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.

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.

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.

Effect of Zangfu ointment and massage therapy on functional constipation:a protocol for a randomised controlled trial

Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irritable bowel syndrome syndrome,at least 6 months before diagnosis,and symptoms within the last 3 months.At present,commonly used drugs include enema and suppositories,laxatives,microecological preparations,gastrointestinal motility drugs and other treatments.However,the effect is limited.Traditional Chinese medicine(TCM)treatment of FC has advantages.Methods:In this randomized controlled study,244 eligible patients were randomly assigned in a 1:1 ratio to a treatment group(Zangfu ointment and massage therapy+Lactulose Oral Liquid)and a control group(Lactulose Oral Liquid)for 14 days.Number of spontaneous defecation per week and First defecation time will be used as primary outcomes,and Traditional Chinese Medicine(TCM)syndrome scores and syndrome scores,PAC-QOL form will be used as secondary outcomes.Blood routine,liver function,and renal function will be used as safety outcomes.The primary and secondary outcomes will be performed at 0th,7th,and 14th day,and the safety outcomes will be performed at 0th and 14th day.Ethics and dissemination:Ethical approval has been obtained from the Committee on Health Research Ethics of the Fangshan Hospital,Beijing University of Chinese Medicine,Beijing,People's Republic of China(FZY LK-2020-010)on September 18,2020.All patients will be provided oral and written information about the trial before screening.The study results will be disseminated by peer-review publications and conference presentations.Trial registration number:ChiCTR2000038754(registered on April 14,2021).This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited,appropriate credit is given,any changes made indicated,and the use is non-commercial.STRENGTHS AND LIMITATIONS OF THIS STUDY(1)The efficacy of the Zangfu ointment and massage therapy is evaluated in a randomised,double-blind 2-week clinical trial in FC patients.(2)Form a complete and generalizable regimen for the treatment of FC(Qi stagnation)with the Zangfu ointment and massage therapy.

Clinical Study of Electro-acupuncture Treatment with Different Intensities for Functional Constipation Patients

Functional constipation （FC） is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupuncture （EA） treatment for FC patients. Totally, 111 patients with FC meeting the Rome III criteria were randomly assigned to different intensities of EA groups （low and high intensity of EA groups） and medicine-controlled （MC） group. In EA groups, patients were treated with EA at quchi （Llll） and shangjuxu （ST37） bilaterally for 4 weeks, 5 times/week in the first 2 weeks, and 3 times/week in the last 2 weeks. In MC group, 5 mg mosapride citrate was administered orally 3 times/day for 4 weeks. Spontaneous bowel movement frequency each day was recorded using a consti- pation diary. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were used to assess the patients＇ psychological state. Cortisol （CORT）, substance P （SP）, and vasoactive intestinal polypep- tide （VIP） were evaluated at baseline and at the end of 4 weeks after treatment. As compared with the baseline, there was statistically significant increase in stool frequency every week （P〈0.01）, but there was no statistically significant difference among the three groups. As compared with the baseline, after 4 weeks of EA therapy, the scores of SDS and serum levels of CORT were decreased significantly in low intensity of EA group （P〈0.01）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the scores of SAS and SDS and serum levels of CORT were decreased significantly in high intensity of EA group （P〈0.05）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the serum levels of CORT and VIP were increased significantly in MC group （P〈0.05）. As compared with MC group, after 4 weeks of treatment, the serum levels of SP were signifcicantly in- creased in low intensity of EA group （P〈0.01）. Low and high intensities of EA could increase the stool frequency, improve the FC patient＇s anxiety and depression, reduce the serum levels of CORT, and in- crease the serum levels of SP and VIP effectively. It is concluded that both low and high intensities of EA are effective for FC patients, but there is no significant difference between the low and high intensi- ties of EA.

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.

