Defecation Research Articles

Clinical manifestations and quality of life in patients with different types of idiopathic megabowel

AIM: to compare the clinical and diagnostic features and quality of life in patients with different types of idiopathic megabowel. PATIENTS AND METHODS: 157 patients with idiopathic megacolon/megarectum, confirmed by barium enema, were divided on 3 groups: 1) distal idiopathic megabowel (megarectum ± distal third of sigmoid colon dilatation); 2) idiopathic megacolon (variable extent of colon dilatation with a normal size rectum); 3) idiopathic megabowel (megarectum ± variable extent of colon dilatation). Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. RESULTS: the cohort included 70 (44.6 %) patients with distal idiopathic megabowel, 50 (31.8 %) patients with idiopathic megacolon and 37 (23.6 %) patients with idiopathic megabowel. Wexner constipation scale rate, rate of integral parameters “abdominal discomfort” and “defecation difficulties”, summary assessment of quality of life by IBSQOL questionnaire did not differ between groups (p > 0.05). At the same time patients with distal idiopathic megabowel were statistically significant younger (p < 0.01), had significant higher rate of faecal incontinence due to faecal impaction overflow (p < 0.01), had less often bowel movement. Also these patients had significant higher rate of distal contrast retention (p < 0.01) during gut transit test, but their colonic transit time was slight faster (p = 0.04).In multivariate analysis both megarectum (OR = 25.42; 95 % CI 5.01–128.92) and insufficiency of anal sphincter (OR = 4.71; 95 % CI 1.38–16.14) were independent predictors of faecal incontinence. The surgical treatment was performed most often in idiopathic megacolon group (p < 0.01), mainly due to colon volvulus. The most patients with distal idiopathic megabowel (97.1 %) were successfully maintained with a conservative treatment. CONCLUSION: there was not substantial difference in clinical features and quality of life in patients with different types of idiopathic megabowel, except of significant higher rate of faecal incontinence and less often bowel movement in distal idiopathic megabowel group. Faecal incontinence in these patients is linked disturbance rather intestinal, than anal component of continence. The necessity in surgical treatment was rising most often in cases of idiopathic megacolon. The conservative treatment was quite effective in most patients with distal idiopathic megabowel.

Impact of physical activity on gastrointestinal health and prevention and treatment of common gastrointestinal diseases: Irritable Bowel Syndrome and Inflammatory Bowel Diseases

Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Diseases (IBD), among them Crohn's disease and ulcerative colitis, are common chronic diseases affecting a growing group of patients. Physical activity (PA) is an important part of a healthy lifestyle. The aim of the study was to critically evaluate current knowledge of impact of PA on gastrointestinal (GI) health and prevention and treatment of some most common GI tract diseases, such as IBS and IBD. The comprehensive research of literature available on PubMed, Google Scholar, ResearchGate and Springer Link was performed. PA improves function of GI by increasing colon transit and bowel movements. These mechanisms contribute to reducing the risk of colorectal cancer and, to varying degrees depending on location, other digestive-system cancers. There is a potential association between PA and the more health-beneficial gut microbiota, but more research in this area is needed. Sedentary lifestyle seems to be a risk factor for IBD, while physical activity seems to be a protective factor only for Crohn disease. Altough, PA contributes to improvement of quality of life and reduction of stress in patients with IBD, futher conclusions on the effect of PA on the course of ulcerative colitis and Crohn disease still require expanded research. Available literature suggests that physical activity prevents obesity, a proven risk factor for worsening the course of the disease, and osteoporosis, an important complication of glucocorticosteroid therapy. Despite evidence of a sedentary lifestyle as a risk factor for IBS, there is still a lack of studies examining the impact of physical activity as a protective factor. the number of RCTs examining the effect of PA on the course of IBS remains insufficient, and studies conducted should take into account the various symptoms of IBS.

