Severity Of Constipation Research Articles

Abdominal Massage in Functional Chronic Constipation: A Randomized Placebo-Controlled Trial.

The aim of this study was to investigate the effects of abdominal massage on the severity of constipation, bowel function, and quality of life (QoL) in patients with functional chronic constipation in a randomized placebo-controlled design. Seventy-four patients diagnosed with functional constipation according to the Rome IV diagnostic criteria were included. Patients were randomly assigned to the intervention group (abdominal massage plus lifestyle advice) or the control group (placebo therapeutic ultrasound plus lifestyle advice). Abdominal massage or placebo ultrasound was applied for 4weeks. The primary outcome measure was the Constipation Severity Instrument score. Bowel diary data and the Patient Assessment of Constipation Quality of Life Questionnaire score were used as secondary outcome measures. Differences in outcome measures within and between groups were analyzed by repeated-measures analysis of variance. Although constipation severity, bowel function indicators (defecation frequency and duration and stool consistency), and QoL were found to improve significantly over time in both groups, improvements in both primary and secondary outcomes were much more significant in the abdominal massage group. In addition, group × time interaction effects were found to be significant for constipation severity, bowel function findings, and QoL. There were approximately 70% and 28% reductions in constipation severity, 56% and 38% improvement rates in QoL, and 70% and 43% increases in defecation frequency in the intervention and placebo groups, respectively. Abdominal massage should be one of the first-line conservative approaches in the management of functional chronic constipation. Further randomized placebo-controlled studies with long-term follow-up are needed. For functional constipation, which is a common gastrointestinal problem, abdominal massage should be considered as an option in first-line therapy because of its effect beyond the placebo effect. If you have functional constipation, your physical therapist may be able to provide abdominal massage to help reduce your symptoms.

Nutritional Intake and Gut Microbiome Composition Predict Parkinson's Disease.

BackgroundModels to predict Parkinson’s disease (PD) incorporating alterations of gut microbiome (GM) composition have been reported with varying success.ObjectiveTo assess the utility of GM compositional changes combined with macronutrient intake to develop a predictive model of PD.MethodsWe performed a cross-sectional analysis of the GM and nutritional intake in 103 PD patients and 81 household controls (HCs). GM composition was determined by 16S amplicon sequencing of the V3-V4 region of bacterial ribosomal DNA isolated from stool. To determine multivariate disease-discriminant associations, we developed two models using Random Forest and support-vector machine (SVM) methodologies.ResultsUsing updated taxonomic reference, we identified significant compositional differences in the GM profiles of PD patients in association with a variety of clinical PD characteristics. Six genera were overrepresented and eight underrepresented in PD patients relative to HCs, with the largest difference being overrepresentation of Lactobacillaceae at family taxonomic level. Correlation analyses highlighted multiple associations between clinical characteristics and select taxa, whilst constipation severity, physical activity and pharmacological therapies associated with changes in beta diversity. The random forest model of PD, incorporating taxonomic data at the genus level and carbohydrate contribution to total energy demonstrated the best predictive capacity [Area under the ROC Curve (AUC) of 0.74].ConclusionThe notable differences in GM diversity and composition when combined with clinical measures and nutritional data enabled the development of a predictive model to identify PD. These findings support the combination of GM and nutritional data as a potentially useful biomarker of PD to improve diagnosis and guide clinical management.

Is there a link between neuropathic pain and constipation in NMOSD and MOGAD? Results from an online patient survey and possible clinical implications

BackgroundNeuropathic pain (NP) and constipation are common among people with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and have a negative impact on quality-of-life measures. The possible association between the two symptoms has not been explored. MethodsPatients with NMOSD and MOGAD, who were members of a closed international Facebook group, were recruited to complete an anonymous survey on REDCap. Participants were queried regarding demographic and disease-related characteristics, the presence and severity of NP and constipation, and whether they believe there is a relationship between the two symptoms. ResultsOf the 317 participants who completed the survey, 213 (67.2%) reported a diagnosis of aquaporin-4 (AQP-4) positive NMOSD, 93 (29.4%) – MOGAD, and 11 (3.4%) – double-seronegative NMOSD. The mean age was 43.9 ± 16.4 years; 259 were female (81.7%). 206 participants (65%) reported NP, of whom 133 (64.6%) were being treated for it with one or more medications. 167 participants (52.7%) reported constipation, of whom 67 (40.2%) received one or more medications. 137 of 206 participants with NP (66%) also had constipation. Both symptoms were significantly more common among patients with a history of myelitis. Among patients with NP and constipation, 47 participants (34.3%) thought there was a relationship between the two conditions, with the majority reporting increased severity of NP when constipation severity was increased and, conversely, alleviation of NP when constipation lessened. ConclusionsNP and constipation were seen in the majority of NMOSD and MOGAD patients with a history of myelitis. Interestingly, one-third of patients with both symptoms reported a link between them, with the majority reporting that NP severity was increased with worse constipation. The possible association opens a possibility of a new approach to managing NP, which tends to be poorly responsive to symptomatic therapies and is associated with worse quality of life in NMOSD and MOGAD. Further studies are warranted to confirm our results.

Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled trial

BackgroundConstipation is a common chronic bowel disorder with an incidence of more than 50% in the elderly population. Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly. ObjectiveThis study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill. and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life. Design, setting, participants and interventionThis double-blind randomized active controlled clinical trial, with parallel group allocation ratio of 1:1, was conducted in a referral clinic in Afzalipour Hospital, affiliated to Kerman University of Medical Sciences in Kerman, Southeastern Iran. Individuals over 60 years of age, diagnosed with functional constipation (based on the Rome IV criteria), were included in this study. Participants received a sachet of 10 g F. vulgare and R. damascena (herbal formula group) or polyethylene glycol 4000 (PEG 4000 group) with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks. Main outcome measuresConstipation severity, stool consistency, and the quality of life were used as the primary outcomes. Drug side effects were used as a secondary outcome. The outcomes were assessed using the Constipation Assessment Scale, the Bristol Stool Form Scale, and the Patient Assessment of Constipation Quality of Life questionnaire. ResultsA total of 25 participants in each group completed the four-week treatment cycle and the eight-week follow-up. At the end of the four-week treatment cycle, all clinical outcomes had significant improvements in both groups (P < 0.05). The analysis of constipation severity (P < 0.001), stool consistency (P < 0.001), and the quality of life (P < 0.001) showed significant improvements with fewer side effects (mild diarrhea) and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group. ConclusionAlthough both interventions significantly improved the treatment outcomes, constipation severity, stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000; however, the mechanism of action is not yet understood. Trial registrationThis trial was registered in the Iranian Registry of Clinical Trials (IRCTID: IRCT20200108046056N1).

A pilot randomized placebo-controlled study on modified MaZiRenWan: a formulated Chinese medicine to relieve constipation for palliative cancer patients

BackgroundConstipation is a common problem among advanced cancer patients; however, many of them find limited effective from current therapies. Thus, we aimed to test the effect of a traditional Chinese herbal formula, modified MaZiRenWan (MZRW), by comparing with placebo among palliative cancer patients with constipation.MethodsThis is a randomized, double-blind, placebo-controlled trial. Participants aged over 18 were recruited and randomized to MZRW or placebo group in addition to current prescriptions (including ongoing laxatives treatment) for two weeks. Exclusion criteria included cognitive impairment, presence of a colostomy or gastrointestinal obstruction and estimated life expectancy of less than one month. Individualized modification of MZRW was allowed according to the traditional Chinese medicine (TCM) pattern of patient. The primary outcome was the global assessment of improvement, which reflected whether the constipation had improved, remained the same or worsened.ResultsSixty patients, with mean age 75.2 years (range 47–95 years), were randomized to MZRW or placebo group. Among the MZRW group, 59.3% (16/27) had improvement in the global assessment score, as compared with 28.6% (8/28) of the placebo group (p-value = 0.022). Besides, the MZRW group had significant increase in stool frequency, and reduction in constipation severity and straining of defecation (p-value < 0.05). No serious adverse event was reported due to the research medication.ConclusionThis pilot trial suggests modified MZRW is well-tolerated and effective for relief of constipation in patients with advance cancer. It could be considered as a potential treatment option for constipation in palliative care.Trial registration: The trial had been registered in ClinicalTrials.gov with identifier number NCT02795390 [https://clinicaltrials.gov/ct2/show/NCT02795390] on June 10, 2016.