Outcome of the efficacy of Chinese herbal medicine for functional constipation:A systematic review and meta-analysis

BACKGROUND Functional constipation(FC)is a common and chronic gastrointestinal disease and its treatment remains challenging.AIM To evaluate the efficacy and safety of Chinese herbal medicine(CHM)on efficacy rate,global symptoms,bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials(RCTs).METHODS RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20,2020.Two independent reviewers assessed the quality of the included articles and extracted data.Meta-analyses were performed to odds ratio(OR),mean differences(MD)and 95%confidence interval(CI)using random-effects models.Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity.The funnel plot,Begg’s test and Egger’s test were used to detect publication bias.RESULTS Ninety-seven studies involving 8693 patients were included in this work.CHM was significantly associated with a higher efficacy rate(OR:3.62,95%CI:3.19-4.11,P<0.00001)less severe global symptoms(OR:4.03,95%CI:3.49-4.65,P<0.00001)compared with control treatment,with the low heterogeneity between studies(I2=0%,P=0.76).CHM was also associated with more frequent bowel movements(MD 0.83,95%CI:0.67-0.98,P<0.00001),a lower score on the Bristol Stool Scale(OR:1.63,95%CI:1.15-2.32,P<0.006),and a not significant recurrence rate(OR:0.47,95%CI:0.22-0.99,P=0.05).No serious adverse effects of CHM were reported.CONCLUSION In this meta-analysis,we found that CHM may have potential benefits in increasing the number of bowel movements,improving stool characteristics and alleviating global symptoms in FC patients.However,a firm conclusion could not be reached because of the poor quality of the included trials.Further trials with higher quality are required.

Network pharmacological prediction and molecular docking analysis of the combination of Atractylodes macrocephala Koidz.and Paeonia lactiflora Pall.in the treatment of functional constipation and its verification

Background:We aimed to reveal the mechanism of functional constipation in the treatment of Atractylodes macrocephala Koidz.(AMK)and Paeonia lactiflora Pall.(PLP).Methods:The main active ingredients of AMK and PLP were screened by the Traditional Chinese Medicine Systems Pharmacology(TCMSP)platform.A database of functional constipation targets was established by GeneCard and OMIM.An“ingredient-target”network map was constructed with Cytoscape software(version 3.7.1),and molecular docking analysis was performed on the components and genes with the highest scores.The rats in the normal group were given saline,and those in the other groups were given 10 mg/kg diphenoxylate once a day for 14 days.The serum and intestinal tissue levels of adenosine monophosphate(cAMP),protein kinase A(PKA),and adenylyl cyclase(AC)of the rats and aquaporin(AQP)1,AQP3,and AQP8 were measured.Results:AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.After treatment with AMK,PLP,or mosapride,the serum and intestinal tissue levels of AC,cAMP,and PKA were significantly downregulated.Groups receiving AMK and PLP or mosapride exhibited a reduction in the level of AQP1,AQP3,and AQP8 to varying degrees.Conclusion:Molecular docking analysis revealed that AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.Studies have confirmed that AMK and PLP can also affect AC,cAMP,and PKA.AC,cAMP,and PKA in model rats were significantly downregulated.AQP expression is closely related to AC,cAMP,and PKA.AMK and PLP can reduce the expression of AQP1,AQP3,and AQP9 in the colon of constipated rats.

Effect of biofeedback combined with high-quality nursing in treatment of functional constipation

BACKGROUND Functional constipation(FC)is a common functional gastrointestinal disease with various clinical manifestations.It is a physical and mental disease,which seriously affects patient physical and mental health and quality of life.Biofeedback therapy is the treatment of choice for FC,especially outlet obstructive constipation caused by pelvic floor dysfunction.High-quality nursing is a new nursing model in modern clinical work and a new concept of modern nursing service.AIM To explore the effect of biofeedback combined with high-quality nursing in the treatment of FC.METHODS A total of 100 patients with FC admitted to our hospital from March 2015 to July 2019 were selected for clinical observation.These patients were randomly divided into two groups of 50:Experimental group(biofeedback combined with highquality nursing treatment group)and control group(biofeedback group).RESULTS The constipation symptom score of the experimental group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).The anal canal resting pressure and initial defecation threshold of the experimental group were significantly lower than those of the control group,and the maximum squeeze systolic pressure of the anal canal of the experimental group was significantly higher than that of the control group(P<0.05).The Self-Rating Anxiety Scale and Zung’s Self-Rating Depression Scale scores of the two groups were significantly lower than before treatment.The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the experimental group were significantly lower than those of the control group(P<0.05).The patient satisfaction score of the experimental group was significantly higher than that of the control group(P<0.05).CONCLUSION The application of biofeedback combined with high-quality nursing in the treatment of FC has significant advantages over pure biofeedback treatment,and it is worthy of promotion in clinical work.

