Constipation In Patients Research Articles

Meta-analysis of the regulatory effect of traditional Chinese medicine on intestinal flora in patients with constipation

Objective: To systematically evaluate the regulatory effect of traditional Chinese medicine on intestinal flora in patients with constipation. Methods: From PubMed, Embase, Web of Science and Cochrane Library to December 2022, the qualified research was screened in strict accordance with the nanofiltration standard. The Cochrane bias risk assessment method and the modified Jadad scale were used to evaluate the quality of literature, and the meta-analysis was carried out using stata 15.0 software. Results: 16 clinical randomized controlled trials were finally included, with a total of 1099 patients. Meta-analysis shows that Chinese medicine can effectively promote bifidobacteria (SMD=0.95, 95% CI (0.78-1.12), Z=10.79, P=0.000<0.05), lactobacillus (SMD=0.61, 95% CI (0.25 - 0.98), Z=3.26, P=0.001<0.05), lactobacillus (SMD=0.72, 95% CI (0.42 - 1.03), Z=4.68, P=0.000<0.05) and gram-positive bacilli (SMD=2.12, 95% CI (1.65, 2.59), Z=8.90, P=0.000<0.05) in the intestine of constipation patients), It can inhibit Escherichia coli (SMD=-0.46, 95% CI (-0.66, -0.27), Z=4.69, P=0.000<0.05), enterobacteria (SMD=-0.86, 95% CI (-1.08, -0.64), Z=7.67, P=0.000<0.05), enterococcus (SMD=-0.42, 95% CI (-0.62, -0.22), Z=4.14, P=0.000<0.05), yeast (SMD=-0.94, 95% CI (-1.28, -0.59), Z=5.32, P=0.000<0.05) and gram negative cocci (SMD=-0.68, 95% CI (-1.23, -0.15), Z=2.50, P=0.012<0.05). There is no significant difference between traditional Chinese medicine and western medicine in terms of gram-negative bacilli (SMD=-0.19, 95% CI (-0.56,0.18), Z=1.02, P=0.306>0.05), gram-positive cocci (SMD=-0.23, 95% CI (-0.60,0.13), Z=1.26, P=0.208>0.05), and cocci ratio (SMD=1.32, 95% CI (-0.22,1.16), Z=1.92, P=0.186>0.05). In addition, traditional Chinese medicine can reduce the intestinal PH value of constipation patients (SMD=-0.85, 95% CI (-1.11, -0.59), Z=6.38, P=0.000<0.05), and keep the intestinal micro-ecological environment in balance. Conclusion: Compared with western medicine, traditional Chinese medicine has more advantages in regulating intestinal flora of constipation patients.

Gut indigenous Ruminococcus gnavus alleviates constipation and stress-related behaviors in mice with loperamide-induced constipation.

Refractory constipation is the most severe form of constipation, and its etiology remains unknown. The symptoms of constipation occur repeatedly, which brings great pain to the patient's body and psychology. Accumulating studies suggest that constipation patients present a significant dysbiosis of the gut microbiota compared with healthy individuals. In this study, we analyzed the gut microbiota composition of fresh feces and accumulated feces (old feces) of patients with refractory constipation and found that there was a significant difference between them. Through a mouse model of loperamide-induced constipation, it was proved that the old feces of patients with refractory constipation could aggravate the constipation symptoms in mice, while the fresh feces could alleviate the symptoms, which is consistent with the effect of feces from healthy volunteers in a mouse model of loperamide-induced constipation. We identified an indigenous strain Ruminococcus gnavus (R. gnavus), which is highly enriched in the fresh feces of patients with refractory constipation, and found that oral administration of R. gnavus could effectively improve the constipation symptoms in mice with constipation induced by loperamide and fecal bacteria transplanted from patients with constipation and significantly improve the stress-related behaviors of mice. This result may be related to the regulation of intestinal muc2, c-kit, sert and other gene expression by R. gnavus and the control of somatostatin (SS) and motilin (MTL) production. Our results suggest that gut microbe intervention with indigenous strains such as R. gnavus is a potential and promising alternative for the treatment of constipation, especially for refractory constipation.

