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
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
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 Rome Foundation’s questionnaires,including the latest version,Rome IV diagnostic criteria since 2016,are widely used globally for diagnosing functional gastrointestinal disorders(FGIDs).However,a tailo...BACKGROUND The Rome Foundation’s questionnaires,including the latest version,Rome IV diagnostic criteria since 2016,are widely used globally for diagnosing functional gastrointestinal disorders(FGIDs).However,a tailored Thai version for diagnosing FGIDs in neonates and toddlers is yet to be developed.AIM To develop and validate the Thai version of the Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers.METHODS This study was conducted at a tertiary hospital in Bangkok.The Rome IV diagnostic questionnaire for neonates and toddlers was translated into Thai following Rome Foundation guidelines.Validity was assessed using item-objective congruence.The final version was administered to 65 caregivers of children under 4 years.Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient based on test-retest responses collected over a 4-15 day interval.RESULTS A total of 58 complete questionnaires were returned.The median interval between the first and second time was 7 days(range:4 days to 15 days).The item-objective congruence index for the Thai-adapted Rome IV diagnostic questionnaire was 0.74.Internal consistency,as indicated by Cronbach’s alpha,was 0.753,0.712,and 0.750 for the three respective sections.The intraclass correlation coefficients for test-retest reliability were 0.782,0.782,and 0.807.CONCLUSION The Thai Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers demonstrates acceptable validity and reliability,supporting its use in future clinical and research applications.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
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
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
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
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 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 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 Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM...BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.展开更多
BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by ...BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by an increase in intra-abdo-minal pressure with physiological disturbance can be caused by severe massive fecal impaction.CASE SUMMARY A 33-year-old female presented to the emergency room with massive abdominal distension that rapidly progressed to abdominal compartment syndrome.The pa-tient was diagnosed with hypoganglionosis.Life-saving emergent proctoco-lectomy was performed to save the patient.CONCLUSION Abdominal compartment syndrome can develop secondary to excessive colonic distension.This extreme but rare situation must be addressed immediately.Hypo-ganglionosis is a potential cause of severe constipation that may present in adu-lthood.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
BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of t...BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of the gut.Loss of miR-10b-5p in ICC im-pairs intestinal motility and contributes to constipation,a common condition in the elderly.Notably,miR-10b-5p is co-expressed with its paralog,miR-10a-5p,in ICC.AIM To investigate the roles of miR-10a-5p and miR-10b-5p in age-associated intestinal dysmotility and assess the therapeutic potential of restoring their expression.METHODS We employed aged mice,mir-10a and mir-10b single and double knockout(KO)models,and human plasma and colon samples across age groups.GI and colonic transit,ICC network integrity,and expression levels of miR-10a/b-5p were eva-luated.Additionally,we tested whether treatment with their microRNA mimics could restore GI motility in aged mice.RESULTS Aged mice exhibited delayed GI and colonic transit,reduced fecal output,and diminished expression of miR-10a-5p and miR-10b-5p,which peaked during late embryonic and early postnatal stages and declined with age.This decline para-lleled ICC network deterioration in the colon.All KO models exhibited impaired motility and ICC loss,with mir-10a KO mice displaying more severe phenotypes than mir-10b KO mice.Double KO mice demonstrated growth retardation and reduced survival,with homozygous mutants living only up to 3 months.Treatment of aged mice with miR-10a-5p and miR-10b-5p mimics encapsu-lated in jetPEI significantly improved GI and colonic motility.Successful delivery to the gut,including the colon,was confirmed.In human samples,both miR-10a/b-5p and KIT expression decreased with age.CONCLUSION miR-10a-5p and miR-10b-5p are essential for ICC maintenance and colonic motility,and their age-related decline contributes to GI dysmotility in both mice and humans.Restoring their levels offers a promising therapeutic stra-tegy for treating age-related constipation and other motility disorders.展开更多
Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion te...Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion tests,pelvic floor electromyography,and dynamic imaging(defecography/pelvic floor magnetic resonance imaging)enable comprehensive assessment of anorectal function,many healthcare facilities lack advanced diagnostic tools and specialized personnel.DRE has notable diagnostic value in the primary evaluation of functional defecation disorders(FDDs),particularly for detecting dyssynergic defecation and structural pelvic floor defects.Its cost efficiency and universal accessibility render it indispensable in resource-limited environments where high-resolution diagnostic technologies(e.g.,high-resolution manometry)are unavailable.This review delineates standardized DRE protocols for assessing FDDs and highlights characteristic imaging features of FDDs with the aim of improving the understanding of DRE.This review will hopefully encourage clinicians to perform DREs in diverse clinical settings.展开更多
Constipation is a common yet underrecognized gastrointestinal complication among critically ill adults,significantly impacting morbidity,length of stay,and overall prognosis.This narrative review explores the current ...Constipation is a common yet underrecognized gastrointestinal complication among critically ill adults,significantly impacting morbidity,length of stay,and overall prognosis.This narrative review explores the current understanding of constipation in the critical care setting,emphasizing the challenges in its definition and identification due to variability in clinical presentation and lack of standardized diagnostic criteria.We examine contributing factors such as immobility,opioid use,altered fluid and electrolyte balance,and the effects of critical illness itself on gastrointestinal motility.Furthermore,we discuss available and emerging management strategies in critically ill adults,including pharmacologic and non-pharmacologic interventions,and highlight the importance of early identification and targeted therapy in improving patient outcomes.Finally,we address the prognostic implications of constipation in critically ill adults and the need for prospective studies to better define its impact and inform evidence-based guidelines.This review aims to raise awareness and stimulate further research into this often-overlooked aspect of gastrointestinal pathophysiology in the intensive care unit.展开更多
BACKGROUND Gut microbiota dysbiosis plays a central role in the pathogenesis of functional constipation(FC),but clinical treatment has shown uneven efficacy through methods of regulating intestinal flora.Most existing...BACKGROUND Gut microbiota dysbiosis plays a central role in the pathogenesis of functional constipation(FC),but clinical treatment has shown uneven efficacy through methods of regulating intestinal flora.Most existing studies have concentrated on overall case-control comparisons,with limited stratification by age or constipation subtype.Knowledge of how these factors shape gut microbiota composition remains inadequate,constraining the development of effective personalized microbiota-based interventions.Ninety-two patients with FC completed questionnaires and underwent anorectal manometry and gastrointestinal transit tests;stool samples were collected for 16S rRNA gene sequencing.Stool samples alone were collected from 34 healthy controls.Patients with FC were categorized into age groups(young,middle-aged,and older)and classified into normal-transit constipation,slow-transit consti-pation(STC),defecatory disorder(DD),and mixed constipation subtypes.Gut mi-crobial compositions across age groups and constipation subtypes were com-pared,and their correlations with clinical parameters were investigated.RESULTS The young group demonstrated significantly higher anal resting and squeeze pressures than the middle-aged and the older groups.Microbial richness and diversity were substantially lower in the older group than in middle-aged and young groups.Gut microbiota in the young group was predominantly enriched in taxa increasing sphincter tone and inhibiting intestinal peristalsis;the older group featured abundances of short-chain fatty acid-producing,beneficial taxa.The middle-aged group showed an enrichment of pro-inflammatory and pathogenic bacteria.Microbial richness and diversity were higher in STC than in the DD group.Moreover,STC group was enriched in taxa associated with slower peristalsis;DD group showed enrichment of motility-promoting taxa.CONCLUSION Significant differences in microbial composition and function were observed across age groups and constipation subtypes in FC,suggesting underlying pathophysiological heterogeneity and providing a basis for precision diagnosis and treatment.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: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
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.
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 Ratchadapiseksompotch Fund,Graduate Affairs,Faculty of Medicines,Chulalongkorn University,No.2566-077,No.2566-078,and No.2566-079and The Royal College of Pediatricians of Thailand,No.2566.2.2.
