Feeling Of Incomplete Evacuation Research Articles

Evaluation of Solitary Rectal Ulcer Syndrome from Twenty-Four Iraqi Patients

Background: Solitary rectal ulcer syndrome (SRUS) is a rare benign rectal disorder that can present with bleeding, mucus passage, straining during defecation, constipation, rectal prolapse, and a feeling of incomplete evacuation. It is characterized by a combination of clinical findings, histological abnormalities, and symptoms. Since patients frequently come with lesions that are neither solitary nor ulcerated, the nomenclature of the syndrome is deceptive. Multiple factors may be implicated in the etiology and pathogenesis of the illness, which is usually linked to pelvic floor abnormalities. Objectives: To study the distribution of age and sex for this syndrome among a sample of Iraqi patients and to further characterize this syndrome in our population. Materials and Methods: A retro-prospective, descriptive single-center study with this research design was carried out at the Baghdad Gastroenterology and Hepatology Teaching Hospital involved reading reports from (1784) lower gastrointestinal endoscopies (sigmoidoscopy and colonoscopy) performed at the Baghdad Gastroenterology and Hepatology hospital over the course of fourteen months. Of those, twenty-four patients who met the requirements for the clinical, endoscopic, and histological diagnosis of SRUS were examined and monitored. Results: Sixteen patients were female and eight patients were male, mean age was (26.5±9.69), mean duration of symptoms until diagnosis was 12.083 months ±11.5. The most frequent symptom was bleeding per rectum (95.8%).All patients(100%) were subjected to several treatment options, they were advised on normal defecatory behavior and bowel habits, Sulfasalazine enema1-2gm/day for(3-6 months),sucralfate enema(2gm/day for 3months), only four patients(16.6%)ended with endoscopic treatment and two patients(8.3%)ended with surgery. Conclusion: SRUS is a chronic, benign disorder in young adults, often related to straining or abnormal defecation. SRUS remains a well-defined but nonspecific entity with varied presentation, characterized by a rectal lesion caused by straining during defecation. Clinicians, surgeons, and pathologists should be aware of the features of SRUS so that it is not confused with other conditions.

Effects of <i>Bifidobacterium longum</i> CLA8013 on bowel movement improvement: a placebo-controlled, randomized, double-blind study

A placebo-controlled, randomized, double-blind study was conducted to evaluate the effect of taking 25 billion colony-forming units of heat-killed Bifidobacterium longum CLA8013 over 2 weeks on bowel movements in constipation-prone healthy individuals. The primary endpoint was the change in defecation frequency between the baseline and 2 weeks after the intake of B. longum CLA8013. The secondary endpoints were the number of days of defecation, stool volume, stool consistency, straining during defecation, pain during defecation, feeling of incomplete evacuation after defecation, abdominal bloating, fecal water content, and the Japanese version of the Patient Assessment of Constipation Quality of Life. A total of 120 individuals were assigned to two groups, 104 (control group, n=51; treatment group, n=53) of whom were included in the analysis. After 2 weeks of consuming the heat-killed B. longum CLA8013, defecation frequency increased significantly in the treatment group compared with that in the control group. Furthermore, compared with the control group, the treatment group showed a significant increase in stool volume and significant improvement in stool consistency, straining during defecation, and pain during defecation. No adverse events attributable to the heat-killed B. longum CLA8013 were observed during the study period. This study revealed that heat-killed B. longum CLA8013 improved the bowel movements of constipation-prone healthy individuals and confirmed that there were no relevant safety issues.

Effect of Oral Intake of Lactiplantibacillus plantarum APsulloc 331261 (GTB1TM) on Diarrhea-Predominant Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study.

