Functional Constipation Group Research Articles

Assessing impaired gastric accommodation in children with functional constipation using the water load test.

This study aimed to evaluate gastric accommodation in pediatric patients with functional constipation using the water load test. This was a cross-sectional case-control study. Herein, the water load test results of children aged >4 years with functional constipation referred to a Pediatric Gastroenterology Outpatient Clinic (functional constipation group) were compared with those of a control group (without functional constipation or chronic abdominal pain) recruited from two public schools. Clinical manifestations outlined in the Rome IV criteria were used to diagnose functional constipation. Water load tests were performed after 3 h of fasting. For the test, the participants were asked to drink as much water as possible in 3 min. A total of 36 patients and 77 students were included in the functional constipation and control groups, respectively. There was no significant difference in age between the groups (8.6 ± 2.3 years and 8.8 ± 1.8 years in the functional constipation and control groups, respectively). The water load test showed intake volumes of 390 ± 245 mL and 528 ± 219 mL in the functional constipation and control groups, respectively (p = 0.001). The maximum volume in the water load test correlated with the 24 h daily intake of energy (rS = +0.42, p = 0.012), protein (rS = +0.48, p = 0.004), and water (rS = +0.39, p = 0.020) only in the group with functional constipation. According to the water load test, gastric accommodation was impaired in children with severe functional constipation. The impairment of gastric accommodation in children with severe functional constipation is related to food intake.

Altered gut microbial profile is associated with differentially expressed fecal microRNAs in patients with functional constipation.

While dysbiosis within the intestinal ecosystem has been associated with functional constipation (FC), the mechanisms underlying the interactions between FC and the microbiome remain poorly elucidated. Recent investigations suggested that host microRNAs (miRNAs) can modulate bacterial growth and influence the composition of the gut microbiome. To explore the connection between gut microbiota and fecal miRNAs in FC patients, we initially employed 16S rRNA sequencing to assess the gut microbial landscape in 30 FC patients and 30 healthy controls (HCs). The α-diversity within the FC group exhibited some alterations, and the β-diversity significantly differed, signifying distinctive variations in gut microbiota composition between FC patients and HCs. Subsequently, we identified 44 differentially expressed (DE) miRNAs in feces from FC patients and HCs. Through correlation analysis between DE miRNAs and FC-associated microbiota, we detected an interaction involving nine DE miRNAs (miR-205-5p, miR-493-5p, miR-215-5p, miR-184, miR-378c, miR-335-5p, miR-514a-3p, miR-141-3p, and miR-34c-5p) with seven bacterial genera (Oscillibacter, Escherichia.Shigella, UCG.002, Lachnospiraceae_NK4A136_group, Lachnospiraceae_UCG.010, Eubacterium_ruminantium_group and Megamonas), as evidenced by a co-occurrence network. Further, a comprehensive panel of seven diagnostic biomarkers (Oscillibacter, Escherichia.Shigella, UCG.002, miR-205-5p, miR-493-5p, miR-215-5p, and Lachnospiraceae_NK4A136_group) demonstrated robust discriminatory capacity in predicting FC status when integrated into a random forest model (AUC = 0.832, 95% CI: 65.73-98.88). Microbiomes correlating with DE miRNAs exhibited enrichment in distinct predicted metabolic categories. Moreover, miRNAs correlated with FC-associated bacteria were found to be enriched in signaling pathways linked to colonic contractility, including Axon guidance, PI3K-Akt signaling pathway, MAPK signaling pathway, and Hippo signaling pathway. Our study offers a comprehensive insight into the global relationship between microbiota and fecal miRNAs in the context of FC, presenting potential targets for further experimental validation and therapeutic interventions.

Prevalence of dyssynergic defecation in children with constipation evaluated by high-resolution anorectal manometry.