Intracorporal isoperistaltic linear colorectal “side-to-side” (overlap) anastomosis: invention concept and primary results

AIM: to present the primary experience of performing intracorporeal linear colorectal anastomosis using the “overlap” technique in laparoscopic anterior rectal resection. MATERIALS AND METHODS: the study presents the outcomes of intracorporeal linear “overlap” anastomosis in patients who underwent laparoscopic anterior rectal resection between October 2023 and February 2024. The results were evaluated based on various parameters including operation time, the postoperative morbidity rate (by Clavien-Dindo scale), conversion rates, hospital stay, quality of life by SF-36 questionnaire 30 days after surgery. RESULTS: the linear “overlap” anastomosis was done in 10 patients (5 females), aged 62.0 ± 9.03 years and BMI of 27.5 ± 7.2 kg/m2. No intraoperative complications occurred. One patient developed a seroma at the incision site (Clavien–Dindo I). The first bowel movement was at 1 (0–3) days after surgery. The post-op hospital stay was 5.7 ± 1.9 days. CONCLUSION: primary results demonstrate the simplicity and safety of intracorporeal linear “overlap” anastomosis technique. The further advanced study is justified.

Overlap of gallbladder dysfunction and irritable bowel syndrome: clinical and microbiological features and therapeutic possibilities

Objective — to analyse the clinical and microbiological features in patients with an overlap between gallbladder dysfunction (GBD) and irritable bowel syndrome (IBS) and a complex assessment of the effectiveness and safety of using ursodeoxycholic acid (Ursis) in these patients. Materials and methods. Under our observation were 115 patients with the overlap of GBD and IBS aged from 19 to 52. The majority of them were women (62.6%). All patients complained of abdominal pain, mostly without clear localization or in the right hypochondrium and along the course of the large intestine. Constipation was diagnosed in 83 (72.2%) patients, and meteorism in 89 (77.4%) patients. Therefore, 62 patients with the overlap of GBD and IBS, who had abdominal pain, constipation and meteorism, were selected for further study. During the study, all patients kept a diary in which the frequency and nature of bowel movements, the severity of abdominal pain, and the degree of meteorism were recorded. All patients before and after treatment underwent an ultrasound examination of the abdominal cavity, which included the study of the contractile function of the gallbladder, the emptying coefficient of the gallbladder, the thickness and density of its wall, and the density of bile. Changes in the main bacterial enterotypes were analyzed by qRT‑PCR using primers targeting 16S rRNA. We studied Bacteroidetes, Firmicutes, Actinobacteria, as well as the content of butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila) and methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae). Results. Before treatment, all patients had abdominal pain of moderate intensity (6.9±0.7 points), mostly without clear localization, constipation, with a frequency of defecation (1.4±0.5) times a week, and meteorism. Before treatment, patients with an overlap of GBD and IBS had changes in the contractile function of the gallbladder with a decrease in the emptying ratio, a thickening of the gallbladder wall and an increase in its density and bile density, as well as a disturbance of the intestinal microbiome (an increase in the number of Firmicutes, Actinobacteria and methanogenic archaea and a decrease in Bacteroidetes and butyrate‑producing bacteria). Conclusions. The use of Ursis® medication in the complex therapy of patients with a GBD and IBS overlap is effective and safe. The aplication of Ursis® led to a more pronounced positive clinical dynamics (a decrease in the intensity of abdominal pain, normalization of the frequency of bowel movements, a decrease in meteorism and an improvement in general well‑being) than in the patients of the comparison group. After treatment with Ursis® the coefficient of emptying of the gallbladder increased, the thickness and density of its wall decreased. The use of the drug Ursis® in the complex therapy of patients with the overlap of GBD and IBS contributed to the improvement of intestinal flora: an increase in the number of Bacteroidetes and butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila), and a decrease in the content of methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae).

Effect of a 50 mg Caffeine Coffee Intake on Bowel Function Recovery in Postoperative Cesarean Delivery Patients: A Randomized Controlled Trial

Effect of a 50 mg Caffeine Coffee Intake on Bowel Function Recovery in Postoperative Cesarean Delivery Patients: A Randomized Controlled Trial

Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

BackgroundEnhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. Study designProspective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 ​h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). ResultsFifty patients were randomized into ERAS(n ​= ​25) and conventional care(n ​= ​25) groups. Ninety-two percent of patients were young males, 58 ​% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 ​%). ERAS group had a reduced median LOH(days) (6 versus 8, p ​= ​0.007), early recovery of bowel function(p ​= ​0.010) and shorter times for nasogastric tube(p ​= ​0.001), urinary catheter(p ​= ​0.007) and drain(p ​= ​0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p ​= ​0.009)]. ConclusionERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

Effects of Coffee on Gut Microbiota and Bowel Functions in Health and Diseases: A Literature Review.

