Functional Constipation Patients Research Articles

Home-Based Transcutaneous Neuromodulation Improved Constipation via Modulating Gastrointestinal Hormones and Bile Acids.

This study aims to investigate the role of transcutaneous neuromodulation (TN) on the regulation of gastrointestinal hormones and bile acids in patients with functional constipation (FC). Twenty FC patients were treated with TN for four weeks. The effects of TN on symptoms were evaluated by questionnaires. Plasma levels of serotonin (5-HT), motilin, somatostatin, and vasoactive intestinal peptide (VIP) were measured by ELISA and 12 individual bile acids assayed by liquid chromatography tandem mass spectrometry. Results were as follows. (1) TN treatment increased the frequency of spontaneous bowel movement, improved the Bristol Stool Score, and reduced Patient Assessment of Constipation Symptom score and Patient Assessment of Constipation Quality of Life score. (2) FC patients showed decreased plasma levels of 5-HT, motilin, and VIP and an increased plasma level of somatostatin (P < 0.05). Four-week TN treatment increased plasma levels of 5-HT and motilin and decreased the plasma level of somatostatin in the FC patients (P < 0.05). (3) Taurocholic deoxycholate, taurocholic acid, and taurocholic lithocholic acid were increased in the FC patients (P < 0.005) but reduced by TN treatment (P < 0.05). This study has suggested that the therapy may improve the symptoms of FC by alleviating the disorders of gastrointestinal hormones and bile acids.

White Matter Microstructural Similarity and Diversity of Functional Constipation and Constipation-predominant Irritable Bowel Syndrome.

Background/AimsThe Rome III criteria separated chronic constipation into functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C), but some researchers questioned the partitioning and treated both as distinct parts of a continuum. The study aims to explore the similarity and diversity of brain white matter between FC and IBS-C.MethodsThe voxel-wise analysis of the diffusion parameters was used to quantify the white matter changes of female brains in 18 FC patients and 20 IBS-C patients compared with a comparison group with 19 healthy controls by tract-based spatial statistics. The correlations between diffusive parameters and clinical symptoms were evaluated using a Pearson’s correlation.ResultsIn comparison to healthy controls, FC patients showed a decrease of fractional anisotropy (FA) and an increase of radial diffusivity (RD) in multiple major fibers encompassing the corpus callosum (CC, P = 0.001 at peak), external capsule (P = 0.002 at peak), corona radiata (CR, P = 0.001 at peak), and superior longitudinal fasciculus (SLF, P = 0.002 at peak). In contrast, IBS-C patients showed FA and RD aberrations in the CC (P = 0.048 at peak). Moreover, the direct comparison between FC and IBS-C showed only RD differences in the CR and SLF. In addition, FA and RD in the CC were significantly associated with abdominal pain for all patients, whereas FA in CR (P = 0.016) and SLF (P = 0.040) were significantly associated with the length of time per attempt and incomplete evacuation separately for FC patients.ConclusionThese results may improve our understanding of the pathophysiological mechanisms underlying different types of constipation.

Clinical findings, child and mother psychosocial status in functional constipation

Functional constipation (FC) is a common problem in childhood. In this study, we aimed to analyze the clinical and sociodemographic findings of patients with FC, parenting behaviors, and psychosocial states of children and parents. According to the Roma III diagnosis criteria, 32 patients with FC and 31 healthy controls were included. Patients' clinical and sociodemographic data set associated with constipation was determined. Strengths and Difficulties Questionnaire was used to screen the emotional and behavioral problems in children. To evaluate the parents and family, Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument were used. Emotional and peer problems subscale scores, parental concerns as well as over-parenting attitude were found higher in patients. Significant difference was also observed between the groups in terms of mean score of authoritarian attitude dimensions. Attitude of hostility and rejection and marital discordance was found to be significantly high in patient families. Our study revealed a decrease in the constipation rate with the increasing education level of parents, higher rate of constipation in families with less income than expenses, and lower rate of working mothers in patients with constipation. Parents' depressive symptoms and anxiety level were determined to be considerably higher. A mother's low education level, low socioeconomic level, presence of psychological symptoms, and problems of parental attitude-primarily the authoritarian attitude-increase the risk of FC occurrence. Therefore, FC patients and their families should definitely undergo a psychosocial assessment.