Irritable bowel syndrome (IBS) causes intestinal discomfort, gut dysfunction, and poor quality of life. This randomized, double-blind placebo-controlled trial evaluated the efficacy of Lactiplantibacillus (Lp., formerly Lactobacillus) plantarum APsulloc 331261 (GTB1TM) from green tea leaves in participants with diarrhea-predominant irritable bowel syndrome (IBS-D). Twenty-seven participants meeting the Rome IV diagnostic criteria were randomized for GTB1 or placebo ingestion for four weeks and follow-up for two weeks. The efficacy endpoints included adequate global relief of symptoms, assessment of intestinal discomfort symptom severity and frequency, stool frequency, satisfaction, and fecal microbiome abundance. Of all participants, 94.4% and 62.5% reported global relief of symptoms in the GTB1 and placebo groups, respectively, with significant differences (p = 0.037). GTB1 significantly reduced the severity and frequency of abdominal pain, bloating, and feeling of incomplete evacuation. The frequencies of diarrhea were decreased −45.89% and −26.76% in the GTB1 and placebo groups, respectively (p = 0.045). Hence, GTB1 ingestion improved IBS-D patient quality of life. After four weeks treatment, the relative abundance of Lactobacillus was higher in the GTB1 than in the placebo group (p = 0.010). Our results showed that GTB1 enhanced intestinal discomfort symptoms, defecation consistency, quality of life, beneficial microbiota, and overall intestinal health.

The relationship between hidradenitis suppurativa and irritable bowel syndrome: a cross-sectional study.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which one experiences abdominal pain, tension, cramping, bloating, and changes in the form and frequency of defecation, without an underlying organic disease. Many skin diseases have been reported to be more common in people with functional bowel disease. To our knowledge, however, no previous study investigated the potential relationship between hidradenitis suppurativa (HS) and IBS. In this study, we aimed to examine the potential association between IBS and HS. Patients with HS and healthy subjects were enrolled in this cross-sectional study. All participants were assessed for the presence of IBS. ROME IV criteria were used to identify IBS cases. Hurley staging, modified Sartorius score, and physician's global assessment score were applied to define clinical severity and staging of HS. According to the Rome IV diagnostic criteria, 54 (67.50%) of 80 HS patients and 23 (28.75%) of 80 control group were diagnosed with IBS. The frequency of IBS was statistically significantly higher in the patient group than in the control group (P < 0.001). No statistically significant difference was found between the two groups in terms of abnormal stool frequency and family history of IBS (P = 0.28, P = 0.862, respectively). Abnormal stool form, mucus in stool, abdominal distension, feeling of incomplete evacuation were statistically significantly higher in HS patients compared to the controls (P = 0.01, P = 0.02, P < 0.001, P = 0.001, respectively).

Constipation: Common Side Effect.

For constipation, standards of care are based on established evidence-based practice.&nbsp;Constipation&nbsp;is the decreased passage of stool characterized by infrequent bowel movements, hard stool, a sensation of abdominal bloating or cramping, straining with bowel movements, and the feeling of incomplete evacuation.&nbsp;Constipation occurs in 43%-58% of people with a diagnosis of cancer.

Is Fecal Calprotectin an Applicable Biomarker of Gut Immune System Activation in Chronic Inflammatory Demyelinating Polyneuropathy? - A Pilot Study.

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a complex autoimmune disease caused by dysregulated response to not fully recognized antigens. Some association between CIDP and inflammatory bowel disease (IBD) has been reported, but the exact pathophysiological links of these disorders are not well understood.Aim of the Study: To evaluate fecal calprotectin as a biomarker of gut inflammation in CIDP patients without IBD.Methods: Fifteen patients with CIDP and 15 healthy controls were included in the study. The CIDP diagnosis was based on the EFNS/PNS criteria. The occurrence of bowel symptoms was assessed based on a questionnaire. The quantitative evaluation of fecal calprotectin level was performed by the ELISA test.Results: The fecal calprotectin level (μg/g) expressed as median along with the lower and upper quartiles [25Q–75Q] was significantly higher in CIDP patients compared to the controls: 26.6 [17.5–109.0] vs 15.6 [7.1–24.1], p = 0.0066. Abnormal fecal calprotectin level (>50 μg/g) was found in 33% of all CIDP patients and in none of the control subjects. The patients with abnormal fecal calprotectin level did not differ from the rest of the study group regarding the neurological status. The most common bowel symptoms reported by CIDP patients included constipation (33%), feeling of incomplete evacuation (33%), bloating (27%), and alternating bowel movement pattern (27%).Conclusion: In one-third of CIDP patients the signs of gut immune system activation have been observed. This finding may be associated with CIDP pathogenesis and induction of autoimmune response as well as concomitant dysautonomia with gastrointestinal symptoms.

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.

