Control Of Bowel Movements Research Articles

Effectiveness of a rectal cancer education video on patient expectations.

Discrepancy between patient expectations and outcomes can negatively affect patient satisfaction and quality of life. We aimed to assess patient expectations of bowel, urinary, and sexual function after rectal cancer treatments, and whether a preoperative education video changed expectations. A total of 45 patients were assessed between January 2018 and January 2021 in a tertiary care hospital in Vancouver, Canada. Patients included were rectal cancer patients who had neoadjuvant chemoradiation and were listed for low anterior resection but had not yet had surgery. Following surgical consultation but before surgery, a questionnaire assessing expectations of lifestyle after treatments was administered. Patients then watched an educational video and repeated the questionnaire to assess for changes in expectations. Patient scores indicated expectation that control of bowel movements, urination, and sexual function would sometimes be problematic, but had a range from occasionally problematic to good function. Significant change after the video was seen in the expectation of needing medications for bowel control, and 44%-69% of individual patient answers changed from prevideo to post-video, depending on the question. The education video was scored as helpful or very helpful by 82% of patients. Patients have varying expectations of problematic control of bowel, urinary, and sexual function following rectal cancer treatments. A pretreatment education video resulted in a trend toward changed expectations for functional outcomes in most patients. Further educational modalities for patients may provide more uniform expectations of function and increase patient satisfaction after rectal cancer treatments.

Patient Preferences for Reducing Bowel Adverse Events following Prostate Radiotherapy

Background The Extended Prostate Cancer Index Composite (EPIC) instrument is a commonly used patient reported outcome (PRO) tool in prostate cancer clinical trials. Summary scores for EPIC subscales are calculated by averaging patient scores for attributes (e.g., side effects), implying equal weighting of the attributes in the absence of evidence showing otherwise. Methods We estimated patient preferences for each of the attributes included in the bowel subscale of the EPIC instrument using best-worst (B-W) scaling among a cohort of men with prostate cancer. Patients were presented with multiple tasks in which they were asked to indicate which attribute they would find most and least bothersome at different levels of severity. Analysis utilized both (simple) B-W counts and scores to estimate patient preferences for each attribute as well as attribute levels. Results A total of 174 respondents from two institutions participated in the survey. Preference estimates for each of the five attributes included in the EPIC-26 bowel subscale showed wide variation preferences: 'losing control of bowel movements' was found to be the most bothersome attribute, with a B-W score of -0.48, followed by bowel urgency which also had negative B-W score (-0.04). Increased frequency of bowel movements was the least bothersome attribute, with a B-W score of +0.33, followed by bloody stools (+0.12), and pelvic/rectal pain (+0.06). Analysis of preference weights for attribute bother levels showed preference estimates be linear. Conclusions We provide novel evidence on patient preferences for side effect reduction following prostate radiotherapy. Within the bowel sub-scale of the EPIC-26 short form, we found that bowel incontinence was perceived to be the most bothersome treatment effect, while increased bowel frequency was least bothersome to patients.

Integrating the patient (pt) voice with clinician reports to identify cancer-specific subsets of symptomatic adverse events (SymAE).