Prediction of Delayed Colonic Transit Using Bristol Stool Form and Stool Frequency in Eastern Constipated Patients: A Difference From the West.

Background/AimsThe correlation between the Bristol stool form scale (BSFS) and colonic transit time (CTT) has been reported in Western populations. Our study aims to study the relationship between BSFS, stool frequency, and CTT in Eastern patients with chronic constipation.MethodsA total of 144 chronic functional constipation patients underwent colonic transit study by using radio-opaque markers, anorectal manometry, and balloon expulsion test. Stool diary including stool forms and frequency was recorded. Delayed CTT was defined as the retention of more than 20.0% of radio-opaque markers in the colon on day 5.ResultsTwenty-five patients (17.4%) had delayed colonic transit. Mean 5-day BSFS (OR, 0.51; 95% CI, 0.34–0.79; P = 0.021) and stool frequency (OR, 0.60; 95% CI, 0.44–0.83; P = 0.002) were independently associated with delayed CTT by logistic regression analysis. Mean 5-day BSFS (area under the curve [AUC], 0.73; 95% CI, 0.62–0.84; P < 0.001) and stool frequency (AUC, 0.75; 95% CI, 0.63–0.87; P < 0.001) fairly predicted delayed CTT. The optimal mean 5-day BSFS of ≤ 3 provided 68.0% sensitivity, 69.7% specificity, and 69.4% accuracy, and the optimal stool frequency ≤ 2 bowel movements in 5 days provided 64.0% sensitivity, 83.1% specificity, and 84.0% accuracy for predicting delayed CTT.ConclusionsBoth stool form and frequency were significantly associated with delayed CTT. Stool frequency ≤ 2 and BSFS 1–3 rather than BSFS 1–2 that was used in the Westerners could be used as surrogate for delayed CTT in Eastern patients with constipation.

Brain processing of rectal sensation in adolescents with functional defecation disorders and healthy controls.

Decreased sensation of urge to defecate is often reported by children with functional constipation (FC) and functional nonretentive fecal incontinence (FNRFI). The aim of this cross-sectional study was to evaluate cerebral activity in response to rectal distension in adolescents with FC and FNRFI compared with healthy controls (HCs). We included 15 adolescents with FC, 10 adolescents with FNRFI, and 15 young adult HCs. Rectal barostat was performed prior to functional magnetic resonance imaging (fMRI) to determine individual pressure thresholds for urge sensation. Subjects received 2 sessions of 5×30seconds of barostat stimulation during the acquisition of blood oxygenation level-dependent fMRI. Functional magnetic resonance imaging signal differences were analyzed using SPM8 in Matlab. Functional constipation and FNRFI patients had higher thresholds for urgency than HCs (P<.001). During rectal distension, FC patients showed activation in the anterior cingulate cortex, dorsolateral prefrontal cortex, inferior parietal lobule, and putamen. No activations were observed in controls and FNRFI patients. Functional nonretentive fecal incontinence patients showed deactivation in the hippocampus, parahippocampal gyrus, fusiform gyrus (FFG), lingual gyrus, posterior parietal cortex, and precentral gyrus. In HCs, deactivated areas were detected in the hippocampus, amygdala, FFG, insula, thalamus, precuneus, and primary somatosensory cortex. In contrast, no regions with significant deactivation were detected in FC patients. Children with FC differ from children with FNRFI and HCs with respect to patterns of cerebral activation and deactivation during rectal distension. Functional nonretentive fecal incontinence patients seem to resemble HCs when it comes to brain processing of rectal distension.

Chronic constipation diagnosis and treatment evaluation: the \u201cCHRO.CO.DI.T.E.\u201d study

BackgroundAccording to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy.MethodsDuring a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded.ResultsEight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC.ConclusionsPatients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the “first line” diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a “second line” approach. Diagnostic tests and prescribed therapies increased by increasing CC severity.

