Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiot...Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.展开更多
Background:Constipation is a common chronic bowel disorder with an incidence of more than 50%in the elderly population.Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipa...Background:Constipation is a common chronic bowel disorder with an incidence of more than 50%in the elderly population.Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly.Objective:This study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill.and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life.Design,setting,participants and intervention:This double-blind randomized active controlled clinical trial,with parallel group allocation ratio of 1:1,was conducted in a referral clinic in Afzalipour Hospital,affiliated to Kerman University of Medical Sciences in Kerman,Southeastern Iran.Individuals over 60 years of age,diagnosed with functional constipation(based on the RomeⅣcriteria),were included in this study.Participants received a sachet of 10 g F.vulgare and R.damascena(herbal formula group)or polyethylene glycol 4000(PEG 4000 group)with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks.Main outcome measures:Constipation severity,stool consistency,and the quality of life were used as the primary outcomes.Drug side effects were used as a secondary outcome.The outcomes were assessed using the Constipation Assessment Scale,the Bristol Stool Form Scale,and the Patient Assessment of Constipation Quality of Life questionnaire.Results:A total of 25 participants in each group completed the four-week treatment cycle and the eightweek follow-up.At the end of the four-week treatment cycle,all clinical outcomes had significant improvements in both groups(P<0.05).The analysis of constipation severity(P<0.001),stool consistency(P<0.001),and the quality of life(P<0.001)showed significant improvements with fewer side effects(mild diarrhea)and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group.Conclusion:Although both interventions significantly improved the treatment outcomes,constipation severity,stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000;however,the mechanism of action is not yet understood.Trial registration:This trial was registered in the Iranian Registry of Clinical Trials(IRCTID:IRCT20200108046056N1).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 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 Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental healt...BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.展开更多
Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic com...Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.展开更多
Background:This study investigated the impacts and mechanisms of yunweiling in the management of Functional Constipation(FC)using network pharmacology and experimental research.Methods:Using the Traditional Chinese Me...Background:This study investigated the impacts and mechanisms of yunweiling in the management of Functional Constipation(FC)using network pharmacology and experimental research.Methods:Using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),Genecard,and Online Mendelian Inheritance in Man(OMIM)databases,a potential gene target for yunweiling in treating FC was found.A pharmacological network was built and viewed in Cytoscape.A protein interac-tion map was created with STRING and Cytoscape.‘clusterProfiler’helped uncover its mechanism.Molecular docking was done with AutoDock Vina.In a constipation mouse model,Western blot was used to assess yunweiling's effectiveness.Results:To investigate yunweiling's therapeutic effects on FC,we employed a loperamide-induced constipation model.Successful model establishment was con-firmed by first black stool time,reduced stool output,and impaired gastrointestinal motility.Yunweiling treatment,especially at high and medium doses,significantly al-leviated constipation symptoms by reducing first black stool time,increasing stool output,and enhancing gastrointestinal motility.HE staining revealed yunweiling's ability to restore colon tissue structure.Yunweiling modulated the expression of key proteins TP53,P-AKT,P-PI3K,RET,and Rai,implicating its involvement in the PI3K-Akt signaling pathway.Comparative analysis showed yunweiling to be more effective than its individual components(shionone,β-sitosterol,and daucosterol)in improving constipation.The combination of yunweiling with TP53 and PI3K-Akt inhibitors fur-ther enhanced its therapeutic effects,suggesting a synergistic mechanism.Conclusions:The integration of network pharmacology and experimental investiga-tions indicated the effectiveness of yunweiling in managing FC,offering essential theoretical support for clinical application.展开更多
BACKGROUND 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 The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the firs...BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.展开更多