Functional constipation in Bangladeshi school aged children:A hidden misty at community

BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary&specialized care,which needs proper evaluation&management.Presentation of constipation is variable among children.In Bangladesh there has been no published data regarding constipation in community among school aged children.AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division,Bangladesh.All school aged children between 5-16 years of age who attended school were included in this study.Samples were collected randomly.Proper clinical history&physical examinations(without digital rectal examination)&available investigations(if done previously)were recorded.Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation.Children with any red flag sign,known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded.Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20.For all statistical tests,P value of less than 0.05 was considered as statistically significant.RESULTS Total study populations were 707 and male was 443 and female 264.Among them,134(19%)children had constipation.In constipated children,78 children fulfilled the Rome IV criteria for functional constipation and it was 11%of total population.Mean age of children having functional constipation was 11.24±3.54 years and Male female ratio was 1:1.78.Anorexia,nausea,abdominal pain,hard stool,blood with hard stool,alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group.Children of school,where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number(OR=2.493,95%CI:1.214-5.120).Children who feel embarrassed to use toilet at school,had 3.6 times higher risk of constipation(OR=3.552,95%CI:1.435-8.794).Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs(OR=3.977,95%CI:1.884–8.397)and parents/grandparents(OR=2.569,95%CI:1.172-5.629).Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake(OR=1.972,95%CI:1.135-3.426).Children who passed electronic screen time of>2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time<2 h(OR=2.138,95%CI:1.063-4.301).CONCLUSION Constipation is not uncommon in Bangladeshi school aged children.Inadequate toilet number,family history of constipation,inadequate fluid intake,feeling embarrassed to use toilet at school,and electronic screen time for>2 h/d were found as risk factors in the present study for functional constipation.

Intestinal mucosal barrier in functional constipation:Dose it change?

BACKGROUND The intestinal mucosal barrier is the first line of defense against numerous harmful substances,and it contributes to the maintenance of intestinal homeostasis.Recent studies reported that structural and functional changes in the intestinal mucosal barrier were involved in the pathogenesis of several intestinal diseases.However,no study thoroughly evaluated this barrier in patients with functional constipation(FC).AIM To investigate the intestinal mucosal barrier in FC,including the mucus barrier,intercellular junctions,mucosal immunity and gut permeability.METHODS Forty FC patients who fulfilled the Rome IV criteria and 24 healthy controls were recruited in the Department of Gastroenterology of China-Japan Friendship Hospital.The colonic mucus barrier,intercellular junctions in the colonic epithelium,mucosal immune state and gut permeability in FC patients were comprehensively examined.Goblet cells were stained with Alcian Blue/Periodic acid Schiff(AB/PAS)and counted.The ultrastructure of intercellular junctional complexes was observed under an electron microscope.Occludin and zonula occludens-1(ZO-1)in the colonic mucosa were located and quantified using immunohistochemistry and quantitative real-time polymerase chain reaction.Colonic CD3+intraepithelial lymphocytes(IELs)and CD3+lymphocytes in the lamina propria were identified and counted using immunofluorescence.The serum levels of D-lactic acid and zonulin were detected using enzyme-linked immunosorbent assay.RESULTS Compared to healthy controls,the staining of mucus secreted by goblet cells was darker in FC patients,and the number of goblet cells per upper crypt in the colonic mucosa was significantly increased in FC patients(control,18.67±2.99;FC,22.42±4.09;P=0.001).The intercellular junctional complexes in the colonic epithelium were integral in FC patients.The distribution of mucosal occludin and ZO-1 was not altered in FC patients.No significant differences were found in occludin(control,5.76E-2±1.62E-2;FC,5.17E-2±1.80E-2;P=0.240)and ZO-1(control,2.29E-2±0.93E-2;FC,2.68E-2±1.60E-2;P=0.333)protein expression between the two groups.The mRNA levels in occludin and ZO-1 were not modified in FC patients compared to healthy controls(P=0.145,P=0.451,respectively).No significant differences were observed in the number of CD3+IELs per 100 epithelial cells(control,5.62±2.06;FC,4.50±2.16;P=0.070)and CD3+lamina propria lymphocytes(control,19.69±6.04/mm^(2);FC,22.70±11.38/mm^(2);P=0.273).There were no significant differences in serum D-lactic acid[control,5.21(4.46,5.49)mmol/L;FC,4.63(4.31,5.42)mmol/L;P=0.112]or zonulin[control,1.36(0.53,2.15)ng/mL;FC,0.94(0.47,1.56)ng/mL;P=0.185]levels between FC patients and healthy controls.CONCLUSION The intestinal mucosal barrier in FC patients exhibits a compensatory increase in goblet cells and integral intercellular junctions without activation of mucosal immunity or increased gut permeability.