Dyssynergic defecation, defined as the incoordination of rectoanal and abdominal muscles and the pelvic floor which are necessary for the appropriate relaxation, is characterized by paradoxical anal contraction, inadequate anal relaxation, or abnormal rectal propulsion; it is considered a cause of refractory primary constipation. The prevalence of dyssynergic defecation in the pediatric age is still little known. The studies that have evaluated the defecation dynamics through anorectal manometry suggest that 36.8% to 80.9% of children with functional constipation (FC) present dyssynergic defecation. High-resolution Anorectal Manometry (HRAM) is a tool for the evaluation of the sensitivity and defecation dynamics; it allows to establish the diagnosis of dyssynergia and its classification. The objective of this study was to determine the prevalence of dyssynergic defecation in children with FC and characterize the most common type of dyssynergia evaluated through a HRAM. In this study, 63 files of pediatric patients with FC diagnoses were included. Of these, 41.3% (n=26) were female and 58.7% (n=37) were male. The median age in the group of dyssynergia was 8 years, while for the FC group it was 9 years; the distribution by sex was similar. Of the included patients, 41.3% (n=26) showed dyssynergic defecation, and 58.7% (n=37) showed normal anorectal manometry. Regarding the type, 84.6% (n=22) were of type I, 7.7% (n=2) was the percentage for both types III and IV, and no patients were reported for type II.

Electro-acupuncture promotes gut motility and alleviates functional constipation by regulating gut microbiota and increasing butyric acid generation in mice

ObjectiveAbnormalities in the gut microbiota and intestinal short-chain fatty acid (SCFA) levels are implicated in the pathogenesis of functional constipation (FC). Electro-acupuncture (EA) has been shown to improve constipation-related symptoms and rebalance the gut microbiota. However, it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs. Therefore, we assessed the effects of EA in FC mice and pseudo-germfree (PGF) mice to address these questions. MethodsForty female Kunming mice were randomly separated into a normal control group (n = 8), an FC group (n = 8), an FC + EA group (n = 8), a PGF group (n = 8) and a PGF + EA group (n = 8). The FC group and FC + EA group were treated with diphenoxylate to establish the FC model; the PGF group and PGF + EA group were given an antibiotic cocktail to initiate the PGF model. After maintaining the model for 14 d, mice in the FC + EA and PGF + EA groups received EA stimulation at the ST25 and ST37 acupoints, once a day, 5 times per week, for 2 weeks. Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility. Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing, and measure SCFA concentrations using gas chromatography-mass spectrometry. ResultsEA significantly shortened the first black stool defecation time (P < 0.05) and increased the intestinal transit rate (P < 0.01), and fecal pellet number (P < 0.05), wet weight (P < 0.05) and water content (P < 0.01) over 8 h, compared with the FC group, showing that EA promoted gut motility and alleviated constipation. However, EA treatment did not reverse slow-transit colonic motility in PGF mice (P > 0.05), demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation. In addition, EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice (P < 0.05), most likely due to the upregulation of Staphylococcaceae microorganisms (P < 0.01). ConclusionEA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.Please cite this article as: Xu MM, Guo Y, Chen Y, Zhang W, Wang L, Li Y. Electro-acupuncture promotes gut motility and alleviates functional constipation by regulating gut microbiota and increasing butyric acid generation in mice. J Integr Med. 2023; Epub ahead of print.

Functional constipation: A commonand often overlooked cause for abdominal pain in children.

The most common causes for chronic pain abdomen in pediatric practice are functional abdominal pain disorders, a subgroup of functional gastrointestinal disorders under the Rome IV classification. Constipation is usually associated with painful defecation, but abdominal pain as a predominant or presenting symptom of functional constipation (FC) is not very well recognized. We conducted this study to ascertain the prevalence of FC in chronic pain abdomen and proportion of FC children presenting with predominant complaints of pain abdomen. Prevalence of FC and functional abdominal pain was ascertained separately over a1-year in children > 4 years of age in our hospital. The number of children with FC presenting with abdominal pain was noted. Abdominal pain site and duration werenoted in the FC group and werecompared with those in the functional abdominal pain group to find out any significance. Diagnosis was based on Rome IV criteria, but relevant investigations to rule out organic pathology were done whenever clinically indicated. The prevalence of abdominal pain was 22% in our gastroenterology service and that of FC was 27%. Among the children presenting with chronic abdominal pain, FC was seen in 10% of the patients and functional abdominal pain disorders in 34%. Among children presenting with constipation, 12% had pain as the sole complaint. However, some form of pain or pain as one of the symptoms was seen in 47.5%. FC is a major cause for abdomen pain in children and is often overlooked. Not attributing pain to constipation may delay the diagnosis, which may have poor prognosis.

Electroacupuncture Alleviates Functional Constipation in Mice by Activating Enteric Glial Cell Autophagy via PI3K/AKT/mTOR Signaling.