Objective To explore the effects of different acupuncture-moxibustion methods on the plasma substance P（SP） content,and the expression of colonic SP m RNA of the rats with functional constipation.Methods Sixty healt...Objective To explore the effects of different acupuncture-moxibustion methods on the plasma substance P（SP） content,and the expression of colonic SP m RNA of the rats with functional constipation.Methods Sixty healthy male SD rats were divided into six groups according to the random number table,including blank control group（group B,n=8）,model group（group M,n=11）,drug control group（group D,n=8）,filiform needle group（group F,n=11）,electroacupuncture group（group E,n=11） and moxibustion group（group MB,n=11）.The rats in group B and group M accepted no intervention,gavage with cisapride suspension was conducted in group D,and electroacupuncture,filiform needling and moxibustion therapies were carried out in group E,group F and group MB for 6 days.After treatment,the stool quantity and fecal moisture content during 24 h of the rats were observed in each group,colon tissue structure and the acidic mucus in mucosa layer were observed,plasma SP content was detected and the expression of colonic SP m RNA was detected.Results compared with group B,the stool quantity and fecal moisture content during 24 h of the rats in group M decreased significantly（P0.01）;compared with group M,the stool quantity during 24 h of the rats in each group increased（P0.05 or 0.01）,and the fecal moisture content during 24 h of the rats in each group also increased significantly except group MB（P0.01）;compared with group D,the fecal moisture content during 24 h of the rats in group MB decreased（P0.01）;according to the comparison among the groups with different acupuncture-moxibustion methods,there was no difference in the stool quantity during 24 h of the rats in each group（P0.05）,the fecal moisture contents during 24 h of the rats in group F and group E were higher than that of group MB（P0.01）,and there was no difference between group F and group E（P0.05）.HE staining of colon tissue of rats showed that the structure was normal and complete,and there was no difference among each group.PAS staining showed that the acidic mucus level of the rats in group M decreased significantly when compared with group B;compared with group M,the acidic mucus level of the rats in group D,fgroup F,group E and group MB increased in varying degrees.Compared with group B,the plasma SP content of the rats in group M decreased（P0.05）;compared with group M,the plasma SP contents of the rats in group F and group MB increased（P0.01）;the plasma SP contents of the rats in group F,group MB and group E were higher than that of group D（P0.05 or 0.01）;according to the comparison among the groups with different acupuncture-moxibustion methods,the plasma SP content of the rats in group F was higher than that of group MB and electro-acupuncture group（P0.05）,and there was no difference between group MB and group E.Compared with group B,the expression level of colonic SP m RNA of the rats in group M elevated（P0.05）;compared with group M,the expression level of colonic SP m RNA of the rats in the four intervention groups declined（P0.05）;compared with drug group D,there was no difference among group F,group E and group MB（P0.1）;according to the comparison among the groups with different intervention methods,the expression level of colonic SP m RNA of the rats in group MB was lower than that of group F（P0.05）.Conclusion The different efficacy of different acupuncture-moxibustion methods in treatment of functional constipation may be related with the mechanism of regulation of plasma SP content and the expression level of colonic SP m RNA.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
AIM To investigate correlations between diet and prevalence of constipation among elderly people in Beijing.METHODS A total of 2776(≥ 60 years) were selected in Beijing region for investigation. Data regarding consti...AIM To investigate correlations between diet and prevalence of constipation among elderly people in Beijing.METHODS A total of 2776(≥ 60 years) were selected in Beijing region for investigation. Data regarding constipation and diet habits was collected via hierarchical status, segmentation and random cluster sampling. Investigation included constipation-related demographic indicators and diet habits. Door-to-door questionnaires and surveys included daily staple food intakes, frequency of fish, egg, fruits and vegetables consumption. Constipation was defined according to the China Chronic Constipation Diagnosis and Treatment Guideline(2013), with the following constipation judgment indicators: decreased defecation frequency, dry and hard stool, and difficulty in defecation.RESULTS The prevalence of constipation among elderly people in Beijing region was 13%. There was a positive correlation between prevalence of constipation and age, but negative correlations between prevalence of constipation and staple food, fish and dietary fibres(fruits and vegetables) intakes. These differences were all statistically significant.CONCLUSION The prevalence of elderly constipation in Beijing region is closely related to diet habits, and is significantly decreased by high staple foods intake, fish eating and high dietary fibres(fruits and vegetables) consumption.展开更多
