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.

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.

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.

Botulinum toxin type A injection combined with biofeedback in the treatment of spastic pelvic floor syndrome

BACKGROUND Spastic pelvic floor syndrome(SPFS)is a refractory pelvic floor disease characterized by abnormal(uncoordinated)contractions of the external anal sphincter and puborectalis muscle during defecation,resulting in rectal emptation and obstructive constipation.The clinical manifestations of SPFS are mainly characterized by difficult defecation,often accompanied by a sense of anal blockage and drooping.Manual defecation is usually needed during defecation.From physical examination,it is commonly observed that the patient's anal muscle tension is high,and it is difficult or even impossible to enter with his fingers.AIM To investigate the characteristics of anorectal pressure and botulinum toxin A injection combined with biofeedback in treating pelvic floor muscle spasm syndrome.METHODS Retrospective analysis of 50 patients diagnosed with pelvic floor spasm syndrome.All patients underwent pelvic floor surface electromyography assessment,anorectal dynamics examination,botulinum toxin type A injection 100 U intramuscular injection,and two cycles of biofeedback therapy.RESULTS After the botulinum toxin A injection combined with two cycles of biofeedback therapy,the patient's postoperative resting and systolic blood pressure were significantly lower than before surgery(P<0.05).Moreover,the electromyography index of the patients in the resting stage and post-resting stages was significantly lower than before surgery(P<0.05).CONCLUSION Botulinum toxin A injection combined with biofeedback can significantly reduce pelvic floor muscle tension in treating pelvic floor muscle spasm syndrome.Anorectal manometry is an effective method to evaluate the efficacy of treatment objectively.However,randomized controlled trials are needed.

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.

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.

Hindi translation and validation of the English version of the gastrointestinal symptom rating scale questionnaire:An observational study

BACKGROUND The gastrointestinal symptom rating scale(GSRS)is a questionnaire in English language which is designed to assess the clinical symptoms in patients with irritable bowel syndrome(IBS)and peptic ulcer disease.This validated scale has questions on around 15 items and has been validated in patients with dyspepsia and IBS.AIM To translate and validate the English version of the GSRS questionnaire to the Hindi version.METHODS The purpose of the present work was to create a Hindi version of this questionnaire for use in the Indian population.The process involved various steps as per the World Health Organization methodology including initial forward translation,backward translation,and assessment by an expert committee.Initial pilot testing was followed by testing in healthy and diseased individuals.RESULTS The Hindi translation was pilot tested in 20 individuals and further validated in healthy controls(n=30,15 females)and diseased individuals(n=72,27 females).The diseased group included patients with functional dyspepsia and IBS.Cronbach's alpha for internal consistency on the final translated GSRS questionnaire was 0.715 which is considered adequate.Twelve questions significantly differentiated the diseased population from the healthy population(P value<0.05)in the translated Hindi version of the GSRS.CONCLUSION The translated Hindi GSRS can be used to evaluate gastrointestinal function in clinical trials and community surveys in Hindi speaking populations.

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.

Functional constipation in children:What physicians should know

Functional constipation(FC)is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4%(95%confidence interval:11.2-17.6)when diagnosed based on the Rome IV criteria.Its pathophysiological mechanisms are thought be multifactorial and complicated,resulting in difficult management.Currently,the most effective medication,when used in parallel with toilet training,is osmotic laxatives.Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure.Recently,novel therapies with a high safety profile have been developed,such as probiotics,synbiotics,serotonin 5-hydroxytryptamine 4 receptor agonists,chloride channel activators,and herbal and transitional medicines;nonetheless,well-designed research to support the use of these therapies is needed.This review aims to focus on multiple aspects of FC in children,including global prevalence,pathogenesis,diagnostic criteria,tools,as well as conventional and novel treatment options,such as non-pharmacological management,including adequate fiber and fluid intake,physiotherapy,or neuromodulators.We also report that in very difficult cases,surgical intervention may be required.

Effects of probiotics and its fermented milk on constipation: a systematic review

This study reviewed clinical evidence of probiotics-mediated effects on constipation.Four databases were used in the literature searches,namely Cochrane Library,Embase,Pubmed,and Web of Science.The last retrieval time was March 2021.Collected data were analyzed by Review Manager(version 5.3)and Stata(version 14).The primary search retrieved 8418 articles after removing duplicates.Eventually,26 studies were included in the meta-analysis.Administration of probiotics signifi cantly increased stool frequency(MD:1.15 times/week;95%CI:0.59 to 1.70;P<0.0001),improved bloating(MD:-0.48;95%CI:-0.89 to-0.07;P=0.02),reduced abdominal pain(MD:-0.71;95%CI:-1.25 to-0.16;P=0.01),and improved quality of life(MD:-0.73;95%CI:-1.37 to-0.10;P=0.02).However,the clinical effect of intake of probiotics on stool consistency was non-signifi cant(MD:0.07;95%CI:-0.34 to 0.48;P=0.73).Based on our analysis,probiotic supplements were effective in relieving constipation through symptom improvement.The effectiveness of dosage forms of intervention ranked:capsules>others(tablets,powder)>fermented milk.

