Differences In Stool Consistency Research Articles

Bowel function in a prospective cohort of 1052 healthy term infants up to 4 months of age

The purpose of this study is to describe the defecation pattern of healthy infants up to 17 weeks of age. We included 1052 healthy term infants from the prospective HELMi cohort (NCT03996304). Parents filled in recurring online questionnaires on feeding, gastrointestinal function, and crying weekly for the first 17 weeks of life. Defecation frequency was highest at the age of 3 weeks (a median of 4 times/day, interquartile range (IQR) 2.9–5). At each time point, the median defecation frequency of breastfed infants was higher than that of infants receiving formula (e.g., at week 17 a median of 2 times/day, IQR 0.9–3.6, and a median of 1.1, IQR 0.6–1.4, respectively). The dominant color of the stool was most often yellow or light brown. Nearly black stools were reported in the first week of life in 3.4%. Nearly half (47.4%) of the infants had green stool color dominating for at least 1 week, with comparable frequency among breastfed (47.7%) and formula-fed (45.2%) infants. Green stools were associated with a higher defecation frequency (linear mixed-effect model p < 0.0001). Occasional blood in stool was reported in 9.3% and recurrent blood in 5.2% of the infants with no difference in stool consistency. Hard stools were rare (≤ 1%). Conclusion: This study enlightens the spectrum of defecation patterns in healthy term infants during the first 17 weeks of life. A better understanding of bowel function helps healthcare professionals distinguish normal from abnormal when addressing defecation, the color of stools, and the type of feeding.What is Known:• Breastfed infants have more frequent and more yellow-colored stools than formula-fed infants.• Stools with green color are often suggested by the parents or even by medical professionals to indicate disease or discomfort in early life.What is New:• Nearly half of the healthy term infants had green stool dominating for at least one week during the first 17 weeks and occasional blood was reported in almost 10% of the infants during this period.• Data on normal variation in bowel function and stool may serve primary health care professionals when educating the families and caretakers of infants.

The effect of abdominal heat therapy on constipation

Background: Constipation is one of the most common complications of the digestive system and has a significant impact on people's health and quality of life. One of the proposed non-drug interventions is the use of heat therapy. This study aimed to determine the effect of abdominal heat therapy on constipation. Aims: To identify if the use of heat therapy reduces constipation in elderly people admitted to the general internal medicine department. Methods: This study employs a triple-blind clinical trial design. A total of 92 elderly patients admitted to the internal medicine department of Sinai Hospital in Arak City in 2023 were randomly assigned to either a control or intervention group. Patients in the intervention group received local heat therapy using a standard hot water bottle with a temperature of 50°C applied to the abdomen. The control group received a hot water bottle at a temperature of 25°C. Data collection tools included the Bristol Stool Form Scale and a demographic data sheet. Analysis was conducted using SPSS 16. Results: The results showed that stool consistency was similar between the interventional and control groups before applying the hot water bag to the abdomen. A significant difference was observed on the first day (P=0.001) and the second day (P=0.005). There was a significant difference in stool consistency before the intervention, on day 1 and day 2 (P&lt;0.001), but most people in the control group had no defecation. Conclusions: Local heat therapy improves bowel function and reduces constipation during defecation in the elderly, and its use is suggested at the same time as complementary studies.

The role of Weizmannia (Bacillus) coagulans LMG S-31876 in treating IBS-diarrhea.

Irritable bowel syndrome (IBS) is a common gastrointestinal condition. Some studies have shown the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). Weizmannia (Bacillus) coagulans LMG S-31876 has been marketed as a dietary ingredient, but to date, its efficacy in diarrhea-predominant irritable bowel syndrome (IBS) condition has not been clinically elucidated. Thus, a double-blind placebo-controlled multi-centered trial was planned to evaluate the safety and efficacy of Weizmannia (Bacillus) coagulans LMG S-31876 in diarrhea-predominant IBS patients. Study participants (n = 50) diagnosed with IBS prominent symptoms that include abdominal pain and other GI-related symptoms were treated with ProBC Plus (2 billion CFU) along with a placebo capsule once daily for approximately 8 weeks. Study participants were evaluated for the treatment success determined by the differences in stool consistency and frequency per day between the intervention and placebo groups over the study period. The vital signs and the biochemistry parameters were under the normal range; the other parameters showed a significant result as compared to the placebo during the study period. This study depicts a significant decline in the clinical symptoms such as abdominal pain, bloating, diarrhea, and frequency of the stool as compared to the placebo. All the parameters such as hematology, lipid profile, and vital signs were in the normal range during the supplementation of ProBC Plus for a period of 8 weeks. Furthermore, the study verified that Weizmannia (Bacillus) coagulans LMG S-31876 and its probiotic product ProBC Plus at a dose of 2 billion/CFU/day has a prominent action in the relief from the clinical symptoms of IBS-D. Therefore, the product is intended safe to utilize for IBS-related symptoms.Clinical trial registration: The clinical study has been registered with CTRI/2023/01/048644 with https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=77708&EncHid=24313.96864&userName=CTRI/2023/01/048644 [CTRI/2023/01/048644].

