Gastrointestinal symptoms in Parkinson's disease (PD), in particular chronic constipation, are common and are treated in China using the traditional Chinese medicine (Jia-Wei-Ji-Chuan-Jian decoction) (JWJCJ)). However, information on therapeutic targets and the underlying mechanism is limited. A total of 72 PD patients with constipation attending Departments of Neurology in Shanghai, China (Shanghai Pudong New Area Gongli Hospital and Shuguang Hospital Affiliated to Shanghai University) were recruited into the study and allocated to a Treatment group (n=36) and a Control group (n=36). Patients in the Control group received a combination treatment comprising anti-Parkinson agents (Western drug regimen) with the addition of a traditional Chinese patent medicine (Huang-Xing Run-Chang Tablets*) over a period of 5 weeks, whereas patients in the Treatment group received the same anti-PD Western drug regimen together with the JWJCJ decoction, also for a period of 5 weeks. An evaluation using clinical efficacy scores was carried out together with network pharmacology analysis. Identified drug targets for JWJCJ using the traditional Chinese medicine Swiss Target Prediction database (TCMSP) and disease targets for chronic constipation in PD were obtained from Genecards and the OMIM database. Therapeutic targets for JWJCJ in the treatment of chronic constipation were identified by intersecting drug targets and disease targets. GO functional enrichment analysis, KEGG pathway analysis, and disease association analysis were carried out using the DAVID database and visualized using Cytoscape 3.9.1 software. CSS efficacy scores in the Treatment group were higher than that in the Control group (88.57 vs. 52.94%, p<0.001). No significant differences were seen prior to treatment in the CSS, PDQ-39 and MDS-UPDRS scores and the corresponding total scores for the two groups. After treatment, CSS values for patients in the Treatment group were higher than values before treatment (p<0.01). Network pharmacology analysis identified 172 active components, 9,542 drug targets, and 421 intersecting target genes for JWJCJ. PPI analysis identified 10 main and possibly key targets for JWJCJ in the treatment of chronic constipation. KEGG analysis identified 198 signaling pathways, where pathways in cancer, specific cancer pathways such as prostate cancer and non-small cell lung cancer, lipid and atherosclerosis, hepatitis B, and the AGE-RAGE signaling pathway in diabetic complications were among the pathways most significantly enriched. These findings are evidence that the active ingredients in JWJCJ in the treatment of chronic constipation in PD mainly target TP53, SRC, AKT1, PIK3R1, and PIK3CA. The efficacy of JWJCJ in treating chronic constipation in PD involves the targets SRC, PIK3R1, JUN, TP53, STAT3, PIK3CA, EGFR, ESR1, MAPK1, and AKT1 domains. These findings provide theoretical basis for the clinical application of JWJCJ decoction in the treatment of chronic constipation in PD.

Spinal structure and function in individuals with chronic functional constipation: A case-control study.

Longitudinal changes in senna-based laxative dosing in pediatric constipation: A single-center retrospective study.

This study aims to compare the efficacy and safety of different dietary fiber subtypes in treating patients with chronic idiopathic constipation (CIC) through network meta-analysis (NMA). PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to October 23, 2025. The risk of bias was evaluated using the Cochrane RoB 2.0 tool, and treatment rankings were calculated using the surface under the cumulative ranking curve (SUCRA). 17 randomized controlled trials (RCTs) involving 1423 adults with CIC were included. NMA suggested that viscous soluble fibers were associated with greater efficacy compared with placebo in relieving defecation difficulty (high certainty, class 1), and were also associated with improvements in stool consistency and stool frequency relative to placebo (moderate certainty, class 1). According to SUCRA rankings, viscous soluble fibers tended to have a higher probability of favorable performance compared with other dietary fiber subtypes in improving straining during defecation (moderate certainty), stool frequency (low certainty), and stool consistency (low certainty), and was associated with a relatively favorable tolerability profile (moderate certainty). Insoluble dietary fibers showed the highest ranking probability for improvement in overall constipation symptom scores; however, this finding was supported by very low certainty evidence. Overall, the findings suggest that viscous soluble fibers have a higher probability of improving stool consistency, stool frequency, and straining during defecation. In contrast, insoluble fibers showed a relatively higher ranking for improvement in overall constipation symptom scores. These results support a symptom-oriented and individualized approach to dietary fiber selection in the management of CIC.

