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.

Ganjiang granule regulates cecal microflora and serum biochemical components in a rat model of constipation-predominant irritable bowel syndrome

Objective:To investigate the effects of Ganjiang granule(GG)on cecal microflora and serum biochemical components in rats with constipation-predominant irritable bowel syndrome(IBSeC).Methods:Twenty-four SpragueeDawley rats were randomly divided into four groups:control,model,GG,and probiotics.Rats in the model,GG,and probiotics groups received 3℃ tap water intragastrically;rats in the GG group were treated with GG;rats in the probiotics group were treated with probiotics.For all rats,enzyme-linked immunosorbent assay and colorimetry were used to assess serum biochemical components related to gastrointestinal function;16S rRNA high-throughput sequencing was used to analyze the cecal microflora.Results:The serum level of 5-hydroxytryptamine(HT)was higher in the model group than in the control group(Z=-2.082,P=.037).The model group exhibited changes in cecal microflora:the relative abundances of Lactobacillus decreased(Z=-2.882,P=.004)and Dorea increased(t=-3.030,P=.023),compared with the control group.The GG and probiotics groups exhibited normal serum levels of 5-HT.The GG and probiotics groups exhibited improved serum levels of gastrin;the probiotics group exhibited an improved serum level of vasoactive intestinal peptide.Compared with the model group,The GG group exhibited greater relative abundance of Ruminococcus(Z=-2.402,P=.016);the probiotics group exhibited greater relative abundance of SMB53(Z=-2.823,P=.005)and lower relative abundances of Desulfovibrio(Z=-2.823,P=.005)and Facklamia(Z=-2.608,P=.009).Conclusion:The effects of GG on IBS-C may be related to regulation of the serum level of 5-HT,as well as elevated relative abundance of beneficial bacteria in cecal microflora.

Personality factors and profiles in variants of irritable bowel syndrome

AIM: To study the association between irritable bowel syndrome (IBS) variants (constipation,diarrhea,or both) and personality traits in non-psychiatric patients. METHODS: IBS was diagnosed using the Rome Ⅱ diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS: One hundred and fifty patients were studied. The mean age (± SD) was 33.4 (± 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 ± 7.80 vs 22.92 ± 9.54,P < 0.0005),openness (26.25 ± 5.22 vs 27.94 ± 4.87,P < 0.0005) and conscientiousness (32.90 ± 7.80 vs 31.62 ± 5.64,P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS,33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 ± 5.65 vs 31.95 ± 6.80,P = 0.035 and 31.97 ± 9.87,P = 0.043,respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles,composed of higher scores for neuroticism and conscientiousness,with low levels of agreeableness,openness and extraversion that were close to those of the general population. CONCLUSION: Differences were observed between IBS patients and the general population,as well as between IBS subtypes,in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions,which can be focused considering the characteristics of each subtype.

Effect of Modified Sinisan (四逆散) on Anorectal Manometry of the Constipation Predominant Type of Irritable Bowel Syndrome

Objective: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (四逆散, SNS). Methods: Forty -seven IBS patients with the constipation predominant type were randomly divided into the treated group ( n =24) and the control group ( n =23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. Results: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment ( P <0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups ( P <0.05), and the improvement of the treated group was more significant than that of the control group( P <0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly ( P <0.05, P <0.01).Conclusion: SNS has good effect on IBS of the constipation predominant type.

The role of 5-HT_7 Receptor in the pathogenesis of IBS

Objective：To investigate the role of 5-HT7 receptor in the pathogenesis of irritable bowel syndrome（IBS）. Methods：Rat model of D-IBS was established by intracolonic instillation of acetic acid and restraint stress; Rat model of C-IBS was established by stomach irrigated with 0-4℃ cool water daily for 14 d. The content and distribution of 5-HT7 receptor at the brain and bowel was examined by immunohistochemistry and the expression of 5-HT7 receptor mRNA was detected by fluorescence quantitative RT-PCR（Real-time PCR）. Results：Immunocytochemistry result showed the 5-HT7 rceptor positive staining at hippocampus and hypothalamus of both C-IBS and D-IBS group was stronger than that of control group（P 〈 0.01）. The 5-HT7R expression at ileum, proximate colon, distal colon of C-IBS group was significantly stronger than that of control group（P 〈 0.05）. Realtime-PCR analysis results showed the expression level of 5-HT7 receptor at hippocampus and hypothalamus of both C-IBS and D-IBS group was increased than that of control group（P〈 0.05）. At proximal and distal colon of C-IBS group, the 5-HT7 receptor mRNA expression was increased compared with control group（P〈 0.05）. Conclusion：The up-regulated expression of 5-HT7 receptor at brain and colon may play an important role in the pathogenesis of C-IBS.

通腑调神针法治疗便秘型肠易激综合征:随机对照试验

Objective To observe the effects of bowls-unblocking and mind-regulating acupuncture therapy on constipation,anxiety,depression and serum neuropeptide Y(NPY)content for the patients with constipation-predominant irritable bowel syndrome(IBS-C).Methods Forty-two IBS-C patients were randomly assigned either into a bowls-unblocking and mind-regulating acupuncture group(acupuncture group)or a mosapride citrate group(medication group)with 21 cases in each group.During the treatment,one patient in the medication group was excluded and 20 patients were included in final statistical analysis;while 21 patients completed the trial in the acupuncture group.Before treatment,after treatment and in follow-up(1 month after the whole treatment),the scores of the Cleveland clinical constipation scoring system(CCS),the self-rating anxiety scale(SAS),and the self-rating depression scale(SDS)were assessed in both groups.The changes in NPY content were compared before and after treatment.Results①Total score of CCS:after treatment,the total score in the acupuncture group and the medication group were(4.76±2.10)points and(5.60±1.88)points,respectively,which were significantly lower than those before treatment in both groups(both P<0.05);and the difference in the score was not significant for the between-group comparison(P>0.05).In the follow-up,the total scores were(4.19±1.69)points in the acupuncture group,and was(6.35±2.06)points in the medication group.The score in the medication group was higher than that after treatment in the same group(P<0.05),but there was no significant difference between acupuncture group and the medication group(P>0.05).②SAS score:after treatment,the SAS scores were(50.24±2.19)points and(53.45±2.46)points in the acupuncture group and the medication group,respectively,which was lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between two groups(P<0.05).In the follow-up,the scores were(51.95±2.27)points and(54.55±1.67)points in the acupuncture group and the medication group,respectively;which was lower than that before treatment in the two groups(both P<0.05),and the difference in the score was significant between two groups(P<0.05).③SDS score:after treatment,the SDS scores were(50.71±2.70)points and(53.15±2.25)points in the acupuncture group and the medication group,respectively,which was significantly lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between the two group(P<0.05).In the follow-up,the score of the acupuncture group was(52.57±3.72)points and it was(56.60±2.42)points in the medication group,which was significantly lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between the two groups(P<0.05).④Comparison of serum NPY content:after treatment,the serum NPY content of the acupuncture group and the medication group were(7.08±3.02)mmol/L and(9.89±3.82)mmol/L,respectively,which was significantly lower than that before treatment within each group(both P<0.05).The difference was significant between the two groups(P<0.05).⑤Effective rate:after treatment,the total effective rate was 95.24%in the acupuncture group and 90.00%in the medication group,without statistically significant difference(P>0.05).Conclusions bowls-unblocking and mind-regulating acupuncture therapy relieved the defecation-related symptoms,anxiety,and depression in IBS-C patients;and it was more effective on abdominal pain compared with mosapride citrate.Acupuncture therapy also had some long-term effect,which may be related to its regulatory effect on the serum NPY content.