Cause Of Constipation Research Articles

The treatment of congenital recto-vestibular fistula and recto-perineal fistula and effect of the megarectum on defecation.

This study aims to discuss the treatment of congenital recto-vestibular fistula and recto-perineal fistula, and the effect of the megarectum on defecation. Congenital recto-vestibular fistula or recto-perineal fistula is the most common type of anorectal malformation, and surgical methods include posterior sagittal anorectoplasty, anterior sagittal anorectoplasty, and mid-sagittal anorectoplasty, which can be performed at stage one or stage two after the ostomy. In the later stages of a recto-vestibular fistula, constipation is a common complication. Rectal dilatation is frequently associated with constipation, and the effect of rectal dilatation on defecation should be discussed for patients with congenital recto-vestibular or recto-perineal fistula who had rectal dilatation prior to surgery. Rectal dilatation may be one of the causes of constipation for congenital recto-vestibular fistula and recto-perineal fistula. The patients in this study were 67 children with congenital recto-vestibular fistula or recto-perineal fistula treated in our hospital from March 2013 to February 2017. All patients underwent an MRI of the spine and a barium enema. Six patients with myelodysplasia and sacral agenesis were excluded from this study. There were 18 patients with rectal dilatation (ages: 4-month-old to 1 year old, male: 3, female: 15). Seven of them had anterior sagittal anorectoplasty (group A), and 11 had anorectoplasty with dilated rectum resection (group B). Forty-three patients (ages: 3- to 10 months old, male: 6; female: 37) without a dilated rectum underwent anterior sagittal anorectoplasty (group C). All patients were followed up for 1 year to 5 years. Among the 50 patients who had undergone an anoplasty, 5 out of 7 patients with rectal dilatation developed post-operative constipation, and 3 of them had normal defecation after the second resection of the dilated rectum. Only two out of 43 patients without rectal dilatation developed post-operative constipation. One out of 11 patients with rectal dilatation who underwent anoplasty and resection of the dilated rectum developed post-operative constipation. Patients with congenital recto-vestibular fistula or recto-perineal fistula complicated by rectal dilatation are more susceptible to post-operative constipation. Resection of the dilated rectum at the same time can reduce the incidence rate of constipation. A barium enema should be performed pre-operatively for patients with congenital recto-vestibular fistula or recto-perineal fistula. If the dilated rectum is found, it can be resected at the same time.

The Role of Ion Channels in Functional Gastrointestinal Disorders (FGID): Evidence of Channelopathies and Potential Avenues for Future Research and Therapeutic Targets.

Several gastrointestinal (GI) tract abnormalities, including visceral hypersensitivity, motility, and intestinal permeability alterations, have been implicated in functional GI disorders (FGIDs). Ion channels play a crucial role in all the functions mentioned above. Hormones and natural molecules modulate these channels and represent targets of drugs and bacterial toxins. Mutations and abnormal functional expression of ion channel subunits can lead to diseases called channelopathies. These channelopathies in gastroenterology are gaining a strong interest, and the evidence of co-relationships is increasing. In this review, we describe the correlation status between channelopathies and FGIDs. Different findings are available. Among others, mutations in the ABCC7/CFTR gene have been described as a cause of constipation and diarrhea. Mutations of the SCN5A gene are instead associated with irritable bowel syndrome. In contrast, mutations of the TRPV1 and TRPA genes of the transient receptor potential (TRP) superfamily manifest hypersensitivity and visceral pain in sensory nerves. Recently, mice and humans affected by Cantu syndrome (CS), which is associated with the mutations of the KCNJ8 and ABCC9 genes encoding for the Kir6.1 and SUR2 subunits, showed dysfunction of contractility throughout the intestine and death in the mice after the weaning on solid food. The discovery of a correlation between channelopathies and FIGD opens new avenues for discovering new direct drug targets for specific channelopathies, leading to significant implications for diagnosing and treating functional GI diseases.