AIM: To investigate the present situation of elderly constipation in urban and rural areas of the Beijing region.METHODS: A total of 1942 cases(≥ 60 years) were selected in the Beijing region for investigation. Const...AIM: To investigate the present situation of elderly constipation in urban and rural areas of the Beijing region.METHODS: A total of 1942 cases(≥ 60 years) were selected in the Beijing region for investigation. Constipation-related data collection was carried out via hierarchical status, segmentation, and random cluster sampling. Patient data concerning constipation-related demographic indicators, education level, occupation, economic status, and history of gastrointestinal disease was obtained via questionnaires and surveys. Constipation was defined according to the Rome Ⅲ criteria, with the following constipation judgment indicators: defecation less than 3 times per week, stool weight less than 35 g/d, dry and hard stool, and difficulty in defecating during more than 25% of evacuation attempts.RESULTS: Of the 1942 cases, 634 were diagnosed with constipation, and the total prevalence rate was 32.6%, which increased with age. There was a statistically insignificantly higher prevalence of constipation in females(compared to males) and urban areas(compared to rural areas). There was a statistically insignificantly higher prevalence in the illiterate group compared to the literacy group. Those engaged in mental work suffered from statistically significantly higher constipation prevalence than those engaged in physical labor. A total of 1847 cases did not suffer from gastritis, of which 595 cases were constipated; although the prevalence rate was 32.2%, showing a higher incidence of constipation in patients with gastritis, no significant statistical difference between the two groups was found. A total of 59 cases with a past history of biliary tract disease were found, of which 26 had constipation; constipation prevalence was 44.1%(far higher than other groups), which was a statistically significant difference.CONCLUSION: The prevalence of elderly constipation in the B eijing region closely resembles Western countries, and is significantly affected by region, age, and past history of other related illnesses.展开更多
Functional constipation （FC） is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupunctu...Functional constipation （FC） is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupuncture （EA） treatment for FC patients. Totally, 111 patients with FC meeting the Rome III criteria were randomly assigned to different intensities of EA groups （low and high intensity of EA groups） and medicine-controlled （MC） group. In EA groups, patients were treated with EA at quchi （Llll） and shangjuxu （ST37） bilaterally for 4 weeks, 5 times/week in the first 2 weeks, and 3 times/week in the last 2 weeks. In MC group, 5 mg mosapride citrate was administered orally 3 times/day for 4 weeks. Spontaneous bowel movement frequency each day was recorded using a consti- pation diary. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were used to assess the patients＇ psychological state. Cortisol （CORT）, substance P （SP）, and vasoactive intestinal polypep- tide （VIP） were evaluated at baseline and at the end of 4 weeks after treatment. As compared with the baseline, there was statistically significant increase in stool frequency every week （P〈0.01）, but there was no statistically significant difference among the three groups. As compared with the baseline, after 4 weeks of EA therapy, the scores of SDS and serum levels of CORT were decreased significantly in low intensity of EA group （P〈0.01）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the scores of SAS and SDS and serum levels of CORT were decreased significantly in high intensity of EA group （P〈0.05）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the serum levels of CORT and VIP were increased significantly in MC group （P〈0.05）. As compared with MC group, after 4 weeks of treatment, the serum levels of SP were signifcicantly in- creased in low intensity of EA group （P〈0.01）. Low and high intensities of EA could increase the stool frequency, improve the FC patient＇s anxiety and depression, reduce the serum levels of CORT, and in- crease the serum levels of SP and VIP effectively. It is concluded that both low and high intensities of EA are effective for FC patients, but there is no significant difference between the low and high intensi- ties of EA.展开更多
Constipation is a common gastrointestinal complaint in clinical practice, affecting an estimated 27% of the population. Many patients are disappointed by current conventional treatments and, therefore, seek help from ...Constipation is a common gastrointestinal complaint in clinical practice, affecting an estimated 27% of the population. Many patients are disappointed by current conventional treatments and, therefore, seek help from complementary and alternative medicine （CAM）. Traditional Chinese medicine, is the most important part of CAM and has been practiced for treating diseases and promoting the health of humans for thousands of years, and has become a popular alternative choice. Although there are many Chinese herbal medicine （CHM interventions available, and some have been verified b＇ clinical trials, their efficacy and safety are still questioned by both patients and health care providers worldwide. The purposes of this review are, first, to appraise the qualities of individual study designs in the new Cochrane approach. Second, the benefits of individual CHM interventions or individual types of CHM intervention for the treatment of functional constipation are analyzed. Finally, valid and comprehensive conclusions are drawn, if applicable, in order to make clinical recommendations.展开更多
Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）...Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）, 6）, Shemgjfuxu （上巨虚 ST 37）, etc. （2）Zhongliao （中髎 BL 33）, Xiadiao （下髎 BL 34）, Dachangshu （大肠俞 BL 25）, etc. Electroacupuncture was applied in combination at Zhongliao （中髎 BL 33）, Xialiao （下髎 BL 34）, Tianshu（天枢 ST 25） and Shamgjuxu （上巨虚 ST 37）, once a day, 10 treatments made one session. By constipation diary of patients, frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, stool quality, a sense of defecation and the Patient Assessment of Constipation Quality of Life questionnaire （PAC-QOL）, as well as the changes before and after treatment were observed. Results After treatment, the apparent improvements were achieved in frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, a sense of defecation and score of PAC-QOL as compared with those before treatment （all P〈0.01）. The total effective rate was 67.7% （61/70）. The acupuncture effieacies were various on CFC of different dynamic mechanisms. The efficacy on slow transit constipation （STC） was superior to that caused by spastic pelvic floor syndrome （SPFS-C） （P〈0.05）, the efficacy on constipation caused by irritable bowel syndrome （IBS-C） was superior to that on either SPFS-C or constipation caused by relaxant pelvic floor syndrome （RPFS-C） （both P〈0.05）. Of 52 eases in effective follow-up, 1 month after treatment, 3 eases were cured, 6 eases markedly effective, 23 eases effective, and 20 cases failed; 3 months after treatment, 3 eases were cured, 5 eases markedly effective, 16 cases effective and 28 cases failed. Conclusion Acupuncture has definite efficacy on CFC with definite etiology, loci and diagnostic classification. But, the efficacies are different due to various dynamic mechanisms. A further optimized treatment program is required to improve the efficacy on SPFS-C and RPFS-C.展开更多
Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Num...Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.展开更多
Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve consti...Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve constipation-related symptoms and rebalance the gut microbiota.However,it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs.Therefore,we assessed the effects of EA in FC mice and pseudo-germfree(PGF)mice to address these questions.Methods:Forty female Kunming mice were randomly separated into a normal control group(n=8),an FC group(n=8),an FC+EA group(n=8),a PGF group(n=8)and a PGF+EA group(n=8).The FC group and FC+EA group were treated with diphenoxylate to establish the FC model;the PGF group and PGF+EA group were given an antibiotic cocktail to initiate the PGF model.After maintaining the model for 14 d,mice in the FC+EA and PGF+EA groups received EA stimulation at the ST25 and ST37 acupoints,once a day,5 times per week,for 2 weeks.Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility.Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing,and measure SCFA concentrations using gas chromatography-mass spectrometry.Results:EA significantly shortened the first black stool defecation time(P<0.05)and increased the intestinal transit rate(P<0.01),and fecal pellet number(P<0.05),wet weight(P<0.05)and water content(P<0.01)over 8 h,compared with the FC group,showing that EA promoted gut motility and alleviated constipation.However,EA treatment did not reverse slow-transit colonic motility in PGF mice(P>0.05),demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation.In addition,EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice(P<0.05),most likely due to the upregulation of Staphylococcaceae microorganisms(P<0.01).Conclusion:EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.展开更多
Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mech...Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mechanism of BZBS in the treatment of functional constipation(FC)has been little studied and remains unclear.In this study,a behavioral investigation,colon tissue morphology,enzyme-linked immunosorbent assay(Elisa)and intestinal microflora analysis have been used to illuminate the potential mechanism of the effects of BZBS on FC in a rat model.Methods:A FC rat model was constructed and BZBS was given as treatment.Observations and recordings were made of the fecal moisture content,the defecation time of the first black stool,and the rate of intestinal propulsion.Elisa was used to detect the expression levels of substance P(SP),vasoactive intestinal peptide(VIP),5-hydroxytryptamine(5-HT)in the colon.To ascertain the composition of the microbial community,a high throughput 16S ribosomal RNA(16S r RNA)gene sequencing technique was employed.Results:Oral administration of BZBS significantly ameliorated several key excretion parameters,including the time to first black stool defecation,stool water content,and the propulsion rate in the small intestine in FC rats.It increased the expression of SP,VIP and 5-HT in the colon.16S r RNA gene sequencing results showed that BZBS changed the microbial community structure,decreased the Bacteroidetes/Firmicutes ratio,increased the relative abundance of Blautia and Fusicatenibacter,and decreased the relative abundance of Ruminococcus and Roseburia.Conclusions:BZBS effectively alleviates FC and improves dysbacteriosis.展开更多
文摘Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.