The analysis of acupoint selection rules for acupuncture treating functional constipation

Objective: To analyze the prescription rule of acupuncture for functional constipation (FC), and explore the effective core clinical acupuncture prescriptions. Methods:The randomized controlled trials published in the PubMed, CNKI, Wanfang, and VIP databases were retrieved from January 1, 2010 to January 31, 2020. And the key information about acupuncture therapy for FC in these RCTs was collected according to the predetermined inclusion and exclusion criteria. Eventually, the statisticians analyzed the use frequency of single acupoints and meridian acupoints by descriptive statistical method and explored the combination rule between different acupoints by association rules. Results: Twenty six randomized controlled trials were included, with a total of 29 acupoints. Tianshu (ST25), Shangjuxu (ST37) and Zhongwan (RN12) were the top 3 frequency of acupuncture therapy for FC and the top 3 frequency meridian had been chosen were the stomach meridian of Foot-Yangming, the spleen meridian of Foot-Taiyin and Ren channel. The two acupoints with high support and compatibility frequency ranking in the top 3 are Tianshu (ST25) - Shangjuxu (ST37), Tianshu (ST25) - Zhongwan (RN12), Tianshu (ST25) - Zusanli (ST36). The three acupoints with compatibility frequency ranking in the top 2 are Tianshu (ST25) - Shangjuxu (ST37) - Zusanli (ST36), and Tianshu (ST25) - Shangjuxu (ST37) - Zhigou (SJ6). Conclusion: Tianshu (ST25) is the most common acupoint for acupuncture therapy of FC. Tianshu (ST25) and Shangjuxu (ST37) are the core acupoints to provide basis for clinical practice and future clinical research.

Analysis of mechanism of Buzhong Yiqi Decoction in treating senile functional constipation via network pharmacology

Objective:To explore the molecular mechanism of buzhong yiqi decoction in the treatment of senile functional constipation based on network pharmacology.Methods:Chemical compositions and selected targets related to the eight traditional Chinese medicine herbs were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).Through GeneCards database and OMIM database,disease targets of senile functional constipation were searched.R language was used to screen the common targets between drugs and disease,and then the interaction network diagram of the targets was constructed by String.Cytoscape3.7.0 was applied to construct the traditional Chinese medicines-chemical compositions-disease targets network.GO enrichment analysis and KEGG enrichment analysis of the targets were based on DAVID.Results:Five main chemical compositions including quercetin,kaempferol,nobiletin,naringenin and formononetin were screened,and five key targets including PTGS2,ESR1,AR,NOS2 and PPARG were identified.622 GO functional entries and 125 pathways were yielded by gene enrichment analysis.Conclusion:Buzhong yiqi decoction may play the role of anti-inflammatory and anti-oxidation through multi-component,multi-target and multi-channel,so as to improve senile functional constipation.

Application of the thought of "simultaneous treatment of medicine and food" in the treatment of intractable functional constipation

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.

Electro-acupuncture promotes gut motility and alleviates functional constipation by regulating gut microbiota and increasing butyric acid generation in mice

Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve constipation-related symptoms and rebalance the gut microbiota.However,it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs.Therefore,we assessed the effects of EA in FC mice and pseudo-germfree(PGF)mice to address these questions.Methods:Forty female Kunming mice were randomly separated into a normal control group(n=8),an FC group(n=8),an FC+EA group(n=8),a PGF group(n=8)and a PGF+EA group(n=8).The FC group and FC+EA group were treated with diphenoxylate to establish the FC model;the PGF group and PGF+EA group were given an antibiotic cocktail to initiate the PGF model.After maintaining the model for 14 d,mice in the FC+EA and PGF+EA groups received EA stimulation at the ST25 and ST37 acupoints,once a day,5 times per week,for 2 weeks.Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility.Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing,and measure SCFA concentrations using gas chromatography-mass spectrometry.Results:EA significantly shortened the first black stool defecation time(P<0.05)and increased the intestinal transit rate(P<0.01),and fecal pellet number(P<0.05),wet weight(P<0.05)and water content(P<0.01)over 8 h,compared with the FC group,showing that EA promoted gut motility and alleviated constipation.However,EA treatment did not reverse slow-transit colonic motility in PGF mice(P>0.05),demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation.In addition,EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice(P<0.05),most likely due to the upregulation of Staphylococcaceae microorganisms(P<0.01).Conclusion:EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.