Probiotics and Functional Constipation in Children

Functional constipation (FC) definition as by the "Rome IV" diagnostic criteria as persistently difficult, infrequent, or seemingly incomplete defecation without evidence of a primary anatomic or biochemical cause This definition required at least two of six symptoms describing stool frequency, hardness, and size; faecal incontinence; or volitional stool retention, with the stipulation that organic causes of constipation are excluded by a thorough evaluation. Children visiting outpatients clinic with defecation-related complaint account for 3% and 25% of pediatric gastroenterology consultations. Functional constipation aetiology is still unclear. So is typically classified into normal transit constipation (NTC), slow transit constipation (STC), and defecatory or rectal evacuation disorders. The World Health Organization defines probiotics as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host”.

Validation of the Chinese DeFeC questionnaire: a comprehensive screening tool for symptoms and causes of constipation and incontinence.

Currently, the diagnosis of defecation disorders in China is usually based on varied and ambiguous criteria. We aimed to translate the Groningen Defecation and Fecal Continence (DeFeC) questionnaire to Chinese and test its reproducibility and feasibility in the general Chinese population. The Groningen Defecation Questionnaire was translated into Chinese according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). The feasibility and reproducibility were evaluated by performing a test-retest online survey and calculating the Cohen's kappa (κ) coefficient [or intraclass correlation coefficient (ICC)], with 0.01-0.20 considered slight agreement; 0.21-0.40, fair agreement; 0.41-0.60, moderate agreement; 0.61-0.80, substantial agreement; and 0.81-1.00, almost perfect agreement. In total, 130 respondents completed the questionnaire twice, with a mean age of 47.08±12.46 years. No remarks were made that indicted that the questions were difficult to understand. The median time to complete the questionnaire was 20.78 min [interquartile range (IQR), 14.83-29.20 min] for the first time. The κ coefficient of all defecation function-related domains ranged between 0.25 and 0.71, with an average value of 0.53. The constipation and fecal incontinence-related domains showed a substantial and moderate agreement level, as indicated by κ of 0.65 and 0.52, respectively. The Agachan constipation score and Wexner incontinence score showed perfect and substantial agreement, as indicated by an ICC of 0.88 and 0.74, respectively. The Chinese version of the Groningen DeFeC questionnaire is highly feasible and reproducible and can be applied in clinical and research activities for the Chinese population.

Pelatihan Pijat Bayi Untuk Kondisi Sembelit Di Posyandu Balita Abadi Sejahtera

Constipation is a digestive problem that can be experienced by anyone, both parents and children. When it occurs in children, constipation which causes pain in the stomach will certainly interfere with their daily activities. There are various causes of constipation in children, ranging from cow's milk allergies, dehydration, to poor diet. Based on the data obtained, there were 2 toddlers with stomach complaints of constipation. Some parents underestimate constipation in toddlers and don't know how to reduce constipation. Based on these data, it is necessary to carry out community service "Baby Massage Training for Constipation Conditions at Posyandu Abadi Sejahtera" as a solution to increase the knowledge and skills of cadre administrators and parents. This activity consists of field visits, face-to-face training, home visits and ongoing monitoring. on line. The output target is achieving community empowerment and increasing skills, publishing the results of community service in national journals and electronic media. The results of this activity showed an increase in knowledge and skills in caring for toddlers who experience constipation.