Approximately one-third of patients with irritable bowel syndrome (IBS) have IBS with constipation (IBS-C). Cardinal symptoms of IBS-C are abdominal pain and reduced bowel movement frequency. However, additional symptoms, including abdominal discomfort, bloating, and straining, are prevalent and are some of the most bothersome symptoms for patients, providing a clinical rationale for efficacy assessments that encompass simultaneous improvement in multiple IBS-C symptoms. This review highlights the diagnostic approach to IBS-C, including differentiation from chronic idiopathic constipation (CIC), and expands on data supporting multisymptom treatment beyond cardinal symptoms. Several medications are indicated for IBS-C, including secretagogues such as guanylate cyclaseC agonists (plecanatide, linaclotide) and chloride channel activators (lubiprostone [women only]), as well as sodium/hydrogen exchanger3 (NHE3) inhibitors (tenapanor). An integrated approach to treatment of IBS-C, particularly in patients with persistent symptoms after treatment with first-line secretagogues or NHE3 inhibitors, may include neuromodulators, appropriate antibiotic regimens in those with intestinal methanogen overgrowth (IMO), and/or nonpharmacologic approaches including dietary interventions and brain-gut behavioral therapies. Effective treatment plans for IBS-C should target the most bothersome symptoms, including a collaborative discussion of risks/benefits of various treatments, culminating in an agreement on a path forward between the patient and healthcare provider.

Disorders of gut-brain interaction (DGBI) are frequently encountered among patients with eating disorders (ED). Underlying both eating disorders and DGBI may be psychological co-morbidities, but it is uncertain how often psychological disorder explains the development of either disorder. We hypothesised a DGBI may predispose to a new onset eating disorder. We aimed to determine the associations and chronological presentation of DGBI, ED and psychological co-morbidities. Data were collected from a retrospective cohort of n =1,256,331 patients attending general practices in the UK; 1018 patients diagnosed with both a DGBI and an ED were included, with 777 also having data on anxiety and/or depression. Timing of order of onset and potential moderators of the sequence of occurrence were considered. Clinical significance level was set at p <0.01 and OR≥ 2.0. Prevalence of any ED was 0.7%. Chronic constipation was associated with anorexia nervosa (OR= 2.12 (95% CI 1.84-2.45) and any eating disorder (OR= 2.06 (95% CI 1.79-2.36). IBS and FD were significantly associated with one or more eating disorders. More patients in primary care were diagnosed with an ED (59.5%, n=606) preceding a DGBI than vice versa (40.5%, n=412, P<0.001). Independent predictors of having a diagnosed DGBI preceding an ED were younger age at first diagnosis of DGBI (P<0.001), antecedent depression (P<0.003) and antecedent proton pump inhibitor (PPI) use (P<0.001). Psychological disorders, ED, and DGBI overlap. ED more frequently preceded the onset of a DGBI diagnosis; younger age, antecedent depression and PPI use were independently associated with a DGBI predicting an ED.

