Constipation and colonoscopy

Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.

Preventive effect of kiwi berry(Actinidia arguta)on loperamide-induced constipation

Constipation is a common intestinal disease.Kiwi berries can effectively prevent constipation.However,studies have yet to be done to determine how kiwi berries prevent constipation.For two weeks,mice in this study were continually orally gavaged with kiwi berry,loperamide,or a combination of the 2.This study found that the kiwi group's feces had more water than the constipated mice.In addition,kiwi berries can speed up gastrointestinal transit(GI),shorten the time it takes to pass the first dark stool,and dramatically enhance body weight gain.In the interstitial cells of Caj al(ICC)cells and colon tissues,alterations in the protein expression of vasoactive intestinal peptide(VIP),cyclic adenosine monophosphate(cAMP),protein kinase A(PKA),and aquapcrin-3(AQP3)were found.At 3,6,and 12 h of ICC cells and mouse colon,the kiwi group's VIP,cAMP,PKA,and AQP3 protein expression levels were lower than those of the constipated mice.The kiwi berry can decrease the Firmicutes to Bacteroidetes ratio and boost the diversity and quantity of gut microbiota.By influencing the gut microbiota and VIP-cAMP-PKA-AQP3 signaling pathway,kiwi berries prevent constipation.

Relationship among Parkinson’s disease, constipation, microbes, and microbiological therapy

This comprehensive review elucidates the complex interplay between gut microbiota and constipation in Parkinson’s disease(PD),a prevalent non-motor symptom contributing significantly to patients’morbidity.A marked alteration in the gut microbiota,predominantly an increase in the abundance of Proteobacteria and Bacteroidetes,is observed in PD-related constipation.Conventional treatments,although safe,have failed to effectively alleviate symptoms,thereby necessitating the development of novel therapeutic strategies.Microbiological interventions such as prebiotics,probiotics,and fecal microbiota transplantation(FMT)hold therapeutic potential.While prebiotics improve bowel movements,probiotics are effective in enhancing stool consistency and alleviating abdominal discomfort.FMT shows potential for significantly alleviating constipation symptoms by restoring gut microbiota balance in patients with PD.Despite promising developments,the causal relationship between changes in gut microbiota and PD-related constipation remains elusive,highlighting the need for further research in this expanding field.

Hydrogen-rich water alleviates constipation by attenuating oxidative stress through the sirtuin1/nuclear factor-erythroid-2-related factor 2/heme oxygenase-1 signaling pathway

BACKGROUND Constipation,a highly prevalent functional gastrointestinal disorder,induces a significant burden on the quality of patients'life and is associated with substantial healthcare expenditures.Therefore,identifying efficient therapeutic modalities for constipation is of paramount importance.Oxidative stress is a pivotal contributor to colonic dysmotility and is the underlying pathology responsible for constipation symptoms.Consequently,we postulate that hydrogen therapy,an emerging and promising intervention,can serve as a safe and efficacious treatment for constipation.AIM To determine whether hydrogen-rich water(HRW)alleviates constipation and its potential mechanism.METHODS Constipation models were established by orally loperamide to Sprague-Dawley rats.Rats freely consumed HRW,and were recorded their 24 h total stool weight,fecal water content,and charcoal propulsion rate.Fecal samples were subjected to 16S rDNA gene sequencing.Serum non-targeted metabolomic analysis,malondialdehyde,and superoxide dismutase levels were determined.Colonic tissues were stained with hematoxylin and eosin,Alcian blue-periodic acid-Schiff,reactive oxygen species(ROS)immunofluorescence,and immunohistochemistry for cell growth factor receptor kit(c-kit),PGP 9.5,sirtuin1(SIRT1),nuclear factor-erythroid-2-related factor 2(Nrf2),and heme oxygenase-1(HO-1).Quantitative real-time PCR and western blot analysis were conducted to determine the expression level of SIRT1,Nrf2 and HO-1.A rescue experiment was conducted by intraperitoneally injecting the SIRT1 inhibitor,EX527,into constipated rats.NCM460 cells were induced with H2O2 and treated with the metabolites to evaluate ROS and SIRT1 expression.RESULTS HRW alleviated constipation symptoms by improving the total amount of stool over 24 h,fecal water content,charcoal propulsion rate,thickness of the intestinal mucus layer,c-kit expression,and the number of intestinal neurons.HRW modulated intestinal microbiota imbalance and abnormalities in serum metabolism.HRW could also reduce intestinal oxidative stress through the SIRT1/Nrf2/HO-1 signaling pathway.This regulatory effect on oxidative stress was confirmed via an intraperitoneal injection of a SIRT1 inhibitor to constipated rats.The serum metabolites,β-leucine(β-Leu)and traumatic acid,were also found to attenuate H2O2-induced oxidative stress in NCM460 cells by up-regulating SIRT1.CONCLUSION HRW attenuates constipation-associated intestinal oxidative stress via SIRT1/Nrf2/HO-1 signaling pathway,modulating gut microbiota and serum metabolites.β-Leu and traumatic acid are potential metabolites that upregulate SIRT1 expression and reduce oxidative stress.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

