AIM: To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires. METHODS: We prospectively evaluated ...AIM: To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires. METHODS: We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-Ⅲ questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence ofintussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group). RESULTS: Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16vs 35.6 ± 2.00,P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20%vs 4%,P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety. CONCLUSION: The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.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
Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI r...Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.展开更多
BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complicatio...BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complications.AIM To investigate the current state of inadequate bowel preparation in patients undergoing colonoscopy,identify the contributing factors,and develop interventions.METHODS This study was designed as a retrospective cohort study.A convenience sampling method was used to select 484 patients who underwent colonoscopy at Beijing Chao-Yang Hospital,Capital Medical University,from October 2023 to October 2024.General patient data,disease-related variables,and the Boston bowel preparation scale were collected.Logistic regression analysis was conducted to identify the factors associated with inadequate bowel preparation.RESULTS Among the 484 patients,the rate of inadequate bowel preparation was 25.8%(125/484).Influential factors for poor bowel preparation included history of colorectal surgery[odds ratio(OR)=5.814],low-residue diet 1 day prior(OR=0.145),time interval from last dose to start of examination(OR=1.447),total exercise time after medication(OR=0.992),and total number of bowel movements after medication(OR=0.900)(all P<0.05).CONCLUSION This study highlights several modifiable and non-modifiable factors influencing bowel preparation,such as surgical history and behavioral adherence.The findings support implementing dietary adjustments,optimized laxative timing,physical activity guidance,and tailored strategies for high-risk patients to improve bowel cleansing and enhance the diagnostic accuracy of colonoscopy.展开更多
Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended form...Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.展开更多
Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate...Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.展开更多
BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult....BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult.Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease.At present,the research mainly focuses on the accurate diagnosis and treatment of spinal infection,and there are few studies on the prevention of spinal infection.The concept of"preventive treatment of diseases"in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI.AIM To determine the association of age,bowel movements,and sleep patterns with NOSI.METHODS Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected.Patients with NOSI had imaging evidence(magnetic resonance imaging)of spinal infections(including infections caused by tuberculosis,brucopathy,and other pathogens)and had no history of spinal surgery in the last 1 year were included in the analysis.Patients with spinalinfection due to spinal surgery are excluded in the study.Data including age,sex,place of residence,sleeping status,and bowel movements were collected.SPSS22.0 was used for correlation analysis of all data.RESULTS The mean age of the NOSI group and the control group was 63.55±14.635 years and 59.18±17.111 years,respectively,without statistical difference(P=0.096).There was also no statistically significant difference in gender between the two groups.In the NOSI group,45(65.22%)were over 60 years old,and 44(63.77%)were rural residents.Compared with the control group,the NOSI group had more patients with sleep disorder and defecation disorder,accounting for 69.57%and 68.12%,respectively,with significant statistical difference(both P<0.001).Regression analysis showed that defecation and sleep disorders were closely related to NOSI(both P<0.001).CONCLUSION Most patients with NOSI are older and have sleep disorders and abnormal defecation.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
Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 case...Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 cases in each group.The patients in the observation group were treated with acupuncture at Tiānshū（天枢 ST 25）,Shàngjùxū（上巨虚 ST 37）,Zúsānlǐ（足三里 ST 36）,Dàchángshū（大肠俞 BL 25）,etc.,and the control group was treated with oral administration of Macrogol 4000 and Mosapride.Defecation frequency,stool property,constipation symptom score,accompanying symptom score,gastrointestinal transit time and adverse reaction were observed before treatment,at the end of treatment and 4 weeks after treatment in the two groups.Results Compared with those before treatment,defecation frequency was increased significantly at the end of treatment in the two groups,while stool property,constipation symptom score,accompanying syndrome score and gastrointestinal transit time all were decreased significantly（all P0.01）,with no significant difference in these indexes between the two groups at the end of treatment （all P0.05）.Compared with the end of treatment,the above-mentioned indexes did not significantly recur in the observation group 4 weeks after the treatment （all P0.05）,but the therapeutic effects were unstable with decreased to some extent in the control group （all P0.05）.No serious adverse reaction was found in the two groups.Conclusion In the patients with functional constipation,acupuncture can significantly increase defecation frequency,change stool property,alleviate constipation and accompanying symptoms,and shorten gastrointestinal transit time with better safety and tolerance,and the therapeutic effect is more stable than that of Macrogol 4000 and Mosapride.展开更多