基金the authorities at the Kerman University of Medical Sciences for supporting this study。
文摘Background:Constipation is a common chronic bowel disorder with an incidence of more than 50%in the elderly population.Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly.Objective:This study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill.and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life.Design,setting,participants and intervention:This double-blind randomized active controlled clinical trial,with parallel group allocation ratio of 1:1,was conducted in a referral clinic in Afzalipour Hospital,affiliated to Kerman University of Medical Sciences in Kerman,Southeastern Iran.Individuals over 60 years of age,diagnosed with functional constipation(based on the RomeⅣcriteria),were included in this study.Participants received a sachet of 10 g F.vulgare and R.damascena(herbal formula group)or polyethylene glycol 4000(PEG 4000 group)with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks.Main outcome measures:Constipation severity,stool consistency,and the quality of life were used as the primary outcomes.Drug side effects were used as a secondary outcome.The outcomes were assessed using the Constipation Assessment Scale,the Bristol Stool Form Scale,and the Patient Assessment of Constipation Quality of Life questionnaire.Results:A total of 25 participants in each group completed the four-week treatment cycle and the eightweek follow-up.At the end of the four-week treatment cycle,all clinical outcomes had significant improvements in both groups(P<0.05).The analysis of constipation severity(P<0.001),stool consistency(P<0.001),and the quality of life(P<0.001)showed significant improvements with fewer side effects(mild diarrhea)and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group.Conclusion:Although both interventions significantly improved the treatment outcomes,constipation severity,stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000;however,the mechanism of action is not yet understood.Trial registration:This trial was registered in the Iranian Registry of Clinical Trials(IRCTID:IRCT20200108046056N1).
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 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Suzhou Clinical Medical Center for Mood Disorders,No.Szlcyxzx202109Suzhou Key Laboratory,No.SZS2024016+1 种基金Multicenter Clinical Research on Major Diseases in Suzhou,No.DZXYJ202413General Program of Lianyungang Health Committee,No.202336.
文摘BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.
基金Supported by The Hubei Pediatric Alliance Medical Research Project,No.HPAMRP202117.
文摘Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.
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.
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.
文摘BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.
基金Supported by Young Talents Program of Hebei Higher Education Institutions:BJ2014047Scientific Research Fund Project for Doctors of Hebei University of Chinese Medicine:BSZ2015009National Natural Science Foundation
文摘Objective To explore the effects of different acupuncture-moxibustion methods on the plasma substance P（SP） content,and the expression of colonic SP m RNA of the rats with functional constipation.Methods Sixty healthy male SD rats were divided into six groups according to the random number table,including blank control group（group B,n=8）,model group（group M,n=11）,drug control group（group D,n=8）,filiform needle group（group F,n=11）,electroacupuncture group（group E,n=11） and moxibustion group（group MB,n=11）.The rats in group B and group M accepted no intervention,gavage with cisapride suspension was conducted in group D,and electroacupuncture,filiform needling and moxibustion therapies were carried out in group E,group F and group MB for 6 days.After treatment,the stool quantity and fecal moisture content during 24 h of the rats were observed in each group,colon tissue structure and the acidic mucus in mucosa layer were observed,plasma SP content was detected and the expression of colonic SP m RNA was detected.Results compared with group B,the stool quantity and fecal moisture content during 24 h of the rats in group M decreased significantly（P0.01）;compared with group M,the stool quantity during 24 h of the rats in each group increased（P0.05 or 0.01）,and the fecal moisture content during 24 h of the rats in each group also increased significantly except group MB（P0.01）;compared with group D,the fecal moisture content during 24 h of the rats in group MB decreased（P0.01）;according to the comparison among the groups with different acupuncture-moxibustion methods,there was no difference in the stool quantity during 24 h of the rats in each group（P0.05）,the fecal moisture contents during 24 h of the rats in group F and group E were higher than that of group MB（P0.01）,and there was no difference between group F and group E（P0.05）.HE staining of colon tissue of rats showed that the structure was normal and complete,and there