Anal Atresia in a Patient Who Had Undergone Hartmann Procedure

Patient: Female, 84-year-old Final Diagnosis: Anal atresia Symptoms: Incomplete evacuation Medication:— Clinical Procedure: Surgery Specialty: Surgery Objective: Rare disease Background:Hartmann procedure can be necessary for the treatment of rectal cancer and colonic perforation. The distal diverted intestinal tract is usually disregarded, while the proximal colon is diverted with a stoma. Most of the reported complications related to a diverted intestinal tract following Hartmann procedure include inflammation and intestinal tumors; however, there are only a few reports about postoperative anal complications. Herein, we report a rare case of anal atresia following Hartmann procedure. Anal atresia is generally considered as a congenital malformation; therefore, this was an extremely rare case, as there are no previous reports about anal atresia following Hartmann procedure.Case Report:An 84-year-old woman presented to our hospital with a persistent feeling of incomplete evacuation. She had undergone Hartmann procedure for diverticular disease of the sigmoid colon, with perforation, 5 years ago and had no major complications after the surgery. She had no history of anal disorders such as hemorrhoids or anal fissures. On examination, her anus was found to be closed by a thin skin, and computed tomography revealed stool retention in the diverted rectum. The anus was surgically opened to remove the stool, after which the feeling of incomplete evacuation resolved with no subsequent recurrence.Conclusions:This is the first report of anal atresia in a patient following Hartmann procedure. The surgical intervention was effective in resolving the blockage and relieving the patient’s feeling of incomplete evacuation.

Acupuncture for chronic constipation in patients with diabetes mellitus: A protocol for systematic review.

Background:Assessing the effectiveness and safety of acupuncture for chronic constipation in patients with diabetes mellitus is the main purpose of this systematic review protocol.Methods:The following electronic databases will be searched from their respective inception dates to December 1st 2020: PubMed, the Cochrane Library, Embase, World Science Net, the Allied and Complementary Medicine Database, the Web of Science, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database and the Wanfang Database. All published randomized controlled trials in English or Chinese related to acupuncture for constipation in patient with diabetes mellitus will be included. The Bristol stool scale, spontaneous complete bowel movements, and observing symptoms (yes/no) including defecation feeling, defecation weakness, feeling of incomplete evacuation, bloating, and flatulence were considered as primary measures. The treatment efficiency consideration according to Bristol stool scale was considered as secondary measure. Two reviewers will conduct the study selection, data extraction and assessment independently. The assessment of risk of bias and data synthesis will be conducted with Review Manager Software (RevMan) V.5.2.Results:The results will provide a high-quality synthesis of current evidence for researchers in this subject area.Conclusion:The conclusion of our study will provide an evidence to judge whether.Acupuncture is an effective intervention for chronic constipation in patients with diabetes mellitus.Ethics and dissemination:Formal ethical approval is not necessary as the data cannot be individualized. The results of this protocol will be disseminated in a peer-reviewed journal or presented at relevant conferences.PROSPERO registration number:INPLASY202110079.

Treatment of IBS with Lactobacillus plantarum 299v: Therapeutic success increases with length of treatment - real-life data of a non-interventional study in Germany

The treatment of irritable bowel syndrome (IBS) in clinical practice is frequently challenging. Modulation of the intestinal microbiome as a treatment option is becoming more and more important. The effectiveness of a bacterial strain, Lactobacillus plantarum 299v (LP299V), was previously investigated in placebo-controlled clinical trials in patients with IBS over 4 weeks. The aims of the present non-interventional study were therefore to investigate tolerability and effectiveness of LP299V under everyday conditions and to gain information on long-term treatment. Data on tolerability and effectiveness of LP299V (1capsule/day; 1 × 1010 CFU) were prospectively collected in 25 centers in 221 patients with IBS. The maximal treatment duration was 12 weeks. The survey was carried out using symptom diaries and medical assessments. Changes in frequency and severity of symptoms were compared to baseline and defined the primary endpoint. During the 12-week treatment, a significant and continuous reduction of overall symptom score (p < 0.05) was observed. In addition, a significant reduction of severity (S) and frequency (H) of individual symptoms, such as abdominal pain (S: - 67 %, H: - 51 %), flatulence (S: - 61 %, H: - 63 %), diarrhea (S: - 70 %, H: - 32 %) and constipation (S: - 79 %, H:- 6 %) was observed. Urgency and feeling of incomplete evacuation were significantly decreased (p < 0.001). Additionally, quality of life increased significantly (mental well-being: + 110 %, influence on everyday life: -67 %, p < 0.01). Self-assessment identified that long-term treatment with LP299V was tolerated well by 94 % of patients. In real life, LP299V significantly alleviates the global symptoms of IBS in patients. In order to achieve the maximum effect, long-term use of LP299V (as here 12 weeks) appears to be indicated and is well tolerated.