Functional Outcomes After Surgery for Total Colonic, Long-Segment, Versus Rectosigmoid Segment Hirschsprung Disease.

ABSTRACTObjectives:Knowledge on long-term outcomes in patients with Hirschsprung disease is progressing. Nevertheless, differences in outcomes according to aganglionic lengths are unclear. We compared long-term bowel function and generic quality of life in Hirschsprung patients with total colonic or long-segment versus rectosigmoid aganglionosis.Methods:In this nationwide, cross-sectional study participants with proven Hirschsprung disease received the Defecation and Fecal Continence questionnaire, and the Child Health Questionnaire Child Form-87, or the WHO Quality of Life-100. We excluded deceased patients, patients who were younger than 8 years, lived abroad, had a permanent enterostomy, or were intellectually impaired.Results:The study population (n = 334) was operated for rectosigmoid (83.9%), long-segment (8.7%), or total colonic aganglionosis (7.5%). Fecal incontinence in general was not significantly different between the three groups, but liquid fecal incontinence was significantly associated with total colonic aganglionosis (odds ratio [OR] = 6.00, 95% confidence interval [CI] 2.07–17.38, P = 0.001). Regarding constipation, patients with total colonic or long-segment aganglionosis were less likely to suffer from constipation than the rectosigmoid group (OR = 0.21, 95% CI, 0.05–0.91, P = 0.038 and OR = 0.11, 95% CI, 0.01–0.83, P = 0.032). Quality of life was comparable between the three groups, except for a lower physical score in children with total colonic aganglionosis (P = 0.016).Conclusions:Over time Hirschsprung patients with total colonic or long-segment aganglionosis do not suffer from worse fecal incontinence in general. A difference in stool consistency may underlie the association between liquid fecal incontinence and total colonic aganglionosis and constipation in patients with rectosigmoid aganglionosis. Despite these differences, generic quality of life is comparable on reaching adulthood.

Use of Thickeners Versus Hydrolysed Formulae in the Management of Gastro-oesophageal Reflux Disease in Infants: A Systematic Review

Background and objective: Regurgitation symptoms in many GERD infants might affect their nutrition status. This review compares thickeners and hydrolysis formula with cow’s milk in the evolution of regurgitation, weight and stool consistency changes in infants with GERD based on currently available evidence, as the benefits of using AR-F in infants with GERD is still contradictory. There is also evidence that hydrolysed formula plays a crucial role in regulating reflux. Methods: The search terms ‘thickener formula/pre-thickener’ OR ‘cow’s milk allergy/hydrolysis formula’ AND ‘gastro-oesophageal reflux disease (GERD)/regurgitations’ were used to search the electronic databases of NUsearch, Google Scholar, ScienceDirect and PubMed for randomised controlled trials (RCTs) published between 2005 and 2020 for thickened formula and 2010-2020 for hydrolysed formula that involved infants (Results: Seven eligible RCTs met the inclusion criteria. Thickened whey protein formula significantly reduced daily regurgitations by up to 7.7 episodes, while the results were insignificant in thickened or normal extensive hydrolysed casein milk (-4.2 vs -3, respectively). However, rice thickener significantly reduced regurgitation and weight gain by 1.261 kg in two months. An insignificant difference in stool consistency was found in most trials (P >0.05), except for the thickened casein formula as 64% of participants had normal stool density (P= 0.45). Conclusion: This study identified that using either thickening formula or extensively hydrolysed formula significantly reduced the number of regurgitations per day (mean range: -1.2 to -7.1; P<0.05). It does, however, seem that hydrolysed whey formula thickened with hydrolysed rice can support weight gain in failure to thrive infants.