To identify risk factors for postpartum pelvic floor dysfunction (PFD) diagnosed at 6 weeks after delivery in a Chinese population. This retrospective study examined data from 828 postpartum women in China, collected from January 2020 to August 2021. Multivariate analyses were employed to identify factors associated with six outcomes of PFD, including anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, stress urinary incontinence (SUI), and impaired type I and type II muscle fiber strength. A series of factors are considered to be associated with PFD. Cesarean delivery significantly reduced severe anterior vaginal wall prolapse risk (OR=0.426, P＜0.001). Age, overweight (BMI ≥24.9 kg/m²), macrosomia (birth weight ≥4000g), forceps-assisted delivery, and constipation significantly increased risks of anterior and posterior vaginal wall prolapse, uterine prolapse, and SUI (all OR>1, P<0.05). Twin pregnancy reduced type I (OR=0.430, P=0.013) and type II (OR=0.385, P=0.009) muscle fiber strength but increased risks of anterior vaginal wall prolapse, uterine prolapse, and SUI. Higher parity (two or more) was correlated with higher risks of anterior (OR=2.402, P<0.001) and posterior vaginal wall prolapse (OR=2.977, P=0.0003) and SUI (OR=1.726, P=0.001). Heavy physical labor was strongly associated with posterior vaginal wall prolapse (OR=6.285, P=0.008), uterine prolapse (OR=5.264, P=0.009), and SUI (OR=3.987, P=0.024). Underweight status (BMI<18.5 kg/m²) significantly increased risks of impaired type I (OR=0.173, P<0.001) and type II muscle fiber strength (OR=0.197, P=0.0003). This study identified significant PFD risk factors in a Chinese population, highlighting the importance of targeted prenatal, perinatal, and postpartum care to mitigate these risks. In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and fetal macrosomia during pregnancy and appropriate assisted delivery could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with chronic constipation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles.

We aimed to evaluate the efficacy and safety of IFT for the treatment of CC in a pilot randomized controlled trial (RCT). Subjects with refractory chronic constipation (CC) have limited treatment options. Interferential Therapy (IFT) offers an alternative approach by delivering a therapeutic current to the colon through skin electrodes. We performed a multicenter, double-blind, sham-controlled pilot trial (3:1, treatment:sham) of IFT in patients meeting Rome IV criteria for refractory CC, with ≥1 spontaneous bowel movement (SBM)/week and <3 SBMs/week. After a 2-week screening period, participants received either IFT or a sham device, completing treatment for an hour/day for 8 weeks. The sham group then received IFT and the treatment group continued IFT for 8 weeks. Both groups completed a 4-week follow-up without the device. We enrolled 17 patients (82% female) at 4 sites, 12 into the treatment group and 5 into sham therapy. There were no significant adverse events. There was no significant difference in the mean number of SBMs/week between groups (3.51 in IFT vs. 2.54 in sham, P=0.35) during the 8-week treatment phase. The IFT device was highly acceptable in this population, with participants willing to pay an average $294±78 out of pocket for the device. In this sham-controlled trial of IFT, there was no significant difference in SBM frequency between the treatment and sham groups. On the basis of the feasibility and acceptability of the IFT device, further research into IFT therapy for CC is merited.

Constipation is a prevalent functional gastrointestinal disorder that impairs quality of life and is frequently accompanied by psychological distress. Emerging evidence suggests a potential association between constipation and depression, possibly mediated by gut-brain axis dysfunction; however, epidemiological findings remain inconsistent. We conducted a systematic review and meta-analysis of observational studies examining the association between constipation and depression in the general population. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to October 1, 2025. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity, prediction intervals, subgroup analyses, sensitivity analyses, and publication bias were assessed. Eighteen studies involving 730,263 participants were included. Constipation was significantly associated with an increased risk of depression (OR = 2.08, 95% CI: 1.84-2.34), with substantial heterogeneity (I² = 92.6%). The association remained robust across sensitivity analyses. Stronger associations were observed in adolescents, in studies conducted in Asia and North America, in smaller studies, and in those using self-reported depression measures. Prediction interval analyses indicated a consistently positive association across diverse populations. This meta-analysis provides robust evidence that constipation is associated with a significantly increased risk of depression. These findings highlight the importance of integrated gastrointestinal and mental health care, particularly for younger individuals with chronic constipation, and support further prospective and mechanistic studies targeting the gut-brain axis.