The effect of abdominal massage on the severity of constipation in elderly patients hospitalized with fractures: A randomized clinical trial

BackgroundThere is significant interest in the use of complementary therapies to control or reduce the severity of constipation. AimThe aim of this study was to determine the effect of abdominal massage on the severity of constipation in elderly patients with fractures. MethodsIn this randomized clinical trial, 60 elderly patients admitted to an Iranian orthopedic referral hospital who were suffering from constipation were randomly assigned to intervention and control groups. For the intervention group, abdominal massage was performed for 3 days, twice a day, for 15 minutes. Both groups were assessed using the Constipation Assessment Scale (CAS) and the Bristol Stool Scale (BSS). ResultsA statistically significant difference was observed between the two groups in BSS scores (p < 0.05). The mean CAS scores in the intervention group decreased from 10.74 to 4.51 after intervention and in the control group, it decreased from 10.20 to 7.37. There was a statistically significant difference in CAS scores between the two groups (p < 0.05). ConclusionThe results of the study showed the positive effect of abdominal massage on stool consistency and reduction of severity constipation.

Clinical phenotypes and constipation severity in Parkinson’s disease: Relation to Prevotella species

Clinical phenotypes and constipation severity in Parkinson’s disease: Relation to Prevotella species

Abstract OT1-12-03: Phase II study of pyrotinib plus nanoparticle albumin-bound (nab)-paclitaxel as adjuvant therapy for lymph node-negative (N0) or micrometastatic (N1mi), HER2-positive early breast cancer (PHAEDRA)

Abstract Background: Nowadays, dual HER2-targeted therapy has become the mainstay for high-risk HER2-positive breast cancer. However, for low-risk resectable HER2-positive breast cancer, the optimal adjuvant regimen remains inconclusive. Mono anti-HER2 antibody combined with single-agent chemotherapy has become a recommended adjuvant regimen for N0, small HER2-positive tumors, but there is scarcity of evidence on tyrosine kinase inhibitors (TKIs) for low-risk HER2-positive breast cancer. The randomized phase III PHOEBE trial has proved the superiority of pyrotinib, a novel irreversible pan-ErbB receptor TKI targeting HER1, HER2, and HER4, over lapatinib when in combination with capecitabine for HER2-positive metastatic breast cancer. We believe pyrotinib can also show promising activity in early breast cancer. Regarding the chemotherapy backbone, nab-paclitaxel exhibits its therapeutic advantage over solvent-based paclitaxel and is widely used in combination with immunotherapy. This study is conducted to evaluate pyrotinib plus nab-paclitaxel in the adjuvant setting for patients with low-risk HER2-positive breast cancer. Moreover, diarrhea is the most common adverse event of pan-HER TKIs. Given the unknown incidence and severity of diarrhea with pyrotinib plus nab-paclitaxel and no consensus on therapeutic or prophylactic strategy of pyrotinib-related diarrhea, a sub-study is conducted to investigate the effect of different prophylactic strategies with loperamide for diarrhea. Trial design: This is a multicenter, open-label, single-arm phase II study. Patients will receive nab-paclitaxel 260 mg/m2 once every 3 weeks for 12 weeks and pyrotinib 240 mg once daily for one year within 90 days after surgery. In the sub-study, 120 patients will be randomly (1:1) assigned to two cohorts. Cohort A will receive loperamide during cycle 1 of adjuvant therapy with pyrotinib plus nab-paclitaxel, at a dose of 4 mg three times a day on days 1-7 and 4 mg twice a day on days 8-21. Cohort B will receive loperamide during cycles 1 and 2 of adjuvant therapy, at a dose of 4 mg three times a day on days 1-7 and 4 mg twice a day on days 8-42. Eligibility criteria: Women aged 18-75 years with histologically confirmed N0/N1mi, HER2-positive invasive breast cancer, primary tumor ≤3 cm, ECOG performance score of 0 or 1, known hormone receptor status, and adequate bone marrow, hepatic, renal, and cardiac function. Aims: The primary endpoint is invasive disease-free survival (iDFS). Secondary endpoints are safety and tolerability. In the sub-study, the primary endpoint is the incidence of grade ≥3 diarrhea, and secondary endpoints include the incidence and severity of diarrhea during the first 2 cycles of adjuvant therapy, the incidence and severity of constipation, the onset time, frequency and duration of grade ≥3 diarrhea, relationship between diarrhea and study drugs, the incidence of dose reduction, discontinuation and hospitalization due to diarrhea, and quality of life questionnaire score using the Functional Assessment of Cancer Therapy-Breast. Statistical methods: The primary efficacy analysis will be performed in the full analysis set, defined as all patients with at least one dose of study drug. iDFS will be estimated using Kaplan-Meier method. Safety will be analyzed in the safety set, defined as all patients with at least one dose of study drug and at least one safety assessment. Accrual: Target accrual is 261 patients at approximately 5 sites in China. The first patient was enrolled on January 14, 2021. Accrual is ongoing. Citation Format: Changjun Wang, Yidong Zhou, Yan Lin, Feng Mao, Jinghong Guan, Xiaohui Zhang, Songjie Shen, Xuejing Wang, Yanna Zhang, Bo Pan, Ying Zhong, Li Peng, Xi Cao, Ru Yao, Xingtong Zhou, Chi Xu, Ying Xu, Qiang Sun. Phase II study of pyrotinib plus nanoparticle albumin-bound (nab)-paclitaxel as adjuvant therapy for lymph node-negative (N0) or micrometastatic (N1mi), HER2-positive early breast cancer (PHAEDRA) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-12-03.