To investigate autophagy-related mechanisms of electroacupuncture (EA) action in improving gastrointestinal motility in mice with functional constipation (FC). According to a random number table, the Kunming mice were divided into the normal control, FC and EA groups in Experiment I. The autophagy inhibitor 3-methyladenine (3-MA) was used to observe whether it antagonized the effects of EA in Experiment II. An FC model was established by diphenoxylate gavage. Then the mice were treated with EA stimulation at Tianshu (ST 25) and Shangjuxu (ST 37) acupoints. The first black stool defecation time, the number, weight, and water content of 8-h feces, and intestinal transit rate were used to assess intestinal transit. Colonic tissues underwent histopathological assessment, and the expressions of autophagy markers microtubule-associated protein 1 light chain 3 (LC3) and Beclin-1 were detected by immunohistochemical staining. The expressions of phosphoinositide 3-kinases (PI3K)-protein kinase B (AKT)-mammalian target of rapamycin (mTOR) signaling pathway members were investigated by Western blot and quantitative reverse transcription-polymerase chain reaction, respectively. The relationship between enteric glial cells (EGCs) and autophagy was observed by confocal immunofluorescence microscopy, localization analysis, and electron microscopy. EA treatment shortened the first black stool defecation time, increased the number, weight, and water content of 8-h feces, and improved the intestinal transit rate in FC mice (P<0.01). In terms of a putative autophagy mechanism, EA treatment promoted the expressions of LC3 and Beclin-1 proteins in the colonic tissue of FC mice (P<0.05), with glial fibrillary acidic protein (GFAP) and LC3 significantly colocalized. Furthermore, EA promoted colonic autophagy in FC mice by inhibiting PI3K/AKT/mTOR signaling (P<0.05 or P<0.01). The positive effect of EA on intestinal motility in FC mice was blocked by 3-MA. EA treatment can inhibit PI3K/AKT/mTOR signaling in the colonic tissues of FC mice, thereby promoting EGCs autophagy to improve intestinal motility.

Internet Addiction in Constipated Adolescents.

This study aims to assess internet addiction among adolescents with functional constipation and its relationship with sociodemographic and family factors. In this case-control study, 57 and 35 adolescents with and without functional constipation, respectively, were recruited. Functional constipation was diagnosed by applying the Rome IV criteria. Previously validated Young's Internet Addiction Test-Short Form and Parent-Child Internet Addiction Test were completed, and sociodemographic data forms were filled out by all participants. According to the Parent-Child Internet Addiction Test questionnaire, 8.8% (n = 5) of the adolescents with FC suffered from internet addiction, whereas none of the healthy adolescents had internet addiction. The Young's Internet Addiction Test-Short Form survey reported internet addiction among 19.3% (n = 11) of the constipated adolescents and 17.1% (n = 6) of the healthy peers. The ratio of adolescents with limited symptoms and internet addiction in the functional constipation group was as high as 40.4%, according to Young's Internet Addiction Test-Short Form, and adolescents with functional constipation accompanied by pathological and problematic internet use was 24.6%, according to Parent-Child Internet Addiction Test. Although there was no significant difference in the internet addiction ratio between functional constipation and controls, our findings indicated that adolescents with functional constipation were suffering from high internet addiction rates. The evaluation of Young's Internet Addiction Test-Short Form and Parent-Child Internet Addiction Test surveys showed high internet usage problems, 40.4% and 24.6% in adolescents with functional constipation. According to adolescents' self-assessment, the internet addiction rate is higher but not significantly higher than their healthy peers. Therefore, internet addiction should be considered while treating adolescents with functional constipation, and clinicians should consider the opinions of adolescents besides their parents.

