AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (ag...AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015).展开更多
Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In rec...Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In recent years,with the change of diet structure,accelerated pace of life and the influence of socio-psychological factors,the incidence rate has increased year by year,seriously affecting the quality of life of patients.Professor Yao Shukun has remarkable clinical effect and experience in the treatment of intractable functional constipation.Professor Yao believes that,combined with the changes of people's diet structure,life style and physique,the main TCM syndrome type of clinical stubborn functional constipation is dampness-heat and blood stasis,and the main treatment should be clearing heat and resolving dampness,regulating qi and removing blood stasis;and we should pay attention to the application of the idea of"Simultaneous Treatment of Medicine and Food"in the process of diagnosis and treatment,and educate patients to change their diet structure in order to fundamentally dispel the etiology.展开更多
Functional constipation (FC) is a common condition in the clinics.It is often recurrent and frequently has drug resistance and drug addiction.Its therapeutic costs are high as well. Therefore,the quality of
AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from ...AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTS Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements(according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools(83%), blood in the stools(36%), fecal incontinence(33%), and/or difficulty in defecating(47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly(according to 68%) The preferred nonpharmacologic treatment are high-fiber diet(96%), increased fluid intake(90%), toilet training(74%), and abdominal massage(49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used(87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment(85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians(69%) expect a positive response during the first week with a mean(± SD) of 4.1(± 2.56) d. Most participants(86%) treat during one month or even less. And the majority(67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSION These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.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
Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of cons...Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of constipation were randomly divided into an acupuncture-moxibustion group and a simple acupuncture group with 50 cases for each group. Two groups of acupoints were adopted every other day alternatively for both groups. Point group 1： Tiansha （天枢ST 25）, Daheng （大横 SP 15）, Qihai （气海 CV 6）, Guanyuan （关元 CV 4）, Ztisanli （足三里 ST 36）, Shangjhxu （上巨虚 ST 37） and Sanyinjiao （三阴交 SP 6）. Point group 2： Zhsngliao （中髎 BL 33）, Xiatliao （下髎 BL 34）, Dachangsha （大肠俞 BL 25）, Shenshu （肾俞 BL 23） and Pisha （脾俞 BL 20）. Acupuncture was the only therapy adopted for acupuncture group on all the above mentioned points. While, for acupuncture-moxibustion group, moxibustion with grain-shaped moxa cones was applied on Qihai （所海 CV 6）, Zusatnli （足三里 ST 36）, Datchangshu （大肠俞 BL 25） and Pishu （脾俞 BL 20）, and acupuncture was applied on the rest points. Clinical therapeutic effect, clinical score of constipation, quality of life and score of psychological symptoms were observed before and after the treatment. Results The total effective rate in acupuncture-moxihustion group was 74.0%（37/50）, which was superior to that （52.0%, 26/50） in acupuncture group （P〈0.05）. The clinical scores of constipation, quality of life and scores of psychological symptoms of both groups improved after the treatment. For clinical scores of constipation, degree of difficulty in bowel movement, duration of defecation, abdominal pain, difficulty in exsufflation, incomplete sensation after defecation, obstruction sense of anus, purgative prescription dependence, score of life quality and psychological symptoms of acupuneture-moxibustion group were all better than those of simple acupuncture group （P〈0.05, P〈0.01）. Conclusion The combined therapy of both moxibustion with grain-shaped moxa cones and acupuncture is safe and effective in treatment of chronic functional constipation, and the effect is superior to simple therapy of acupuncture.展开更多
Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. Thes...Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. These patients deserve better evaluation and thorough investigations before their labeling as refractory to treatment. Indeed, several cases of apparent refractoriness are actually due to misconceptions about constipation, poor basal evaluation (inability to recognize secondary causes of constipation, use of constipating drugs) or inadequate therapeutic regimens. After a careful reevaluation that takes into account the above factors, a certain percentage of patients can be defined as being actually resistant to first-line medical treatments. These subjects should firstly undergo specific diagnostic examination to ascertain the subtype of constipation. The subsequent therapeutic approach should be then tailored according to their underlying dysfunction. Slow transit patients could benefit from a more robust medical treatment, based on stimulant laxatives (or their combination with osmotic laxatives, particularly over the short-term), enterokinetics (such as prucalopride) or secretagogues (such as lubiprostone or linaclotide). Patients complaining of obstructed defecation are less likely to show a response to medical treatment and might benefit from biofeedback, when available. When all medical treatments prove to be unsatisfactory, other approaches may be attempted in selected patients (sacral neuromodulation, local injection of botulinum toxin, anterograde continence enemas), although with largely unpredictable outcomes. A further although irreversible step is surgery (subtotal colectomy with ileorectal anastomosis or stapled transanal rectal resection), which may confer some benefit to a few patients with refractoriness to medical treatments.展开更多
Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose fun...Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.展开更多
基金Supported by Grants from Conselho Nacional de Desenvolvi-mento Cientifico e TecnológicoFundaco de Amparo à Pesquisa do Estado de Minas Gerais
文摘AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015).