Exploration of the complex origins of primary constipation

Constipation is a common gastrointestinal disorder characterized by infrequentbowel movements and difficulty in passing stools.It can significantly affect anindividual's quality of life and overall well-being.Understanding the causes ofconstipation is important for its effective management and treatment.In thispaper,we have reviewed the primary causes of constipation or functional constipation.Primary constipation is a bowel disorder associated with colonic oranorectal sensorimotor or neuromuscular dysfunction.As per the literature,it ismultifactorial and involves factors such as decreased interstitial cells of Cajal,altered colonic motility,enteric nervous system dysfunction,intestinal flora disturbances,and psychological influences.Clinical symptoms include difficulty indefecation,decreased frequency of defecation,or a feeling of incomplete evacuation.A comprehensive evaluation and management of constipation require aninterdisciplinary approach incorporating dietary modifications,lifestyle changes,pharmacotherapy,and psychological interventions.Further research is imperativeto explain the intricate mechanisms underlying constipation and develop targetedtherapies for improved patient outcomes.

Microbiota treatment of functional constipation:Current status and future prospects

Functional constipation(FC)is a common disorder that is characterized by diffi-cult stool passage,infrequent bowel movement,or both.FC is highly prevalent,recurs often,accompanies severe diseases,and affects quality of life;therefore,safe and effective therapy with long-term benefits is urgently needed.Microbiota treatment has potential value for FC treatment.Microbiota treatments include modulators such as probiotics,prebiotics,synbiotics,postbiotics,and fecal micro-biota transplantation(FMT).Some probiotics and prebiotics have been adopted,and the efficacy of other microbiota modulators is being explored.FMT is con-sidered an emerging field because of its curative effects;nevertheless,substantial work must be performed before clinical implementation.

Preservation of superior rectal artery in laparoscopic colectomy:The best choice for slow transit constipation?

Laparoscopic colectomy with ileorectal anastomosis may be beneficial for patients with slow transit constipation who do not respond to conservative treatment,particularly if the superior rectal artery(SRA)is preserved.Several important concerns have been addressed in this commentary.It is important to first go over the definition of surgical procedure as it is used in this text.Second,the current study lacked a control group that had SRA preservation.Thirdly,it would be best to use a prospective,randomized controlled study.Lastly,a description of the mesenteric defect’s state following a laparoscopic colectomy is necessary.

Effect of KiwiBiotic on functional constipation and related symptoms:A prospective,single-center,randomized,comparative,crossover study

BACKGROUND Functional constipation(FC)is a common gastrointestinal disorder characterized by abdominal pain and bloating,which can greatly affect the quality of life of patients.Conventional treatments often yield suboptimal results,leading to the exploration of alternative therapeutic approaches.AIM To evaluate the efficacy of KiwiBiotic in the management of FC and related symptoms.METHODS This prospective,interventional,single-center,crossover study compared the safety and effectiveness of KiwiBiotic®vs psyllium husk in managing FC,abdominal pain,and bloating.Participants diagnosed with FC were randomly assigned to receive KiwiBiotic or psyllium husk during the two treatment periods,with a 14-day washout period between them.RESULTS Seventy participants were enrolled,32 of whom received KiwiBiotic followed by psyllium husk,and 33 received KiwiBiotic.KiwiBiotic showed superiority over psyllium husk in alleviating abdominal pain and bloating,as evidenced by significantly lower mean scores.Furthermore,KiwiBiotic resulted in more than 90.0%of patients experiencing relief from various constipation symptoms,while psyllium husk showed comparatively lower efficacy.CONCLUSION KiwiBiotic is an effective treatment option for FC,abdominal pain,and bloating,highlighting its potential as a promising alternative therapy for patients with FC and its associated symptoms.