A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong,China

Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches.This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.Methods:A systematic search of the PubMed,Cochrane Library,and China National Knowledge Infrastructure databases was performed from their inception to June 30th,2022,collecting the current evidence about the efficacious integrative management for FC.We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.Results:We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts.This pathway includes a hierarchy of recommendations for every step of the clinical process,including clinical intake,diagnostic examination,recommended labs,diagnostic flowchart,and guidance for selection of therapeutic drugs.Conclusion:This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine;it will help to provide high-quality medical services in Hong Kong for patients with FC.

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.

Efficacy of Electroacupuncture in the Treatment of Functional Constipation:A Randomized Controlled Pilot Trial

Objective： To evaluate the efficacy and safety of electroacupuncture at Tianshu （ST25） for patients with functional constipation （FC）. Methods： Ninety-six patients with FC were randomized to receive deep needling on bilateral ST25 （group A, 48 cases） or shallow needling on bilateral ST25 （group B, 48 cases） with electroacupuncture once daily for 4 weeks. The proportion of patients with four or more complete spontaneous bowel movements （CSBMs） per week, and scores of constipation symptoms and satisfaction with treatment were compared between two groups. Safety was also assessed. Results： The proportion of patients with four or more CSBMs per week was 52.1% in group A, significantly higher than 25.0% in group B during the 4-week treatment （P〈0.05）. The constipation symptom score of patients were significantly improved in group A as compared with group B at week 2-4 （P〈0.05）. Patients in group A were more satisfied with their treatment compared with those in group B at week 1-4 （P〈0.05）. Five patients in group A felt significant pain and discomfort. No other adverse reaction was observed in both groups. Conclusion： Using electroacupuncture at ST25 to treat patients with FC is effectively, and deep needling had more stable effect than shallow needling.

Investigation of attention via the counting Stroop task in patients with functional constipation

Background The etiology and pathology of functional constipation （FC） is unclear.Some researches suggest that psychological factors may be related to this common problem.This study aimed to investigate the relationship between attention processing and emotional status in FC patients compared with healthy controls.Methods We investigated selective attention and emotional status in patients with FC using the counting Stroop task.Thirty-five FC patients （FCP group） and 24 healthy controls （HCs） underwent an event-related potential （ERP） study while performing the task.Response time,latency and amplitude of P300 were collected and compared between the two groups.The Hamilton Depression Rating Scale （HAMD-17）,Hamilton Anxiety Scale （HAMA）,Symptom Checklist-90 （SCL-90） and Eysenck Personality Questionnaire （EPQ） were administered prior to the counting Stroop task.Results Scores for the FCP group differed significantly from those for the HCs on the HAMD-17,HAMA,SCL-90 （Global Severity Index,Positive Symptoms Total,dimensions of somatization,obsessive-compulsive,depression,anxiety,and psychosis）,as well as extraversion and neurosis dimensions of the EPQ （P〈0.05）.There was no significant difference in response time or accuracy rate between the two groups （P〉0.05）.ERP results showed prolonged latency at F4,additionally found enhanced activation at F3,FC1 and T8,and decreased activation at sites FC6 and P7 in the patients with FC.Statistically,significant differences of P300 latency at site F4 （P 〈0.05） and P300 amplitude at F3,F4,T8,P7,FC1 and FC6 （P〈0.05） between the patients with FC and the HC were revealed.Conclusions The findings suggest that patients with FC are more susceptible to depression and anxiety,as well as somatization,obsessive-compulsive tendencies and other neurotic personality characteristics.Patients may employ psychological defense mechanisms to avoid the pain of depression and anxiety.ERP results imply there may be some brain dysfunction and attention deficits in patients with FC.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.