基金Evaluation and promotion of appropriate technology for the prevention and treatment of common frequently occurring diseases at grassroots level(No.2014BA108B00)。
文摘Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In recent years,with the change of diet structure,accelerated pace of life and the influence of socio-psychological factors,the incidence rate has increased year by year,seriously affecting the quality of life of patients.Professor Yao Shukun has remarkable clinical effect and experience in the treatment of intractable functional constipation.Professor Yao believes that,combined with the changes of people's diet structure,life style and physique,the main TCM syndrome type of clinical stubborn functional constipation is dampness-heat and blood stasis,and the main treatment should be clearing heat and resolving dampness,regulating qi and removing blood stasis;and we should pay attention to the application of the idea of"Simultaneous Treatment of Medicine and Food"in the process of diagnosis and treatment,and educate patients to change their diet structure in order to fundamentally dispel the etiology.
文摘Functional constipation (FC) is a common condition in the clinics.It is often recurrent and frequently has drug resistance and drug addiction.Its therapeutic costs are high as well. Therefore,the quality of
文摘AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTS Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements(according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools(83%), blood in the stools(36%), fecal incontinence(33%), and/or difficulty in defecating(47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly(according to 68%) The preferred nonpharmacologic treatment are high-fiber diet(96%), increased fluid intake(90%), toilet training(74%), and abdominal massage(49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used(87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment(85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians(69%) expect a positive response during the first week with a mean(± SD) of 4.1(± 2.56) d. Most participants(86%) treat during one month or even less. And the majority(67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSION These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.
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 National Program on Key Basic Research Project (973 Program): 2009 CB 522905
文摘Objective To compare the differences of therapeutic effects of chronic functional constipation treated with the combined therapy of moxibustion and acupuncture and simple acupuncture. Methods One hundred cases of constipation were randomly divided into an acupuncture-moxibustion group and a simple acupuncture group with 50 cases for each group. Two groups of acupoints were adopted every other day alternatively for both groups. Point group 1： Tiansha （天枢ST 25）, Daheng （大横 SP 15）, Qihai （气海 CV 6）, Guanyuan （关元 CV 4）, Ztisanli （足三里 ST 36）, Shangjhxu （上巨虚 ST 37） and Sanyinjiao （三阴交 SP 6）. Point group 2： Zhsngliao （中髎 BL 33）, Xiatliao （下髎 BL 34）, Dachangsha （大肠俞 BL 25）, Shenshu （肾俞 BL 23） and Pisha （脾俞 BL 20）. Acupuncture was the only therapy adopted for acupuncture group on all the above mentioned points. While, for acupuncture-moxibustion group, moxibustion with grain-shaped moxa cones was applied on Qihai （所海 CV 6）, Zusatnli （足三里 ST 36）, Datchangshu （大肠俞 BL 25） and Pishu （脾俞 BL 20）, and acupuncture was applied on the rest points. Clinical therapeutic effect, clinical score of constipation, quality of life and score of psychological symptoms were observed before and after the treatment. Results The total effective rate in acupuncture-moxihustion group was 74.0%（37/50）, which was superior to that （52.0%, 26/50） in acupuncture group （P〈0.05）. The clinical scores of constipation, quality of life and scores of psychological symptoms of both groups improved after the treatment. For clinical scores of constipation, degree of difficulty in bowel movement, duration of defecation, abdominal pain, difficulty in exsufflation, incomplete sensation after defecation, obstruction sense of anus, purgative prescription dependence, score of life quality and psychological symptoms of acupuneture-moxibustion group were all better than those of simple acupuncture group （P〈0.05, P〈0.01）. Conclusion The combined therapy of both moxibustion with grain-shaped moxa cones and acupuncture is safe and effective in treatment of chronic functional constipation, and the effect is superior to simple therapy of acupuncture.
文摘Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. These patients deserve better evaluation and thorough investigations before their labeling as refractory to treatment. Indeed, several cases of apparent refractoriness are actually due to misconceptions about constipation, poor basal evaluation (inability to recognize secondary causes of constipation, use of constipating drugs) or inadequate therapeutic regimens. After a careful reevaluation that takes into account the above factors, a certain percentage of patients can be defined as being actually resistant to first-line medical treatments. These subjects should firstly undergo specific diagnostic examination to ascertain the subtype of constipation. The subsequent therapeutic approach should be then tailored according to their underlying dysfunction. Slow transit patients could benefit from a more robust medical treatment, based on stimulant laxatives (or their combination with osmotic laxatives, particularly over the short-term), enterokinetics (such as prucalopride) or secretagogues (such as lubiprostone or linaclotide). Patients complaining of obstructed defecation are less likely to show a response to medical treatment and might benefit from biofeedback, when available. When all medical treatments prove to be unsatisfactory, other approaches may be attempted in selected patients (sacral neuromodulation, local injection of botulinum toxin, anterograde continence enemas), although with largely unpredictable outcomes. A further although irreversible step is surgery (subtotal colectomy with ileorectal anastomosis or stapled transanal rectal resection), which may confer some benefit to a few patients with refractoriness to medical treatments.
文摘Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.