Characteristics and risk factors of functional constipation in children aged 0-4 years in Xi 'an

Objective: To investigate the epidemiology, characteristics and risk factors of functional constipation (FC) in children aged 0-4 years in Xi'an. Methods: From October, 2020 to June, 2021, a prevalence survey was conducted among 2 615 children aged 0-4 years in Xi'an by group sampling. The related factors of FC were investigated by questionnaire designed based on Rome Ⅳ diagnostic criteria.The children were divided into FC group and non-FC group. The prevalence, symptoms and signs of FC were analyzed, and its risk factors were analyzed by multivariate Logistic regression. Results: A total of 2 985 valid questionnaires were handed out, and 2 711 (90.8%) were received back. A total of 2 615 questionnaires were valid, with an effective rate of 96.5%. There were 1 338 males (51.2%) and 1 277 females (48.8%). There were 260 cases in FC group and 2 355 cases in non-FC group. The prevalence of FC in children aged 0-4 years in Xi 'an was 10.6%.There were significant differences in FC prevalence among children of different ages and sex (χ2=14.58,4.39, both P<0.05), but not in urban or rural residence (χ2=3.29, P=0.070). The main symptoms of FC group in the last month were large-diameter feces (73.5%, 191/260), painful defecation or dry and hard defecation (65.8%, 171/260). In the last month, FC group had higher incidences of the Bristol type 1, 2 and 3 stool, fecal retention, prolonged defecation, abdominal pain and incomplete defecation compared with non-FC group, with statistical significance (all P<0.05). Parental history of childhood constipation (OR=2.13, 95%CI 1.55-2.92), fever in the last month (OR=1.86, 95%CI 1.32-2.63), history of constipation (OR=3.24, 95%CI 2.46-4.26) and taking probiotics in the last month (OR=1.45, 95%CI 1.11-1.91) were risk factors of FC in children aged 0-4 years. Stratified with age, the results showed that complementary feeding earlier than 5 months of age or later than 6 months of age (OR=2.42, 95%CI 1.13-5.20), dry stools during the complementary feeding (OR=11.27, 95%CI 5.15-24.66), history of constipation (OR=2.29, 95%CI 1.23-4.29) and taking probiotics in the last month (OR=1.88, 95%CI 1.10-3.23) were risk factors of FC in children aged 0-<1 year, and breastfeeding (OR=0.53, 95%CI 0.29-0.94) was a protective factor of FC in children aged 0-<1 year. Family members' recent constipation history (OR=2.02, 95%CI 1.06-3.85) and past history of constipation (OR=3.06, 95%CI 1.74-5.38) were FC risk factors for children aged 1-<2 years. Parental history of childhood constipation (OR=3.12, 95%CI 2.00-4.85), frequency of eating vegetables less than 3 times per week (OR=3.28, 95%CI 2.00-5.38), history of constipation (OR=3.66, 95%CI 2.42-5.53) and taking antibiotics in the last month (OR=1.65, 95%CI 1.06-2.55) were risk factors for FC in children aged 2-4 years. Conclusions: FC in children aged 0-4 years in Xi'an is mainly manifested with large-diameter feces and painful defecation or dry and hard defecation in the last month. It is associated with a variety of risk factors, which are different in different age groups.

Anxiety Disorders in Children with Functional Constipation: A Case-Control Study

Background: Functional constipation as a common disorder in children, may be induce by psychiatric disorders. The present study aimed to evaluate and compared anxiety disorders in children with and without functional constipation. Methods: This case-control study was conducted on 200 children (100 cases with functional constipation and 100 children without functional constipation) aged 15 - 8 years. The participants’ age and gender were evaluated and compared in two groups. Moreover, the Spence Children Anxiety Scale (SCAS) (parent form) for children was completed. Finally, the collected data were analyzed using SPSS software version 24. Results: Of 200 evaluated cases in the case and control groups, there were 46 (46.0%) and 59 (59.0%) males, respectively (P = 0.113). The mean ± SD of age in total, the case, and the control groups were 7.51 ± 1.91, 7.61 ± 0.91, and 7.41 ± 2.49 years, respectively (P = 0.585). Furthermore, SCAS in the case group was significantly higher (33.06 ± 14.4 vs. 24.8 ± 14.9, P = 0.001). Furthermore, the mean of separation anxiety disorder (P = 0.001), generalized anxiety (P = 0.003), and obsessive-compulsive disorder (OCD) were significantly higher in the functional constipation group (P = 0.001). Conclusions: Anxiety was higher in children with functional constipation than in children without functional constipation (ie, control group), among which separation anxiety, generalised anxiety, and OCD were significantly different in the two groups.

Functional constipation in Bangladeshi school aged children: A hidden misty at community.