Background and objectives: As one of the most popular beverages in the world, coffee has long been known to affect bowel functions such as motility, secretion, and absorption. Recent evidence obtained in human and animal studies suggests that coffee has modulating impacts on gut microbiota. We aim to present an overview of the specific effects of coffee on gut microbiota composition, diversity, and growth. We will also critically review the impacts of coffee on bowel functions in health and diseases and discuss whether gut microbiota play a role in the coffee-associated functional changes in the gastrointestinal tract. Methods: We searched the literature up to June 2024 through PubMed, Web of Science, and other sources using search terms such as coffee, caffeine, microbiota, gastrointestinal infection, motility, secretion, gut-brain axis, absorption, and medication interaction. Clinical research in patients and preclinical studies in rodent animals were included. Results: A majority of the studies found that moderate consumption of coffee (<4 cups a day) increased the relative abundance of beneficial bacterial phyla such as Firmicutes and Actinobacteria and decreased Bacteroidetes. Moderate coffee consumption also increased Bifidobacterium spp. and decreased the abundance of Enterobacteria. Coffee consumption is reported to increase gut microbiota diversity. Although the effects of coffee on bowel functions have been known for a long time, it is not until recently that we have recognized that some of the effects of coffee may be partly due to its impacts on microbiota. Conclusions: The current literature suggests that moderate coffee consumption has beneficial effects on oral and gut microbiota and motility function. However, excessive coffee intake (>5 cups a day) is implicated in reflux disorders, periodontal diseases, and progression of Crohn's disease. Further research in the field is needed, as there are many conflicting results regarding the impacts of coffee in the gastrointestinal tract.

Association between bowel movement disorders and depressive symptoms: a cross-sectional study.

This study aimed to explore the association between bowel movement disorders and depression in adults. A cross-sectional study was conducted using data from the National Health and Nutritional Examination Survey (NHANES), 2005-2010. Depression, constipation, diarrhea, and fecal incontinence were self-reported via questionnaires. Weighted logistic regression and subgroup analyses were performed to explore the association between bowel movement disorders and the risk of depression. Restricted cubic spline (RCS) was also conducted to investigate the association between bowel movements disorder and depression. A total of 13,820 participants were collected. Compared to the participants with normal bowel movements, the full-adjusted depression model ORs for constipation and diarrhea were 2.28 (95%CI,1.78-2.92), 1.75 (95%CI,1.31-2.31), respectively. Any kind of bowel leakage were associated with depression. The RCS showed the possible nonlinear association between bowel movement frequency/stool shape and depression. Constipation, diarrhea, and bowel leakage are associated with an increased risk of depression.

Clinical efficacy of enhanced recovery surgery in Da Vinci robot-assisted pancreatoduodenectomy

Da Vinci robot-assisted pancreaticoduodenectomy offers advantages, including minimal invasiveness, precise, and safe procedures. This study aimed to investigate the clinical effectiveness of implementing enhanced recovery after surgery (ERAS) concepts in Da Vinci robot-assisted pancreaticoduodenectomy. A retrospective analysis was conducted on clinical data from 62 patients who underwent Da Vinci robot-assisted pancreaticoduodenectomy between January 2018 and December 2022. Among these patients, 30 were managed with ERAS principles, while 32 were managed using traditional perioperative management protocols. Surgical time, intraoperative blood loss, postoperative oral intake time, time to return of bowel function, time to ambulation, visual analog scale (VAS) pain scores, fluid replacement volume, length of hospital stay, total hospital expenses, complications, and patient satisfaction were recorded and compared between the two groups. Postoperative follow-up included assessment of postoperative functional scores, reoperation rates, SF-36 quality of life scores, and survival rates. The average follow-up time was 35.6 months (range: 12–56 months). There were no statistically significant differences in general characteristics, including age, surgical time, intraoperative blood loss, and preoperative medical history between the two groups (P > 0.05). Compared to the control group, the intervention group had an earlier postoperative oral intake time, faster return of bowel function, rapid ambulation, and shorter hospital stays (P < 0.05). The intervention group also had lower postoperative VAS scores, lower fluid replacement volume, lower total hospital expenses, and a lower rate of complications (P < 0.05). Patient satisfaction was higher in the intervention group (P < 0.05). There were no statistically significant differences between the two groups in two-year functional scores, reoperation rates, quality of life scores, and survival rates (P > 0.05). Implementing ERAS principles in Da Vinci robot-assisted pancreaticoduodenectomy substantially expedited postoperative recovery, lowered pain scores, and diminished complications. However, there were no notable differences in long-term outcomes between the two groups.