Measurement of Rectal Diameter and Anterior Wall Thickness by Ultrasonography in Children with Chronic Constipation.

Measurement of rectal diameter by ultrasonography helps the clinician in the diagnosis of chronic constipation in children for whom rectal examination cannot be performed. The aim of the study is to determine the rectal diameter and anterior wall thickness values in constipated and healthy children and to evaluate the feasibility of ultrasonography in the diagnosis of functional constipation in children who refuse digital rectal examination. One hundred forty constipated and 164 healthy children participated in the study. All patients were divided into 4 subgroups according to their ages (≤3 years [group I], 3.1-6 years [group II], 6.1-12 years [group III], and >12 years [group IV]) and were referred to the radiology department. The measurement was made from above the symphysis pubis, under the ischial spine, and at the bladder neck. Anterior wall thickness measurement was performed. The measurements were recorded according to the presence or absence of fecal mass in the rectum. Constipated children with fecal mass positive group III was found to have significant difference in all of the planes in rectal diameter measurement. Rectum anterior wall thickness measurement was found to be higher in constipated patients with fecal mass (+) compared to the control. Its measurements in constipated patients in group II, group III, and group IV with no fecal mass were found to be statistically higher than the control group. The measurement of rectal diameter and anterior wall thickness by ultrasonography as a noninvasive method was per formed in children who did not want the digital rectal examination, and it may be useful in the diagnosis of constipation.

Results of Anorectal Physiological Testing in Patients with Limited English Proficiency.

Patients with limited English proficiency (LEP) experience barriers to healthcare. These include language barriers and difficulty accessing medical subspecialties. Consequently, patients with LEP may be underrepresented, and may be more likely to have abnormal results, among individuals referred for anorectal testing. To explore whether differences exist in the results of high-resolution anorectal manometry (HRM), rectal sensory testing (RST), and balloon expulsion testing (BET) between patients with LEP and English proficiency (EP). The electronic health records at Mayo Clinic, Rochester were used to identify constipated patients without organic anorectal disease who had undergone anorectal testing in 2018, 2019, and 2020. The language spoken by the patients was determined. HRM, RST, and BET results were compared. Nominal logistic regression explored the influence of age, gender, test operator, and LEP on the likelihood of abnormal findings. Among 3298 patients (80% female, mean age ± standard deviation 46 ± 16years), 67 (2%) had LEP. HRM measurements were similar in LEP and EP patients. However, LEP patients were more likely to have abnormal BET and RST. Logistic regression revealed that age (older than 50years), gender, test operator, and LEP influenced the results of BET and RST, with LEP having the strongest influence. Results of anorectal testing in constipated patients differ between LEP and EP patients. This is likely to represent a difference in disease prevalence between these groups, for example, due to referral bias, rather than a difference in physiology or a language barrier.

Clinical Factors Affecting Constipation in Patients with Schizophrenia Taking Clozapine

Objectives: To investigate clinical factors affecting constipation in patients with schizophrenia taking clozapine.Methods: The participants were patients with schizophrenia taking clozapine and tested for the Therapeutic Drug Monitoring from September 1, 2020 to July 1, 2022 at a university hospital. To evaluate the effect of clozapine on constipation, clozapine dosage, clozapine concentration, and norclozapine concentration were investigated. To evaluate effects of drugs other than clozapine on constipation, dosage and type of other drug were investigated. Anticholinergic Drug Scale was used to evaluate anticholinergic action.Results: A total of 56 patients were enrolled in the study. Clozapine daily dose, clozapine concentration, and norclozapine concentration were higher in the constipated patient group. Through logistic regression analysis, it was discovered that the risk of constipation increased as the norclozapine concentration increased, and the results remained similarly even after adjustments of related variables was performed.Conclusion: It was discoverd that among patients taking clozapine, the higher the norclozapine concentration, the higher the probability of constipation. Among patients taking clozapine, patients with high norclozapine concentration may need additional evaluation and management of constipation.