A284 DIAGNOSTIC ACCURACY OF THE ABDOMINAL X-RAY IN CHILDHOOD CONSTIPATION: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract Background Childhood constipation is a relatively common condition in pediatrics, with a global pooled prevalence of 9.5%. The most common form of constipation in children is functional in nature, a clinical diagnosis defined by the Rome IV criteria. Although available data discourage the use of the abdominal x-ray (AXR) for the evaluation of constipation in children due to its limited value, radiation exposure, as well as its possible misleading nature, a significant number of clinicians continue to use AXRs in children with constipation. Given that it has been 10 years since the last systematic review on this topic was published, an updated systematic review is now warranted. Purpose To evaluate the diagnostic accuracy of the abdominal x-ray in children with functional constipation (FC). Method The protocol was registered (PROSPERO ID: CRD42022301833) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligibility criteria Study population included children and adolescents aged 2 to 18 years with a clinical diagnosis of FC in whom AXR was performed. The radiographic parameters that were used to evaluate the AXR had to be specified by the authors. Exclusion criteria included children with organic causes of constipation and children younger than two years. Information sources, search strategy and selection criteria A reference librarian searched the Medline, Embase and Scopus databases from 2012 (year of last systematic review) to May 2022. The search was limited to English only. In addition, reference lists from selected papers were screened for relevant articles. Data collection Two authors independently screened eligible articles. Disagreements between investigators were resolved by consensus with a third investigator. Extracted data was inputted into a structured collection sheet by two authors working independently. Risk of bias assessment and applicability concerns To assess the risk of bias and applicability concerns, two investigators working independently applied six of the QUADAS-2 items to each of the included articles. Result(s) The search identified a total of 1,125 articles, of which only three were included in the final qualitative analysis. A quantitative analysis was not conducted due to clinical and methodologic heterogeneity. Two studies were conducted in the USA (case-control studies) and one study was conducted in Iran (cohort study), involving a total of 416 children. All three studies used different radiographic parameters to define constipation. The two case-control studies were deemed unclear-to-low risk of bias, while the cohort study was considered unclear-to-high risk of bias. Figure 1 shows the study findings. Image Conclusion(s) There is insufficient evidence to support the use of AXR for the diagnostic workup of FC. More methodologically rigorous studies are needed in order to determine the utility of the AXR in FC. The diagnosis of FC should be based on history and clinical findings. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared OBESITY, METABOLIM & NUTRITION

Desmosis coli as an extremely rare cause of constipation in children – case report and mini-review

Desmosis coli as an extremely rare cause of constipation in children – case report and mini-review

Etiology and clinical classification of constipation

The causes of constipation are extremely complex and are still not fully clear. In addition to secondary factors such as organic diseases and drugs, constipation may also be related to genetics, diet, intestinal flora, age, gender and so on. At present, according to the etiology, chronic constipation is divided into primary constipation and secondary constipation. However, there are significant differences among current clinical guidelines in the clinical classification of primary constipation. Some guidelines classify primary constipation as slow-transit constipation (STC), outlet obstruction constipation (OOC), and mixed constipation; however, some guidelines classify primary constipation as STC, defecation disorder (DD), mixed constipation, and normal-transit constipation (NTC); what's more, some even propose types which are different from the above sub-types. There are also differences in the understanding of the relationship between functional constipation (FC) and primary constipation and the classification of irritable bowel syndrome predominant constipation (IBS-C) among various clinical guidelines. By reviewing domestic and international guidelines and relevant literature on constipation, the following conclusions are drawn: primary constipation can be divided into IBS-C and FC, and FC can be further divided into STC, OOC, and mixed constipation; primary constipation should not be confused with FC, nor should IBS-C be classified as FC.

S539 Systematic Review and Meta-Analysis of the Prevalence of Constipation and Nausea Among Adults Using Calcitonin Gene-Related Peptide (CGRP) Inhibitors for Preventative Treatment of Cluster Headache or Migraine