Management of bloating.

Abdominal bloating is a subjective sensation of trapped abdominal gas, producing abdominal pressure, fullness sensation, and, in some patients, associated objective abdominal distension. In this month's edition of the journal, a new validated questionnaire to assess the prevalence and impact of gas-related symptoms is presented by Duracinsky et al., showing that gas-related abdominal symptoms are prevalent in patients with irritable bowel syndrome and have a measurable impact on patients daily life. A parallel study by Gardiner et al. assessing the severity of bloating in functional gastrointestinal disorders shows that severe bloating is associated with the severity of abdominal pain, constipation, and somatization, advancing our understanding of the clinical characteristics and relevance of gas-related symptoms in the broad spectrum of functional gastrointestinal disorders. Management of bloating includes non-pharmacological and pharmacological strategies. Dietary interventions to reduce intestinal fermentation and ingestion of food supplements like prebiotics or probiotics can reduce bloating by reducing gas production. The main targets of pharmacological treatments are to improve transit and evacuation with prokinetics, to improve intestinal gas tolerance with antispasmodics and/or neuromodulators, and to modify intestinal microbiota with antibiotics. Secretagogues act by increasing intestinal secretion and decreasing visceral sensitivity and have been reported to be an effective treatment alternative for patients with bloating associated with constipation. Biofeedback therapy addressed to correct abdomino-phrenic dysynergia may be useful for patients with objective abdominal distension, and patients with bloating associated with outlet obstructed defecation may benefit from anorectal biofeedback.

Anorectal dysfunction in adults with spina bifida and associated socio-emotional factors-a retrospective, cross-sectional cohort study.

Retrospective, cross-sectional study. To investigate prevalence, types, and severity of fecal incontinence (FI) and constipation in adults with spina bifida (SB), in relation to self-perception and help-seeking, and to compare findings to data from a general population reference group. University Medical Center Groningen (UMCG), the Netherlands. The 294 adults with SB registered at UMCG in 2017 were invited to participate. The Groningen Defecation and Fecal Continence Questionnaire was used to assess functional outcomes for FI and constipation using Rome IV criteria. Vaizey (for FI) and Agachan (for constipation) scores were determined. Socio-demographic factors and self-perception of bowel-related problems were recorded through the questionnaire. Data were compared with an age and sex matched reference group. The completed questionnaires of 112 (38%) responding participants were analyzed. FI and constipation were more prevalent in the study group (35% and 45%, respectively) than in the reference group (8.9% and 22%, respectively). In general, in participants with SB aperta (SBA; n = 75), FI was more severe than in participants with SB occulta (SBO; n = 37). However, severity of FI was higher in SBO participants than in the SBA group after the age of 61. Bowel problems in adults with SB were associated with worse self-perception regarding health. In adults with SB, anorectal dysfunction is often present and severe. Older persons with SBO experience more severe FI than in early age. Bowel problems should systematically and more adequately be addressed and controlled throughout adulthood in both the spina bifida groups.

A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults.

Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (β = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (β = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.

Women with chronic constipation have more bothersome urogenital symptoms.