A clinical study to observe the efficacy and safety of Besunyen Detox Tea for constipation.

Introduction:Functional constipation (FC) is a common functional gastrointestinal disease and is one of the most common outpatient diseases. The purpose of this study was to investigate the efficacy and safety of the traditional Chinese medicine Besunyen Detox Tea (BDT) for FC and to compare the effect of BDT between constipation patients with and non-dryness-heat syndrome.Methods and analysis:This multicenter, prospective, observational registry study included 1000 participants diagnosed with FC. This study will collaborate with 3 comprehensive hospitals and 15 community hospitals and recruit patients into the registry between July 2022 and July 2023. After enrollment, we will collect the individual characteristics of each patient, anthropometric data and general condition, bowel movement, patient assessment of constipation symptoms, patient assessment of constipation quality of life, TCM syndrome scale, and time to take the laxative product again after treatment. We will also record adverse events and economic indicators at each visit.Discussion:This is the first registry-based study to collect real-world data of participants diagnosed with FC receiving BDT treatment. The results of this registry may also reflect these characteristics and provide direct clinical evidence to verify the importance of syndrome differentiation and treatment for the use of TCM health care products.

Effect of miR-129-3p on autophagy of interstitial cells of Cajal in slow transit constipation through SCF C-kit signaling pathway.

To explore the mechanism by which miR-129-3p affected the autophagy of interstitial cells of Cajal (ICCs) in slow transit constipation tissues through the SCF C-kit signaling pathway. Colon samples from 20 Slow transit constipation (STC) patients who underwent total colectomy plus ileorectal anastomosis or subtotal colon resection plus anti-peristaltic rectal anastomosis were collected in our hospital. The colon of 20 non-STC patients was used as control. The control of this study was 20 patients undergoing radical surgery for colon cancer (left colon cancer) in our hospital. Fifty healthy SPF Kunming mice were purchased from Liaoning Changsheng Biotechnology Co., Ltd. The mRNA expression of miR-129-3p in the STC group was lower than that in the control group (CTLR) group (P<0.05). The mRNA expression of miR-129-3p in STC group was lower than that in the NC group (P<0.05), and mRNA expression in STC+miR-129-3p group was higher than that in STC+miR-NC group (P<0.05). In the first week, the weight of dry and wet feces of the STC group was lower than that of the NC mice (P<0.05), and the weight of dry feces and wet feces of the STC group was lower than that of the NC group at the 2, 3, and 4 weeks, STC+miR-129 -3p was higher than that in the STC group (P<0.05). The increased expression of C-kit and SCF regulated by miR-129-3p contributed to the protection of interstitial cells. Knockdown of miR-129-3p expression could inhibit the activation of AKT/mTOR signaling pathway, reduce cell proliferation activity.

Reproducibility of high-resolution manometry among healthy and constipated persons.

Although high-resolution manometry (HR_ARM) is commonly used to diagnose defecatory disorders, its intraindividual day-to-day reproducibility is unknown. Since these measurements entail voluntary effort, this study aimed to evaluate the intraindividual day-to-day reproducibility of HR_ARM. In 22 healthy women (35 years [14] mean [SD]) and 53 constipated patients(42 years [13], 46 women), the rectal balloon expulsion time (BET), and anorectal pressures were measured with HR_ARM on 2 days separated by a median (interquartile range) of 15 days (11-53) in healthy and 40 days (8-75) in constipated patients. Anorectal pressures were evaluated at rest (20 s), during squeeze, and duringevacuation. Rectal sensation was also evaluated in constipated patients. The agreement between both measurements was evaluated with Lin's concordance correlation coefficient (CCC) and other tests. Among constipated patients, the anal resting (mean CCC [95%CI] 0.62 [0.43-0.76]) and squeeze pressures (CCC 0.65 [0.47-0.79]), rectoanal gradient during evacuation (CCC 0.42 [0.17-0.62]), and rectal sensory thresholds (CCC for urgency 0.72 [0.52-0.84]) were concordant. Between days 1 and 2, one or more outcomes, characterized as normal or abnormal, differed in 79% of constipated patients, i.e., anal resting and squeeze pressures, the gradient, and the rectal BET differed in, respectively, 25%, 19%, 36%, and 10% of constipated patients. The rectal BET was prolonged in three healthy persons (both days) and either on 1 day (six patients) or 2 days (33 patients) in constipated patients. While HR_ARM variables and the BET are reproducible within healthy and constipated persons, the outcome on repeat testing differed in 79% of constipated patients.

Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders

The utility of high-resolution anorectal manometry (HR-ARM) for diagnosing defecatory disorders (DDs) is unclear because healthy people may have features of dyssynergia. We aimed to identify objective diagnostic criteria for DD and to ascertain the utility of HR-ARM for diagnosing DD. Constipated patients were assessed with HR-ARM and rectal balloon expulsion time (BET), and a subset underwent defecography. Normal values were established by assessing 184 sex-matched healthy individuals. Logistic regression models evaluated the association of abnormal HR-ARM findings with prolonged BET and reduced rectal evacuation (determined by defecography). A total of 474 constipated individuals (420 women) underwent HR-ARM and BET, and 158 underwent defecography. BET was prolonged, suggesting a DD, for 152 patients (32%). Rectal evacuation was lower for patients with prolonged vs normal BET. A lower rectoanal gradient during evacuation, reduced anal squeeze increment, and reduced rectal sensation were independently associated with abnormal BETs; the rectoanal gradient was 36% sensitive and 85% specific for prolonged BET. A lower rectoanal gradient and prolonged BET were independently associated with reduced evacuation. Among constipated patients, the probability of reduced rectal evacuation was 14% when the gradient and BET were both normal, 45% when either was abnormal, and 75% when both variables were abnormal. HR-ARM, BET, and defecography findings were concordant for constipated patients, and reduced rectoanal gradient was the best HR-ARM predictor of prolonged BET or reduced rectal evacuation. Prolonged BET, reduced gradient, and reduced evacuation each independently supported a diagnosis of DD in constipated patients. We propose the terms probable DD for patients with an isolated abnormal gradient or BET and definite DD for patients with abnormal results from both tests.

Increased NOX1 and DUOX2 expression in the colonic mucosa of patients with chronic functional constipation.

To determine whether oxidative stress and inflammation are associated with constipation by examining the expression of the main producers of reactive oxygen species, nicotinamide adenine dinucleotide phosphate (NADPH) oxidases, and pro-inflammatory cytokines in the colon of patients with chronic functional constipation.The colonic biopsies were collected from 32 patients with chronic functional constipation and 30 healthy subjects who underwent colonoscopy. Colonic mucosal histology was observed. Interleukin (IL)-1β, IL-6, IL-8 messenger RNA (mRNA), and 4 members of NADPH oxidase (NOX1, NOX2, DUOX2, and NOX4) protein and mRNA were assessed by immunohistochemistry, western blotting, and reverse transcription polymerase chain reaction.The tissues from both patients and healthy subjects showed normal histological structure without increase of inflammatory cells. NOX1 protein and mRNA levels were significantly increased compared to controls (P < .05). DUOX2 protein, but not mRNA, was increased by 2-fold compared to controls (P < .05). The levels of NOX2 and NOX4 protein and mRNA demonstrated no significant difference between patients and control subjects. The levels of IL-1β and IL-6 mRNA were significantly higher in constipation patients (P < .05), while IL-8 mRNA level was no different between the 2 groups.NADPH oxidase and pro-inflammatory cytokine might be involved in the pathogeneses of chronic functional constipation.

Associations between intestinal microbiota, fecal properties, and dietary fiber conditions: The Japanese traditional medicine Junchoto ameliorates dietary fiber deficit-induced constipation with F/B ratio alteration in rats.