Introduction: Constipation and nausea are frequently encountered medication-associated side effects. Calcitonin gene-related peptide (CGRP) inhibitor use may be potential cause of constipation and nausea, but the magnitude of this impact in patients with cluster headaches or migraines has not been well characterized. Methods: We conducted a systematic review using PUBMED and ClinicalTrials.Gov to identify randomized, placebo-controlled clinical trials using anti-CGRP antibodies or CGRP receptor antagonists for the prevention of cluster headaches or chronic migraine. We extracted data including CGRP inhibitor dose, dose frequency, and the reported proportions of patients in these trials with constipation and nausea. We compared the prevalence of these symptoms in those on medication to those on placebo, using two-tailed paired t-tests. The risk of a specific adverse event was assessed using odds ratios with 95% confidence intervals. Results: We identified an initial pool of 449 studies to which we applied a priori criteria to yield 27 studies for nausea and 15 studies for constipation analyses. In the anti-CGRP antibody-treated group, the pooled prevalence of constipation was 2.69% (N=3,574) and nausea was 2.03% (N=9,231), compared with 1.39% (N=4,520, p=0.004) and 2.47% (N=11,680, p=0.0095) in placebo-treated groups, respectively. In the CGRP receptor antagonist-treated group, the prevalence of constipation was 5.20% (N=1,847) and nausea was 6.04% (N=1,689), compared to 1.46% (N=1,852, p=0.002) and 3.05% (N=1,967, p=0.0001) in placebo-treated groups, respectively. CGRP receptor antagonist use demonstrated greater risks of constipation (OR=3.71 [2.41, 5.71], p< 0.0001) and nausea (OR=2.04 [1.48, 2.83], p< 0.0001) than anot-CGRP antibody use (constipation: OR=1.96 [1.41, 2.72], p=0.0001; nausea: OR=0.82, [0.68, 0.99], p = 0.0343). Anti-CGRP antibody use did not appear to be associated with an increased risk of nausea. Conclusion: Constipation and nausea are associated with CGRP inhibitor use in those with cluster headache or migraine. With the increased prevalence of CGRP inhibitor use, CGRP inhibitor-associated constipation and nausea cases could grow substantially. Gastroenterologists should consider CGRP inhibitor use as a medication-induced cause of nausea and constipation. CGRP receptor antagonist use is associated with higher rates of these gastrointestinal side effects than the use of anti-CGRP antibodies.

LimosiLactobacillus pentosus Isolated from Mustard Relieves Drug-induced Constipation in Mice Fed a High-fat Diet by Modulating Enteric Neurotransmitter Function.

Functional constipation is one of the most common gastrointestinal disorders. Oxidative stress can aggravate organ dysfunction. Enteric neurotransmitters have significant effects on the regulation of the enteric nervous system and intestinal muscle contraction. Oxidative stress and reduced gastrointestinal motility are considered to be one of the main causes of constipation. This study aimed to investigate whether LimosiLactobacillus pentosus CQZC02 alleviated loperamide hydrochloride (Lop)-induced constipation in mice under high-fat diet (HFD) conditions and to elucidate the underlying mechanism, focusing on enteric neurotransmitters. Four-week-old female BALB/c mice were randomly divided into five groups: normal group (Nor), constipation model group (H-Lop), L. pentosus CQZC02 low-dose group (H-Lop + ZC02L), L. pentosus CQZC02 high-dose group (H-Lop + ZC02H), and LimosiLactobacillus bulgaricus control group (H-Lop + LB). The fecal weight, water content, and total gastrointestinal transit time were measured to determine whether the mice were constipated. Small bowel and colon tissue damage was assessed by hematoxylin and eosin staining, while the degree of damage was determined by double-blind scoring. The levels of serum oxidative stress markers malondialdehyde, superoxide dismutase, glutathione peroxidase, and catalase and neurotransmitters motilin, gastrin, substance P, endothelin, somatostatin, and vasoactive intestinal peptide were measured. The gene expression levels of endothelial nitric oxide synthase, inducible nitric oxide synthase, neuronal nitric oxide synthase, nuclear factor kappa-B, and cyclooxygenase-2 in small intestine tissue were calculated. The constipation symptoms of mice in H-Lop group were manifested by a variety of physiological indicators. In addition, compared with the H-Lop group, H-Lop + ZC02H could effectively relieve the symptoms of constipation in mice. In symptom characterization, the mice in the H-Lop + ZC02H group lost weight and increased feces and water content. In functional experiments, gastrointestinal motility was enhanced; the inflammation score of intestinal tissue was decreased, and gene expression levels were modulated; serum oxidative factor levels were modulated, and oxidative stress levels were decreased.

