary symptoms,SGRQ,6MWD and AECOPD.CONCLUSION:Lower gastrointestinal tract symptoms such as constipation and abdominal distention can adversely affect pulmonary symptoms,frequency of acute exacerbations and quality of life in patients with stable COPD.
文摘BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary tract duplications.Based upon anatomic feature,colonic duplications can be classified as spherical(cystic)or tubular,with the latter being less common(approximately 20%).Symptoms of colonic duplication are dependent on the duplication site and extent,and patient age,etc.Usually,patients with colonic duplication manifest typical intestinal obstruction,potentially accompanied by recurrent dark or bright red bloody stool,varying degrees of anemia-related symptoms,and body wasting.CASE SUMMARY A young male patient was admitted to our hospital due to recurrent abdominal pain.No definite diagnosis was achieved by computed tomography(CT)or electronic colonoscopy,and the bowel preparation efficacy was suboptimal.Hirschsprung disease was suspected,and thus laparoscopic exploration was performed.An approximately 60-cm-long inverted duplicated colon with severe edema and dilation was identified.It originated from the mesenteric side of the transverse colon and ended in the terminal part of the descending colon with a blind end.The parallel native colon had a thickened colonic wall,became stiff,and was poor in peristalsis.The patient then underwent subtotal colectomy and was discharged 7 d after the surgery.From 3 mo post-surgery to date,the patient had regular bowel movement once daily and a steady increase in body weight.CONCLUSION Tubular colonic duplication is a rare type of alimentary tract duplication that can be detected by ultrasonography,CT,or magnetic resonance imaging based on the actual clinical situation.Surgical resection of aberrant colon(including the duplicated colonic segment and other potentially involved colonic segments)is the only approach to cure this medical condition.