Changes in the intestinal microbiota are known to occur in constipated patients. Dietary fiber restriction presents obstacles to appropriate defecation and affects fecal properties, but the relationship between fecal microbiota and fecal morphological properties remains obscure. Therefore, we examined the influence of fiber diets on the fecal microbiome and properties in rats, and the effectiveness of the Japanese traditional medicine Junchoto (JCT) in rats with fiber deficit-induced constipation. Rats were fed three different fiber diets with varying cellulose contents (0%, FFD; 5%, ND; 15%, HFD), respectively, as follows: study 1: 21 days of feeding; study 2: 14 days of feeding followed by 7 days of ND (fiber normalization in all groups); study 3: FFD for 21 days, followed by JCT administration from 14 days. Fecal properties and 16S rRNA amplicon sequencing results were examined. We observed that the fecal frequency, dry weight, and length were increased, and water ratio were decreased in a cellulose dose-dependent manner. The difference in several kinds of fecal microbiota, but not the α-diversity Chao1 index and the Firmicutes/Bacteroidetes ratio (F/B ratio), between groups were observed. The change in fecal property in both the HFD and FFD groups was ameliorated with fiber normalization, accompanied by alteration of the Chao1 index and/or F/B ratio. JCT administration reversed the fecal morphological changes in FFD group, accompanied by F/B ratio increasing. In conclusion, short-term dietary changes modulated microbial homeostasis, which is linked to fecal property. JCT may alter the F/B ratio and improve fecal properties to facilitate easier excretion.

A Randomized, Double-blind, Active-controlled Exploratory Clinical Trial for the Evaluation of the Efficacy and Safety of Goodmorning S Granule® on Constipation

Constipation is a common gastrointestinal disease that reduces the quality of life and incurs considerable medical expenses. Bisacodyl and sodium docusate are generally used to treat constipation. This study assessed the effectiveness and safety of Goodmorning S Granule® (Hanpoong Pharm. Co., Ltd., Wanju, Korea) in functional constipation by a comparison with bisacodyl. A 2-week randomized, double-blind, active-controlled exploratory clinical trial was conducted to compare the treatment (Goodmorning S Granule®) with the control (bisacodyl). The efficacy was measured by the changes in transition, Bristol stool type, stomachache, clinical manifestation, defecation time after drug consumption, 36-item short-form survey (SF-36), and the results of improvement evaluation. The safety was evaluated by the incidence of adverse drug events and vital signs. Additional analyses were conducted by dividing the severity according to the proportion of Bristol Stool Scale types 1 and 2. Subjects were randomized to the treatment (n=24) or control (n=26) groups. No significant differences were observed in demographics. After 2 weeks from the baseline, the changes in the complete spontaneous bowel movement (CSBM) were higher in the treatment (4.00±2.62) group than in the control group (1.40±2.34) (p<0.05). The treatment group exhibited significant improvement in the score on the SF-36 questionnaire. The clinical side effects, such as stomachache and borborygmus, were reduced in the moderate constipation patients in the treatment group, according to additional analyses. Goodmorning S Granule®, a herbal medicine, was more effective in improving quality of life and CSBM per week and safer in the moderate constipation groups because of the reduced clinical side effects.

The colonic motility and classification of patients with slow transit constipation by high-resolution colonic manometry