Compilation of the Elderly Functional Constipation Health Education Scale and its reliability and validity test

Objective To prepare the Elderly Functional Constipation(FC) Health Education Scale, and verify its reliability and validity. Methods The Elderly FC Health Education Scale was prepared by qualitative interviews, literature review, and Delphi method. The elderly patients who were over 60 years old and at Chinese PLA 181st Hospital were recruited by the purposive sampling method from January 2013 to August 2015.The diagnostic criteria of Roman Ⅲ was used to diagnose FC, the data of preliminary investigation and large sample test was used to form the formal scale, and its reliability and validity were further verified. Results The Elderly FC Health Education Scale was compiled with 6 dimensions and 28 items, and the Cronbach alpha coefficient which was the internal consistency reliability of the 6 factor was 0.965; the correlation coefficient analysis of equality reliability Kendall tau-b rank and various index variables score were positive correlation significantly. Both item level content validity index and scale level content validity index of the content validity were as a result of 1. The structure validity of the cumulated variance contribution ratio of the 6 factors were 60.15%. All factor loading coefficients between the items were more than 0.5, which indicated the fitting was good. Conclusions The reliability and validity of the Elderly FC Health Education Scale are good, and the scale may be used as a tool to prevent the elderly FC health education, and also be applied to the elderly FC patients in self-management and continue nursing after leaving hospital. Key words: Aged; Constipation; Scale; Reliability; Validity

Female Functional Constipation Is Associated with Overactive Bladder Symptoms and Urinary Incontinence.

This noninterventional cross-sectional study aims to assess the association between functional constipation (FC) and urinary symptoms in female patients with no treatment for urination and defecation. The Rome III criteria for evaluation of defecation, Overactive Bladder Symptom Score (OABSS) for evaluation of urinary symptoms, and clinical features were investigated in 145 female patients. Latent FC and moderate to severe overactive bladder (OAB) were defined on the basis of positivity for two or more of the Rome III criteria and an OABSS ≥ 6 with OABSS Q3 ≥ 2, respectively. In 60 latent FC patients, the OABSS was higher (5.0 versus 3.2, p = 0.001), and concurrent moderate to severe OAB symptoms and OAB with urinary incontinence were more frequent than those in 85 nonlatent FC patients (33.3 versus 10.6%, p = 0.001, and 31.7 versus 7.1%, p < 0.001). Multivariate analysis demonstrated that moderate to severe OAB symptoms were a significant associated factor of latent FC (odds ratio (OR) = 4.125, p = 0.005), while latent FC was the only associated factor of moderate to severe OAB and OAB with urinary incontinence (OR = 4.227, p = 0.005 and OR = 4.753, p = 0.004). In conclusion, moderate to severe OAB symptoms are correlated with FC. Moreover, FC is related to moderate to severe OAB symptoms and to OAB with urinary incontinence.

Psychological characteristics and GoNogo research of patients with functional constipation.

The emotional state, psychological characteristics, cognitive function, and the relevance among above factors in patients with functional constipation (FC) are complex. This study aimed to investigate whether FC symptoms might be related to implicit processing such as psychological characteristics and emotional somatization.Thirty-five FC patients and 24 normal volunteers were recruited to collect event-related potentials (ERP) behavior and electroencephalogram data when simple digital GoNogo visual tasks were performed. Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale (HAMA), Symptom Checklist, and Eysenck Personality Inventory (EPQ) were assessed before the ERP test.There was significant difference in average score, positive index, somatization, obsessive-compulsive disorder, anxiety, depression and psychoticism in HAMD-17, HAMA, Symptom Checklist, and extroversion or introversion and neuroticism in EPQ between the FC patients group and the normal control group (P < 0.05). There was a significant difference in the amplitude of ERP-P300 at site F4, F7, and FZ (P < 0.05).FC patients showed anxiety and depression. The asymmetric forebrain abnormal activities in the 2 hemispheres might initiate implicit automatic processing, such as somatization and obsessive-compulsive disorder, in order to cope with painful experience caused by anxiety and depression in patients with FC. Cognitive dysfunction of implicit processing might be involved in the abnormality of visual communication and information processing.