Effectiveness of a Probiotic for Functional Chronic Constipation: A Meta-analysis of Randomized Controlled Trials

Context: The metabolic effects of Lactobacillus reuteri DSM 17938 administration in the treatment of functional chronic constipation are unknown. Objectives: The purpose of this review is to investigate the function of L. reuteri DSM 17938 in bowel movements and stool consistency in children and adults diagnosed with functional chronic constipation. Methods: Five electronic databases were used to search for the English version of Randomized Controlled Trials (RCTs) published between 2000 and 2018 that investigated the metabolic functions of 4–8 weeks of a dietary L. reuteri DSM 17938 intervention in children and adults diagnosed with functional chronic constipation. The risk of bias was evaluated in eligible studies, and a random-effects model was used to perform a meta-analysis for qualitative and quantitative analyses. Results: Five high-quality RCTs involving 737 participants were included in the review. L. reuteri DSM 17938 supplementation was effective in increasing bowel movements (mean difference = 1.12; 95% CI 0.85, 1.39, P &lt; 0.00001) in patients with functional chronic constipation. However, no significant differences in stool consistency from baseline were observed following L. reuteri DSM 17938 supplementation (0.98; 95% CI 0.66, 1.44, P = 0.90). Conclusions: There were significant differences in bowel movements between the experimental and placebo groups, and no significant differences in stool consistency. In addition, there were no adverse effects of the L. reuteri DSM 17938 treatment reported. These results demonstrate the beneficial effects of L. reuteri DSM 17938 in functional chronic constipation patients in comparison with placebo.

Low FODMAP Diet Is Not Effective in Children with Functional Abdominal Pain: A Randomized Controlled Trial

Introduction: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been shown to reduce symptoms among adult patients and children with irritable bowel syndrome. There are no studies investigating the effectiveness of the low FODMAP diet in pediatric patients with functional abdominal pain (FAP). Objective: The study aimed to evaluate the effectiveness of the low FODMAP diet in reducing gastrointestinal symptoms in children with FAP in comparison to the control diet based on the National Institute for Health and Care Excellence (NICE) guidelines. Methods: Twenty-seven children with diagnosed FAP were randomized to 2 groups. Each group received an intervention: the low FODMAP diet or the diet based on NICE. All food was prepared and delivered by a catering company. Data regarding gastrointestinal symptoms were recorded by participants during the 2-week baseline assessment and 4-week dietary intervention. The frequencies of abdominal pain and stools were reported as a number of events per day. The severity of abdominal pain was assessed using the Wong-Baker FACES Pain Rating Scale. The assessment of stool consistency was based on the Bristol Stool Form Scale. Results: The tendency toward the improvement in abdominal symptoms was noted in the low FODMAP group but without statistical significance. No significant differences in stool consistency were observed in this group. The NICE group experienced significant reduction in abdominal pain intensity and frequency (p < 0.01) and improvement in stool consistency (93% reporting normal stool, p < 0.05). Conclusions: The results of this pilot study suggest that the low FODMAP diet is not effective in the reduction of symptoms in children with FAP.

Prebiotics Affect the Fecal Microbiota and Gastrointestinal Health of Adults Participating in a Randomized, Double-Blind, Placebo-Controlled, Crossover Trial