BackgroundThis study aimed to evaluate the colonic motility of slow transit constipation (STC) patients using high-resolution colonic manometry (HRCM) and classify the patients’ subtypes to instruct treatment based on HRCM characteristics. MethodsThis study enrolled one hundred and twenty-six STC patients and 35 volunteers (healthy controls, HCs). Ambulatory HRCM was performed in all participants by placing a 36-sensor water-perfused probe up to the cecum. Quantitative and qualitative manometric analysis was conducted in the state of rest, postprandial, during sleep, and wakefulness. ResultsThe occurrence rate and times of high amplitude propagated contraction (HAPC) in STC patients were lower than HCs. As for the HAPC contraction characteristics, the mean velocity was similar, contraction length, amplitude, area under the curve (AUC) of pressure wave, and duration were reduced in STC patients compared with HCs. In addition, the occurrence rate and times of low amplitude propagated contraction (LAPC) in STC patients were similar compared to HCs. There was no difference in HAPC occurrence, LAPC occurrence, and most detailed HAPC characteristics between STC patients ≤60 years and STC patients >60 years or between male STC patients and female STC patients. Based on the HRCM characteristics (including HAPC, neostigmine induced HAPC, LAPC, and waking/gastrocolic response), STC patients were classified into four types, respectively, with recommended treatment by clinical experience. ConclusionHRCM serves as a valuable tool in characterizing, classifying the pathophysiology, and guiding clinical management for STC.

Expert opinion on the habit forming properties of laxatives in patients with constipation

Constipation is a commonly reported disorder in many patients. Constipation treatment using laxatives on a regular and long term basis can lead to patient dependence, especially among the elderly. However, there is scanty data on the habit-forming potential of laxatives in Indian constipated patients. This review has explored literature evidence and expert opinion on patients’ experience regarding habit-forming attributes of stimulant and osmotic laxatives. Additionally, structured face-to-face discussions were conducted with 2 key opinion leaders to understand their clinical experience on the habit-forming aspects stimulant and osmotic laxatives in patients with constipation. Based on literature evidence, lactulose is not known to lead to any habit-forming behaviors in patients. Furthermore, experts pointed out that dependence on stimulant laxatives is common, but not on osmotic laxatives, and emphasized that milk of magnesia is not habit forming. In conclusion, no habit-forming characteristics or dependence was observed with the use of osmotic laxatives in India. Nevertheless, real-world, studies exploring patient and physician perspectives are warranted to establish the dependence and habit forming attributes of laxatives.

Fecal bacterial microbiota in constipated patients before and after eight weeks of daily Bifidobacterium infantis 35624 administration

Introduction and aimIn recent years, probiotics have been used in functional gastrointestinal disorders, including chronic constipation (CC). The effect of Bifidobacterium infantis strain 35624 on the gut microbiota of CC patients has not been previously studied.Our aim was to analyze the fecal microbiota of constipated patients, before and after consuming a single-strain probiotic (B. infantis strain 35624). Materials and methodsWe used 16S rRNA gene high-throughput sequencing to analyze the fecal microbiota of female patients (n=13) with CC. Patients were instructed to ingest one capsule of Alflorex® (containing 1×109 CFUs/g B. infantis strain 35624) daily for eight weeks. Fecal samples were obtained at the baseline and end (final) of probiotic administration. ResultsAlpha diversity metrics did not differ between the baseline and final periods. The butyrate producer, Oscillospira, was the taxon most strongly correlated with amplicon sequence variants (R2=0.55, p<0.0001). Except for a few bacterial taxa, there were no significant differences in relative abundance between the baseline and final periods. Beta-diversity measures also showed limited evidence for the differences between the two time periods. ConclusionsThe results suggest that the fecal bacterial microbiota remains stable in constipated women consuming a single-strain probiotic. Those findings may be helpful in better understanding probiotic functioning in patients with digestive disorders.

Sleep Deficiency Is Associated With Exacerbation of Symptoms and Impairment of Anorectal and Autonomic Functions in Patients With Functional Constipation.