The aim of our study was to characterize urogenital symptoms in women with and without constipation, and by severity of constipation. This was a retrospective cohort study conducted at a pelvic floor disorder center in a tertiary healthcare facility from May 2007 through August 2019 and completed an intake questionnaire were included. We collected demographic, physical exam data and quality of life outcomes. The Urinary Distress Inventory (UDI-6) was used to assess urogenital symptoms. Women with constipation completed the Constipation Severity Instrument (CSI). We excluded women with a history of a bowel resection, inflammatory bowel disease, or pelvic organ prolapse symptoms. The cohort was then divided into two groups, constipated and non-constipated, and the prevalence and severity of urogenital-associated symptoms were compared. A secondary analysis was made among constipated subjects stratified by constipation severity based on CSI scores. During the study period, 875 women (59.5%) had chronic constipation. Women with chronic constipation were more likely to experience urogenital symptoms, such as dyspareunia, urinary hesitancy, and a sensation of incomplete bladder emptying (all p < 0.05). Moreover, on univariate analysis,women with high CSI scores (75 percentile or higher)were found to have higher UDI-6 scores, increasedbladder splinting, pad use, urinary frequency and dyspareuniawhile onmultivariate analysis higher UDI score, increasedbladder splinting, urinary frequency and dyspareunia were significantly associated (p < 0.05). We found that the presence and severity of chronic constipation worsened the degree of bother from urogenital symptoms. Given that chronic constipation can modulate urogenital symptoms, our study suggests that pelvic floor specialists should assess the presence and severity of urogenital and bowel symptoms to provide comprehensive care.

Constipation is Associated With Mild Cognitive Impairment in Patients With de novo Parkinson's Disease.

ObjectiveThe association between gastrointestinal (GI) symptoms and cognitive profile in patients with Parkinson’s disease (PD) at diagnosis remains unclear, although GI symptoms and cognitive impairment are highly prevalent in patients with PD. We investigated the relationship between constipation and cognitive status. We also aimed to identify the correlation between constipation and each neuropsychological dysfunction.MethodsA total of 427 patients with de novo Parkinson’s disease with normal cognition (PD-NC, n = 170) and Parkinson’s disease with mild cognitive impairment (PD-MCI, n = 257) at Korea University Guro Hospital in Seoul, Korea were included. All patients underwent comprehensive neuropsychological tests and completed the Non-Motor Symptoms Scale (NMSS). The frequency and severity of constipation were assessed using the NMSS GI symptoms scale, we used logistic regression analysis and partial correlation analysis to determine the associations between constipation score, MCI, and each neuropsychological dysfunction.ResultsFrequent and severe constipation was associated with MCI in patients with PD at diagnosis regardless of disease severity. Specifically, constipation was related to poor performance in frontal-executive and visuospatial functions after controlling for age and sex.ConclusionOur findings may provide an understanding of constipation as a marker associated with cognitive impairment in individuals with PD. Therefore, the evaluation of cognitive function is warranted in PD patients with constipation, while further studies are necessary to investigate the detailed mechanism of our results.

Effect of Face-to-Face and Multimedia Methods of Education on Children’s Constipation Severity

Background: Constipation is a common problem among children. The aim of this study was to compare the effect of face-to-face and multimedia education on the severity of functional constipation in children. Methods: It was a two-group pre-test post-test quasi-experimental study that was carried out at the Specialized Clinics of Pediatrics affiliated with the Arak University of Medical Sciences, Arak, Iran. The sample consisted of 96 eligible children in the age range of 6 to 12 years that were randomly assigned to face-to-face (n=48) and multimedia (n=48) groups. Functional constipation was detected by Rome ΙΙΙ criteria. Data were collected by a demographic characteristics form and the Constipation Assessment Scale (CAS) before intervention and one month later in both groups. In the face-to-face group, education was provided using two 15-min training sessions in the form of a lecture in the presence of the mother. The multimedia training group received a 15-min training video. Both groups were given a pamphlet. The data were analyzed by Fisher’s exact test, independent t-test, and paired t-test using SPSS version 16. Results: There was no significant difference between the groups’ constipation severity before the intervention (P=0.12). There was a significant difference between the mean score of constipation severity between the face-to-face (P=0.01) and multimedia (P=0.001) groups before and after the intervention. However, the mean±SD score of constipation severity after the intervention was 7.05±1.79 in the face-to-face group and 5.91±1.69 in the multimedia group (p=0.001). Conclusion: The results of this study showed that both educational interventions reduced the severity of constipation in children. However, multimedia training was more effective than face-to-face education so that it reduced the severity of constipation to a greater extent.

Efficacy of Natural Formulation Containing Activated Charcoal, Calcium Sennosides, Peppermint Oil, Fennel Oil, Rhubarb Extract, and Purified Sulfur (Nucarb®) in Relieving Constipation.