Quantitative data on colon length in adult chronic constipation (CC) are lacking. This study aimed to measure the length of the colon in CC, in the undisturbed state and after an osmotic laxative challenge, using magnetic resonance imaging (MRI) as compared to healthy volunteers (HV) and IBS-C patients. Segmental and total colon length were measured by manual tracing on fasting MRI scans, retrieved retrospectively for 57 HV, 17 CC, and nine patients with irritable bowel syndrome with constipation (IBS-C). In all CC patients and 22 HV, MRI scans were also performed after an oral osmotic laxative challenge. Participants' age range was 18-75 years. CC patients showed significantly longer colons (162 ± 6 cm) than HV (127 ± 2 cm; p < 0.01), with 10/17 being longer than the upper limit of normal. Colon length in IBS-C (129 ± 6 cm) was similar to HV. The colon in HV was able to elongate from 133 ± 3 to 148 ± 4 cm (p < 0.0001) to accommodate the macrogol challenge influx, while the CC colon could not do so (from total length at baseline 162 ± 6 to 168 ± 5 cm; p = 0.0768). The study provides normative values of colon length, to which CC and IBS-C are compared. CC was associated with increased colon length and reduced capacity to elongate longitudinally, rather than radially, in response to a laxative challenge. Colon length in IBS-C was similar to HV. These measurements can improve our understanding of gut disease pathophysiology and response to treatment.

Constipation affects about 25% of the general population, with higher prevalence in elderly people. Many of the products used for the treatment of constipation, laxatives and drugs with this indication have undesirable effects such as dehydration, electrolyte disturbances and diarrhea or side effects that, in frail patients with comorbidities, such as the elderly, can have clinically significant consequences. For these reasons, the treatment of chronic constipation constitutes, especially in the elderly patient, a partial unmet medical need. This interventional, single-arm pilot study evaluated efficacy and safety of a probiotic-prebiotic combination in elderly patients with chronic constipation. The probiotics included Lactobacillus rhamnosus, Lactobacillus paracasei, Bifidobacterium animalis ssp. lactis, and Bifidobacterium breve. Treatment lasted 28 consecutive days. Fifty elderly patients (average age 65.3 years) with chronic constipation participated. At baseline, 72% of patients reported ≤2 complete spontaneous bowel movements (CSBM) per week. After the treatment, 36% of patients reported ≤2 CSBMs/week (P=0.023), 64% experienced improvement of 1-4 CSBMs/week. Quality of Life (QoL) related to abdominal pain, bloating, and constipation improved. No adverse events were reported. This real-world study suggests that probiotic-prebiotic combinations can rapidly improve bowel transit and constipation symptoms, potentially reducing dependence on laxatives and enemas while improving QoL. A longer-term randomized controlled trial is needed to confirm these findings.

Chronic constipation is prevalent in middle-aged and elderly individuals and can markedly impair quality of life and increase comorbidity risk. However, safe and effective therapies for this population remain limited because of age-related physiological changes, polypharmacy, and concerns about long-term medication use. We conducted a randomized, double-blind, controlled clinical trial enrolling 140 participants aged ≥45 years with chronic constipation to evaluate a synbiotic containing Heyndrickxia coagulans (H. coagulans) TBC169 plus dietary fibers as an adjunct intervention. Compared with dietary fiber alone, the TBC169-based synbiotic significantly improved constipation outcomes, including increased weekly bowel movements (WBMs), higher Bristol stool scale (BSS) scores, and reduced Wexner and Patient Assessment of Constipation Quality of Life (PAC-QOL) scores. Post-intervention gut microbiota profiling showed higher Shannon and Faith_PD diversity indices and distinct community composition in the synbiotic group compared with the dietary-fiber control group, along with higher relative abundance of Blautia, Akkermansia, Faecalibacterium, and Bacillus and lower relative abundance of Collinsella. Because baseline faecal samples were not collected, these microbiota findings should be interpreted as exploratory between-group associations. Ecological analyses suggested enhanced microbial stability and metabolic potential, and correlations linked key taxa with clinical improvement. The intervention was well-tolerated, with only mild, transient adverse events. The synbiotic formulation containing H. coagulans TBC169 and dietary fiber-related components was well-tolerated and may improve constipation-related outcomes in middle-aged and elderly adults. Because the formulation contained both probiotic and fiber components, the observed effects should be attributed to the combined synbiotic product rather than to H. coagulans TBC169 alone. Chinese Clinical Trial Registry (ChiCTR2400085844, http://www.chictr.org.cn/), registered on June 19, 2024.