Abstract Objectives Prebiotics are defined as substrates that are selectively utilized by host microorganisms conferring a health benefit. We aimed to determine the effects of the prebiotics fructooligosaccharides (FOS) and galactooligosaccharides (GOS) on the fecal microbiota and gastrointestinal health in adults. Methods We conducted a randomized, double-blind, placebo-controlled, crossover trial in healthy adults (n = 26) 25–45 years of age. Participants consumed two 4-week treatments in a randomized, counterbalanced order. The prebiotic beverage (PRE) was 8 oz low-fat lactose-free milk with 5 g FOS and 5 g GOS. The control beverage (CON) was 8 oz low-fat lactose-free milk without the added prebiotics. Each condition was separated by a 4-week washout. Fecal samples were collected at baseline and end of each condition. Fecal short-chain fatty acid (SCFA) concentrations were quantified using gas chromatography-mass spectrometry (GC-MS). Fecal pH was measured using a pH meter. Gastrointestinal health was assessed using the Bristol stool scale and a stool frequency and ease of passage log before the first and during the last week of each condition. SAS 9.4 was used to conduct general linear mixed modeling with treatment as a fixed effect and participant and period as random effects. Normality was assessed using the Shapiro-Wilk test and log and arcsine transformations were applied as needed. Results There was a 153% increase in fecal bifidobacteria relative abundances in the prebiotic group compared to control (CON: 2.8 ± 0.6, PRE: 6.9 ± 1.7; P = 0.002). No differences were detected between the groups in fecal acetate (CON: 278 ± 30.1, PRE: 231 ± 24.4; P = 0.2), butyrate (CON: 68.4 ± 10.1, PRE: 62.9 ± 12.2; P = 0.4), or propionate (CON: 76.5 ± 7.5, PRE: 76.7 ± 12.5; P = 0.4) concentrations, or fecal pH (CON: 6.86 ± 0.10, PRE: 6.91 ± 0.14; P = 0.5). Stool frequency (stool/day) increased by 26% in PRE compared to CON (CON: 1.0 ± 0.1, PRE: 1.3 ± 0.1; P = 0.01). Ease of stool passage tended to improve in PRE compared to CON (CON: 2.2 ± 0.1, PRE: 2.0 ± 0.1; P = 0.1). There was no difference in stool consistency (CON: 3.7 ± 0.3, PRE: 3.7 ± 0.2; P = 0.8). Conclusions These findings are suggestive of the beneficial health effects of consumption of the prebiotics FOS and GOS on gastrointestinal health in adults. Funding Sources USDA National Institute of Food and Agriculture, Hatch Project 1009249.

Effects of β-Fructans Fiber on Bowel Function: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to assess the effects of β-fructan supplementation on bowel function in healthy volunteers and patients. The search process was based on the selection of publications listed in the Pubmed and EUPMC database until December 2017, plus two unpublished studies, to identify studies evaluating the impact of β-fructans on bowel movement and stool parameters. Forty-seven publications were selected for inclusion. Primary parameter was frequency of bowel movements, evaluated by the number of defecations per day during the study period. Secondary outcomes were stool consistency, stool dry and wet weights, and transit time. Short-chain (DP < 10) β-fructans contributed to increased stool frequency (0.36 defecation +/− 0.06 per day; p < 0.001), while no significant effect was reported with long-chain (DP ≥ 10) β-fructans (−0.03 +/− 0.11, p = 0.82). A minimal increase in stool wet weight was also statistically demonstrated with short-chain β-fructans. Moreover, the meta-analysis highlighted significant differences in stool consistency in contrast to fecal dry weight after β-fructan supplementation. This systematic review and meta-analysis indicates that short-chain β-fructan supplementation has a positive effect on bowel function by significantly increasing the frequency of bowel movements.

Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined oxycodone and naloxone tablets

Abstract Background Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction. However, it is unknown if the inhibition can be reduced by opioid antagonism with oral naloxone, and how this compares to osmotic laxative treatment. Aims To compare the effects of oxycodone and macrogol 3350 treatment (OX + PEG) versus combined oral oxycodone and naloxone (OXN) on anal sphincter function and gastrointestinal symptoms. Methods A randomised, double-blind, crossover trial was conducted in 20 healthy, male volunteers. Participants were randomised to five days treatment of OX + PEG or OXN. Anal resting pressure, anal canal distensibility, and rectoanal inhibitory reflex-induced sphincter relaxation were evaluated at baseline and on day 5. The Patient Assessment of Constipation questionnaire (PAC-SYM), stool frequency, and stool consistency were assed daily. Results Sphincter relaxation was reduced after OX + PEG treatment compared to OXN (difference = −17.6% [95% Cl;−25.2, −10.2]; P &lt; 0.001). Anal resting pressure and anal canal distensibility did not differ between the treatments. PAC-SYM abdominal symptom subscale increased during OX + PEG compared to OXN (cumulated score: 3.2±2.3 vs. 0.2±1.8; P =0.002). Number of bowel movements was higher during OX + PEG vs. OXN (5.4±1.5 vs. 4.2±1.2; P = 0.035), but there was no difference in stool consistency (3.5±0.5 vs. 3.2±0.4; P = 0.14). Conclusions Sphincter relaxation was significantly reduced after OX + PEG compared to OXN. Evaluation of the rectoanal inhibitory reflex may serve as an important objective measure in future trials on treatment of opioid-induced bowel dysfunction.

Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials.

Context: Constipation in children is a prevalent, burdensome, and psychologically important pediatric issue, the treatment of which remains a global challenge. The use of probiotics has been reported for management of the gastrointestinal microbiota.Objective: This study reviewed the existing literatures of 6 Randomized Control Trials (RCTs) to ascertain some baseline understanding and available information for the effects of probiotics on stool frequency and consistency in children with constipation.Data Sources: PubMed, Springer, Elsevier Science, Cochrane Library, Scopus, Ovid (Medline, EMBASE, PsycINFO), Orbis, and Web of Science from the earliest record in each database to 15 September, 2016.Study selection: Eligible studies were randomized controlled trials that compared the effect of probiotics interventions to any control intervention on stool frequency and consistency.Data Extraction: Studies were identified by searching electronic databases. The meta-analysis was performed by Review Manager 5.3 software using a randomized model.Results: Six studies were identified. The use of probiotics significantly increased the stool frequency [mean difference (MD), 0.73; 95% confidence interval (CI), 0.14–1.31; P = 0.02]. Subgroup assessment showed a significantly increased stool frequency in Asian patients (MD, 1.18; 95% CI, 0.33–2.02; P = 0.006), but no significant difference in stool consistency (MD, −0.07; 95% CI, −0.21–0.06; P = 0.27).Limitations: Only six RCTs met the criteria and were included. Each RCT in this study was performed in a different country, and some of the included studies had a small sample size, which might have influenced the reliability and validity of the conclusions.Conclusion: The present study shows that probiotics increase stool frequency and have beneficial effects in Asian children. However, caution is needed when interpreting these outcomes because of the existence of heterogeneity. Evidence from larger samples and more adequately powered RCTs with results obtained by standardized measurements are necessary to determine which species and dosage of probiotics and what length of treatment are most efficacious for constipation in children.

Growth and tolerance of formula with lactoferrin in infants through one year of age: double-blind, randomized, controlled trial.

BackgroundHuman milk provides necessary macronutrients (protein, carbohydrate, fat) required for infant nutrition. Lactoferrin (Lf), a multifunctional iron-binding protein predominant in human milk, shares similar protein sequence, structure, and bioactivity with bovine Lf (bLf). This large-scale pediatric nutrition study was designed to evaluate growth and tolerance in healthy infants who received study formulas with bLf at concentrations within the range of mature human milk.MethodsIn this multi-center, double-blind, parallel-designed, gender-stratified prospective study 480 infants were randomized to receive a marketed routine cow’s milk-based infant formula (Control; n = 155) or one of two investigational formulas with bLf at 0.6 g/L (LF-0.6; n = 165) or 1.0 g/L (LF-1.0; n = 160) from 14–365 days of age. Investigational formulas also had a prebiotic blend of polydextrose (PDX) and galactooligosaccharides (GOS) and adjusted arachidonic acid (ARA). The primary outcome was weight growth rate from 14–120 days of age. Anthropometric measurements were taken at 14, 30, 60, 90, 120, 180, 275, and 365 days of age. Parental recall of formula intake, tolerance, and stool characteristics was collected at each time point. Medically-confirmed adverse events were collected throughout the study period.ResultsThere were no group differences in growth rate (g/day) from 14–120 days of age; 353 infants completed the study through 365 days of age (Control: 110; LF-0.6: 127; LF-1.0: 116). Few differences in growth, formula intake, and infant fussiness or gassiness were observed through 365 day of age. Group discontinuation rates and the overall group incidence of medically-confirmed adverse events were not significantly different. From 30 through 180 days of age, group differences in stool consistency (P < 0.005) were detected with softer stools for infants in the LF-0.6 and LF-1.0 groups versus Control.ConclusionCompared to the Control, infants who received investigational formulas with bLf and the prebiotic blend of PDX and GOS experienced a softer stooling pattern similar to that reported in breastfed infants. This study demonstrated routine infant formulas with bLf, a blend of PDX and GOS, and adjusted ARA were safe, well-tolerated, and associated with normal growth when fed to healthy term infants through 365 days of age.Trial registrationClinicalTrials.gov NCT01122654. Registered 10 May 2010.