ObjectiveSleep deficiency (SD) is commonly seen in patients with functional constipation (FC). Our aim was to determine whether the presence of SD would influence symptoms, anorectal motility, sensation, and autonomic function in FC patients.Materials and MethodsA total of 85 FC patients with SD and 193 FC patients without SD underwent high-resolution anorectal manometry. SD was assessed by using the Pittsburgh Sleep Quality Index (PSQI) score. Participants were required to fill in the entire questionnaires, including Patients’ Constipation-symptoms, State-Trait Anxiety Inventory, and Hamilton Depression Scale. Autonomic dysfunction was studied by recording the heart rate variability. Multiple logistic regression was performed to explore the potential risk factors for anorectal function.ResultsFunctional constipation patients with SD had a higher total score of constipation symptom (P < 0.001), in comparison with those without SD. FC patients with SD demonstrated significantly lower threshold volume for first sensation (P < 0.001) and urge (P < 0.001), as compared to those without SD. The PSQI score positively correlated with constipation symptom total score (P < 0.001), and negatively correlated with threshold volume for first sensation (P < 0.001) and urge (P < 0.001). FC patients with SD had a reduced vagal activity (P = 0.016) and a higher sympathetic activity as compared to those without SD (P = 0.003). Multivariate logistic regression revealed that SD, anxiety and depression were independent risk factors for anorectal function, with SD exhibiting the highest degree of association with first sensation (OR: 4.235).ConclusionSleep deficiency is associated with worse constipation related symptoms, altered anorectal function and perception, and impaired autonomic function in FC patients.

Recto-anal Pressures in Constipated Men and Women Undergoing High-Resolution Anorectal Manometry.

In constipated individuals, high-resolution anorectal manometry (HRM) may suggest the presence of a defecatory disorder. Despite known physiological differences between men and women, our understanding of functional anorectal pathophysiology is based upon predominantly female cohorts. Results are generalized to men. To evaluate whether recto-anal pressure patterns in constipated men are similar to those in constipated women. The electronic health records at Mayo Clinic, Rochester were used to identify constipated adult patients, without organic anorectal disease, who had undergone HRM and balloon expulsion testing (BET) in 2018, 2019, and 2020. Comparative analyses were performed. Among 3,298 constipated adult patients (2,633 women, 665 men), anal and rectal pressures were higher in men. Women more likely to have HRM findings suggestive of a defecatory disorder (39% versus 20%, P < 0.001). Women were more likely to exhibit a type 4 pattern (27% versus 14%, P < 0.001), and less likely to exhibit a type 1 pattern (14% versus 38%, P < 0.001), of dyssynergia. Men were more likely to have an abnormal balloon expulsion test (BET, 34% versus 29%, P = 0.006). Nominal logistic regression demonstrates that male sex, age over 50years, reduced recto-anal gradient during simulated evacuation, and types 2 and 4 dyssynergia are associated with an abnormal BET. In this large retrospective study, constipated men and women exhibited different patterns of dyssynergia both in the presence and absence of an abnormal BET. These findings were independent of sex-specific baseline physiological differences.

La microbiota bacteriana fecal en pacientes estreñidos previa y posterior a ocho semanas de administración diaria de Bifidobacterium infantis 35624

Introduction and aimIn recent years, probiotics have been used in functional gastrointestinal disorders, including chronic constipation (CC). The effect of Bifidobacterium infantis strain 35624 on the gut microbiota of CC patients has not been previously studied.Our aim was to analyze the fecal microbiota of constipated patients, before and after consuming a single-strain probiotic (B. infantis strain 35624). Material and methodsWe used 16S rRNA gene high-throughput sequencing to analyze the fecal microbiota of female patients (n=13) with CC. Patients were instructed to ingest one capsule of Alflorex® (containing 1×109CFUs/g B. infantis strain 35624) daily for eight weeks. Fecal samples were obtained at the baseline and end (final) of probiotic administration. ResultsAlpha diversity metrics did not differ between the baseline and final periods. The butyrate producer, Oscillospira, was the taxon most strongly correlated with amplicon sequence variants (R2=0.55, p<0.0001). Except for a few bacterial taxa, there were no significant differences in relative abundance between the baseline and final periods. Beta-diversity measures also showed limited evidence for the differences between the two time periods. ConclusionsThe results suggest that the fecal bacterial microbiota remains stable in constipated women consuming a single-strain probiotic. Those findings may be helpful in better understanding probiotic functioning in patients with digestive disorders.