ABSTRACTIntroductionMagnesium‐rich mineral water influences stool consistency and bowel habits. However, randomized controlled trials directly comparing magnesium‐rich mineral water with soft water using standardized bowel outcomes remain limited.MethodsThis single‐center, randomized, parallel‐group trial enrolled 40 healthy subjects who did not meet Rome IV criteria for chronic constipation or irritable bowel syndrome. After a 7‐day observation period, participants consumed either soft water or magnesium‐rich mineral water (1 L/day) for 14 days. The primary endpoint was change in weekly mean Bristol Stool Form Scale (BSFS) score from baseline to intervention week 2, analyzed using analysis of covariance. Secondary endpoints included spontaneous bowel movements (SBM; bowel movements without rescue medication), complete spontaneous bowel movements (CSBM; SBM with a sensation of complete evacuation), subjective global improvement, time to first SBM, and daily total fluid intake.Key ResultsAll participants completed the trial. Compared with soft water, magnesium‐rich mineral water significantly increased BSFS score at week 1 and week 2 (both p < 0.05). Weekly frequencies of SBM and CSBM were higher in the magnesium‐rich mineral water group. Subjective improvement at week 2 was more frequent with magnesium‐rich mineral water. Compared with the observation period, no difference in water intake was observed between the two groups.Conclusions and InferencesIn healthy subjects, magnesium‐rich mineral water was associated with stool softening and increased bowel movement frequency. No safety concerns were observed during the study period. These findings support further investigation of magnesium‐rich mineral water as a strategy for modulating bowel habits.

Functional defecation disorders (FDD) are a prevalent etiology of refractory constipation. The diagnosis of FDD requires specific physiology testing, including anorectal manometry (ARM) and balloon expulsion test (BET). The aims of our study were to evaluate whether the complaint of painful defecation added to the Rome III symptoms questionnaire could help to differentiate subtypes of refractory chronic constipation. One hundred and ninety-eight constipated patients (Rome III Criteria) who had failed a 30-day fiber/laxative trial were enrolled. Before entering the study (T0) the patients underwent a digital rectal examination, including the assessment of tenderness elicited by traction of the puborectalis muscles (DRE-tenderness). Patients reporting painful defecation (occurring at least once per week) were specifically assessed at T0. Thirty days after T0, the patients underwent: DRE with DRE-tenderness evaluation. ARM + BET. Barium defecography (when ARM and BET were discordant). Colonic transit time evaluation with radiopaque markers. Based on these tests, the patients were classified into five subgroups: dyssynergic defecation (DD), inadequate defecatory propulsion (IDP), isolated structural outlet obstruction (mostly large rectocele), isolated slow transit constipation, and normal transit constipation. The association between symptoms and diagnostic outcomes was assessed using multivariate analysis based on binary logistic regression. Eighty-one patients (40.9%) reported weekly episodes of painful defecation, while 86 patients (43.3%) reported DRE-tenderness. Ninety-six patients (48.5%) showed features of FDD: 70 DD and 26 IDP; 25 (12.6%) showed isolated structural outlet obstruction, and 23 (11.6%) showed isolated slow transit constipation. No predictors were found for IDP. The subjective complaint of painful defecation added to the Rome III criteria is critical to improve the identification of specific subtypes of refractory chronic constipation, thus improving care and potentially decreasing the need for physiology testing.