Experimental evaluation of an artificial anal sphincter based on biomechanical compatibility.

The artificial anal sphincter is a device used to treat patients with fecal incontinence who are unable to control their bowel movements on their own. Long-term morphological changes in the tissue surrounding the artificial anal sphincter can cause biomechanical compatibility problems, which seriously affect the clinical application of the artificial anal sphincter. In this paper, the superelasticity of shape memory alloys was utilized to design and fabricate a biomechanically compatible constant force clamping artificial anal sphincter. An invitro simulation system was constructed to verify the effectiveness, safety, and constant force characteristics of the artificial anal sphincter. The experimental results demonstrated that the artificial anal sphincter could be effectively closed with no leakage of the liquid-like intestinal contents, which are most likely to leak. The pressure of the artificial anal sphincter on the intestinal tube gradually increased and eventually became constant during closure, and the pressure value was always less than the intestinal blood supply pressure threshold. In this paper, we designed an artificial anal sphincter based on biomechanical compatibility and the corresponding invitro simulation experimental program and preliminarily verified the effectiveness, safety, and constant force characteristics of the artificial anal sphincter.

The bowel function instrument for rectal cancer survivors with anastomosis and ostomy

ObjectiveRectal cancer is often treated with surgery such as ostomy or anastomosis. The Bowel Function Instrument (BFI) is a valid and reliable 18-item measure of physical bowel symptoms. Some items on the BFI do not apply to those with ostomies. We reanalyzed data from a previous validation study to inform the best method for scoring the BFI for both people with ostomies and anastomosis. MethodsPeople (n = 575) with rectal cancer treated with ostomy (n = 181, 31 %) or anastomosis (n = 394, 69 %) completed the BFI and Short Form 12 (SF12) measure on a mailed survey. The full BFI has three subscales and a total score based on 14 items: soilage/urgency (4 items); frequency of bowel movements (6 items); and dietary changes (4 items). We used confirmatory factor analysis (CFA) to examine two versions (8-item, 11-item) of the BFI adapted for use with both ostomy and anastomosis. We also examined reliability and validity of the version supported by the CFA. ResultsCFA results supported the 8-item BFI that included only the soilage/urgency items and dietary changes items but not the frequency items. The 8-item BFI was reliable (Cronbach's alpha of 0.788). The 8-item BFI score significantly correlated with all SF12 subscales with Pearson correlations ranging from 0.115 (Vitality) to 0.318 (social function). ConclusionsThe 8-item version of the BFI was valid and reliable as a total score for people with ostomy or anastomosis. The 8-item BFI may be useful for monitoring bowel function during and after treatment for rectal cancer.

Effect of sugammadex with neostigmine on postoperative bowel function and on recovery of neuromuscular functions: A randomized controlled trial.

Early recovery of neuromuscular and bowel function after abdominal surgery are important clinical indicators of postoperative recovery. This study aimed to investigate the effects of sugammadex, and neostigmine added to sugammadex, on postoperative bowel function and recovery from neuromuscular blocking agents. Ninety gynecological surgery patients, aged 18 to 65 years, with American Society of Anesthesiologists of 1 to 2 were randomly assigned to 3 groups: sugammadex 2 mg/kg (Group S), sugammadex 1 m/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S1N), and sugammadex 1.5 mg/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S2N), for reversal at the end of surgery during moderate block (train-of-four [TOF] count 1-2). Propofol, remifentanil, rocuronium, and sevoflurane were used for general anesthesia, and neuromuscular function was assessed using kinemyography. The primary outcomes assessed the effects of sugammadex alone and in combination with neostigmine on the time to first flatus. The secondary outcomes included time to first defecation and recovery time; defined as the administration of reversal agent to TOF ratio 90%. Data from 90 female patients who underwent abdominal gynecological surgery were analyzed. No significant differences were found between the groups in term of the time to first flatus, defecation, or postoperative nausea and vomiting after surgery. However, significant differences were observed in the time to reach a TOF ratio 90% (P < .001) and extubation time (P = .003). The addition of neostigmine to sugammadex did not affect bowel function recovery. However, combining 20 μg/kg neostigmine with 1.5 mg/kg sugammadex or 2 mg/kg sugammadex alone antagonized moderate-depth nondepolarizing neuromuscular blockade with similar efficacy.