BACKGROUNDConstipation is a common problem in children and a frequent cause of hospital visit in both primary & specialized care, which needs proper evaluation & management. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.AIMTo determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODSThis descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical history & physical examinations (without digital rectal examination) & available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests, P value of less than 0.05 was considered as statistically significant.RESULTSTotal study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884–8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of > 2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time < 2 h (OR = 2.138, 95%CI: 1.063-4.301).CONCLUSIONConstipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation.

Subjective Taste and Smell Changes in Conjunction with Anxiety and Depression Are Associated with Symptoms in Patients with Functional Constipation and Irritable Bowel Syndrome.

Background Patients with functional constipation (FC) and irritable bowel syndrome (IBS) often report psychological abnormalities and decreased eating enjoyment. Several patients also complain of changes in the sense of smell and taste, but these are often disregarded clinically. Aims Therefore, there is a need to determine whether taste/smell disturbances and psychological abnormalities are present in patients with FC or IBS and whether these are related to the severity of lower gastrointestinal symptoms. Methods A total of 337 subjects were recruited, including FC (n = 115), IBS (n = 126), and healthy controls (n = 96). All participants completed questionnaires evaluating taste and smell (taste and smell survey (TSS)), Lower Gastrointestinal Symptoms Rating Scale (LGSRS), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). TSS recorded information on the nature of taste and smell changes (TSCs) and the impact of these changes on the quality of life. LGSRS was used to assess the severity of lower gastrointestinal symptoms; HAMA and HAMD scales were used to reflect the psychosocial state. This study protocol was registered on the Chinese Clinical Trial Registry (No. ChiCTR-2100044643). Results Firstly, we found that taste and smell scores were higher in patients with IBS than in healthy controls. Secondly, for FC and IBS patients, LGSRS was significantly correlated with the taste score (Spearman′s rho = 0.832, P < 0.001). LGSRS was also significantly correlated with HAMA (Spearman′s rho = 0.357, P = 0.017) and HAMD (Spearman′s rho = 0.377, P = 0.012). In addition, the taste score was significantly correlated with HAMD (Spearman′s rho = 0.479, P = 0.001), while the smell score was also significantly correlated with HAMD (Spearman′s rho = 0.325, P = 0.031). Thirdly, 60.87% and 71.43% of patients complained of taste abnormality, while 65.22% and 71.43% had smell abnormality in the FC and IBS groups, respectively. Meanwhile, 47.83% and 47.62% of patients suffered from anxiety, while 43.48% and 57.14% suffered from depression in the FC and IBS groups, respectively. Finally, we found significant differences in the taste, smell, HAMD, and LGSRS scores between the female and male IBS groups (P < 0.050). Conclusions TSCs and psychological disorders are prominent in FC and IBS patients. Taste abnormalities, as well as anxiety and depression, are significantly correlated with LGSRS. Awareness of this high prevalence of taste/smell abnormalities and the psychological changes among patients with FC and IBS may help better predict and understand the severity of symptoms.

Three-dimensional high-resolution anorectal manometry: cut-off values for diagnosis of dyssynergic defecation in children.

Dyssynergic defecation (DD) may be one of the most important causes of constipation, but its diagnostic criteria have not been formally validated in children. This study aims to evaluate constipated children with 3DHRAM (three-dimensional high-resolution anorectal manometry) and determine a new pediatric cut-off for DD variables. 205 patients diagnosed with functional constipation (FC) based on Rome III criteria were prospectively enrolled. Data were compared to a historical control group (C). Initially, the diagnosis of DD was based on adult criteria and divided into 4 types. A new cut-off value for percent anal relaxation was determined based on ROC curve analysis. The FC group presented significantly lower values of percent anal relaxation during straining compared to the C group (9.5% vs. 20%, respectively, p=0.03). Based on adult criteria, DD was found in 53% of the FC group and 46% of the C group (p=0.3), with type II occurring most frequently (35.8%). New cut-off value of 31% for percent anal relaxation in children was derived based on the ROC curve analysis. Based on this new cut-off value, DD was diagnosed in 69.3% of constipated children, with type IV occurring most frequently (28.9%). The analysis of segmental pressure showed significant influence of segments at the locations of the puborectalis muscle and external anal sphincter. We found that during bear down maneuver the percent anal relaxation variable significantly differed between patients and controls. The higher cut-off value should be used when 3DHRAM and the standard four-type classification are used to diagnose DD in children.

Colonic Volume Changes in Paediatric Constipation Compared to Normal Values Measured Using MRI.