Anorectal manometry: Should it be performed in a seated position?

Anorectal manometry (ARM) is typically preformed in a lateral position. This non-physiological testing position has produced an unexpected negative rectoanal pressure gradient (RAPG, i.e. difference between rectal and anal pressure) with normal defecation. This study was designed (i) to study differences in ARM parameters between water-perfused and solid-state sensors and between lateral and seated positions and (ii) to investigate the roles of ARM parameters in predicting balloon expulsion. ARM was performed in 18 healthy volunteers (HV) and 60 patients with functional constipation (FC) under three randomized conditions: water-perfused in lateral position, solid-state in lateral position, and solid-state in seated position, followed by a balloon expulsion test in seated position. i) Under the same lateral position, solid-state sensors produced higher rectal resting pressure and RAPG than water-perfused sensors. ii) Using the solid-state sensors, ARM in the seated position revealed higher resting rectal pressure (34.9 vs 10.9mmHg in HV, 30.9 vs 10.6mmHg in FC, both P<.001) and higher RAPG (22.6 vs -6.2mmHg in HV, 17.1 vs -8.1mmHg in FC, both P<.001) than the lateral position. iii) When ARM was performed using solid-state sensors in seated position, RAPG was predictive of balloon expulsion; using 10mmHg as a threshold, RAPG could predict balloon expulsion with specificity of 82% and sensitivity 77%. ARM performed in a seated position using solid-state sensors seems more accurate in assessing rectal pressure, and the RAPG measured under these conditions is predictive of balloon expulsion in FC patients.

The clinical efficacy of rhubarb acupoint sticking joint liver qi stagnation diet for chronic functional constipation in patients with depressive anxiety

Objective To investigate the clinical efficacy of rhubarb acupoint sticking joint shuganjieyu diet in the treatment of chronic functional constipation patients with depressive anxiety. Methods 120 patients of chronic functional constipation with depression anxiety were selected, they were randomly divided into control group and observation group, 60 cases in each group.The patients in the control group were given promoting gastrointestinal motility drugs mosapride capsules, and orally given laxatives rhubarb with sodium bicarbonate.The patients in the observation group were treated with topical rhubarb acupoint, and orally given medicated shuganjieyu diet.7 days for a course of treatment, the patients were treated for four courses.The clinical efficacy of the two groups, defecation interval and fecal nature, SAS, SDS scale score changes and quality of life (PAC-QOL) scale score changes before and after treatment and adverse reactions during treatment were recorded. Results The total effective rate of the observation group was 90.00%, which of the control group was 91.67%, the difference between the two groups was not significant (χ2=0.32, P>0.05). Before treatment, the bowel movement and stool ratings between the two groups had no statistically significant differences (t=0.23, 0.33, all P>0.05). After treatment, the two points of the two groups were significantly decreased, but the differences between the two groups were not significant (t=0.18, 0.41, all P>0.05). Before treatment, the SAS, SDS scale scores between the two groups had no statistically significant differences (t=0.78, 0.69, all P>0.05). After treatment, the SAS, SDS scores of the two groups were significantly decreased, which of the observation group decreased more significantly than those of the control group (t=4.18, 4.72, all P 0.05). After treatment, the dimensions of the two groups showed a decline trend, and those of the observation group decreased more significantly than the control group (t=2.10, 3.56, 2.76, 2.34, all P<0.05). In the control group during the treatment, 2 cases of diarrhea, three cases of dry mouth, the patients were improved after given symptomatic treatment.No serious adverse event occurred during therapy in the observation group. Conclusion Rhubarb acupoint joint shuganjieyu diet in the treatment of chronic functional constipation patients with depression anxiety has significant clinical effect, which can significantly improve patients' depression and anxiety scores, quality of life, and without significant adverse reactions, it is worthy of clinical application. Key words: Constipation; Acupoint application; Shuganjieyu; Depression and anxiety