155 Background: The Pt-Reported Outcomes Version of the Common Terminology Criteria for AE (PRO-CTCAE) was developed for pts to report on the frequency, severity, and interference of SymAE. A study was conducted to identify a hepatocellular carcinoma (HCC)-relevant subset of the PRO-CTCAE's 124 items to enhance evaluation of SymAE in HCC trials and long-term effects in survivorship. Methods: Qualitative and quantitative data were collected from medical oncologists specializing in HCC and pts diagnosed with HCC stratified by Child-Pugh class and treatment. Oncologists were asked about HCC diagnosis, treatment, and SymAE and provided ratings (ranging from 0 = unimportant to 10 = very important) of the following: 1) importance to pts of 34 prevalent SymAE from past HCC trials (all phases); 2) importance to pts of each PRO-CTCAE item; and 3) their own perceived importance of each PRO-CTCAE item with regard to tolerability. Pts were asked about their diagnosis, treatment, and experience of SymAE after which they completed the PRO-CTCAE and were debriefed on the importance of each item. Results: Four medical oncologists from Spain, Taiwan, Korea, and Hong Kong with ≥ 20 years of experience completed interviews. SymAE from prior trials rated highly important to pts (mean rating across oncologists ≥ 7) included hand-foot syndrome, diarrhea, fatigue, decreased appetite, rash, vomiting, and weight loss. PRO-CTCAE items rated highly important to pts included diarrhea, vomiting, shivering or shaking chills, hand-foot syndrome, rash, fatigue, difficulty swallowing, and loss of control of bowel movements. Items rated highly for tolerability included diarrhea, shivering or shaking chills, and hand-foot syndrome. Pt interviews (planned up to 24) are ongoing. Conclusions: Oncologists identified 10 clinically relevant items from sponsor SymAE data and the PRO-CTCAE for use in HCC trials. Findings from pt interviews will compare provider and pt perspectives about SymAE and strengthen the set of selected items. Combining clinician and pt ratings with clinical trial data may be a promising method for identifying cancer-specific PRO-CTCAE item sets for use throughout the cancer care continuum.

Inhibition of Peripheral Synthesis of Serotonin as a New Target in Neuroendocrine Tumors.

: The carcinoid syndrome represents a set of signs and symptoms associated with neuroendocrine tumors (NETs) that occur primarily when metastases are developed in the liver, resulting in the worsening of quality of life. Serotonin plays a central role in the physiology of carcinoid syndrome by promoting intestinal motility. Somatostatin analogs (SSAs) have widely demonstrated their efficacy as symptomatic relievers of carcinoid syndrome, but this control is ephemeral, being reduced by approximately 50% within the first year. The exact mechanisms of resistance to SSAs are not fully understood, but it is believed that serotonin might be involved. Patients with carcinoid syndrome present with a significant increase in serotonin plasma levels and, consequently, in the soluble urinary metabolite 5-hydroxyindole acetic acid. Telotristat etiprate is a potent inhibitor of tryptophan hydroxylase, a rate-limiting enzyme in the synthesis of serotonin, that has demonstrated in the phase III TELESTAR clinical trial a significant improvement in the control of bowel movements in patients with NETs who have carcinoid syndrome and who have progressed to an SSA. Based on these results, telotristat etiprate has emerged as a potential new option in the treatment algorithm of symptomatic control of functioning NETs. However, some issues need to be clarified, such as the safety profile of the drug outside clinical trials, the benefit in quality of life, and the possible impact on tumor growth, as well as its role within sequencing or combination treatment strategies with pre-existing drugs effective in NET treatment. This article reviews the literature about carcinoid syndrome, which affects patients diagnosed with neuroendocrine tumors. Few articles have been published about this syndrome and its pathophysiology. Somatostatin analogs provide symptomatic relief; however, patients may become refractory to this strategy, usually within the first year of treatment. In this context, as an agent with an innovative mechanism of action, telotristat etiprate has demonstrated activity in a phase III trial, and findings may offer a path to an improve quality of life and prolonged survival for certain patients.

Infantile perianal pyramidal protrusion.