Background: Functional constipation in children is common. Management of this condition can be challenging and is often based on symptom reports. Increased, objective knowledge of colonic volume changes in constipation compared to health could provide additional information. However, very little data on paediatric colonic volume is available except from methods that are invasive or require unphysiological colonic preparations. Objectives: (1) To measure volumes of the undisturbed colon in children with functional constipation (FC) using magnetic resonance imaging (MRI) and provide initial normal range values for healthy controls, and (2) to investigate possible correlation of colonic volume with whole gut transit time (WGTT). Methods: Total and regional (ascending, transverse, descending, sigmoid, and rectum) colon volumes were measured from MRI images of 35 participants aged 7–18 years (16 with FC and 19 healthy controls), and corrected for body surface area. Linear regression was used to explore the relationship between total colon volume and WGTT. Results: Total colonic volume was significantly higher, with a median (interquartile range) of 309 mL (243–384 mL) for the FC group than for the healthy controls of 227 mL (180–263 mL). The largest increase between patients and controls was in the sigmoid colon–rectum region. In a linear regression model, there was a positive significant correlation between total colonic volume and WGTT (R = 0.56, p = 0.0005). Conclusions: This initial study shows increased volumes of the colon in children with FC, in a physiological state, without use of any bowel preparation. Increased knowledge of colonic morphology may improve understanding of FC in this age group and help to direct treatment.

Study on the characteristics of intestinal motility of constipation in patients with Parkinson's disease.

BACKGROUNDConstipation is one of the most important nonmotor symptoms in Parkinson's disease (PD) patients, and constipation of different severities is closely related to the pathogenesis of PD. PD with constipation (PDC) is considered a unique type of constipation, but its mechanism of formation and factors affecting its severity have been less reported. Understanding the gastrointestinal motility characteristics and constipation classification of PDC patients is essential to guide the treatment of PDC. In this study, the colonic transit test and high-resolution anorectal manometry were used to identify the intestinal motility of PDC to provide a basis for the treatment of PDC.AIMTo investigate the clinical classification of PDC, to clarify its characteristics of colonic motility and rectal anal canal pressure, and to provide a basis for further research on the pathogenesis of PDC.METHODSTwenty PDC patients and 20 patients with functional constipation (FC) who were treated at Xuanwu Hospital of Capital Medical University from August 6, 2018 to December 2, 2019 were included. A colonic transit test and high-resolution anorectal manometry were performed to compare the differences in colonic transit time, rectal anal canal pressure, and constipation classification between the two groups. RESULTSThere were no statistically significant differences in sex, age, body mass index, or duration of constipation between the two groups. It was found that more patients in the PDC group exhibited difficulty in defecating than in the FC group, and the difference was statistically significant. The rectal resting pressure, anal sphincter resting pressure, intrarectal pressure, and anal relaxation rate in the PDC group were significantly lower than those in the FC group. The proportion of paradoxical contractions in the PDC group was significantly higher than that in the FC group. There was a statistically significant difference in the type composition ratio of defecatory disorders between the two groups (P < 0.05). The left colonic transit time, rectosigmoid colonic transit time (RSCTT), and total colonic transit time were prolonged in PDC and FC patients compared to normal values. The patients with FC had a significantly longer right colonic transit time and a significantly shorter RSCTT than patients with PDC (P < 0.05). Mixed constipation predominated in PDC patients and FC patients, and no significant difference was observed. CONCLUSIONPatients with PDC and FC have severe functional dysmotility of the colon and rectum, but there are certain differences in segmental colonic transit time and rectal anal canal pressure between the two groups.

Prediction of Inadequate Bowel Preparation Using Total and Segmental Colon Transit Time in Patients with Chronic Constipation: Some Different Outcomes