Lactobacillus GG (LGG) and smectite versus LGG alone for acute gastroenteritis: a double-blind, randomized controlled trial

Diarrhea treatment with either Lactobacillus GG (LGG) or smectite as an adjuvant to standard rehydration therapy has proven efficacy. In countries where both LGG and smectite are available, concomitant use is frequently practiced. We investigated whether LGG plus smectite is superior to LGG alone in the management of children with acute gastroenteritis (AGE). A double-blind, placebo-controlled, randomized trial was performed. Children aged 4 to 60 months with AGE received LGG 6 × 109 colony forming units/day plus randomly either smectite (3 g) or placebo as an adjuvant to the standard rehydration therapy. Of the 88 children randomized, 81 (92 %) were available for intention-to-treat analysis. The duration of diarrhea in the LGG/smectite group (n = 44) compared with the LGG/placebo group (n = 37) was similar (P = 0.43). There were no significant differences between the study groups for the secondary outcomes, with three exceptions. On day 4, in the LGG/placebo group compared to the LGG/smectite group, there was significantly reduced stool frequency (P = 0.03). While there was a significant (P = 0.05) difference in stool consistency on the Bristol Stool Form Scale on day 4, it was not of clinical relevance. Finally, in the LGG/smectite group compared to the LGG/placebo group, there was a significantly shorter duration of intravenous therapy after randomization (P = 0.02). No adverse events were observed in the study groups. Conclusion: LGG plus smectite and LGG alone are equally effective for treating young children with AGE. Combined use of the two interventions is not justified.

Effect of dietary fiber on constipation: A meta analysis

To investigate the effect of dietary fiber intake on constipation by a meta-analysis of randomized controlled trials (RCTs). We searched Ovid MEDLINE (from 1946 to October 2011), Cochrane Library (2011), PubMed for articles on dietary fiber intake and constipation using the terms: constipation, fiber, cellulose, plant extracts, cereals, bran, psyllium, or plantago. References of important articles were searched manually for relevant studies. Articles were eligible for the meta-analysis if they were high-quality RCTs and reported data on stool frequency, stool consistency, treatment success, laxative use and gastrointestinal symptoms. The data were extracted independently by two researchers (Yang J and Wang HP) according to the described selection criteria. Review manager version 5 software was used for analysis and test. Weighted mean difference with 95%CI was used for quantitative data, odds ratio (OR) with 95%CI was used for dichotomous data. Both I(2) statistic with a cut-off of ≥ 50% and the χ(2) test with a P value < 0.10 were used to define a significant degree of heterogeneity. We searched 1322 potential relevant articles, 19 of which were retrieved for further assessment, 14 studies were excluded for various reasons, five studies were included in the analysis. Dietary fiber showed significant advantage over placebo in stool frequency (OR = 1.19; 95%CI: 0.58-1.80, P < 0.05). There was no significant difference in stool consistency, treatment success, laxative use and painful defecation between the two groups. Stool frequency were reported by five RCTs, all results showed either a trend or a significant difference in favor of the treatment group, number of stools per week increased in treatment group than in placebo group (OR = 1.19; 95%CI: 0.58-1.80, P < 0.05), with no significant heterogeneity among studies (I(2)= 0, P = 0.77). Four studies evaluated stool consistency, one of them presented outcome in terms of percentage of hard stool, which was different from others, so we included the other three studies for analysis. Two studies reported treatment success. There was significant heterogeneity between the studies (P < 0.1, I(2) > 50%). Three studies reported laxative use, quantitative data was shown in one study, and the pooled analysis of the other two studies showed no significant difference between treatment and placebo groups in laxative use (OR = 1.07; 95%CI 0.51-2.25), and no heterogeneity was found (P = 0.84, I(2)= 0). Three studies evaluated painful defecation: one study presented both quantitative and dichotomous data, the other two studies reported quantitative and dichotomous data separately. We used dichotomous data for analysis. Dietary fiber intake can obviously increase stool frequency in patients with constipation. It does not obviously improve stool consistency, treatment success, laxative use and painful defecation.

