Abstract
Synbiotic intake may efficiently restore the balance of gut microbiota and improve gastrointestinal functions. The aim of the study was to evaluate the efficacy of a synbiotic in patients with slow transit constipation. A total of 100 patients with slow transit constipation were randomized to receive either a synbiotic or placebo twice daily for 12 weeks. The primary efficacy endpoints were the clinical remission and improvement rates at weeks 4 and 12. Stool frequency and consistency, colonic transit time (CTT), evacuation and abdominal symptoms, patient assessment of constipation symptoms, gastrointestinal quality-of-life index scores, satisfaction scores, and adverse events were also monitored. The clinical remission rates reached 37.5% at week 4 and 45.8% at week 12 in the treatment group, compared to 13.3% at week 4 and 16.7% at week 12 in the placebo group (p < 0.01 for both comparisons). Over 12 weeks, 64.6% of the patients who received the synbiotic experienced clinical improvement, compared to 29.2% of the patients in the placebo group (p < 0.01). During the intervention period, patients who were treated with the synbiotic exhibited increased stool frequency, improved stool consistency, decreased CTT, and improved constipation-related symptoms. This randomized, placebo-controlled trial suggested that dietary supplementation with a synbiotic improved evacuation-parameters-associated symptoms and colonic motility in patients with slow transit constipation (STC).
Highlights
Chronic constipation has become a common, often long-term, functional gastrointestinal disease that influences the quality of life in patients worldwide [1]
Patients were eligible if they fulfilled the following criteria: Inclusion criteria: age ≥18 years; body mass index 18.5–25 kg/m2 ; chronic constipation was diagnosed according to the Rome III criteria with two or fewer spontaneous, complete bowel movements (SCBMs) per week for a minimum of 6 months [21]; colonic transit time (CTT) >48 h [22]; mild-to-moderate constipation with a Wexner constipation scale score between 16 and 25 [23,24]
Exclusion criteria: Megacolon, intestinal obstruction, inflammatory bowel disease, and cancer; secondary constipation; severe anterior rectocele or full thickness rectorectal intussusception according to defecography; pregnant or lactating women; infection with an enteric pathogen; usage of antibiotics or proton pump inhibitors (PPIs); hepatic, renal, cardiovascular, respiratory or psychiatric disease; and other diseases or factors evaluated by the investigator which could influence intestinal transit or intestinal microbiota [24]
Summary
Chronic constipation has become a common, often long-term, functional gastrointestinal disease that influences the quality of life in patients worldwide [1]. Constipation is defined as difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation [4]. Constipation can always be categorized as normal transit constipation (NTC), slow transit constipation (STC), pelvic floor dysfunction, or a defecatory disorder due to assessments of anorectal function and colonic transit time [5]. STC is the major category and is characterized by a decreased rate of colonic transit [5]. The treatments for chronic constipation are varied, but remain challenging [6]. Most patients with chronic constipation have used laxatives (osmotic or stimulant) or prokinetic agents to alleviate
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