Effects of neoagarooligosaccharides on body fat and bowel movement indicators in overweight or obese adults: A randomized, double-blind, placebo-controlled trial

The prevalence of obesity is increasing globally, and dietary fiber supplementation can aid in its treatment. This 12-week randomized, double-blind, placebo-controlled trial examined the effect of Dyne-neoagarooligosaccharides (Dyne-NAOs), hydrolyzed from agar via β-agarase DagA, in overweight or obese adults. Eighty participants were randomly assigned using block randomization (1:1, block size 4) to receive either 15 g of Dyne-NAOs daily or a placebo (maltodextrin). After the intervention, body fat mass (−1.07 kg vs. −0.05 kg; p = 0.015) and body fat percentage (−1.04 % vs. −0.08 %; p = 0.018) were significantly lower in the NAO group than in the placebo group. The Constipation Scoring System (−1.42 vs. −0.06; p = 0.010) and Patient Assessment of Constipation-Symptoms (−3.28 vs. −0.42; p = 0.021), used to assess changes in bowel movements, also showed significant between-group differences. These findings suggest that Dyne-NAOs could be a promising anti-obesity dietary fiber supplement.

Evaluation of Risk Factors, Clinical Spectrum and Management of New Onset Seizure

A seizure is a brief deviation from the brain's regular electrical activity that alters awareness and behavior. Seizures are brief burst so fun controllable movement that can affect either a piece of the body (partial) or the full body (generalized) and are frequently followed by a loss of awareness and control over bowel or bladder function. Epilepsy is distinguished by recurring seizures. Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, associated with abnormal electrical activity in the brain. The goal of the study is to find out risk factors and prescribing pattern of antiseizure drugs in different types of seizure disorder. An educational observational study was carried out among 42 samples in the In-patient Department of General Medicine, ESI MC- PGIMSR, and Rajajinagar. The data was collected using self-designed data collection form. All information’s were processed and analyzed by using Microsoft excel. It was observed that a majority of the subjects involved in the study was prescribed with Levetiracetam (69.81%). A high prevalence of New onset seizure with risk factor of CVS causes (36.92%) and Alcohol withdrawal (20%) was observed. In CVS cause, stroke was prominent. From this study, generalized tonic clonic seizure was most commonly observed type of seizure and Levetiracetam was most frequently prescribed drug to them. Majority of patients were given mono therapy to achieve seizure control.

Alvimopan for postoperative ileus following abdominal surgery: a systematic review.

Postoperative ileus (POI) is a common complication following abdominal surgery, often leading to extended hospital stays and a higher risk of post-operative complications, leading to poorer patient outcomes. Alvimopan, a peripherally acting µ-opioid receptor antagonist, has been shown to aid in the recovery of normal bowel function after surgery. While its benefits are well-established in open abdominal surgeries, its efficacy in laparoscopic procedures had not been conclusively determined. However, recent clinical trials involving laparoscopic surgeries have since been conducted. This review aims to reassess the efficacy of Alvimopan by incorporating findings from these new studies, potentially providing further insight into its clinical benefits. A comprehensive search of PubMed, Google Scholar, EMBASE, and the Cochrane Library was conducted. Studies were included based on the PICO framework, focusing on Alvimopan's impact on postoperative gastrointestinal recovery. Primary outcomes were time to gastrointestinal function recovery (GI-3) and hospital stay duration. Ten studies met the inclusion criteria, with seven focusing on the use of Alvimopan in open abdominal surgeries and three in laparoscopic procedures. Collectively, these studies involved 18,822 patients undergoing various types of abdominal Administration of Alvimopan 6mg accelerated gastrointestinal function recovery by an average of 14h (Hazard ratio: 1.62, p = 0.002) and reduced hospital stays by 5.2h (Hazard ratio: 1.52, p = 0.04) compared to placebo. Similarly, Alvimopan 12mg reduced GI-3 recovery time by 13.5h (Hazard ratio: 1.58, p = 0.02) and hospital stay duration by 6.2h (Hazard ratio: 1.46, p = 0.018). Alvimopan shows promise in reducing POI and hospital stay durations following abdominal surgeries. The incorporation of the recent studies in laparoscopic abdominal procedures further supports these findings. Integrating Alvimopan into perioperative care protocols may enhance patient outcomes and help lower healthcare costs.