IntroductionLong-term use of laxatives may have side effects such as bloating, allergic reaction, abdominal pain, metabolic disturbances, and hepatotoxicity. In this study, we have compared the efficacy of herbal medicine Nucarb, a combination of activated charcoal, calcium sennosides, peppermint oil, fennel oil, rhubarb extract, and purified sulfur, in relieving constipation.MethodsThis longitudinal study was conducted in multiple cities of Pakistan from April 2021 to June 2021. A total of 1000 patients, of either gender between age group 18 and 75 years, with complete spontaneous bowel movement of less than or equal to two times per week, were enrolled in the study. Participants were prescribed two tablets of Nucarb once daily (OD) at bedtime for the first seven days, followed by one tablet of Nucarb OD at bedtime for the following seven days. They were asked to return for follow-up after 14 days.ResultsThere was a statistically significant improvement in all six components of constipation. After 14 days, the severity of constipation reduced by 80.70%, the sensation of straining was reduced by 72.69%, and the feeling of incomplete evacuation was reduced by 71.87%. There was no adverse event reported.ConclusionNucarb is efficacious in reducing the severity of constipation, sensation of straining, bloating and abdominal pain, feeling of incomplete evacuation, and difficulty in passing gas. Since it is a herbal product, it can be safely used in all populations.

Measuring self-efficacy in defecation: Validation and utilization of a Chinese version of the self-efficacy for functional constipation questionnaire (SEFCQ) in a pediatric population.

Self-efficacy in defecation plays an important role on behavioral therapy for functional constipation (FC). There is an unmet need for valid child self-report measures of task-specific self-efficacy for pediatric FC. Our aim was to cross-culturally validate the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ) and to explore the salient factor(s) of self-efficacy in defecation that correlate with anxiety and constipation symptom severity among Chinese children. The SEFCQ was adapted to Chinese version following the Rome Foundation guidelines for the translation of questionnaires. Two hundred and three children with FC were involved in psychometric testing. Confirmatory factor analysis was conducted to determine the structure of the SEFCQ. Construct validity was evaluated by testing the relationship between the SEFCQ and both anxiety and the Patient Assessment of Constipation Symptoms (PAC-SYM). Test-retest reliability, internal consistency, and interfactor correlation were used to evaluate reliability. Hierarchical multiple regression was used to identify salient self-efficacy for FC that correlates with anxiety and constipation symptom severity. Confirmatory factor analysis supports the two-factor structure of the SEFCQ. Adequate test-retest reliability (r=0.973, p<0.001) and internal consistency (Cronbach's α=0.871) were obtained. Both self-efficacy factors were significantly associated with anxiety (r=-0.227 to -0.350, p<0.001) and PAC-SYM (r=-0.495 to -0.602, p<0.001), with emotional self-efficacy being the most salient factor for predicting the symptom severity of constipation after controlling for sex, age, quality of parents' marriage, and family history. The SEFCQ showed satisfactory psychometric properties. Low self-efficacy in defecation correlates with anxiety and may contribute to poor adherence to behavior change, which exacerbates the symptoms of constipation. Further study is needed to apply social cognitive intervention to increase children's self-efficacy in defecation and assess its effect on treatment outcomes.

Do Children With Constipation Have Increased Risk of Asthma? Real-World Data From a Nationwide Population-Based Cohort Study.

Background: Asthma is one of the most burdensome childhood disorders. Growing evidence disclose intestinal dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microbiota. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess whether pediatric constipation influence the risk of developing asthma by a nationwide population-based cohort study.Methods: We analyzed 10,363 constipated patients and 10,363 individuals without constipation between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Analysis of propensity score was utilized to match age, sex, comorbidities, and medications at a ratio of 1:1. In addition, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were performed.Results: After adjustment for age, sex, comorbidities, and medications, constipated patients had a 2.36-fold greater risk of asthma compared to those without constipation [adjusted hazard ratio (aHR): 2.36, 95% C.I. 2.04–2.73, p < 0.001]. Furthermore, the severity of constipation is associated with an increased risk of asthma; the adjusted hazard ratio was 2.25, 2.85, and 3.44 within < 3, 3–12, and ≥12 times of laxatives prescription within 1 year, respectively (p < 0.001).Conclusion: Constipation was correlated with a significantly increased risk of asthma. Pediatricians should be aware of the possibility of asthma in constipated patients. Further research is warranted to investigate the possible pathological mechanisms of this association.

Symptom severity and clinical characteristics of patients with bloating.