Constipation in children in the practice of a pediatrician

Constipation in children is currently one of the major complaints that parents present at a pediatrician's appointment. The article discusses the issues of diagnosis and treatment of functional constipation in children based on the international and Russian clinical guidelines. The following are some major causes of constipation in young children. Constipation is most often caused by colon dyskinesia (hypo- and hypermotor disorders), impaired and painful bowel movement (spasm of the rectal sphincters, weakened smooth muscle tone, etc.) or a combination of these factors. In rare cases, the cause of constipation is organic disorders. Also, low parental socio-economic status, low educational level, depression, neuroticism, attitude of parents towards their children's upbringing such as being overprotective, and attitudes that promote high or low levels of autonomy, increase the risk of functional constipation. In addition, the article sets detailed factors leading to constipation in older children and adolescents. The pathogenesis of functional constipation is given, and the problem of psychological constipation is described. The outlined therapeutic approach includes dietary intervention, compliance with drinking water treatment, behavioural and drug therapy. The author presents its own experience of using sodium picosulfate to treat constipation in children. Constipation in children is a common problem, functional constipation accounts for 95% of cases, therefore in most cases they do not require clarifying diagnostic methods. Besides, you shouldn't forget about the possibility of organic pathology, malformations in young children. Constipation in children requires the timely administration of complex treatment.

1074 QUALITY IMPROVEMENT PROJECT AIMED TO REDUCE THE AVERAGE NUMBER OF PATIENTS DEVELOPING CONSTIPATION ON BOURNVILLE WARD IN QEHB

Abstract Introduction Constipation is an overlooked but frequent problem in elderly patients on geriatrics wards. The prevalence in inpatients aged over 65 years is estimated at about 50%.There are many reasons for this: reduced oral intake due to illness, delirium, immobility, and constipating drugs. If constipation is addressed correctly, we can reduce the rate of unpleasant complications and prolonged hospital stay by increasing awareness of non-laxative methods to be advocated initially to avoid worsening poly-pharmacy with side effects. Queen Elizabeth Hospital Birmingham guidelines advocates use of conservative measures. However these methods can be frequently underutilized and cause of constipation rarely considered to treat. We aimed to identify the barriers to our outcome by tackling lack of awareness, utilization of non-laxative method DRE prior to rapid relief. This included teaching sessions, MDT, posters, introducing constipation booklets. Method We used prospective data collection with a standardized questionnaire having a mix of descriptive and quantitative questions based on SMART Aims for the project. This was carried out once a week on alternate beds. Baseline data n44,2ndcycle n44,3rd cycle n43,4thcycle n42.With each cycle we used following interventions to improve constipation prevalence in Bournville ward i.e. individually educate patient/staff during ward rounds, MDT presentations, improve documentation of constipation causes, addition of separate educational posters for staff/patients,identification of at risk patients. Introduced Patient information booklet with documented discussion on hospital online record system. Results Following interventions from 1st-4th cycle inpatient constipation prevalence was reduced by 13%,Increased consideration of cause by 38%, significant increase in education by 65%,Increased use of non-laxative approach by 35%,Increased rates of DRE by 35%,reduced use of x-ray prior to DRE by 8.3%,reductions in complication rate by 9%. Conclusion Despite increased education, cause consideration, utilization of conservative non-laxative approaches, introduction of new constipation booklet in welcome pack to all new patients a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.