Aims Radio-opaque markers have been widely used in the study of colon motility in patients with chronic functional constipation (FC). Here, we evaluate the relationship between the colon transit time (CTT) and the Boston Bowel Preparation Scale (BBPS) to determine whether CTT is a sufficient predictor of bowel preparation in patients with chronic functional constipation. Methods A total of fifty-six patients with constipation and fifty-two healthy controls (HC) were enrolled in this study. All subjects underwent the colonic transit study using radio-opaque markers and were given a follow-up colonoscopy examination on day 3 to 7 to determine BBPS. The correlation between total and segmental CTT and BBPS was evaluated, and risk factors for predicting inadequate bowel preparation were determined. Results In our study, we found some distinct outcomes compared with previous studies. The mean total CTT (TCTT) was determined to be 43.37 ± 18.82 h in the FC group and 23.08 ± 10.18 h in the HC group. This difference was found to be significant for both the total and segmental CTTs between the two groups (P < 0.05). Further, TCTT was negatively correlated with BBPS both in the FC (r = −0.899, 95% CI -0.748 to -0.925, P < 0.001) and the HC (r = −0.978, 95% CI -0.854 to -1.003, P = 0.004) groups, as was segmental CTTs and segmental BBPS (P < 0.05). In the case of patients with slow transit constipation, multivariate logistic regression analysis indicated that prolonged TCTT (OR 0.722, 95% CI 0.589-0.885, P = 0.002) was independently associated with poor bowel preparation. The total and right to left CTTs were found to predict inadequate bowel preparation and exhibited the best sensitivity and specificity at 48.0 h, 15.5 h, 17.5 h, and 19.0 h, based on ROC curve analysis. Conclusions The CTT test represents a valuable method for predicting the level of bowel preparation prior to a colonoscopy examination. That is, both total and segmental CTTs can be considered an objective predictor of bowel preparation prior to colonoscopy. The present study demonstrates some distinct results relative to previous studies, including STC subtype proportion in FC, the proportion of inadequate bowel preparation in the STC subtype, and the cut-off value of TCTT for predicting inadequate bowel preparation.

Internet survey on the actual situation of constipation in the Japanese population under 70\xa0years old: focus on functional constipation and constipation-predominant irritable bowel syndrome

BackgroundIn Japan, the prevalence of constipation-predominant irritable bowel syndrome (IBS-C) and functional constipation (FC) diagnosed by the Rome III criteria is unclear, as are the demographic profile, quality of life (QOL), and habits of persons with IBS-C or FC.MethodsWe performed an internet survey of constipation. After extracting 3000 persons fitting the composition of the general Japanese population, we investigated demographic factors, lifestyle, defecation, and laxatives. IBS-C and FC were diagnosed by Rome III criteria. Respondents also completed the Japanese IBS severity index (IBS-SI-J), Japanese IBS QOL scale (IBS-QOL-J), SF-8, Hospital Anxiety and Depression Scale (HADS), and Japanese Health Practice Index (JHPI).ResultsThere were 262 respondents with FC (8.73%) [73 men and 189 women; mean age: 49.8 ± 13.1 years; mean body mass index (BMI): 21.0 ± 3.3 g/m2] and 149 respondents with IBS-C (4.97%) (76 men and 73 women; mean age; 41.6 ± 13.7 years; mean BMI: 20.8 ± 3.0 kg/m2). Total IBS-QOL-J score were significantly lower in the IBS-C group than the FC group. With regard to SF-8, score of mental component summary (MCS) was significantly lower in the IBS-C group. The total IBS-SI-J score and item scores, except for satisfactory defecation, were significantly higher in the IBS-C group than the FC group. HADS showed a significant increase of anxiety and depression in both the groups, and the JHPI revealed insufficient sleep.ConclusionsIn Japan, among the population of under 70 years old, the prevalence of IBS-C and FC (Rome III criteria) was 4.97% and 8.76%, respectively. IBS-C caused more severe symptoms than FC, resulting in impairment of QOL.

Dietary properties and anthropometric findings of children with functional constipation: a cross-sectional study.

Functional constipation (FC) is a common problem in childhood. This study intended to investigate the dietary properties and anthropometric findings of children with FC. Patients with FC were defined according to the Rome IV diagnostic criteria. The control group included children who were not diagnosed with FC or any other organic disease. The children who admitted to pediatric gastroenterology outpatient clinic between September 2017-March 2018 were included. Anthropometric measurements of weight, height, and body mass index were recorded. Body mass index z-scores were used to identify for overweight and obese children. Malnutrition was defined according to Waterlow criteria. The three-day nutritional diaries of both FC patients and control subjects were assessed and the daily average of calorie, fiber, carbohydrate, protein and fat intake were calculated by the same nutritionist. Fourty patients with FC and fourty healthy control were included. Twenty-four patients with FC were in the normal height and weight ranges. There was no significant difference in the average daily calorie, carbohydrate, fat and fiber intake between the FC and control groups. Although protein ratios (%) in the diet were found to be significantly lower in children with FC, the amount of protein that taken daily was found to be within normal limits in both groups. Most children with FC were in the normal range for height and weight. There was no significant relationship between FC and carbohydrate, fat and fiber content in the diet, only low protein ratios were found in FC.