Expression and its significance of aquaporin 8 in patients with functional constipation or constipated irritable bowel syndrome

Objective To detect the expression level of aquaporin 8 (AQP8) in patients with functional constipation(FC) or constipated irritable bowel syndrome (IBS-C), and the correlation between the expression of AQP8 and clinical features. Methods From March to December 2014, a total of 16 patients with IBS-C and 19 patients with FC met Rome Ⅲ criteria were collected, and nine healthy individuals were assigned to control group at the same period. The ascending and decending colonic tissues mucosa of FC, IBS-C and control group were taken under endoscope. The expression of AQP8 at mRNA and protein level was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). The differences in AQP8 mRNA expression and AQP8 relative area were analyzed by Kruskal-Wallis test among groups, and Pearson correlation coefficient was performed for correlation analysis between the expression and clinical features. Results The relative expressions of AQP8 mRNA of ascending colon and descending colon of FC patients (1.38, 0.61 to 4.09; 2.65, 0.82 to 7.52) and IBS-C patients (2.23, 0.82 to 4.67; 1.35, 0.51 to 2.03) were higher than those of control group (0.56, 0.19 to 0.97; 0.38, 0.21 to 1.19), and the differences were statistically significant (ZFC=-2.435, -3.149, ZIBS-C=-2.690, -2.152; all P 0.05). Most of AQP8 of FC group was expressed in cytoplasm of colonic mucosa epithelial cells, while that of IBS-C group and control group was mostly expressed at apical membrane and basal membrane of epithelial cells. The results of semi-quantification demonstrated that AQP8 relative area of descending colon of FC and IBS-C group increased compared with that of control group (3.42%(1.24% to 5.61%), 2.45%(1.72% to 4.27%) vs 1.18%(0.35% to 2.81%); Z=-2.534, -2.151, both P<0.05). Meanwhile, AQP8 relative area of ascending colon of FC group increased compared with that of control group (2.46%(1.48% to 4.18%) vs 1.14%(1.29% to 2.15%) Z=-2.041, P<0.05). Conclusion There are differences in AQP8 expression quantity and location in cells of descending colon between patients with FC and patients with IBS-C, which is a way for differentiation these two diseases. Key words: Functional constipation; Irritable bowel syndrome; Aquaporin 8; Colonic mucosa; Clinical features

Association between Rome III Diagnostic Criteria and Treatment Failure in Children Brought for Emergency Department Care

Abstract BACKGROUND: Many children diagnosed with functional constipation (FC) in the ED in fact meet Rome III criteria for irritable bowel syndrome constipaion subtype (IBS-C). The frequency of this misdiagnosis and its relation to outcomes is unknown. OBJECTIVES: To determine if treatment failure frequency differs based on Rome III diagnostic criteria classification in a cohort of ED children diagnosed by treating physicians as having constipation. DESIGN/METHODS: We performed a prospective cohort study of children 1 month – 18 years of age who were diagnosed with or were treated as FC in a pediatric ED. ED chart data was abstracted and a follow-up call was performed 7 days post-ED visit to enable the completion of the ROME III functional intestinal disorder questionnaire, confirm treatments administered, and enable symptom resolution assessment. 'Adequate therapy' was defined in accordance with ESPGHAN/NASPGHAN consensus guidelines. Treatment failure was defined by ≥2 of the following: persistence of presenting symptom(s), bowel movement frequency &amp;lt;1 every other day, pain or difficulty passing stools, abdominal pain between bowel movements, and/or persistence of the ED chief complaint. RESULTS: 929 potentially eligible children were identified; 237 were excluded. We failed to contact 162 patients and 17 refused consent. 513 (74%) completed day 7 follow up – 227 (44%) met FC ROME III criteria, 119 (23%) met IBS-C criteria and 167 (33%) did not meet IBS-C or FC criteria and were classified as ‘other’. Mean age was 6.1±3.9 years. Treatment failure occurred in 69 (30%) FC patients, 50 (43%) of those with IBS-C, and 41 (25%) of ‘other’ group; P=0.007. These differences persisted when only those receiving ‘adequate therapy’ (n=308) were included: 41 (28%) of FC and 16 (22%) of those in the ‘other’ group had persistent symptoms compared to 37 (43%) of IBS-C patients; P=0.008. Kaplan-Meier analysis revealed greater symptom persistence in children with IBS-C compared to those with FC (P&amp;lt;0.001). Those classified as FC were more likely to have abdominal distension (P=0.05) and tenderness (P=0.04) compared to the IBS-C. CONCLUSION: Children diagnosed with constipation in an ED who fulfill ROME III irritable bowel syndrome (constipation subtype) criteria have a higher treatment failure rate at day 7 compared to functional constipation even when including only those who received adequate functinal constipation therapy. ROME III criteria can be employed to identify children with irritable bowel syndrome; such children might benefit from diagnosis specific therapy.