was no difference among each group.PAS staining showed that the acidic mucus level of the rats in group M decreased significantly when compared with group B;compared with group M,the acidic mucus level of the rats in group D,fgroup F,group E and group MB increased in varying degrees.Compared with group B,the plasma SP content of the rats in group M decreased（P0.05）;compared with group M,the plasma SP contents of the rats in group F and group MB increased（P0.01）;the plasma SP contents of the rats in group F,group MB and group E were higher than that of group D（P0.05 or 0.01）;according to the comparison among the groups with different acupuncture-moxibustion methods,the plasma SP content of the rats in group F was higher than that of group MB and electro-acupuncture group（P0.05）,and there was no difference between group MB and group E.Compared with group B,the expression level of colonic SP m RNA of the rats in group M elevated（P0.05）;compared with group M,the expression level of colonic SP m RNA of the rats in the four intervention groups declined（P0.05）;compared with drug group D,there was no difference among group F,group E and group MB（P0.1）;according to the comparison among the groups with different intervention methods,the expression level of colonic SP m RNA of the rats in group MB was lower than that of group F（P0.05）.Conclusion The different efficacy of different acupuncture-moxibustion methods in treatment of functional constipation may be related with the mechanism of regulation of plasma SP content and the expression level of colonic SP m RNA.
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AIM To investigate correlations between diet and prevalence of constipation among elderly people in Beijing.METHODS A total of 2776(≥ 60 years) were selected in Beijing region for investigation. Data regarding constipation and diet habits was collected via hierarchical status, segmentation and random cluster sampling. Investigation included constipation-related demographic indicators and diet habits. Door-to-door questionnaires and surveys included daily staple food intakes, frequency of fish, egg, fruits and vegetables consumption. Constipation was defined according to the China Chronic Constipation Diagnosis and Treatment Guideline(2013), with the following constipation judgment indicators: decreased defecation frequency, dry and hard stool, and difficulty in defecation.RESULTS The prevalence of constipation among elderly people in Beijing region was 13%. There was a positive correlation between prevalence of constipation and age, but negative correlations between prevalence of constipation and staple food, fish and dietary fibres(fruits and vegetables) intakes. These differences were all statistically significant.CONCLUSION The prevalence of elderly constipation in Beijing region is closely related to diet habits, and is significantly decreased by high staple foods intake, fish eating and high dietary fibres(fruits and vegetables) consumption.
文摘AIM: To investigate the present situation of elderly constipation in urban and rural areas of the Beijing region.METHODS: A total of 1942 cases(≥ 60 years) were selected in the Beijing region for investigation. Constipation-related data collection was carried out via hierarchical status, segmentation, and random cluster sampling. Patient data concerning constipation-related demographic indicators, education level, occupation, economic status, and history of gastrointestinal disease was obtained via questionnaires and surveys. Constipation was defined according to the Rome Ⅲ criteria, with the following constipation judgment indicators: defecation less than 3 times per week, stool weight less than 35 g/d, dry and hard stool, and difficulty in defecating during more than 25% of evacuation attempts.RESULTS: Of the 1942 cases, 634 were diagnosed with constipation, and the total prevalence rate was 32.6%, which increased with age. There was a statistically insignificantly higher prevalence of constipation in females(compared to males) and urban areas(compared to rural areas). There was a statistically insignificantly higher prevalence in the illiterate group compared to the literacy group. Those engaged in mental work suffered from statistically significantly higher constipation prevalence than those engaged in physical labor. A total of 1847 cases did not suffer from gastritis, of which 595 cases were constipated; although the prevalence rate was 32.2%, showing a higher incidence of constipation in patients with gastritis, no significant statistical difference between the two groups was found. A total of 59 cases with a past history of biliary tract disease were found, of which 26 had constipation; constipation prevalence was 44.1%(far higher than other groups), which was a statistically significant difference.CONCLUSION: The prevalence of elderly constipation in the B eijing region closely resembles Western countries, and is significantly affected by region, age, and past history of other related illnesses.