Current diagnostic tools and treatment modalities for rectal prolapse

Rectal prolapse is a circumferential,full-thickness protrusion of the rectum through the anus.It is a rare condition,and only affects 0.5%of the general population.Multiple treatment modalities have been described,which have changed significantly over time.Particularly in the last decade,laparoscopic and robotic surgical approaches with different mobilization techniques,combined with medical therapies,have been widely implemented.Because patients have presented with a wide range of complaints(ranging from abdominal discomfort to incomplete bowel evacuation,mucus discharge,constipation,diarrhea,and fecal incontinence),understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure.It is crucial to assess these additional symptoms and their severities using preoperative scoring systems.Additionally,radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders.However,there is no consensus on or standardization of the optimal extent of dissection,type of procedure,and materials used for rectal fixation;this makes providing maximum benefits to patients with minimal complications difficult.Even recent publications and systematic reviews have not recommended the most appropriate treatment options.This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.

Baizhu-Baishao herb pair ameliorates functional constipation and intestinal microflora disorder in rats

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.

Cinnamic acid regulates the intestinal microbiome and short-chain fatty acids to treat slow transit constipation

BACKGROUND Slow transit constipation(STC)is a disorder with delayed colonic transit.Cinnamic acid(CA)is an organic acid in natural plants,such as Radix Scrophulariae(Xuan Shen),with low toxicity and biological activities to modulate the intestinal microbiome.AIM To explore the potential effects of CA on the intestinal microbiome and the primary endogenous metabolites-short-chain fatty acids(SCFAs)and evaluate the therapeutic effects of CA in STC.METHODS Loperamide was applied to induce STC in mice.The treatment effects of CA on STC mice were assessed from the 24 h defecations,fecal moisture and intestinal transit rate.The enteric neurotransmitters:5-hydroxytryptamine(5-HT)and vasoactive intestinal peptide(VIP)were determined by the enzyme-linked immunosorbent assay.Hematoxylin-eosin and Alcian blue and Periodic acid Schiff staining were used to evaluate intestinal mucosa's histopathological performance and secretory function.16S rDNA was employed to analyze the composition and abundance of the intestinal microbiome.The SCFAs in stool samples were quantitatively detected by gas chromatography-mass spectrometry.RESULTS CA ameliorated the symptoms of STC and treated STC effectively.CA ameliorated the infiltration of neutrophils and lymphocytes,increased the number of goblet cells and acidic mucus secretion of the mucosa.In addition,CA significantly increased the concentration of 5-HT and reduced VIP.CA significantly improved the diversity and abundance of the beneficial microbiome.Furthermore,the production of SCFAs[including acetic acid(AA),butyric acid(BA),propionic acid(PA)and valeric acid(VA)]was significantly promoted by CA.The changed abundance of Firmicutes,Akkermansia,Lachnoclostridium,Monoglobus,UCG.005,Paenalcaligenes,Psychrobacter and Acinetobacter were involved in the production of AA,BA,PA and VA.CONCLUSION CA could treat STC effectively by ameliorating the composition and abundance of the intestinal microbiome to regulate the production of SCFAs.

Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors

Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A single-center,retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021.The study involved a review of electronic medical records and radiographs and the collection of clinical data.The differences in clinical manifestations between patients with constipation and those without constipation were analyzed.Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled,including 131 patients with constipation and 96 without constipation.The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery(83.2%vs.17.7%,χ~2=99.035,P 0.001).Constipation(OR=9.522,95%CI:4.150±21.849,P 0.001)and urinary retention(OR=14.490,95%CI:4.543±46.213,P 0.001)were independent risk factors for muscle strength decline in the lower limbs.Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness.Moreover,the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.

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.

Microbiota regulation in constipation and colorectal cancer

The relevance of constipation to the development and progression of colorectal cancer(CRC)is currently a controversial issue.Studies have shown that changes in the composition of the gut microbiota,a condition known as ecological imbalance,are correlated with an increasing number of common human diseases,including CRC and constipation.CRC is the second leading cause of cancerrelated deaths worldwide,and constipation has been receiving widespread attention as a risk factor for CRC.Early colonoscopy screening of constipated patients,with regular follow-ups and timely intervention,can help detect early intestinal lesions and reduce the risks of developing colorectal polyps and CRC.As an important regulator of the intestinal microenvironment,the gut microbiota plays a critical role in the onset and progression of CRC.An increasing amount of evidence supports the thought that gut microbial composition and function are key determinants of CRC development and progression,with alterations inducing changes in the expression of host genes,metabolic regulation,and local and systemic immunological responses.Furthermore,constipation greatly affects the composition of the gut microbiota,which in turn influences the susceptibility to intestinal diseases such as CRC.However,the crosstalk between the gut microbiota,constipation,and CRC is still unclear.