Influence of Diet on Bowel Function and Abdominal Symptoms in Children and Adolescents with Hirschsprung Disease-A Multinational Patient-Reported Outcome Survey.

Introduction: This study aimed to understand the influence of diet and nutrition items on gastrointestinal symptoms in patients with Hirschsprung Disease (HD). Method: An online questionnaire was created to obtain patient-reported outcomes using the multinational Holistic Care in Hirschsprung Disease Network. This was distributed in Dutch, English, German, Italian, Polish, and Swedish via patient associations. Information on demographics, the extension of disease, current diet, and the influence of food ingredients on bowel function were obtained. Results: In total, 563 questionnaires were answered by parents or patients themselves. The length of the aganglionic segment was short in 33%, long in 45%, total colonic aganglionosis (TCA) in 11%, and involved the small intestine in 10%. Overall, 90% reported following a mixed diet, and 31% reported taking probiotics, with twice as many patients taking probiotics in the TCA group compared to standard HD. Mealtimes and behaviours around eating were affected by 61%, while 77% had established food items that worsened symptoms, and of these, 80% stated that they had worked these items out themselves. A high-fibre diet was followed by 24% and 18% a low-fibre diet. Symptoms were reported, particularly from dairy in 30%, fruits in 39%, pulses in 54%, and sugar in 48%. Conclusions: This first multinational survey on diet and bowel function in HD reports an association between certain dietary items with gastrointestinal symptoms. This study can support an improved understanding of the interaction between food items and bowel function in children with HD. We suggest a multidisciplinary approach to balance dietary exclusions and support adequate growth, preventing nutrition deficiencies and enhancing quality of life.

Efficacy and safety of long-term treatment with elobixibat in hemodialysis patients with chronic constipation: an observational study

BackgroundConstipation is a common complication in hemodialysis patients and can impact their quality of life. Elobixibat selectively inhibits ileal bile acid transporter to suppress bile acid reabsorption, increase the amount of bile acid entering the colonic lumen, and promote water secretion and colonic motility in the large intestine. While the efficacy and safety of elobixibat in hemodialysis patients up to 12 weeks after administration have been reported, the long-term efficacy and safety of elobixibat in hemodialysis patients with chronic constipation are yet to be elucidated. This study evaluates the efficacy and safety of long-term treatment with elobixibat in hemodialysis patients with chronic constipation.MethodsThis was a single-center observational study. A total of 54 patients who had received elobixibat for at least 24 weeks were enrolled. Data on the frequency of spontaneous bowel movements (SBM), Bristol stool form scale (BSFS), patient satisfaction, constipation scoring system (CSS), interdialytic weight gain, laboratory values including blood electrolyte levels, controlling nutritional status (CONUT) score, and adverse events were collected and retrospectively compared between baseline and the last observation.ResultsLong-term elobixibat treatment in the 54 hemodialysis patients with chronic constipation significantly increased (p < 0.05) the frequency of SBM and mean stool form score assessed as per the BSFS at the last observation (duration of treatment, 24.4 to 240.0 weeks). Patient satisfaction and CSS also improved (p < 0.05). Mean serum phosphorus levels decreased (p < 0.05). The treatment was well tolerated.ConclusionsLong-term treatment with elobixibat maintained good bowel movement status and patient satisfaction in hemodialysis patients with chronic constipation. Improved dialysis-related laboratory levels were also demonstrated.Trial registration: UMIN Clinical Trials Registry, UMIN000049865, 22 December 2022, retrospectively registered.

Tailored lateral internal sphincterotomy (T-LIS) for chronic anal fissure by LigaSure Small Jaws©: a comparison with other non-conservative treatments for anal fissures.