基金supported by the National Basic Research Program of China(973 Program)(No.2011CB505203)
文摘Functional constipation （FC） is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupuncture （EA） treatment for FC patients. Totally, 111 patients with FC meeting the Rome III criteria were randomly assigned to different intensities of EA groups （low and high intensity of EA groups） and medicine-controlled （MC） group. In EA groups, patients were treated with EA at quchi （Llll） and shangjuxu （ST37） bilaterally for 4 weeks, 5 times/week in the first 2 weeks, and 3 times/week in the last 2 weeks. In MC group, 5 mg mosapride citrate was administered orally 3 times/day for 4 weeks. Spontaneous bowel movement frequency each day was recorded using a consti- pation diary. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were used to assess the patients＇ psychological state. Cortisol （CORT）, substance P （SP）, and vasoactive intestinal polypep- tide （VIP） were evaluated at baseline and at the end of 4 weeks after treatment. As compared with the baseline, there was statistically significant increase in stool frequency every week （P〈0.01）, but there was no statistically significant difference among the three groups. As compared with the baseline, after 4 weeks of EA therapy, the scores of SDS and serum levels of CORT were decreased significantly in low intensity of EA group （P〈0.01）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the scores of SAS and SDS and serum levels of CORT were decreased significantly in high intensity of EA group （P〈0.05）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the serum levels of CORT and VIP were increased significantly in MC group （P〈0.05）. As compared with MC group, after 4 weeks of treatment, the serum levels of SP were signifcicantly in- creased in low intensity of EA group （P〈0.01）. Low and high intensities of EA could increase the stool frequency, improve the FC patient＇s anxiety and depression, reduce the serum levels of CORT, and in- crease the serum levels of SP and VIP effectively. It is concluded that both low and high intensities of EA are effective for FC patients, but there is no significant difference between the low and high intensi- ties of EA.
基金Supported by Health and Health Services Research Fund of Hong Kong Health, Welfare and Food Bureau, No. 05060161
文摘Constipation is a common gastrointestinal complaint in clinical practice, affecting an estimated 27% of the population. Many patients are disappointed by current conventional treatments and, therefore, seek help from complementary and alternative medicine （CAM）. Traditional Chinese medicine, is the most important part of CAM and has been practiced for treating diseases and promoting the health of humans for thousands of years, and has become a popular alternative choice. Although there are many Chinese herbal medicine （CHM interventions available, and some have been verified b＇ clinical trials, their efficacy and safety are still questioned by both patients and health care providers worldwide. The purposes of this review are, first, to appraise the qualities of individual study designs in the new Cochrane approach. Second, the benefits of individual CHM interventions or individual types of CHM intervention for the treatment of functional constipation are analyzed. Finally, valid and comprehensive conclusions are drawn, if applicable, in order to make clinical recommendations.