Effectiveness of traditional chinese medicine nursing intervention on constipation and anxiety in chemotherapy

Background:In a study conducted from March to September 2021,124 cancer patients undergoing chemotherapy at our hospital were divided into two groups.The control group received routine inpatient nursing care,while the observation group received Traditional Chinese Medicine(TCM)nursing interventions in addition to routine care.Data analysis was conducted to compare the incidence of clinical adverse reactions,constipation scores,and changes in anxiety levels between the two groups.The results showed that the observation group,receiving TCM nursing interventions,had lower incidence of clinical adverse reactions and lower constipation scores compared to the control group.Additionally,anxiety levels were found to decrease significantly in the observation group post-intervention.These findings suggest that incorporating TCM nursing interventions in the care of cancer patients undergoing chemotherapy may help in reducing the occurrence of adverse reactions,alleviating constipation,and managing anxiety levels.Further research is needed to explore the full potential of integrating TCM into conventional nursing care for cancer patients.Methods:Following interventions,both groups experienced varying degrees of clinical adverse reactions,with the observation group demonstrating a significantly lower total incidence(29.03%)compared to the control group.This disparity was statistically significant(P<0.05).Furthermore,improvements were observed in defecation time(0.53±0.18)points and defecation frequency(1.17±0.25)points post-intervention.These findings suggest that the intervention had a positive impact on reducing adverse reactions and improving defecation patterns.Results:In a recent study,researchers found that individuals in the observation group experienced lower levels of difficulty with defecation and had a more regular defecation form compared to those in the control group.The results showed a significant difference in defecation difficulty and form,with the observation group scoring lower in both aspects.Interestingly,there was no significant difference in anxiety levels between the two groups prior to the intervention.However,after the intervention,both groups experienced a decrease in anxiety levels,with the observation group showing a greater reduction compared to the control group.This suggests that the intervention had a positive impact on reducing anxiety levels,particularly in the observation group,where anxiety scores were significantly lower.These findings highlight the possible benefits of certain interventions in improving both physical and psychological well-being.Conclusion:TCM nursing interventions have shown to be beneficial in reducing anxiety and improving constipation symptoms in cancer patients.These methods not only enhance the quality of life for patients but also offer a promising approach in clinical cancer treatment.The efficacy of TCM nursing highlights its value and encourages further promotion and application in future cancer care strategies.TCM nursing helps cancer patients undergoing chemotherapy with constipation and anxiety.

Consensus statement AIGO/SICCR:Diagnosis and treatment of chronic constipation and obstructed defecation(partⅠ:Diagnosis)

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.

Defecation function and quality of life in patients with slow-transit constipation after colectomy

BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.

Eficacy of Electro-acupuncture in Treatment of Functional Constipation: A Randomized Controlled Trial

Functional constipation(FC)is a chronic discasc that significantly afcts the life quality of patients.Acupuncture has been used for the treatment of FC for many years,but its effectiveness has not been scientifcally assessed.The present study aimed to evaluate the efficacy of electro-acupuncture(EA)in relieving the symptoms,mental states and quality of life(QOL)of FC patients.A total of 96 FC patients were randomly allocated into EA,mosapride&sham EA group(MS)and mosapride control group(MC).In the EA group,patients were treated with 16 sessions of needling at Quchi(LI1I)and Shangjuxu(ST37)bilaterally,5 times a week in the first 2 weeks,and 3 times a.week in the last 2 weeks.In the MC group,patients were treated with 5 mg mosapride citrate three times a day for 4 weeks.In the MS group,patients underwent sham EA and the same mosapride citrate treatment as in the MC group.The primary outcome was the number of weekly spontaneous bowel movements(SBMs).The secondary outcomes included stool consistency,intensity of defecating difficulty,36-Item Short-Form Health Survey(SF-36),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),and the validated Patient Assessment of Constipation-Quality of Life(PAC-QOL).The results showed that as compared with the baseline,EA significantly improved the weekly SBMs,stool consistency and intensity of defecating difficulty(P<0.05).It also partly ameliorated the PAC-QOL,SF-36,SDS and SAS scores when compared with MC or MS group(P<0.05).However,no significant difference was observed between MS and MC groups in bowel function outcomes and QOL scores.It was concluded that EA could effectivcly improve bowel function,mental states and QOL of FC patients.

Colorectal motility patterns and psychiatric traits in functional constipation and constipation-predominant irritable bowel syndrome:A study from China

BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on Western populations,with limited data originating from China.AIM To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.METHODS Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled.FC and IBS-C diagnoses were established using ROME IV criteria,and patients underwent high-resolution anorectal manometry(ARM)and a colonic transmit test using the Sitz marker study.Constipation-related symptoms were obtained through questionnaires.Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21.The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.RESULTS No significant differences in sex,age or abdominal discomfort symptoms were observed between IBS-C and FC patients(all P>0.05).The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC(36.63%vs 15.91%,P<0.05),while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group(50%vs 26.73%,P<0.05).Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM.IBS-C patients were found to have a higher prevalence of depression than FC patients(66.30%vs 42.42%,P<0.05).The scores for feelings of guilt,suicide,psychomotor agitation,diurnal variation,obsessive/compulsive disorder,hopelessness,self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients(P<0.05).For IBS-C(χ^(2)=5.438,P<0.05)but not FC,patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time.For IBS-C patients but not FC patients,the threshold of first constant sensation,desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety(r=0.414,r=0.404,and r=0.418,respectively,P<0.05).The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression(69.6%vs 41.9%,χ2=4.054,P<0.05).CONCLUSION Our findings highlight both overlapping and distinctive patterns of colon transit,dyssynergic patterns,anorectal sensation,psychological distress,and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population,providing valuable insights into the pathophysiological underpinnings of these disorders.