Antipsychotics induced constipation in patients with mental disorders. treatment suggestion with prucalopride in refractory cases. case report and literature review

IntroductionSuccessful stabilization of patients with mental disorders requires most of the times the use of more than one antipsychotic medications with increase prevalence of clozapine in refractory cases. Constipation consists one of the most debilitating side effect of the therapy, which gradually progresses to a chronic state of bowel movement dysfunction, with recurrent episode of paralytic ileus of various severity.ObjectivesWe describe the case of a middle age male treated with clozapine for refractory mental disorder, who developed ileus and subsequent bowel dysfunction not amenable to laxatives.MethodsThe acute episode have been treated conservatively with nasogastric decompression, intravenous replacement of fluids and electrolytes, antibiotics chemoprophylaxis and low molecular weight heparin. His overall physical status was unremarkable for obesity, diabetes, hypertension, allergies, previous operations and a former endoscopic evaluation conducted in the recent past, which had ruled out malignant neoplastic disease.ResultsA course of per os prucalopride have been instituted, which showed preliminary promising results in restoring proper bowel movements, without any serious side effect and without the need to discontinue his course with antipsychotics. Prucalopride is a 5 HT4 agonist which selectively binds to the receptors of the intestine, resulting in muscular contractions as well as clorium secretion from the mucosa promoting an osmotic defecation.The substance has been extensively use in the treatment of irritable bowel disease of the chronic constipation type.ConclusionsWe suggest the more systematic use of this agent in this group of patients after proper endoscopic evaluation and restoration of all secondary causes of constipation.DisclosureNo significant relationships.

The Adventures of Alexander von Humboldt by Andrea Wulf

Reviewed by: The Adventures of Alexander von Humboldt by Andrea Wulf Stephen Bell Andrea Wulf (author) and Lillian Melcher (illustrator) The Adventures of Alexander von Humboldt. New York: Pantheon Books, 2019. Illustrations, chiefly color, author’s note, online links and sources, selection of Humboldt’s published diaries and letters, picture credits, and acknowledgements. $29.95 hardcover (ISBN 97815244747374); electronic (ISBN 97815244747381). This work treating humboldtian scientific exploration, or adventuring, stems from a rich research collaboration between Andrea Wulf, the author of a renowned biography of Alexander von Humboldt, and Lillian Melcher, a graduate of the Parsons School of Design, who undertook the graphic work. The format is that of a comic book and the work is classified as graphic nonfiction, a challenging category in classification. While other authorities are treated, mainly important scientific ones, the book is structured above all around the journey made by Humboldt with his French collaborator and assistant Aimé Bonpland to the Americas between 1799 and 1804. But since the dialogs between these two figures are imagined ones, there are heavy elements of storytelling here. These cannot escape issues of historiography. Wulf quickly brings up Humboldt’s extraordinary and laudable capacity for making connections between phenomena and that theme provides a main core for the treatment in the book. While the leading focus is the journey through parts of the Americas, there is scope for including earlier and later experiences. Important concepts are included in this way, such as deforestation and its consequences, or the powers of humans as ecological agents. This approach should be helpful for the stimulation of curiosity in teaching. Scientific influences are ultimately more complex, of course, than can be rendered in a book of this kind. Given the immense range of themes to treat, including ascents of both a major river, the Orinoco, and the Chimborazo volcano, considered at the time to be the highest peak on the globe, the artwork is impressive. Using the backdrop of some of the manuscripts and collected materials, including specimen plants, proves effective and should stimulate new readers toward Humboldt. Inclusion of pagination would not have helped the aesthetic impact of this book, but its absence makes it difficult to trace the use of the extensive sources behind the research work much of the time. The plates are designed in very [End Page 201] different ways. Some concentrate on the aesthetics of nature, are free of commentary, and encourage contemplation. Others are dense in text and invite close study, with the fold-out plate concerning Chimborazo perhaps the one of single greatest importance, in part for its guidance toward the enduring concept of vertical zonation. Humboldt is treated there as a predictor that global warming will affect the distribution of tropical plants. Plates particularly valued by this reviewer included one depicting South American crops and cultivation, conveying the idea that commercial crops sometimes depleted soils. The same plate also includes consideration of the vernacular names for plants, that definite adventure of the interface of knowledge systems between western science and vernacular lore. Thus, a tomato that would be named scientifically from Berlin in honor of Humboldt was commemorated by the local population as a cause of constipation, gaining a more earthy name. I also greatly enjoyed the image based on Humboldt’s profile of the physical profile from Acapulco to Mexico City, one that adroitly addresses the challenges of the sheer scale of the movement of the collections gathered by Humboldt and Bonpland, by linking Humboldt’s deep scientific work with the charm and lightness of Melcher’s new visual material. Complicated themes are treated with goodwill and humor throughout the book. What does not work so well in a shared journey is that the focus is always thrown toward Humboldt, who is presented as an invincible figure, while Bonpland is mainly a worrier and a naysayer. Early in the book, Bonpland is treated as a disappointment to Humboldt, mainly on account of his later perceived slowness to publish when back in Europe. This device skips the context and ultimately much of the achievement of Bonpland’s botanical work. The working relationship between Humboldt and Bonpland is a complex matter and one not easily...