Rectal Hyposensitivity Is Associated With a Defecatory Disorder But Not Delayed Colon Transit Time in a Functional Constipation Population.

The physiological mechanism of functional constipation (FC) includes defecatory disorders and delayed colon transit. About 18% to 68% constipated patients may have rectal hyposensitivity (RH). We performed this study to investigate the association between RH and functional defecatory disorder (FDD) as well as that between RH and delayed colon transit in FC patients.A total of 218 FC patients were enrolled. The constipation severity instrument (CSI) was used to assess constipation symptoms. High-resolution anorectal manometry (HR-ARM), defecography, balloon expulsion tests, and colon transit studies were performed for each patient. RH was defined as 1 or more sensory threshold pressures raised beyond the normal range based on HR-ARM. We investigated the association between RH and constipation symptoms, and the occurrence of FDD and delayed CTT. Ninety FDD patients completed the initial phase of biofeedback treatment (BFT). We investigated the association between RH and the effect of BFT.Totally 122 (56.0%) patients had RH. The total CSI (49.82 ± 1.09 vs 41.25 ± 1.55, P = 0.023) and obstructive defecation subscale scores (23.19 ± 0.69 vs 17.07 ± 0.90, P < 0.001) were significantly higher in RH than in non-RH patients. No significant difference was observed in slow transit symptoms (21.77 ± 0.72 vs 19.90 ± 0.85, P = 0.121) or abdominal pain (6.85 ± 2.61 vs 5.00 ± 1.04, P = 0.380). The frequency of prolonged CTT was not significantly different between RH and non-RH groups (54.1% vs 58.3%, P = 0.403). RH patients rated more occurrence of FDD (72.1% vs 53.1%, P = 0.014) and dysynergic defecation (79.8% vs 50.2%, P = 0.004) than non-RH patients, whereas no differences were seen for inadequate defecatory propulsion (59.2% vs 55.0%, P = 0.589). After BFT, the proportion of “no effect” was significantly higher in the RH group than in the non-RH group (22.4% vs 9.4%, P = 0.010).RH is associated with obstructive defecation symptoms and the occurrence of FDD. Further studies are needed to detect the mechanism of RH's effect on BFT and FC.

Difficult defecation in constipated patients and its relationship to colonic disorders.

The importance in constipated subjects of having difficult defecation is poorly known. According to the Rome III criteria, constipated patients are classified as having either irritable bowel syndrome with constipation or functional constipation, depending on the presence and characteristics of abdominal pain. But, the Rome III criteria also identify another group of patients, labeled as suffering from functional anorectal disorders. Within this group, two complaints are akin to being constipated, but not labeled so: having dyssynergic defecation or inadequate defecation. The aim of this study was to search for an association between difficult defecation and colonic transit abnormalities in constipated patients and, thus, shed some light on the definition of constipation according to the Rome III criteria. Four hundred four consecutive patients (81% female), aged 44.9 ± 16.6 years, with a BMI of 25.5 ± 6.4 kg/m(2) (mean ± SD), suffering from chronic constipation were included in the present study. After filling out a standard Rome III questionnaire, patients were classified as suffering from an irritable bowel syndrome with constipation or functional constipation. In addition, they were classified as complaining of difficult defecation or not. Patients completed the Bristol Stool Form Scale as well as visual analogue scales for constipation, bloating, and abdominal pain. The colonic transit time was measured using radiopaque markers and analyzed according to three sites: the right colon, the left colon, and the rectosigmoid area. Difficult defecation is more frequent in patients with irritable bowel syndrome with constipation (84%) than in patients with functional constipation (68%). It is associated with an increase in constipation and abdominal pain scores on Likert scales, and a longer oroanal transit time, due to a delay in the left part of the colon. This study demonstrates that difficult defecation is part of a more generalized colorectal dysfunction in both irritable bowel syndrome and in functional constipation patients with an overlap of symptomatology. It also demonstrates the relative inadequacy of the Rome III criteria to describe the relationship between constipation and difficult defecation.