Systematic review of randomised controlled trials:Probiotics for functional constipation

AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.

Differing coping mechanisms, stress level and anorectal physiology in patients with functional constipation

AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P＜0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of'monitoring' coping strategy (14+6 vs9+3, P = 0.001),which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.

Slow transit constipation: A functional disorder becomes an enteric neuropathy

Slow transit constipation has been traditionally considered and classified as a functional disorder. However, clinical and manometric evidence has been accumulating that suggests how most of the motility alterations in STC might be considered of neuropathic type.In addition, further investigations showed that subtle alterations of the enteric nervous system, not evident to conventional histological examination, may be present in these patients. In the present article we will discuss these evidences, and will try to put them in relation with the abnormal motor function of the large bowel documented in this pathological condition.

Epidemiological study: Correlation between diet habits and constipation among elderly in Beijing region

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.

Irritable bowel syndrome and functional constipation management with integrative medicine: A systematic review

BACKGROUND Irritable bowel syndrome(IBS)and functional constipation(FC)are two commonly encountered functional gastrointestinal disorders in clinical practice and are usually managed with Western medicines in cooperation with traditional Chinese medicine(TCM)interventions.Although clinical practice guidelines(CPGs)have been developed to assist clinicians with their decisions,there are still gaps in management with regard to integrative medicine(IM)recommendations.AIM To comprehensively review the currently available CPGs and to provide a reference for addressing the gaps in IBS and FC management.METHODS We searched mainstream English and Chinese databases and collected data from January 1990 to January 2019.The search was additionally enriched by manual searches and the use of publicly available resources.Based on the development method,the guidelines were classified into evidence-based(EB)guidelines,consensus-based(CB)guidelines,and consensus-based guidelines with no comprehensive consideration of the EB(CB-EB)guidelines.With regard to the recommendations,the strength of the interventions was uniformly converted to a 4-point grading scale.RESULTS Thirty CPGs met the inclusion criteria and were captured as data extraction sources.Most Western medicine(WM)CPGs were developed as EB guidelines.All TCM CPGs and most IM CPGs were identified as CB guidelines.Only the 2011 IBS and IM CPG was a CB-EB set of guidelines.Antispasmodics and peppermint oil for pain,loperamide for diarrhea,and linaclotide for constipation polyethylene glycol and lactulose as osmotic laxatives,bisacodyl and sodium picosulfate as stimulant laxatives,lubiprostone and linaclotide as prosecretory agents,and prucalopride were strongly recommended or recommended in FC.TCM interventions were suggested based on pattern differentiation,while the recommendation level was considered to be weak or insufficient.CONCLUSION WM CPGs generally provide a comprehensive management algorithm,although there are still some gaps that could be addressed with TCM.Specific high-quality trials are needed to enrich the evidence.

Chronic constipation in hemiplegic patients

AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy. METHODS: Ninety consecutive hemiplegic patients and 81 consecutive orthopedic patients were investigated during physical motor rehabilitation in the same period, in the same center and on the same diet. All subjects were interviewed ≥ 3 mo after injury using a questionnaire inquiring about bowel habits before injury and at the time of the interview. Patients’ mobility was evaluated by the Adapted Patient Evaluation Conference System. Drugs considered for the analysis were nitrates, angiogenic converting enzyme (ACE) inhibitors, calcium antagonists, anticoagulants, antithrombotics, antidepressants, anti-epileptics. RESULTS: Mobility scores were similar in the two groups. De novo constipation (OR = 5.36) was a frequent outcome of the neurological accident. Hemiplegics showed an increased risk of straining at stool (OR: 4.33), reduced call to evacuate (OR: 4.13), sensation of incomplete evacuation (OR: 3.69), use of laxatives (OR: 3.75). Logistic regression model showed that constipation was significantly and independently associated with hemiplegia. A positive association was found between constipation and use of nitrates and antithrombotics in both groups. Constipation was not related to the site of brain injury. CONCLUSION: Chronic constipation is a possible outcome of cerebrovascular accidents occurring in 30% of neurologically stabilized hemiplegic patients. Its onset after a cerebrovascular accident appears to be independent from the injured brain hemisphere, and unrelated to physical inactivity. Pharmacological treatment with nitrates and antithrombotics may represent an independent risk factor for developing chronic constipation.