Term Infants Fed Formula Supplemented With Selected Blends of Prebiotics Grow Normally and Have Soft Stools Similar to Those Reported for Breast‐fed Infants

The present study was designed to evaluate the effect of 2 different combinations of prebiotic ingredients, polydextrose (PDX), galactooligosaccharides (GOS), and lactulose (LOS), at 2 different intake levels on the overall growth and tolerance in healthy term infants up to 120 days of age. Healthy, formula-fed, term infants (n = 226) were randomly assigned to 1 of 3 study formula groups: control group (n = 76), PG4 group (control formula supplemented with 4 g/L of a prebiotic blend, n = 74), or PGL8 group (control formula supplemented with 8 g/L of a prebiotic blend, n = 76). Anthropometric measurements were taken at 14, 30, 60, 90, and 120 days of age, and 24-hour dietary recall and 24-hour tolerance recall were recorded at 30, 60, 90, and 120 days of age. Adverse events were recorded throughout the study. There were no statistically significant differences among the 3 formula groups for weight growth rate or length growth rate at any time point. Significant differences in stool consistency were detected among the 3 formula groups at 30, 60, and 90 days of age (P < 0.001, P = 0.025, P = 0.004, respectively), with the supplemented formula groups having looser stools than the control group. The PGL8 group had significantly higher stool frequency compared with the control and PG4 groups at 30 days of age (P = 0.021 and P = 0.017, respectively), but all of the groups were similar at 60, 90, and 120 days of age. A statistical difference was detected among the formula groups in 3 categories of adverse events: diarrhea (control vs PG4, 4% vs 18%, P = 0.008), eczema (PG4 vs control, 18% vs 7%, P = 0.046; PG4 vs PGL8, 18% vs 4%, P = 0.008), and irritability (control vs PGL8, 4% vs 16%, P = 0.027). Infants fed formula supplemented with a prebiotic mixture achieved normal growth and stool characteristics more similar to those of breast-fed infants in comparison with infants fed an unsupplemented formula. A pediatrician needs to consider the risk of possible intolerance against the benefits of prebiotics.

Susceptibility Differences to Cryptosporidium parvum Infection in Two Strains of Gamma Interferon Knockout Mice

Differences in susceptibility to cryptosporidial infections were investigated between 2 strains of gamma interferon knockout (GKO) mice. Male C57BL/6J-Ifg and BALB/c-Ifg (GKO) mice, ages 8-10 wk, were inoculated with infectious oocysts at various doses. C57BL/6J-Ifg mice developed overwhelming infections and died 9-12 days after infection. Low inoculum doses (1 x 10(3)) did not increase the survival time significantly. The infection intensity in C57BL/6J-Ifg mice inoculated with 1 x 10(5) oocysts/mouse increased markedly on day 4 postinfection (PI) and continued to increase significantly over the next 6-7 days. Most of the C57BL/6J-Ifg mice exceeded 15% weight loss and died by day 10 PI. In contrast, BALB/c-Ifg mice developed moderate infections from which they recovered. The average parasite load in the BALB/c-Ifg mice was 100 times lower than in C57BL/6J-Ifg mice. Mice survived until termination of the experiment (39 days) even when 1 x 10(6) oocysts per mouse were used for inoculation. BALB/c-Ifg mice did not exhibit significant weight loss (or difference in stool consistency). These 2 mouse strains make excellent models for studying differences in recovering and nonrecovering immune mechanisms.

Intestinal effects of sulfate in drinking water on normal human subjects.

Uncontrolled observations implicate sulfate in drinking water at concentrations exceeding 500-700 mg/liter as a cause of diarrhea, but controlled studies have not been reported. We conducted a controlled study in normal adults to determine the effect of various drinking water sodium sulfate concentrations on bowel function. Ten healthy subjects were given a constant diet and fluid intake. Fluid consisted of 36 ml/kg/day of drinking water of various known sulfate concentrations and 500 ml of other fluid. In a dose-ranging study, four subjects received drinking water with sulfate concentrations of 0, 400, 600, 800, 1000, and 1200 mg/liters for six consecutive two-day periods. In a single-dose study, six other subjects received water with sulfate concentrations of 0 and 1200 mg/liter for two consecutive six-day periods. Stool mass, frequency, and consistency and mouth-to-anus appearance time of colored markers were measured. In the dose-ranging study, the only significant linear trend was decreasing mouth-to-anus appearance time with increasing sulfate concentrations. In the single-dose study, 1200 mg/liter sulfate caused a significant but clinically mild increase in mean stool mass per six-day pool from 621 g to 922 g (P = 0.03). When all 10 subjects were used to compare effects of 0 mg/liter and 1200 mg/liter sulfate, significant differences in stool consistency (P = 0.02) and transit time (P = 0.03) were observed. None of the subjects reported diarrhea or passed more than three stools per day. In 10 normal adult subjects, sulfate in drinking water at a concentration of 1200 mg/liter, which is higher than reported to occur in US municipal water sources, caused a measurable but clinically insignificant increase in stool mass and decrease in stool consistency and appearance time, but no change in stool frequency and no complaint of diarrhea.