Effects of Lactobacillus plantarum P9 Probiotics on Defecation and Quality of Life of Individuals with Chronic Constipation: Protocol for a Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Background Although probiotics have been shown to improve constipation-related symptoms, a clear consensus on the use of probiotics as a constipation-relieving agent has not been reached, which is attributed to the limited available evidence and inconsistent protocols used in existing studies. Method A randomized, double-blind, placebo-controlled clinical trial is designed to study the efficiency and possible mechanism of action of probiotics for chronic constipation, in which 200 eligible volunteers with chronic constipation will be randomly assigned to a probiotic group (oral Lactobacillus plantarum P9 probiotic powder, 100 billion colony-forming units (CFUs)/day) or a placebo group. Volunteers, treatment distributors, data collectors, and data analysts will be blinded. The primary outcome is the weekly mean frequency of complete spontaneous bowel movements (CSBMs), and secondary outcomes include weekly mean frequency of CSBMs ≥3, weekly mean frequency of spontaneous bowel movements (SBMs), weekly mean stool appearance score, weekly mean difficulty of passing stool score, weekly percentage of volunteers who use auxiliary measures to assist with defecation (WPUAMA), quality-of-life (QOL) score, emotional status score, gut microbiome, and faecal metabolome. Each outcome measure will be assessed at the time points of preadministration (day 0), administration (day 14 and/or 28), and postadministration (day 42) to identify inter- and intragroup differences. Adverse events will be recorded to evaluate the safety of L. plantarum P9. Discussion. The protocol will provide methodological guidance for other similar studies, avoiding methodological bias and ultimately facilitating the formulation of consensus on the use of probiotics as a constipation-relieving agent. In addition, the results are more comprehensive than those of existing studies and may objectively and scientifically reflect the effectiveness of L. plantarum P9 on constipation. If the expected study findings are obtained, L. plantarum P9, taken as a probiotic, may become a complementary choice for chronically constipated patients. This trial is registered with Chinese Clinical Trial Registry (ChiCTR) (no. ChiCTR2000038396) registered on November 22, 2020, https://www.chictr.org.cn/showproj.aspx?proj=54024.

Rapid health technology assessment of four oral Chinese patent medicines for constipation

This study evaluated the safety, efficacy, and cost effectiveness of Biantong Capsules(Tablets), Maren Runchang Pills, Qirong Runchang Oral Liquid, and Qihuang Tongmi Soft Capsules in the treatment of constipation by the rapid health technology assessment(RHTA) to provide evidence for clinical decision and references for rapid evaluation of Chinese patent medicine(CPM). CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Web of Science, and Cochrane Library were searched for research articles from database inception to February 2022. Two reviewers conducted literature screening, data extraction, and quality evaluation according to the predetermined standards. Descriptive analysis of the results combined with visual charts was performed. Sixty research articles were included, involving 44 randomized controlled trials(RCTs), 7 clinical controlled trials(CCTs), 4 systematic reviews/Meta-analyses, and 5 economic analysis studies. As revealed by the results, Biantong Capsules(Tablets) could be used for postoperative and senile constipation, in which some studies reported Biantong Capsules(Tablets) were superior to Maren Runchang Pills and Qirong Runchang Oral Liquid. Maren Runchang Pills were mainly used for senile constipation, and the efficacy was similar to that of conventional wes-tern medicine, but the cost was low and the compliance of patients was good. Qirong Runchang Oral Liquid was indicated for disease-derived or drug-induced constipation, chronic constipation, and senile constipation with fewer adverse reactions. Qihuang Tongmi Soft Capsules had good efficacy and safety in the treatment of functional constipation. Overall, compared with western medicine glycerine enema and lactulose, the number of clinical studies of the four CMPs was small, but they targeted constipation patients with different subtypes. In conclusion, the four CMPs have their advantages and characteristics in the treatment of constipation, but they are restric-ted by sparse existing evidence, low quality of evidence, and insufficient economic research. In the future, more high-quality and long-term follow-up studies should be carried out to obtain reliable evidence. Meanwhile, it is called for strengthening the economic evaluation of CMPs to provide evidence for decision-making.