Толстокишечный стаз во время беременности: эффективность применения препаратов на основе пищевых волокон

Aim: to evaluate the clinical efficacy of dietary fibers and lactulose in pregnant women with large bowel obstruction. Patients and Methods: this prospective study included 60 pregnant women (20–24 weeks of pregnancy) with large bowel obstruction occurred during pregnancy and persisted for at least 3 months. All women were randomized and divided into two groups. Group 1 received soluble fibers and group 2 received group 2 received lactulose. Clinical efficacy of treatment was evaluated using a specialized questionnaire filled at baseline, 48 h, 4 days, and 14 days after starting treatment. Results: mean age was 27.1±4.0 years in group 1 and 28.3±5.0 years in group 2. Bowel evacuation less than 3 times a week occurred in 87% and 77%, respectively, the duration of pushing occupied more than 25% of defecation in 70% and 60%, respectively, hard stool occurred in 100%, anal fissures and a feeling of incomplete evacuation were reported in 47% and 57%, respectively. Comfort bowel evacuation 48 h after starting treatment was reported in 63% of women who received dietary fibers and 47% of patients who received lactulose. Normal defecation by day 4 was observed in 80% of women in group 1 and 53% in group 2. Treatment effect was achieved by day 14 in 87% in group 1 and 70% in group 2. The most common complaint was abdominal distension that occurred 3.5 times more common after treatment with lactulose (р&lt;0.05). Conclusions: dietary fibers were more effective in terms of achieving the desired outcome and patient satisfaction. KEYWORDS: large bowel obstruction, defecation, pregnancy, dietary fibers, OptiFibere, lactulose. FOR CITATION: Dobrokhotova Yu.E., Borovkova E.I., Simonyan T.D., Selimshaeva D.S. Large bowel obstruction during pregnancy: the efficacy of dietary fibers. Russian Journal of Woman and Child Health. 2021;4(1):36–41. DOI: 10.32364/2618-8430-2021-4-1-36-41.

A randomized, comparative, open clinical trial for evaluating the efficacy of PP/JLN/107/09-10 Syrup in the management of Functional Constipation

Context: Functional constipation which has no underlying organic causes is difficult to be allopathic treatment for long term due to its side effects and undeniable effect, thus a natural balanced and compatible formulation needs to be validated. Objectives: Current study aimed to assess a poly-herbal formulation in management of functional constipation. Material and Methods: This study was 28 days, two armed, randomized, open labeled, prospective clinical study. 60 clinically confirmed cases of functional constipation patients randomized to receive orally either 2 teaspoonful of PP/JLN/107/09-10 Syrup or 1 teaspoonful of 5- 6 gm of Isabgol powder. Results were analyzed as per Rome II criteria and other associated symptoms like headache, acidity, belching, barborgysmy, flatulence and abdominal dis tension or bloating which are recorded on VAS score. Results: PP/JLN/107/09-10 scored over Isabgol on four out of six parameters of Rome II Criteria viz., frequency of bowel movement, straining at defecation, lumpy I har dstool formation, feeling of incomplete evacuation, feeling of ano-rectal blockage and manual maneuvers (p less than 0.001). Trial drugs showed comparable effects (p &gt; 0.05) in reducing the mean scores of associated symptoms like headache, acidity, belching, borgorgysmy, flatulence and abdominal distension. However, trial drug was found to perform statistically significant result in more number of parameters in comparison to Isabgol. Conclusion: PP/JLN/107/09-10 was found to be effective and safe in reliving functional constipation.

Low anterior resection syndrome following different surgical approaches for low rectal endometriosis: A retrospective multicenter study.