The present paper points out the problems and defects existing in college English reference books in China.Further more,measures for improvement are suggested and the need for such improvement is also analyzed.Finally...The present paper points out the problems and defects existing in college English reference books in China.Further more,measures for improvement are suggested and the need for such improvement is also analyzed.Finally,through a case study,an improved version of college English reference books is presented and concluded.展开更多
Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or...Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because there.are no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining （increasing intra-abdominal pressure） and having the patient practice defecating a water filled balloon. Tn adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises （described as sham biofeedback）, and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.展开更多
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The a...Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.展开更多
The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yog...The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.展开更多
AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r...AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.展开更多
Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and ...Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.展开更多
OBJECTIVE: To explore the short and long-term efficacy of combining Fuzhengliqi mixture (FLM) with acupuncture in treating functional constipation (FC). METHODS: The 560 patients with confirmed diagnosis of FC were ra...OBJECTIVE: To explore the short and long-term efficacy of combining Fuzhengliqi mixture (FLM) with acupuncture in treating functional constipation (FC). METHODS: The 560 patients with confirmed diagnosis of FC were randomly assigned to four groups: FLM group, acupuncture group, combined therapy group, and control group. There were 140 cases in each group. The FLM group was administered FLM 60 mL twice a day, while the acupuncture group was treated with acupuncture at acupoints Tianshu (ST 25), Shangjuxu (ST 37), Zusanli (ST 36), Dachangshu (BL 25), and Zhigou (TE 6) twice a day, the combined therapy group with FLM and acupuncture, and the control group was administered mosapride (5 mg thrice a day) and Macrogol 4000 (10 g twice a day). The treatment lasted 6 weeks. The defecation interval, stool property, constipation symptoms, and accompanying symptomswere recorded, graded, and scored.The gastrointestinal transit time (GITT) and motilin (MTL) level in serum and life quality score were detected at three time points (pre-treatment, at the end of treatment, and 60 weeks post-treatment). Moreover, the adverse reactions were also observed. RESULTS: In the FLM group 2 cases were eliminated for not taking medication strictly according to the research plan and 1 case was lost to follow-up, while 2 cases in the acupuncture group and 2 cases in the combined therapy group were lost to follow-up. Compared with those detected pre-treat- ment, the defecation interval, stool property, consti- pation symptom grade, accompanying symptom grade, and GITT were all decreased markedly at the end of treatment in every group, while the MTL levels in serum and life quality score were increased markedly (P<0.01), the above-mentioned detecting indices were better in the combined therapy group than those in other groups (P<0.05). Compared with the end of treatment, above-mentioned detecting indices all recurred significantly in the FLM group and control group 60 weeks post-treatment (P>0.05), but these indices recurred insignificantly in the acupuncture and combined therapy groups (P>0.05). The short and long-term total effective rates in the combined therapy group were significantly different from those in other groups (P<0.05 or P<0.01). No serious adverse reactions were found in four groups. CONCLUSION: Both FLM and acupuncture can significantly shorten the defecation interval and GITT, increase MTL levels in serum, decrease the scores of stool property, constipation symptoms, and accompanying symptoms in patients with FC to increase their life quality. The combined therapy is much better in long-term efficacy and the safety is also good, worth spreading in clinical practice.展开更多
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal proced...External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.展开更多
AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation.
Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative te...Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.展开更多
AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed wit...AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed with long-term inpatients receiving enteral tube feeding at Kitakyushu Hospital Group,Fukuoka,Japan.BB536 was administered as BB536-L and BB536-H powders that contained approximately 2.5 × 10 10 and 5 × 10 10 cfu of BB536,respectively.In the first trial,83 patients(age range:67-101 years) were randomized into 2 groups that received placebo(placebo group) or BB536-H(BB536 group) powders.In the second trial,123 patients(age range:65-102years) were randomized into 3 groups,and each group received placebo(placebo group),BB536-L(BB536-L group),or BB536-H(BB536-H group) powders.Each patient received the study medication for 16 wk after 1 wk of pre-observation.Fecal samples were collected from each patient prior to and after the intervention during Trial 2.Clinical observations included body temperature,occurrence of infection,frequency of defecation,and fecal microbiota.RESULTS:No significant changes were observed in the frequency of defecation for either treatment in Trial 1.However,a significant change was noted in the BB536-L group(P = 0.0439) in Trial 2 but not in the placebo or BB536-H groups.Subgroup analyses based on the frequency of defecation for each patient during the pre-observation period for both trials revealed significant increases in bowel movements in patients with a low frequency of defecation and significant decreases in the bowel movements of patients with a high frequency of defecation during the intervention period in the BB536 groups.The combination of Trials 1 and 2 data revealed a modulatory effect of BB536 ingestion on the changes in bowel movements.Significantly increased bowel movements were observed in patients in the low frequency subgroup with significant intergroup differences(P < 0.01).Significantly decreased bowel movements were observed in patients in the high subgroup,but no significant intergroup differences were observed compared with the placebo group.BB536 ingestion increased the prevalence of normally formed stools.BB536 intake also significantly(P < 0.01) increased the cell numbers of bifidobacteria in fecal microbiota,and significant intergroup differences were observed at week 16.No adverse events were reported in any group.CONCLUSION:Our results suggest that BB536 ingestion modulated the intestinal environment and may have improved the health care of elderly patients receiving enteral feeding.展开更多
文摘AIM: To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires. METHODS: We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-Ⅲ questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence ofintussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group). RESULTS: Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16vs 35.6 ± 2.00,P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20%vs 4%,P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety. CONCLUSION: The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.
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.
基金supported by Grant-in-Aid for Scientific Research on Innovative Areas from the Japan Society for the Promotion of Science(Nos.18H05473 and 23K13290).
文摘Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.
基金Supported by the Beijing Key Clinical Specialty Project.
文摘BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complications.AIM To investigate the current state of inadequate bowel preparation in patients undergoing colonoscopy,identify the contributing factors,and develop interventions.METHODS This study was designed as a retrospective cohort study.A convenience sampling method was used to select 484 patients who underwent colonoscopy at Beijing Chao-Yang Hospital,Capital Medical University,from October 2023 to October 2024.General patient data,disease-related variables,and the Boston bowel preparation scale were collected.Logistic regression analysis was conducted to identify the factors associated with inadequate bowel preparation.RESULTS Among the 484 patients,the rate of inadequate bowel preparation was 25.8%(125/484).Influential factors for poor bowel preparation included history of colorectal surgery[odds ratio(OR)=5.814],low-residue diet 1 day prior(OR=0.145),time interval from last dose to start of examination(OR=1.447),total exercise time after medication(OR=0.992),and total number of bowel movements after medication(OR=0.900)(all P<0.05).CONCLUSION This study highlights several modifiable and non-modifiable factors influencing bowel preparation,such as surgical history and behavioral adherence.The findings support implementing dietary adjustments,optimized laxative timing,physical activity guidance,and tailored strategies for high-risk patients to improve bowel cleansing and enhance the diagnostic accuracy of colonoscopy.
基金funded by the Chinese Nutrition Society and PepsiCo Inc.
文摘Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.
文摘Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.