A family history of chronic constipation (CC) is considered an important predisposing factor for developing CC. This study aimed to compare the associations of maternal and paternal histories of CC with constipation in offspring. Students at Hiroshima University completed a web-based health checkup questionnaire between April and June 2025. Data included baseline characteristics, lifestyle factors, family history of CC, Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26, and Bulimic Investigatory Test (BITE). CC was diagnosed using the Rome IV criteria. Multivariate logistic regression analysis was performed to identify associated factors. Among 5,518 participants, both maternal and paternal histories of CC were significantly associated with CC, showing similar strength of association (maternal: odds ratio [OR] = 3.47, 95% confidence interval [CI] = 2.82-4.27; paternal: OR = 3.41, 95% CI = 2.16-5.40; both p < 0.001). Other significant factors included higher EAT-26 score (OR: 4.27, 95% CI: 2.31-7.87, p<0.004), female sex (OR: 2.74, 95% CI: 2.28-3.28, p<0.001), lack of physical exercise (OR: 1.67, 95% CI: 1.40-1.98, p<0.001), and short sleep duration (OR: 1.45, 95% CI: 1.22-1.71, p=0.001). Both maternal and paternal histories of CC were similarly associated with CC. However, this association may be largely driven by unmeasured shared environmental factors and should be interpreted cautiously.

Chronic constipation is common, and the appropriate use of stimulant laxatives remains challenging. Although dependence due to habitual stimulant-laxative use is frequently observed, the long-term effects of regular use on dependence and tolerance have not been fully elucidated. This study aimed to characterize the clinical features and substance use-related symptoms associated with stimulant-laxative use in patients with chronic constipation. This multicenter prospective observational study was conducted at three centers and enrolled patients with chronic constipation, including those meeting the Rome IV criteria. Patients were categorized based on stimulant-laxative use into None (N), Short-term/Rescue (SR), and Regular (R), defined as the use of stimulant laxatives ≥ 3 per week for > 1year. Substance use-related symptoms were assessed using the CAGE-AID questionnaire (≥ 2 point), and self-reported ICD-11 and DSM-5-TR substance use disorder criteria. A total of 280 patients were included (N = 197, SR = 51, R = 32). Baseline characteristics did not differ significantly among groups. CAGE-AID positivity was 5.1%, 58.8%, and 90.6% in the N, SR, and R groups, respectively. ICD-11 criteria were markedly higher in the R group (65.6%) compared with the N (0%) and SR (11.8%) groups. DSM-5-TR criteria showed a similar pattern (0%, 15.7%, and 65.6%, respectively). The R group consistently demonstrated higher positive screening rates across all tools. Long-term stimulant-laxative use is associated with increased substance use-related symptoms and features suggestive of habituation in patients with chronic constipation. The study was registered in the University Hospital Medical Information Network (UMIN000051617) on July 15, 2023.

Chronic constipation (CC) and fecal incontinence (FI) are significant problems for pediatric patients. Transanal irrigation (TAI) is a therapy that effectively relieves symptoms in patients with disorders of gut-brain interactions (DGBI) or organic CC/FI. This mixed-methods study aimed to identify predictive factors for TAI adherence and outcomes in pediatric patients. Out of 151 screened patients, 63 were eligible for enrollment, with a 60.3% response rate and 97.3% survey completion. We analyzed adherence, symptom severity, quality of life (QOL), and manometry data from 38 patients who initiated TAI at Nemours Children's Hospital (2017-2023). Additionally, seven parents of noninitiating patients were interviewed to assess barriers. No significant differences were found in TAI-related difficulties (pain, independence, and technical issues), though patients with DGBI etiologies reported slightly more psychological difficulties with TAI (p = 0.077). Adherent patients showed fewer CC symptoms and higher QOL compared to nonadherent patients (p = 0.002) at the time of interview. Attention-deficit/hyperactivity disorder (ADHD), diagnosed in 42.1% of patients, was a significant predictor of nonadherence, with these patients reporting more severe symptoms and lower psychosocial scores. Manometry results did not predict outcomes, indicating a need for improved diagnostics. Barriers to TAI initiation included insurance challenges, fear of trauma, and logistical obstacles. Patients with organic and DGBI CC/FI experienced similar challenges using TAI. Adherence was associated with improved symptoms and QOL. ADHD was a significant predictor of nonadherence, underscoring the need for tailored interventions. Future research should focus on long-term outcomes and strategies to enhance adherence, particularly for children with ADHD.