There is increasing evidence that intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery for rectal deep endometriosis (DE). Typical symptoms include constipation, feeling of incomplete evacuation, clustering of stools, and urgency. This is described in the colorectal surgical literature as low anterior resection syndrome (LARS). Within this, several studies suggested that differences regarding functional outcomes could be favorable to more conservative surgical approaches, that is, excision of endometriotic tissue with preservation of the luminal structure of the rectal wall when compared with classical segmental resection techniques for DE, especially when performed for low DE. A total of 211 patients undergoing rectal surgery for low DE (≤7cm from the anal verge) in three different tertiary referral centers between October 2009 and December 2018 were retrospectively reviewed regarding major complications and LARS. From the 211 eligible patients, six women were excluded because of loss to follow-up. Finally, a total number of 205 patients were enrolled for the statistical analysis; 139 with nerve- and vessel-sparing segmental resection (NVSSR) and 66 operated for laparoscopic-transanal disk excision (LTADE) were included. Gastrointestinal functional outcomes of the two procedures were compared using the validated LARS questionnaire. The median follow-up time was 46±11months. As a secondary outcome, the surgical sequelae were examined. We found no statistically significant difference between the incidence of LARS (31.7% and 37.9%, respectively) among patients operated by LTADE when compared with NVSSR (P=.4). The occurrence of LARS was positively associated with the use of protective ileostomy or colostomy (P=.02). A higher rate of severe complications was observed in women undergoing LTADE (19.7%) when compared with patients with NVSSR (9.0%, P=.029). LARS is not more frequent after NVSSR when compared with a more conservative approach such as LTADE in patients undergoing rectal surgery for low DE. To confirm our findings prospective studies are required.

Endoscopic band ligation with hypertonic glucose cushion in the treatment of ileal pouch prolapse.

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical treatment of choice of patients with ulcerative colitis (UC) or familial adenomatous polyposis who require the removal of the colon. While this reconstructive surgery significantly improves patients’ quality of life, post-operative structural, inflammatory, and functional complications are common. In our Pouch Center, we have noticed a growing number of patients presenting with dyschezia, feeling of incomplete evacuation, and frequent bowel movements. Clinical, endoscopic, and radiographic evaluation of cohorts of patients has identified a cluster of disease phenotypes that are collectively diagnosed with floppy pouch complex (FPC) [1]. Common forms of FPC are pouch prolapse, afferent limb syndrome, and pouch folding. In a survey of 269 surgeons, 35 indicated that they had been taking care of a total of 83 patients with symptoms suggestive of pouch prolapse, such as external prolapse of tissue, sense of obstructed defecation, seepage, and pain [2]. In an early study of 3,176 patients who underwent ileal pouch surgery, 11 were diagnosed with pouch prolapse (0.3%) [3]. The true prevalence may be higher in clinical practice. Pouch prolapse may be mucosal or full-thickness; and anterior, posterior, or circumferential. The treatment of pouch prolapse has traditionally been medical (such as suppositories and creams) and surgical (such as pouch pexy, mesh placement, and excision) [1, 2, 4]. Over the past decade, we have developed a novel endoscopic approach for the treatment of pouch prolapse.

Seated anorectal manometry during simulated evacuation: A physiologic exercise or a new clinically useful diagnostic test?

Symptoms such as a feeling of incomplete evacuation, straining, absence of the call to stool, anal blockage, or digitation suggest the presence a functional defecation disorder. As symptoms do not distinguish between patients with and without functional defecation disorder, Rome IV criteria recommend that this disorder is diagnosed when two of three tests are positive: balloon expulsion test (BET), anorectal manometry (ARM), and defecography. However, previous studies have demonstrated that the agreement among these tests is limited. In this issue of Neurogastroenterology and Motility, Sharma et al tested the hypothesis that conducting the ARM in a seated position would increase the diagnostic accuracy of the test in discriminating between patients with normal and prolonged BET. This minireview discusses the current knowledge on the role of the techniques to diagnose defecation disorder and the potential role of the ARM in a seated position.

Solitary Rectal Ulcer Syndrome in Children: A Report of 140 Cases.