An anal fissure is a small tear in the thin tissue (mucosa) that lines the anus. Anal fissures typically cause pain and bleeding with bowel movements. The cause is not fully understood, but low intake of dietary fiber may be a risk factor. Chronic anal fissure was defined as a split or ulceration in the posterior or anterior anoderm for at least 6weeks: have distinct anatomic features such as muscle fibers visible in the wound. Anal fissures can be attributed to constipation or repeated straining: a hard fecal bolus cut the mucosa of anal canal that is relatively thigh at sphincter level management and optimal treatment of the disease is controversial. Many studies recommend conservative and medical treatment modalities as the initial treatment options since they are non-invasive and do not have risks such as anal sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is another option among those techniques which address the issues with LIS. LigaSure© (Valleylab) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. The use of LigaSure Small Jaw was never reported for anal fissures in literature. We have applied the use of this device to a group of patients complaining for chronic anal fissure in order to verify if there is any advantage to perform it compared to traditional technique (blade, scissors, electrocautery).

Naldemedine for Opioid-Induced Constipation in Patients With Cancer: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.

Opioid-induced constipation is the most frequent and non-self-limiting adverse effect of opioid analgesia, reducing adherence and interfering with pain relief. This clinical trial aimed to clarify the preventive effect of naldemedine versus placebo for constipation in patients with cancer starting regularly dosed strong opioids therapy. This multicenter, double-blinded, randomized, placebo-controlled, confirmatory trial was conducted between July 2021 and May 2023 at four academic hospitals in Japan (ClinicalTrials.gov identifier: jRCTs031200397). Patients with cancer starting a first-time regularly dosed strong opioid for cancer pain and age 20+ years were included. Eligible patients were randomly assigned to the naldemedine (Symproic 0.2 mg) or placebo group in a 1:1 ratio for 14 days with protocol treatment. The primary end point was the proportion of patients with a Bowel Function Index (BFI) of <28.8 on day 14. The secondary end points included frequency of spontaneous bowel movements (SBM), quality of life (QOL), and frequency of opioid-induced nausea and vomiting (OINV). Of the 103 patients assessed for eligibility, 99 received either naldemedine (n = 49) or placebo (n = 50). A BFI of <28.8 on day 14 was significantly more likely to occur in the naldemedine group (64.6%; 95% CI, 51.1 to 78.1) versus placebo (17.0%; 95% CI, 6.3 to 27.8), and the difference between groups was 47.6% (95% CI, 30.3 to 64.8; P < .0001). The frequency of SBM, QOL, and the severity of OINV were nominally significant in the naldemedine group than in the control group. Naldemedine prevented constipation and improved constipation-related QOL, with possible preventive effect on OINV in patients with cancer starting regularly dosed opioids therapy.

SP5.8 - A survey of the actual incidence of Low Anterior Resection Syndrome in our patients and its effect on their quality of life

Abstract Aim Following rectal surgery, bowel function is often affected and leads to a constellations of symptoms called Low Anterior Resection syndrome (LARS). Whilst several risk factors have been identified from previous studies, the most important question is how these symptoms impact the quality of life (QOL) of our patients. The aim of our study was to gain an overview of LARS among our patients, identify risk factors, quantify how it affects their daily lives and recommend preventive and management options. Method We contacted all patients who had undergone anterior resections 01/10/2020-01/10/2023 via a telephone consultation carried out by a single doctor. Using the LARS questionnaire which has been internationally validated, we quantified the severity of LARS symptoms and effects on QOL in our patients. Results A total 36 patients were included in the study. We found 75% patients had no LARS, 25% had minor LARS; no patients had major LARS. 15 patients experienced tenesmus, 11 urgency, 11 accidental leakage of stool, 10 inability to control flatus and 8 frequency. Only 8.33% reported their symptoms affecting their QOL; in this group, accidental leakage of stool was the common symptom. We found no correlation between the incidence of LARS and post-operative time period. None of our LARS patients had had pre-op radiotherapy; only 10% patients who had post- op chemo developed LARS. Conclusion In our cohort of Anterior resection patients, most had no LARS; none had major LARS. Though some patients had some symptoms, QOL was affected in only 8.33%. Those who had symptoms were directed to our LARS clinic in Lower GI physiology for further management.