Randomized Double-blind Controlled Trial: Benefits of Lactobacillus reuteri in Chronic Functional Constipation Patients

Background: Chronic functional constipation is a common problem that affects between 15-25% of the population and cause symptoms and disorders that creates discomfort, morbidity, and high costs for health care. Recently, the consumption of probiotics in treating chronic constipation in adults have been investigated. However, there are still limited and controversial evidences available from controlled trials. The aim of this study was to evaluate the effects of Lactobacillus reuteri (L. reuteri) in improving the Agachan constipation score, the number of L. reuteri in the feces and the fecal pH in the patients with chronic functional constipation.Method: A double-blind, placebo randomized controlled trial (RCT) was conducted in 40 adults (12 males/28 females with mean age 45.95 ± 16 years) affected by chronic functional constipation according to Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri or placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to 8.00 with p 0.001, the increase number of L. reuteri was from 6.80 x 107 to 2.12 x 108 with p 0.001 and the decrease of pH feces was from 5.44 (SD 0.70) to 4.78 (SD 0.56) with p 0.001 in the L. reuteri group, otherwise in the placebo group there were no significant results in Agachan constipation score, the number of L. reuteri and fecal pH assessed.Conclusion: L. reuteri is more effective than the placebo group in improving the Agachan constipation score, increasing the number of L. reuteri in the feces and decreasing the fecal pH in adult with chronic functional constipation.

Spexin Enhances Bowel Movement through Activating L-type Voltage-dependent Calcium Channel via Galanin Receptor 2 in Mice

A novel neuropeptide spexin was found to be broadly expressed in various endocrine and nervous tissues while little is known about its functions. This study investigated the role of spexin in bowel movement and the underlying mechanisms. In functional constipation (FC) patients, serum spexin levels were significantly decreased. Consistently, in starved mice, the mRNA of spexin was significantly decreased in intestine and colon. Spexin injection increased the velocity of carbon powder propulsion in small intestine and decreased the glass beads expulsion time in distal colon in mice. Further, spexin dose-dependently stimulated the intestinal/colonic smooth muscle contraction. Galanin receptor 2 (GALR2) antagonist M871, but not Galanin receptor 3 (GALR3) antagonist SNAP37899, effectively suppressed the stimulatory effects of spexin on intestinal/colonic smooth muscle contraction, which could be eliminated by extracellular [Ca2+] removal and L-type voltage-dependentCa2+ channel (VDCC) inhibitor nifedipine. Besides, spexin dramatically increased the [Ca2+]i in isolated colonic smooth muscle cells. These data indicate that spexin can act on GALR2 receptor to regulate bowel motility by activating L-type VDCC. Our findings provide evidence for important physiological roles of spexin in GI functions. Selective action on spexin pathway might have therapeutic effects on GI diseases with motility disorders.