文摘BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult.Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease.At present,the research mainly focuses on the accurate diagnosis and treatment of spinal infection,and there are few studies on the prevention of spinal infection.The concept of"preventive treatment of diseases"in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI.AIM To determine the association of age,bowel movements,and sleep patterns with NOSI.METHODS Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected.Patients with NOSI had imaging evidence(magnetic resonance imaging)of spinal infections(including infections caused by tuberculosis,brucopathy,and other pathogens)and had no history of spinal surgery in the last 1 year were included in the analysis.Patients with spinalinfection due to spinal surgery are excluded in the study.Data including age,sex,place of residence,sleeping status,and bowel movements were collected.SPSS22.0 was used for correlation analysis of all data.RESULTS The mean age of the NOSI group and the control group was 63.55±14.635 years and 59.18±17.111 years,respectively,without statistical difference(P=0.096).There was also no statistically significant difference in gender between the two groups.In the NOSI group,45(65.22%)were over 60 years old,and 44(63.77%)were rural residents.Compared with the control group,the NOSI group had more patients with sleep disorder and defecation disorder,accounting for 69.57%and 68.12%,respectively,with significant statistical difference(both P<0.001).Regression analysis showed that defecation and sleep disorders were closely related to NOSI(both P<0.001).CONCLUSION Most patients with NOSI are older and have sleep disorders and abnormal defecation.
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Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 cases in each group.The patients in the observation group were treated with acupuncture at Tiānshū（天枢 ST 25）,Shàngjùxū（上巨虚 ST 37）,Zúsānlǐ（足三里 ST 36）,Dàchángshū（大肠俞 BL 25）,etc.,and the control group was treated with oral administration of Macrogol 4000 and Mosapride.Defecation frequency,stool property,constipation symptom score,accompanying symptom score,gastrointestinal transit time and adverse reaction were observed before treatment,at the end of treatment and 4 weeks after treatment in the two groups.Results Compared with those before treatment,defecation frequency was increased significantly at the end of treatment in the two groups,while stool property,constipation symptom score,accompanying syndrome score and gastrointestinal transit time all were decreased significantly（all P0.01）,with no significant difference in these indexes between the two groups at the end of treatment （all P0.05）.Compared with the end of treatment,the above-mentioned indexes did not significantly recur in the observation group 4 weeks after the treatment （all P0.05）,but the therapeutic effects were unstable with decreased to some extent in the control group （all P0.05）.No serious adverse reaction was found in the two groups.Conclusion In the patients with functional constipation,acupuncture can significantly increase defecation frequency,change stool property,alleviate constipation and accompanying symptoms,and shorten gastrointestinal transit time with better safety and tolerance,and the therapeutic effect is more stable than that of Macrogol 4000 and Mosapride.
文摘The present paper points out the problems and defects existing in college English reference books in China.Further more,measures for improvement are suggested and the need for such improvement is also analyzed.Finally,through a case study,an improved version of college English reference books is presented and concluded.
文摘Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because there.are no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining （increasing intra-abdominal pressure） and having the patient practice defecating a water filled balloon. Tn adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises （described as sham biofeedback）, and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri via N Colajanni,4-00191 Roma,ItalySocietà Italiana di Chirurgia Colo-Rettale via Medici,23-10143Torino,Italy
文摘Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
文摘The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.
文摘AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.
文摘Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.