Massive Ovarian Cyst Mimics Constipation

BackgroundAbdominal pain and constipation are common presenting symptoms of pediatric patients presenting to the emergency department. Sometimes these symptoms are related to uncomplicated constipation from stool burden, and other cases may be secondary to more serious pathologies, including obstruction from intra- or extra-intestinal compression. Point-of-care ultrasound (PoCUS) can be helpful in discerning the etiology for this undifferentiated symptomatology. Case ReportA 14-year-old girl presented with 3 days of constipation and abdominal pain. This was similar to previous symptoms that resolved with laxatives. This time, however, her symptoms were associated with one episode of vomiting. PoCUS expanded a narrow differential with the discovery of a large ovarian cyst. This finding helped to expedite her transfer to a pediatric hospital for definitive treatment in the operating room. Why Should an Emergency Physician Be Aware of This?Constipation is one of the leading reasons pediatric patients present to the ED with abdominal pain. PoCUS can detect uncommon causes of constipation, especially pathologies associated with large volumes of fluid, such as a large ovarian cyst, bladder outlet obstruction, or small bowel obstruction.

The Involvement of the Endogenous Opioid System in the Gastrointestinal Aging in Mice and Humans.

Nearly 20% of elderly patients suffer from constipation, but the age-related changes in the gastrointestinal (GI) tract remain insufficiently elucidated. In this study, the alterations within the endogenous opioid system (EOS) as a potential cause of constipation in the elderly were evaluated. The GI functions were assessed in vitro and in vivo and compared between 6-, 12- and 18-month old mice. Moreover, the effect of opioid receptor (MOP, DOP, KOP) agonists on the mouse GI tract functions and the EOS components expression in mouse tissues and colonic biopsies from patients with functional constipation were determined. In the oldest mice, the GI peristalsis was significantly impaired as compared to the younger groups. The tissue response to MOP and DOP, but not KOP, agonists weakened with age in vitro; for DOP, it was confirmed in vivo. In the mouse upper GI tract, Oprm1, Oprd1, Oprk1 expression decreased with age; in the colon, Oprm1 expression increased. There were no differences in the expression of these genes in the colonic biopsies from patients >50 years old as compared to the younger group. In conclusion, the age-related impairment of the GI peristalsis may result from reduced MOP and DOP response to the activation with opioid agonists or the alterations in the EOS expression.