文摘BACKGROUND The Rome Foundation’s questionnaires,including the latest version,Rome IV diagnostic criteria since 2016,are widely used globally for diagnosing functional gastrointestinal disorders(FGIDs).However,a tailored Thai version for diagnosing FGIDs in neonates and toddlers is yet to be developed.AIM To develop and validate the Thai version of the Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers.METHODS This study was conducted at a tertiary hospital in Bangkok.The Rome IV diagnostic questionnaire for neonates and toddlers was translated into Thai following Rome Foundation guidelines.Validity was assessed using item-objective congruence.The final version was administered to 65 caregivers of children under 4 years.Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient based on test-retest responses collected over a 4-15 day interval.RESULTS A total of 58 complete questionnaires were returned.The median interval between the first and second time was 7 days(range:4 days to 15 days).The item-objective congruence index for the Thai-adapted Rome IV diagnostic questionnaire was 0.74.Internal consistency,as indicated by Cronbach’s alpha,was 0.753,0.712,and 0.750 for the three respective sections.The intraclass correlation coefficients for test-retest reliability were 0.782,0.782,and 0.807.CONCLUSION The Thai Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers demonstrates acceptable validity and reliability,supporting its use in future clinical and research applications.
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.
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.
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.
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.
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 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.
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Supported by Sainte-Justine University Hospital Research Center excellence grant in 2020-2021.
文摘BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.
文摘BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by an increase in intra-abdo-minal pressure with physiological disturbance can be caused by severe massive fecal impaction.CASE SUMMARY A 33-year-old female presented to the emergency room with massive abdominal distension that rapidly progressed to abdominal compartment syndrome.The pa-tient was diagnosed with hypoganglionosis.Life-saving emergent proctoco-lectomy was performed to save the patient.CONCLUSION Abdominal compartment syndrome can develop secondary to excessive colonic distension.This extreme but rare situation must be addressed immediately.Hypo-ganglionosis is a potential cause of severe constipation that may present in adu-lthood.
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.
基金Supported by National Institutes of Health Grants,No.R01DK103055(to Ro S)RosVivo Therapeutics,No.AWD-01-00003158(to Ro S)the National Research Foundation of Korea Grant Funded by the Korean Government(MSIT),No.NRF-2021R1C1C2006743(to Kim MS)and No.NRF-2021R1A2C1095311(to Lee MY).
文摘BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of the gut.Loss of miR-10b-5p in ICC im-pairs intestinal motility and contributes to constipation,a common condition in the elderly.Notably,miR-10b-5p is co-expressed with its paralog,miR-10a-5p,in ICC.AIM To investigate the roles of miR-10a-5p and miR-10b-5p in age-associated intestinal dysmotility and assess the therapeutic potential of restoring their expression.METHODS We employed aged mice,mir-10a and mir-10b single and double knockout(KO)models,and human plasma and colon samples across age groups.GI and colonic transit,ICC network integrity,and expression levels of miR-10a/b-5p were eva-luated.Additionally,we tested whether treatment with their microRNA mimics could restore GI motility in aged mice.RESULTS Aged mice exhibited delayed GI and colonic transit,reduced fecal output,and diminished expression of miR-10a-5p and miR-10b-5p,which peaked during late embryonic and early postnatal stages and declined with age.This decline para-lleled ICC network deterioration in the colon.All KO models exhibited impaired motility and ICC loss,with mir-10a KO mice displaying more severe phenotypes than mir-10b KO mice.Double KO mice demonstrated growth retardation and reduced survival,with homozygous mutants living only up to 3 months.Treatment of aged mice with miR-10a-5p and miR-10b-5p mimics encapsu-lated in jetPEI significantly improved GI and colonic motility.Successful delivery to the gut,including the colon,was confirmed.In human samples,both miR-10a/b-5p and KIT expression decreased with age.CONCLUSION miR-10a-5p and miR-10b-5p are essential for ICC maintenance and colonic motility,and their age-related decline contributes to GI dysmotility in both mice and humans.Restoring their levels offers a promising therapeutic stra-tegy for treating age-related constipation and other motility disorders.