Mixed drug overdose presents a complex and potentially unpredictable clinical course, particularly in the presence of comorbidities that may alter drug metabolism, half-life and pharmacodynamic effects. We report a man in his 50s presenting with reduced consciousness, Glasgow Coma Scale (GCS) 11, requiring oxygen therapy after ingesting 100 mg diazepam, 1200 mg pregabalin and suspected co-ingestion of zopiclone and gabapentin. Flumazenil produced rapid but transient improvement. However, fluctuating consciousness persisted, with further deterioration in GCS on day 8 that again responded to flumazenil. He had liver fibrosis and a raised body mass index (33 kg/m²). Investigations revealed hyperammonaemia, mild diffuse encephalopathy on electroencephalogram (EEG) and faecal retention. CT head was unremarkable.The prolonged clinical course was likely multifactorial, reflecting synergistic central nervous system depressant effects in the context of polypharmacy, hepatic dysfunction, hyperammonaemia and obesity. This case highlights the importance of recognising mixed overdose and comorbid modifiers in prolonged complex toxic presentations.

The management of chronic constipation when it coexists with chronic pain syndrome is challenging because of complex pathophysiologic and constipating analgesic side effects. Transcutaneous auricular vagus nerve stimulation (taVNS) is an effective neuromodulation method to modulate gastrointestinal function and pain processing by targeting vagal pathways. Accordingly, this study evaluated the short-term effects of taVNS in patients with functional constipation (FC) comorbid with myofascial pain syndrome (MPS). A total of 38 female participants with FC and MPS (aged 20-50 years) were randomly allocated (1:1) using a computer-generated randomization to either taVNS or sham-taVNS groups. Participants received the intervention for 30 minutes, five days a week for two weeks. The complete spontaneous bowel movements per week (CSBMs/week) as the primary outcome was assessed at baseline and after the treatment. Secondary outcomes were Wexner constipation scores (WCS), patient assessment of constipation quality of life (PAC-QoL) score, visual analogue scale (VAS), pressure pain threshold (PPT), and heart rate variability (HRV). The result of analysis of covariance (ANCOVA) showed that taVNS significantly and clinically improved CSBMs/week compared with the sham-taVNS (p = 0.007; Cohen d = 0.97, 95% CI 0.26 - 1.66). The mean increase of CSBMs/week was 1.65 times compared with the baseline and 1.37 times compared with the sham-taVNS (MCID = 1.3 times). Moreover, the taVNS group had greater reduction in WCS and VAS compared with the sham group. In the HRV analysis, the taVNS enhanced high frequency (HF) and decreased low frequency (LF) and the LF/HF ratio compared with the sham-taVNS. However, there was no substantial difference in the PPT and PAC-QoL between groups. These promising findings provide preliminary evidence that taVNS may be an effective nonpharmacologic intervention in female patients with FC coexisting with chronic pain conditions, particularly MPS. Further large-scale studies with longer follow-up and mechanistic assessments are warranted.

Artificial intelligence has the potential to provide an objective, accurate and fast evaluation of the colon for clinical assessment of gastrointestinal diseases, such as chronic constipation. Accurate colon segmentation is a labor-intensive task, prone to interobserver variability. This study presents a method for automatic colon segmentation in T2-weighted MRI images, using 297 MRI scans from 72 healthy subjects and a neural network based on the 2D U-Net architecture. The presented network provided a Dice similarity coefficient (DSC) of 0.82 ± 0.04 when compared to ground truth data (p=0.722), allowing for accurate evaluations of colonic physiology. The estimated colonic volumes were significantly correlated with the ground truth volumes with no tendency for over- or underestimation (p<0.001). This study is, to our knowledge, the first to fully automatically segment the colon using MRI data, thus providing a method for objective colon evaluation without radiation exposure or disturbance of its physiology.