AN EVALUATION OF FORMULA TOLERANCE AFTER HUMAN MILK FEEDING. 1814

A study was conducted to determine the influence of formula on tolerance during the weaning from exclusive human milk to exclusive formula feeding. Tolerance was characterized by the incidence of spit-up or vomit and stool characteristics. Eighty-two exclusively HM fed infants were randomized to an experimental infant formula (EF) or a commercially available whey predominant formula (CP) at the onset of weaning. EF was whey fortified (48:52 whey:casein) with a fat blend of 42% high oleic safflower (HO), 30% coconut(CO), 28% soy (SO) oils. CP is whey dominant (60:40) with fat blend of 45% palm olein (PO), 20% SO, 20% CO, and 15% HO oils. Tolerance was monitored daily during exclusive human milk feeding, while weaning to formula and when the infants were completely weaned to formula. The transition from HM to formula primarily affected stool characteristics: fewer and firmer stools, more odor with stools, fewer yellow and greener stools. Infants weaned onto CP had significantly firmer and fewer stools/day than those fed EF, both during weaning and when weaning was completed. HM=exclusively human milk feeding, W=weaning, F=exclusive formula feeding periods Infants weaned from human milk to CP underwent greater changes in stool characteristics than infants weaned to EF. The differences in stool consistency may be related to the soap formation resulting from the ingestion of palm olein which is known to cause harder stools. EF is tolerated more like human milk than the whey predominant study formula. Table

Effect of Anoreceptive Intercourse on Anorectal Function

This study is the first published assessment of the effect of anoreceptive intercourse (ARI) on anal sphincter tone and function. Forty anoreceptive (AR) male homosexuals were compared with 18 age matched non-anoreceptive (non-AR) heterosexual males. Subjects were questioned about ARI, defaecation and faecal incontinence. Anal resting pressure, maximum voluntary squeeze pressure, anal mucosal electrosensitivity, perineal descent and rectal sensation were measured in all subjects. Fourteen of the AR subjects but only one of the non-AR subjects had symptoms of frequent anal incontinence (P < 0.05). There was a significant reduction in both maximum anal resting pressure (P < 0.01) and anal mucosal electrosensitivity (P < 0.05) and a significant difference in the anal resting pressure profile (P = 0.02) in the AR subjects compared with the non-AR subjects. There was a significant reduction in maximum squeeze pressure in AR subjects with anal incontinence compared with either AR subjects without anal incontinence (P < 0.01) or non-AR subjects (P < 0.01). There were no significant differences in stoll consistency, frequency of defaecation, perineal descent or rectal sensation between the groups. ARI is associated with reduced resting pressure in the anal canal and an increased risk of anal incontinence. The risk of incontinence is greatest amongst AR subjects with reduced maximum squeeze pressure.

Sennahaltiges Laxans: Übertritt in Muttermilch?

The excretion of rhein, a cathartic with active metabolite from sennosides, was investigated in breast milk samples of 15 post-partum women for at least 24 h after the intake of a therapeutic dose (15 mg sennosides/day) of a standardized, fiber containing senna laxative (Agiolax). Rhein was analyzed by a HPLC-method with a lower limit of detection at 1 ng/ml rhein, taking into account a possible binding as monoglucuronide and monosulfate. Maximal concentrations up to 27 ng/ml and in 89% values below 10 ng/ml were measured. Related to the daily milk volume, 73% of the women excreted less than 2 ng rhein/day. Based on median values, 0.017% of the sennoside intake (calculated as rhein) was excreted in breast milk. The amount of rhein transmitted to the infant is therefore 0.3% of the rhein intake of the mother. This is far below the oral rhein dose necessary for inducing a laxative effect. Accordingly, none of the breast-fed infants (n = 8) showed any difference in stool consistency in comparison with the non breast-fed infants.