Dear Editor: Infantile perianal pyramidal protrusion (IPPP) is a rare benign cutaneous disorder, first reported by Kayashima et al. in 19961. It is characterized by a solitary protrusion, most often observed in the perineal area, anterior to the anus. Herein, we report a case of acquired IPPP in a female Korean patient; to the best of our knowledge, this is only the second such case reported in Korean dermatologic literature2. A 2-year-old girl visited our clinic, presenting with an anal lesion that was discovered 5 months previously. She had no medicosurgical history, but experienced intermittent constipation that was untreated. The patient had no history of sexual abuse. Skin exam revealed a solitary skin-colored papule, located anterior to the anus (Fig. 1). A skin biosy of the papule indicated epidermal acanthosis, and dermal fibrovascular cores with lymphocytic infiltration (Fig. 2). Vacuolar changes and dermal edema were not observed. Correlation of the clinical and histologic findings resulted in a final diagnosis of acquired IPPP. Excluding this recent case, approximately 107 IPPP cases have been reported in the literature1. All patients with IPPP, except one, were women, including our patient. Age at diagnosis ranged from birth, to 13 years. Three types of IPPP were recently proposed: constitutional IPPP, acquired IPPP, and IPPP caused by lichen sclerosus et atrophicus (LSA). Constitutional IPPP that could have familial or congenital origin, is the most common type, and is thought to be associated with structural weakness of the perineum in women. It regresses within a few weeks, although some cases have reportedly been prolonged for years. Constipation is known to be indicative of acquired IPPP, although the pathogenesis of this disorder is not yet completely understood. Regression of IPPP was reportedly observed, after constipation was controlled1. LSA associated IPPP involves a skin protrusion clinically similar to those observed in other types of IPPP, but is histopathologically different in the exhibition of dermal vacuolar changes, along with dermal edema, and a lichenoid lesion, characterized by infiltration of inflammatory cells. Although our patient did not exhibit pathologic findings typical of LSA associated IPPP, she presented with constipation, which indicated acquired IPPP. Despite being proposed as a subtype of IPPP, the pathophysiology of acquired IPPP is unclear. Histologic findings of IPPP, except in patients with LSA associated IPPP, indicate epidermal acanthosis and dilated vessels with fibrous tissue, although normal histology has also been reportedly observed1. Condyloma should be differentiated from IPPP, by epithelial cells with perinuclear vacuolization, and the presence of human papilloma virus3. Hemorrhoids, which also occur in the anal area, are vascular cushions within the anal canal. The disease is different, in that the onset of hemorrhoidal disease is commonly between 45 to 65 years of age, accompanied by symptoms such as painless bleeding, painful mass, anal swelling, or soiling4. Histologically, hemorrhoids exhibit superficial ulcerations, overlying mucosa with acute and chronic inflammations. Thrombosed vessels could be detected5. Various treatment modalities are available for IPPP, such as management and control of bowel movement, application of topical corticosteroids, or observation based on the type and suspected underlying conditions. IPPP is clinically important, because the papule at the perineum in children may confuse physicians, and result in a misdiagnosis of condyloma or sexual abuse. Although we now present this case as the 'second' report, we also consider this disease to be quite common in Korean infants. Our case is worthy and informative, however, in that we observed not only typical clinical features, but also showed histologic features of IPPP by skin biopsy, which is not routinely done. Herein, we report a case of IPPP, and physicians are recommended to consider this disease during diagnosis. Fig. 1 Solitary skin-colored soft papule is noted on the anterior part of the anus. Fig. 2 (A) A papular lesion containing fibrovascular core with inflammatory cells infiltration is noted at a lower magnification. (B) Epidermal acanthosis and dilated vessels with fibrous tissue infiltrated by lymphocytes are mainly observed at higher magnification. ...

Anorectal pressure and rectal compliance after low anterior resection.

Measurements of the resting pressure profile of the anorectum, recto-anal reflex and of rectal compliance (reservoir function of the rectum) were made in 24 normal subjects and 16 patients who had undergone low anterior resection for cancer of the sigmoid colon or upper half of the rectum. In the early postoperative period (< 6 month) frequent bowel movements and occasional soiling were experienced by most patients. Fifteen of 16 such patients had regular bowel movements and no soiling after six months. The present studies disclosed that there was a close correlation between control of bowel movements and rectal compliance, but not between the resting pressure profile of the anorectum or the recto-anal reflex and control of bowel movements after low anterior resection.

An In Vitro Evaluation of the Efficacy of the More Frequently Used Antacids with Particular Attention to Tablets

Summary 1.A comparison of the antacid efficacy of aluminum hydroxide in liquid and tablet form by an ‘in vitro' evaluation technique, shows the liquid form to be superior to the tablet form. 2.Aluminum, in the form of dihydroxy aluminum aminoacetate, evaluated for antacid efficacy in liquid and tablet form, is found to be as effective in both forms as liquid aluminum hydroxide preparations. 3.Mixtures of glycine and calcium carbonate, and of dry skimmed milk and calcium carbonate are found to be effective antacids if used in relatively large amounts. 4.Aluminum hydroxide gel combined with milk of magnesia is a much more effective antacid than aluminum hydroxide gel alone. Varying the milk of magnesia content permits also control of bowel movement.