Solitary rectal ulcer syndrome (SRUS) is said to be rare in children (largest series so far; 55 in children, 116 in adults). We analyzed our experience to look at its clinical presentations, endoscopic appearance, and treatment outcome in a large cohort of children. Clinical and endoscopic data were collected between 2000 and 2018. Children (18 years or younger) diagnosed to have SRUS on colonoscopy and confirmed by histopathology were included. All children with SRUS were treated with behavioral modification, bulk laxative. Most with ulcer received steroid enema and some sulfasalazine or sucralfate enema. The median age of 140 children was 12 (interquartile range [IQR]: 10-14) years, 79% were boys. The median symptom duration was 21 (IQR: 9-36) months. Rectal bleeding was the presenting feature in 131 (93.6%); constipation in 38 (27%); and small, frequent stools in 79 (56%). Most children had features of dyssynergic defecation such as prolonged sitting in the toilet (131, 93.6%), excessive straining (138, 98.6%), a feeling of incomplete evacuation (130, 92.8%), and rectal digitation (71, 50.7%). Rectal prolapse was noted in 24 (17%) cases. Colonoscopy documented rectal ulcer in 101 (72%) [Single: 84]. Over a median follow-up of 6 (IQR: 4-18) months, 27 patients were lost to follow-up and of the remaining 113 cases, 71 (62.8%) showed clinical improvement (healing of ulcer documented in 36/82, 44%). The majority of cases of SRUS presented in second decade with rectal bleeding and features of dyssynergic defecation. Ulcer was noted in three fourths of cases. The outcome of medical treatment with behavioral modification and local therapy was modest.

Microbiome Diversity and Differential Abundances Associated with Gastrointestinal Symptoms, BMI, Immune Markers, and Fecal Short Chain Volatile Fatty Acid Profiles

Abstract Objectives The gut microbiota and its metabolites – namely short chain volatile fatty acids (SCVFAs) – interact with the digestive, immune, and nervous systems. States of microbiome dysbiosis are highly associated with obesity and GI symptoms, and profiles of SCVFAs, which serve functions as fuel sources and signaling molecules, mimic this dysbiotic state. This study aimed to further our understanding of associations between bacterial diversity and GI symptoms, BMI, immune markers, and SCVFAs and to identify bacteria differentially abundant with changes to the previously mentioned variables. Methods Data (measures of GI distress, BMI, immunoglobulins, fecal proximate analysis, SCVFAs, and 16s RNA sequences) was extracted from a study containing non-celiac gluten-sensitive and control participants. QIIME2 was used to process 16s RNA data, analyze quantitative, qualitative, phylogenetic quantitative, and phylogenetic qualitative measures of alpha and beta diversity and to perform an analysis of composition of microbes (ANCOM) for differential abundances data. Results Many significant differences were seen, namely in multiple measures of alpha diversity for IgG4 (P &amp;lt; 0.018), propionate (P &amp;lt; 0.014), caproate (P &amp;lt; 0.003), heartburn (P &amp;lt; 0.004), urgent need to defecate (P &amp;lt; 0.027), and feelings of incomplete evacuation (P &amp;lt; 0.024). Statistical significance was seen in multiple measures of beta diversity between normal and overweight (P &amp;lt; 0.01), normal and obese (P &amp;lt; 0.005), and overweight and obese BMI (P &amp;lt; 0.016), IgG4 (P &amp;lt; 0.033), propionate (P &amp;lt; 0.001), increased gas (P &amp;lt; 0.024), and urgent need for defecation (P &amp;lt; 0.026). The ANCOM identified multiple species of bacteria differentially abundant with changes to variables. Conclusions Findings suggest differences in both alpha and beta diversity with various GI symptoms, SCVFAs, and BMI. This research supports plans to apply analysis to larger sample sizes to train machine learning classifiers to identify important features of microbial profiles associated with certain SCVFA and markers of health. Funding Sources ETSU (CCRHS, Deans's Research Enhancement Award and CPH, Health Sciences Funding, Honors College Summer Research Fellowship) and Shield Nutraceuticals, LLC.