文摘Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion tests,pelvic floor electromyography,and dynamic imaging(defecography/pelvic floor magnetic resonance imaging)enable comprehensive assessment of anorectal function,many healthcare facilities lack advanced diagnostic tools and specialized personnel.DRE has notable diagnostic value in the primary evaluation of functional defecation disorders(FDDs),particularly for detecting dyssynergic defecation and structural pelvic floor defects.Its cost efficiency and universal accessibility render it indispensable in resource-limited environments where high-resolution diagnostic technologies(e.g.,high-resolution manometry)are unavailable.This review delineates standardized DRE protocols for assessing FDDs and highlights characteristic imaging features of FDDs with the aim of improving the understanding of DRE.This review will hopefully encourage clinicians to perform DREs in diverse clinical settings.
文摘Constipation is a common yet underrecognized gastrointestinal complication among critically ill adults,significantly impacting morbidity,length of stay,and overall prognosis.This narrative review explores the current understanding of constipation in the critical care setting,emphasizing the challenges in its definition and identification due to variability in clinical presentation and lack of standardized diagnostic criteria.We examine contributing factors such as immobility,opioid use,altered fluid and electrolyte balance,and the effects of critical illness itself on gastrointestinal motility.Furthermore,we discuss available and emerging management strategies in critically ill adults,including pharmacologic and non-pharmacologic interventions,and highlight the importance of early identification and targeted therapy in improving patient outcomes.Finally,we address the prognostic implications of constipation in critically ill adults and the need for prospective studies to better define its impact and inform evidence-based guidelines.This review aims to raise awareness and stimulate further research into this often-overlooked aspect of gastrointestinal pathophysiology in the intensive care unit.
基金Supported by the China Medical and Health Development Foundation,No.2022-HX-76China-Japan Friendship Hospital Highlevel Hospital Clinical Business Expenses Special Project,No.2023-NHLHCRF-YYPPLC-ZR-19.
文摘BACKGROUND Gut microbiota dysbiosis plays a central role in the pathogenesis of functional constipation(FC),but clinical treatment has shown uneven efficacy through methods of regulating intestinal flora.Most existing studies have concentrated on overall case-control comparisons,with limited stratification by age or constipation subtype.Knowledge of how these factors shape gut microbiota composition remains inadequate,constraining the development of effective personalized microbiota-based interventions.Ninety-two patients with FC completed questionnaires and underwent anorectal manometry and gastrointestinal transit tests;stool samples were collected for 16S rRNA gene sequencing.Stool samples alone were collected from 34 healthy controls.Patients with FC were categorized into age groups(young,middle-aged,and older)and classified into normal-transit constipation,slow-transit consti-pation(STC),defecatory disorder(DD),and mixed constipation subtypes.Gut mi-crobial compositions across age groups and constipation subtypes were com-pared,and their correlations with clinical parameters were investigated.RESULTS The young group demonstrated significantly higher anal resting and squeeze pressures than the middle-aged and the older groups.Microbial richness and diversity were substantially lower in the older group than in middle-aged and young groups.Gut microbiota in the young group was predominantly enriched in taxa increasing sphincter tone and inhibiting intestinal peristalsis;the older group featured abundances of short-chain fatty acid-producing,beneficial taxa.The middle-aged group showed an enrichment of pro-inflammatory and pathogenic bacteria.Microbial richness and diversity were higher in STC than in the DD group.Moreover,STC group was enriched in taxa associated with slower peristalsis;DD group showed enrichment of motility-promoting taxa.CONCLUSION Significant differences in microbial composition and function were observed across age groups and constipation subtypes in FC,suggesting underlying pathophysiological heterogeneity and providing a basis for precision diagnosis and treatment.
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.