Sex-related differences in resting-state brain activity and connectivity in the orbital frontal cortex and insula in patients with functional constipation.

Functional magnetic resonance imaging (fMRI) has been used to investigate sex-related differences in brain abnormalities in patients with irritable bowel syndrome (IBS). Like IBS, women with functional constipation (FC) are 2.1 times as many as men. No study has been performed yet to examine sex-related differences in brain activity and connectivity in patients with FC. Here, we employed resting-state fMRI with amplitude of low-frequency fluctuation (ALFF) to investigate brain functional differences in 51 patients with FC (34 females) and 52 healthy controls (34 females). Results showed abdominal pain and abdominal distension correlated with trait (TAI) and state (SAI) anxiety ratings in the female FC group, and abdominal distension correlated with sensation of incomplete evacuation in the male FC group. Two-way ANOVA revealed sex effects on ALFF in precentral gyrus, thalamus, insula (INS), and orbital frontal cortex (OFC, PFWE <0.05). Post hoc test showed that the female FC group had lower ALFF than males in these brain regions (P<0.01), and ALFF in INS and OFC was correlated with abdominal pain and difficulty of defecation, respectively. Seed voxel correlation analysis showed that the female FC group had weaker connectivity than males between INS and lateral OFC (lOFC). INS-lOFC connectivity was negatively correlated with the anxiety score in the female FC group and was negatively correlated with abdominal distension in the male FC group. These findings provide the first insight into sex-related differences in patients with FC and highlight that INS and OFC play an important role in modulating the intrinsic functional connectivity of the resting brain network showing that this role is influenced by sex.

A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders

To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children. In total, 102 pediatric patients diagnosed with functional constipation (FC), irritable bowel syndrome (IBS), or functional abdominal pain (FAP) in years 2013-2015 were subjected to anthropometric measurements. Anthropometry comprised body height, leg and trunk lengths, body weight, mid-upper arm circumference, and 3 skinfold thicknesses. Body fat percentage was obtained with bioelectrical impedance analysis. Indices of the nutritional status and body proportions were calculated and adjusted for age and sex. Excessive body weight and excessive fatness were the most common in children with IBS. Being underweight was most common in children with FAP, but fat deficiency was similarly frequent in the FAP and in FC groups. Short stature was the most common in children with FC. Children with IBS were the best nourished and the tallest for age and sex due to increased trunk length. Body height and linear body proportions adjusted for age and sex were positively associated with body weight and body fatness in the total sample. Children with FGIDs present various linear growth abnormalities that are associated with body weight and body fatness. Although excessive body weight and body fat are common in children with IBS, pediatricians should be aware of the risk of malnutrition in children with other FGIDs.

Prevalence of Functional Constipation and Relationship with Dietary Habits in 3- to 8-Year-Old Children in Japan

Objectives To determine the prevalence and effect of dietary habits on functional constipation in preschool and early elementary school children in Japan. Study Design A total of 3595 children aged 3 to 8 years from 28 nursery schools and 22 elementary schools in Yokohama City, Kanagawa Prefecture, Japan, were evaluated. The subjects were divided into a functional constipation group and a nonfunctional constipation group according to the Rome III criteria. Dietary intake data were collected using a brief-type, self-administered, diet-history questionnaire validated for Japanese preschool-aged children. Results Of the 3595 subjects evaluated, 718 (20.0%) had functional constipation. The association between functional constipation and gender was not statistically significant (p = 0.617). A decrease in bowel frequency was observed in 15.9% of those with functional constipation. There was no significant difference in the proportion of participants in the constipation group by age (p = 0.112). Binomial logistic regression analysis indicated that only fat per 100 kcal positively correlated with functional constipation [odds ratio = 1.216, 95% confidence interval: 1.0476–1.412]. Conclusions Functional constipation is common among children in preschool and early elementary school in urban areas of Japan. Parents should pay attention to constipation-related symptoms other than defecation frequency. A high-fat diet should be avoided to prevent functional constipation.