Profile of Functional Constipation in Children at a Referral Hospital

To study the social, demographic and clinical profile of functional constipation (FC) in children. A cross-sectional study was performed in a tertiary-care hospital to assess prevalence and profile of functional constipation among children (1-18 years) using Rome IV diagnostic criteria. Children with FC constituted 5.56% (87/1565) of hospital attendees. 64.4% were between 2-6 years old and 48.3% had a past history of use of laxatives. Painful defecation was the commonest (62.1%) presenting symptom, while avoidance to school toilet was the commonest (25.3%) precipitating factor. Fecal impaction was present in 70.1% children. Functional constipation was the commonest cause of constipation, and a majority of these children had associated fecal impaction.

Magnetic Resonance Defecography in Obstructive Defecation Syndrome: A Pictorial Review Imaging Findings and Impact on Surgical Management

AbstractPelvic floor, a funnel-shaped muscular structure plays a significant role in bowel and bladder activities. Defecatory disorders result from the structural changes and functional disorders. Pelvic floor dysfunction affects 15% of multiparous women. It is being expected that after 30 years, there would be 45% rise in demand of pelvic floor imaging. After ruling out primary and secondary causes of constipation, diagnosis of obstructed defecation syndrome (ODS) is made. ODS is emerging as one of the important causes of constipation. As the symptoms are nonspecific and examination findings are frequently inaccurate, the clinical evaluation becomes a difficult task. Hence, various imaging modalities are becoming popular as an adjunct tool for the assessment of these disorders. Clinical management of ODS is based on the Constipation and Bowel Activity Score (CABA) and delineation of the pelvic floor anatomy. After defining the pelvic floor anatomy–based structural abnormality, day care ambulatory surgical procedure, that is, stapled transanal resection rectopexy (STARR), is offered to the patients of ODS. It provides significant relief to patients suffering from constipation and reduction in postoperative CABA score. This review discusses the role of magnetic resonance defecography imaging in ODS its impact on subsequent management.

Challenges in the diagnosis of intestinal neuronal dysplasia type B: A look beyond the number of ganglion cells.

Intestinal neuronal dysplasia type B (IND-B) is a controversial condition among gastrointestinal neuromuscular disorders. Constipation is its most common clinical manifestation in patients. Despite intense scientific research, there are still knowledge gaps regarding the diagnostic criteria for IND-B in the histopathological analysis of rectal biopsies. The guidelines published in the past three decades have directed diagnostic criteria for quantifying the number of ganglion cells in the nervous plexus of the enteric nervous system. However, it is very complex to distinguish numerically what is pathological from what is normal, mainly because of the difficulty in determining a reliable control group composed of healthy children without intestinal symptoms. Thus, a series of immunohistochemical markers have been proposed to assist in the histopathological analysis of the enteric nervous system. Several of these markers facilitate the identification of other structures of the enteric nervous system, in addition to ganglion cells. These structures may be related to the etiopathogenesis of IND-B and represent new possibilities for the histopathological diagnosis of this disease, providing a view beyond the number of ganglion cells. This review critically discusses the aspects related to the disease definitions and diagnostic criteria of this organic cause of constipation.

Pain and discomfort in violation of bowel movements in children – an actual problem

Pain and discomfort during bowel movements in children are among the most common symptoms in the modern civilized world. The most common cause of these symptoms is chronic constipation, which is often treated by a pediatrician or pediatric gastroenterologist. In differen­tial diagnosis, it is very important to distinguish between chronic symptomatic constipation and functional (without an organic basis), which are most common in childhood. Organic causes of constipation are usually dealt with in cooperation with specialized specialists. The main patho­physiological mechanisms of functional constipation are stress, pain during emptying, and fear of further painful bowel movements. The clinical picture is dominated by in­frequent and difficult defecation of a large amount of hard stools. If the history, laboratory and other additional stud­ies indicate functional constipation, and there are no warn­ing signs of chronic symptomatic constipation, complex treatment can be started. Therapy includes psychological preparation of the patient and his family, working with the correct technique of defecation, dietary and regimen mea­sures, sufficient physical activity, the use of osmotic lax­atives. The presence of warning signs requires a rational differential diagnostic procedure, which varies depending on the age of the child.