基金Supported by Nanjing Provincial Science and Education Health Project:HL 07061
文摘Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）, 6）, Shemgjfuxu （上巨虚 ST 37）, etc. （2）Zhongliao （中髎 BL 33）, Xiadiao （下髎 BL 34）, Dachangshu （大肠俞 BL 25）, etc. Electroacupuncture was applied in combination at Zhongliao （中髎 BL 33）, Xialiao （下髎 BL 34）, Tianshu（天枢 ST 25） and Shamgjuxu （上巨虚 ST 37）, once a day, 10 treatments made one session. By constipation diary of patients, frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, stool quality, a sense of defecation and the Patient Assessment of Constipation Quality of Life questionnaire （PAC-QOL）, as well as the changes before and after treatment were observed. Results After treatment, the apparent improvements were achieved in frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, a sense of defecation and score of PAC-QOL as compared with those before treatment （all P〈0.01）. The total effective rate was 67.7% （61/70）. The acupuncture effieacies were various on CFC of different dynamic mechanisms. The efficacy on slow transit constipation （STC） was superior to that caused by spastic pelvic floor syndrome （SPFS-C） （P〈0.05）, the efficacy on constipation caused by irritable bowel syndrome （IBS-C） was superior to that on either SPFS-C or constipation caused by relaxant pelvic floor syndrome （RPFS-C） （both P〈0.05）. Of 52 eases in effective follow-up, 1 month after treatment, 3 eases were cured, 6 eases markedly effective, 23 eases effective, and 20 cases failed; 3 months after treatment, 3 eases were cured, 5 eases markedly effective, 16 cases effective and 28 cases failed. Conclusion Acupuncture has definite efficacy on CFC with definite etiology, loci and diagnostic classification. But, the efficacies are different due to various dynamic mechanisms. A further optimized treatment program is required to improve the efficacy on SPFS-C and RPFS-C.
基金supported by grants from the National Natural Science Foundation of China(No.8207455481774430)the Foundation of the Science and Technology Department of Sichuan Province,China(No.2021YJ0197)。
文摘Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.
基金National Natural Science Foundationof China(grant number:82074554,82205270 and 81774430)Chengdu University of Traditional Chinese Medicine Xinglin Scholars Program(grant number:YXRC2018007).
文摘Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve constipation-related symptoms and rebalance the gut microbiota.However,it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs.Therefore,we assessed the effects of EA in FC mice and pseudo-germfree(PGF)mice to address these questions.Methods:Forty female Kunming mice were randomly separated into a normal control group(n=8),an FC group(n=8),an FC+EA group(n=8),a PGF group(n=8)and a PGF+EA group(n=8).The FC group and FC+EA group were treated with diphenoxylate to establish the FC model;the PGF group and PGF+EA group were given an antibiotic cocktail to initiate the PGF model.After maintaining the model for 14 d,mice in the FC+EA and PGF+EA groups received EA stimulation at the ST25 and ST37 acupoints,once a day,5 times per week,for 2 weeks.Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility.Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing,and measure SCFA concentrations using gas chromatography-mass spectrometry.Results:EA significantly shortened the first black stool defecation time(P<0.05)and increased the intestinal transit rate(P<0.01),and fecal pellet number(P<0.05),wet weight(P<0.05)and water content(P<0.01)over 8 h,compared with the FC group,showing that EA promoted gut motility and alleviated constipation.However,EA treatment did not reverse slow-transit colonic motility in PGF mice(P>0.05),demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation.In addition,EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice(P<0.05),most likely due to the upregulation of Staphylococcaceae microorganisms(P<0.01).Conclusion:EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.
基金Natural Science Foundation of Zhejiang Province,Grant/Award Number:Y19H280022。
文摘Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mechanism of BZBS in the treatment of functional constipation(FC)has been little studied and remains unclear.In this study,a behavioral investigation,colon tissue morphology,enzyme-linked immunosorbent assay(Elisa)and intestinal microflora analysis have been used to illuminate the potential mechanism of the effects of BZBS on FC in a rat model.Methods:A FC rat model was constructed and BZBS was given as treatment.Observations and recordings were made of the fecal moisture content,the defecation time of the first black stool,and the rate of intestinal propulsion.Elisa was used to detect the expression levels of substance P(SP),vasoactive intestinal peptide(VIP),5-hydroxytryptamine(5-HT)in the colon.To ascertain the composition of the microbial community,a high throughput 16S ribosomal RNA(16S r RNA)gene sequencing technique was employed.Results:Oral administration of BZBS significantly ameliorated several key excretion parameters,including the time to first black stool defecation,stool water content,and the propulsion rate in the small intestine in FC rats.It increased the expression of SP,VIP and 5-HT in the colon.16S r RNA gene sequencing results showed that BZBS changed the microbial community structure,decreased the Bacteroidetes/Firmicutes ratio,increased the relative abundance of Blautia and Fusicatenibacter,and decreased the relative abundance of Ruminococcus and Roseburia.Conclusions:BZBS effectively alleviates FC and improves dysbacteriosis.