文摘OBJECTIVE: To explore the short and long-term efficacy of combining Fuzhengliqi mixture (FLM) with acupuncture in treating functional constipation (FC). METHODS: The 560 patients with confirmed diagnosis of FC were randomly assigned to four groups: FLM group, acupuncture group, combined therapy group, and control group. There were 140 cases in each group. The FLM group was administered FLM 60 mL twice a day, while the acupuncture group was treated with acupuncture at acupoints Tianshu (ST 25), Shangjuxu (ST 37), Zusanli (ST 36), Dachangshu (BL 25), and Zhigou (TE 6) twice a day, the combined therapy group with FLM and acupuncture, and the control group was administered mosapride (5 mg thrice a day) and Macrogol 4000 (10 g twice a day). The treatment lasted 6 weeks. The defecation interval, stool property, constipation symptoms, and accompanying symptomswere recorded, graded, and scored.The gastrointestinal transit time (GITT) and motilin (MTL) level in serum and life quality score were detected at three time points (pre-treatment, at the end of treatment, and 60 weeks post-treatment). Moreover, the adverse reactions were also observed. RESULTS: In the FLM group 2 cases were eliminated for not taking medication strictly according to the research plan and 1 case was lost to follow-up, while 2 cases in the acupuncture group and 2 cases in the combined therapy group were lost to follow-up. Compared with those detected pre-treat- ment, the defecation interval, stool property, consti- pation symptom grade, accompanying symptom grade, and GITT were all decreased markedly at the end of treatment in every group, while the MTL levels in serum and life quality score were increased markedly (P<0.01), the above-mentioned detecting indices were better in the combined therapy group than those in other groups (P<0.05). Compared with the end of treatment, above-mentioned detecting indices all recurred significantly in the FLM group and control group 60 weeks post-treatment (P>0.05), but these indices recurred insignificantly in the acupuncture and combined therapy groups (P>0.05). The short and long-term total effective rates in the combined therapy group were significantly different from those in other groups (P<0.05 or P<0.01). No serious adverse reactions were found in four groups. CONCLUSION: Both FLM and acupuncture can significantly shorten the defecation interval and GITT, increase MTL levels in serum, decrease the scores of stool property, constipation symptoms, and accompanying symptoms in patients with FC to increase their life quality. The combined therapy is much better in long-term efficacy and the safety is also good, worth spreading in clinical practice.
文摘External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
基金Supported by Research Award Fund of First Affiliated Hospital of Xinjiang Medical University,Fund Serial No.2012YFY30
文摘AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation.
文摘Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.
文摘AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed with long-term inpatients receiving enteral tube feeding at Kitakyushu Hospital Group,Fukuoka,Japan.BB536 was administered as BB536-L and BB536-H powders that contained approximately 2.5 × 10 10 and 5 × 10 10 cfu of BB536,respectively.In the first trial,83 patients(age range:67-101 years) were randomized into 2 groups that received placebo(placebo group) or BB536-H(BB536 group) powders.In the second trial,123 patients(age range:65-102years) were randomized into 3 groups,and each group received placebo(placebo group),BB536-L(BB536-L group),or BB536-H(BB536-H group) powders.Each patient received the study medication for 16 wk after 1 wk of pre-observation.Fecal samples were collected from each patient prior to and after the intervention during Trial 2.Clinical observations included body temperature,occurrence of infection,frequency of defecation,and fecal microbiota.RESULTS:No significant changes were observed in the frequency of defecation for either treatment in Trial 1.However,a significant change was noted in the BB536-L group(P = 0.0439) in Trial 2 but not in the placebo or BB536-H groups.Subgroup analyses based on the frequency of defecation for each patient during the pre-observation period for both trials revealed significant increases in bowel movements in patients with a low frequency of defecation and significant decreases in the bowel movements of patients with a high frequency of defecation during the intervention period in the BB536 groups.The combination of Trials 1 and 2 data revealed a modulatory effect of BB536 ingestion on the changes in bowel movements.Significantly increased bowel movements were observed in patients in the low frequency subgroup with significant intergroup differences(P < 0.01).Significantly decreased bowel movements were observed in patients in the high subgroup,but no significant intergroup differences were observed compared with the placebo group.BB536 ingestion increased the prevalence of normally formed stools.BB536 intake also significantly(P < 0.01) increased the cell numbers of bifidobacteria in fecal microbiota,and significant intergroup differences were observed at week 16.No adverse events were reported in any group.CONCLUSION:Our results suggest that BB536 ingestion modulated the intestinal environment and may have improved the health care of elderly patients receiving enteral feeding.