Differentiation of functional constipation and constipation predominant irritable bowel syndrome based on Rome III criteria: a population‐based study

While the Rome III classification recognises functional constipation (FC) and constipation predominant IBS (IBS-C) as distinct disorders, recent evidence has suggested that these disorders are difficult to separate in clinical practice. To identify whether clinical and lifestyle factors differentiate Rome III-defined IBS-C from FC based on gastrointestinal symptoms and lifestyle characteristics. 3260 people randomly selected from the Australian population returned a postal survey. FC and IBS-C were defined according to Rome III. The first model used logistic regression to differentiate IBS-C from FC based on lifestyle, quality-of-life and psychological characteristics. The second approach was data-driven employing latent class analysis (LCA) to identify naturally occurring clusters in the data considering all symptoms involved in the Rome III criteria for IBS-C and FC. We found n=206 (6.5%; 95% CI 5.7-7.4%) people met strict Rome III FC whereas n=109 (3.5%; 95% CI 2.8-4.1%) met strict Rome III IBS-C. The case-control approach indicated that FC patients reported an older age at onset of constipation, were less likely to exercise, had higher mental QoL and less health care seeking than IBS-C. LCA yielded one latent class that was predominantly (75%) FC, while the other class was approximately half IBS-C and half FC. The FC-dominated latent class had clearly lower levels of symptoms used to classify IBS (pain-related symptoms) and was more likely to be male (P=0.046) but was otherwise similar in distribution of lifestyle factors to the mixed class. The latent class analysis approach suggests a differentiation based more on symptom severity rather than the Rome III view.

Efficacy and Safety of High Specific Volume Polysaccharide-A New Type of Dietary Fiber for Treatment of Functional Constipation and IBS-C.

We investigated the efficacy and safety of a new type of dietary fiber (high specific volume polysaccharide) for use in treating constipation of different etiologies. Functional constipation patients and irritable bowel syndrome-constipation (IBS-C) patients were administrated high specific volume polysaccharide (HSVP) three times daily for a period of 2 wk to relieve their symptoms. Scores on a stool form scale, and patient reports of straining during a bowel movement, having sensations of an incomplete bowel movement or a blocked anorectum, and abnormal defecation intervals were recorded, graded, and scored by a functional constipation sample group. Similarly, a cohort of IBS-C patients reported their occurrence of abdominal discomfort or pain, abnormal stool formation, defecation frequency, and straining during a bowel movement. Additionally, both groups reported any adverse reactions associated with taking HSVP. All patients in both groups returned for follow-up visits, and no adverse reactions to treatment with HSVP were reported. In the functional constipation group, HSVP was effective for treating symptoms of constipation in 81.46% and 93.17% of patients after 7 and 14 d of dosing, respectively (both p<0.05). In the IBS-C group, symptoms of constipation were relieved in 71.67% and 88.34% of patients after 7 and 14 d of dosing, respectively (both p<0.05). High specific volume polysaccharide was shown be effective for treatment of functional constipation and IBS-C, without causing significant adverse events.

Total and Segmental Colon Transit Time Study in Functional Constipation: Comparison With Healthy Subjects.

BackgroundConstipation is a common problem worldwide. Constipation can be primary or secondary. Primary constipation is subdivided in slow transit constipation, normal transit constipation, and dyssynergic defecation. Colon transit time (CTT) is the most basic and primary tool in evaluating disorders of colonic motility. CTT helps to differentiate between types of constipation and plan the treatment.MethodsFifty functional constipation patients and 25 healthy controls were asked to ingest four gelatin capsules (each containing five radio-opaque markers) at 0, 12 and 24 hours. An abdominal X-ray was taken at 36 hours. Total or segmental CTT was measured after calculating the number of markers remaining in each segment at 36 hours on abdominal X-ray.ResultsMean CTT in healthy controls in our study was 15.4 hours which is shorter than western population. Total CTT is significantly higher in constipation group (23 hours) compared to healthy subjects (15.4 hours). Transit time in right segment was significantly high in constipation group than healthy population (14.2 vs. 8.3 hours). Total as well as segmental transit times are slightly higher in females as compared to males in both the groups, however not statistically significant. To the best of our knowledge, there are no studies from India that compared the CTTs in functional constipation and healthy controls.ConclusionRadio-opaque marker study for CTT is a simple and reliable technique for evaluation of constipation. Patients with functional constipation have significantly longer CTT than healthy population. Total CTT is much less in this study population compared to west. There is need to establish standards for slow colon transit.