The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease characterized by chronic abdominal pain and changes in bowel movements without underlying organic pathology. Many skin diseases have been reported to be more common in individuals with functional bowel diseases. In this study, we aimed to investigate a possible relationship between acne vulgaris (AV) and IBS. This prospective controlled study included patients with AV and healthy volunteers. All the subjects were evaluated in terms of the presence of IBS. The diagnosis of IBS was made based on the ROME IV diagnostic criteria. The clinical severity of AV was calculated using the global acne grading system (GAGS). A total of 300 patients with acne vulgaris and 300 age and gender-matched healthy controls were included in the study. The majority of the patients were female (n=175, 58.3%). The mean ages of the patients and controls were 20.22±5.24years and 20.49±5.36years, respectively. A total of 183 patients (61.0%) and 84 (28.0%) controls were diagnosed with IBS based on the Rome IV diagnostic criteria. The frequency of IBS was statistically significantly higher in the patient group than in the control group. (P=.001). There was also statistically significant relationship between the GAGS scores and IBS diagnosis (P=.001), abnormal stool form (P=.001), abdominal distention (P=.001), and feeling of incomplete evacuation (P=.001). Our study showed that IBS is significantly more common in patients with AV than in healthy controls. Additionally, GAGS scores were higher in patients diagnosed with IBS. To the best of our knowledge, this is the first study focusing on the subject.

Constipation Treatment: A Review.

Constipation seems like a ubiquitous condition, something people of all ages experience and many complain about. It is often associated with infrequent bowel movements; however, in reality, constipation has a wide array of symptoms including hard stools, feeling of incomplete evacuation, abdominal discomfort, bloating, distension, excessive straining, sensation of anorectal blockage, or need for manual maneuvers during defecation. Determining the cause of the constipation is essential to ensure the appropriate treatment approach. The patient evaluation consists of collecting subjective and objective information. Constipation has many different treatment options, with many treatments available as over-the-counter products as well as prescription medications. For most types of constipation, nonpharmacological and dietary changes are typically recommended as first-line treatment. Prescription medications are available with indications for specific types of constipation. Both nonpharmacological and pharmacological interventions have a key role, and follow-up is important to ensure treatment is appropriate and adequate.

Clinicopathological differences and correlations between right and left colon cancer.

BACKGROUNDThe differences in histopathology and molecular biology between right colon cancer (RCC) and left colon cancer (LCC) were first reported in the literature by Bufill in 1990. Since then, a large number of studies have confirmed their differences in epidemiology, clinical presentation, comorbidities and biological behaviours, which may be related to the difference in prognosis and overall survival (OS) between the two groups.AIMTo investigate statistically significant differences between Greek patients with LCC and RCC.METHODSThe present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period. Clinical information, comorbidities, histopathologic characteristics and molecular biomarkers were collected from the patients’ medical records retrospectively, while administered chemotherapy regimens, targeted agents, progression-free survival (PFS) periods with first- and second-line chemotherapy and OS were recorded retroactively and prospectively. Data analysis was performed with the SPSS statistical package.RESULTSEighty-six males and 58 females participated in the study. One hundred (69.4%) patients had a primary lesion in the left colon, and 44 (30.6%) patients had a primary lesion in the right colon. Patients with RCC were more likely to display anaemia than patients with LCC [odds ratio (OR) = 3.09], while LCC patients were more likely to develop rectal bleeding (OR = 3.37) and a feeling of incomplete evacuation (OR = 2.78) than RCC patients. Considering comorbidities, RCC patients were more likely to suffer from diabetes (OR = 3.31) and coronary artery disease (P = 0.056) than LCC patients. The mucinous differentiation rate was higher in the right-sided group than in the left-sided group (OR = 4.49), as was the number of infiltrated lymph nodes (P = 0.039), while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients (OR = 2.78). RAS wild-type patients who received anti-epidermal growth factor receptor (EGFR): Treatment experienced greater benefit (PFS: 16.5 mo) than those who received anti-vascular endothelial growth factor treatment (PFS: 13.7 mo) (P = 0.05), while among RAS wild-type patients who received anti-EGFR treatment, LCC patients experienced greater benefit (PFS: 15.8 mo) than the RCC subgroup (PFS: 5.5 mo) in the first-line chemotherapy setting (P = 0.034). BRAF-mutant patients had shorter PFS (9.3 mo) than BRAF wild-type patients (14.5 mo) (P = 0.033). RCC patients showed a shorter tumour recurrence period (7.7 mo) than those with LCC (14.5 mo) (P < 0.001), as well as shorter (OS) (58.4 mo for RCC patients; 82.4 mo for LCC patients) (P = 0.018).CONCLUSIONRCC patients present more comorbidities, worse histological and molecular characteristics and a consequently higher probability of tumour recurrence, poor response to targeted therapy and shorter OS than LCC patients.