Abdominal bloating is common in functional gastrointestinal disorders (FGID). To better characterize this patient population, we evaluated clinical and psychological characteristics of bloating and analyzed their differences by bloating severity. Patients with FGIDs evaluated at a single academic outpatient referral gastroenterology clinic were surveyed. Bloating severity was classified as minimal, moderate or severe. Symptom-specific questionnaires were used to evaluate bowel habits, abdominal bloating, depression, anxiety, somatization and sleep disturbance. Associations between bloating severity, clinical characteristics and FGID subtypes were analyzed in univariate and multivariate modeling. Of 612 FGID patients included (78% female, mean age of 44±16.5years), bloating was reported as minimal in 231(37.8%), moderate in 217(35.4%), or severe in 164(26.8%). Patients with severe bloating were more likely to be female, younger, and have co-existing functional dyspepsia than those with minimal bloating (p<0.05). Bloating severity and severity of abdominal distension were significantly correlated (p<0.05). On multivariable regression, patients who met criteria for functional constipation and functional dyspepsia had 80% and 125% higher odds, respectively, of severe bloating compared to minimal to moderate bloating. Younger age, abdominal pain and constipation severity, and somatization scores were also independently associated with severity of bloating. Severe bloating is associated with younger age, and with more severe abdominal pain, constipation, and somatization. Patients who met criteria for functional constipation and functional dyspepsia are more likely to experience severe bloating.

Chronic constipation is negatively associated with colonic diverticula

Objectives Constipation has been considered the key risk factor for diverticulosis occurrence, but the underlying mechanism is unclear. We investigated the factors associated with diverticulosis, focusing on the association of constipation severity with the localization and number of diverticula. Materials and methods We analyzed consecutive patients who underwent colonoscopy between March and December 2019. Chronic constipation was diagnosed as constipation meeting Rome IV criteria or as that requiring laxative therapy for more than 6 months. The degree of constipation was scored using the Constipation Scoring System (CSS). Results We assessed 1014 patients. Multivariate analysis revealed that age, alcohol consumption, and hypertension were positively associated with diverticulosis, whereas chronic constipation was negatively associated with diverticulosis (odds ratio [OR] = 0.74; 95% confidence interval [CI], 0.55–0.99). When assessed according to the location of diverticula, right-sided diverticula were significantly associated with a lower incidence of constipation (OR = 0.94; 95% CI, 0.89–0.98), whereas neither left-sided nor bilateral diverticula was associated with constipation. This negative association of diverticula with constipation was stronger in patients with a high CSS score. In stratified analysis, the number of diverticula decreased with increasing degree of constipation (p for trend <.01), and a high CSS score was associated with a decreased prevalence of ≥3 diverticula (OR = 0.64; 95% CI, 0.44–0.99). Conclusions Chronic constipation was negatively associated with colonic diverticulosis. The association increased with the degree of constipation and was strong only in cases with right-sided diverticula and those with ≥3 diverticula.

Melanosis Coli Is Not Associated with Colonic Dysmotility Nor Severity of Pediatric Functional Constipation.

Sennosides are commonly used for the treatment of constipation and associated with melanosis coli. In the present study, we evaluated the utility of melanosis coli as a marker of severity and its association with colonic motility in children with functional constipation. Prospective study includes pediatric patients undergoing colonic manometry and colonic biopsies. Demographic data, medication history, surgical history, colonic manometry results (gastrocolonic response to a meal, high-amplitude propagating contractions, and nonpropagating contractions), colonic manometry catheter position, and pathologic results were collected and analyzed. We compared those variables with outcome (need for surgery) between both patient groups (presence or absence of melanosis coli). A total of 150 patients were included, median age was 9.9years (range 2.1-18) and 77 (51.3%) were female, 17 had melanosis. Patients who took sennosides had higher rates of melanosis coli compared to those who did not (adjusted OR 13.88; 95% CI 4.05-47.57; P < 0.001), and we did not find an association between melanosis coli and use of other medications (osmotic laxatives, bisacodyl, lubiprostone), age, gender, weight, and height. We found no significant difference in the results colonic manometry between patients with and without melanosis coli. The rates of surgery for constipation between patients with and without melanosis coli were not statistically different. (OR 3.00; 95% CI 0.45-20.07; P = 0.257). Melanosis coli is associated with sennosides use, but it does not influence colonic motility nor is associated with increased subsequent need for surgery in pediatric functional constipation.