Functional Constipation Research Articles

High-Resolution Anorectal Manometry and Balloon Expulsion Test Outcomes in Functional Constipation: A Comparative Study.

BACKGROUND Functional constipation can occur in children and adults and consists of difficult or infrequent bowel movements, painful defecation, or the sensation of incomplete bowel movement, and it can be idiopathic. This study aimed to compare the findings from high-resolution anorectal manometry (HRAM) and the balloon expulsion test (BET) in 360 patients with functional constipation and 73 healthy volunteers. MATERIAL AND METHODS In total, 360 patients with functional constipation and 73 healthy volunteers underwent HRAM and BET in our hospital from January 2017 to December 2023. We collected the general data of all participants and surveyed the defecation symptoms of patients with functional constipation. RESULTS Our study showed no significant correlation between HRAM results and age in healthy volunteers, while men had a higher residual anal pressure (P=0.022), higher anal squeeze pressure (P=0.020), and lower rectoanal pressure gradient than women (P=0.017). Using logistic regression analysis, it was concluded that sex (OR=2.880, 95% CI [1.654,5.015], P=0.000) and sensation of incomplete evacuation (OR=1.892, 95% CI [1.023,3.500], P=0.042) affected the occurrence of dyssynergic defecation. The specificity of BET in diagnosing dyssynergic defecation was 81.89%, while that of HRAM was 52.78%. CONCLUSIONS This observation provides normal values for anorectal pressures by HRAM. HRAM and BET are effective methods for assessing functional constipation. Being male and having sensation of incomplete evacuation are risk factors for dyssynergic defecation. The specificity of BET for diagnosing dyssynergic defecation was higher than that of HRAM.

Eight-Week Supplementation With Bifidobacterium lactis HN019 and Functional Constipation

Probiotic supplementation may improve bowel movements. However, large, properly designed studies are lacking. To evaluate the potential benefit of Bifidobacterium animalis subsp lactis HN019 on constipation, expressed as complete spontaneous bowel movements (CSBMs). This randomized triple-blind placebo-controlled clinical trial with 2 weeks of run-in and 8 weeks of intervention was conducted from December 25, 2020, to February 28, 2022, at 5 hospitals in Shanghai, China. Participants included healthy volunteers with functional constipation according to Rome III criteria, 18 to 70 years of age, and a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of less than 30.0. Eligibility after the run-in phase required the randomized participants to have 3 or fewer CSBMs/wk. Data were analyzed from September 29, 2022, to March 23, 2023, and reported as intention to treat. Participants were randomized to receive probiotic (B lactis HN019, 7.0 × 109 colony forming units (CFU)/d in maltodextrin at the start of the study and 4.69 × 109 CFU/d at the end of the study or maltodextrin placebo once a day for 8 weeks. Primary outcome was change in CSBMs. Secondary outcomes included use of rescue medication, stool consistency, degree of straining for each bowel movement, abdominal pain, and bloating. Further, dietary habits and physical activity were recorded. Fecal samples were analyzed for moisture content, short-chain fatty acids, branched-chain fatty acids, microbiota composition, and calprotectin. Of the 283 individuals assessed for eligibility, 229 were randomized to either the placebo (n = 117) or the HN019 (n = 112) group. One participant in the placebo group discontinued due to COVID-19 restrictions. The 229 participants (194 [84.7% female) had a median age of 45 (38-52) years, mean (SD) BMI of 22.8 (2.5), and a mean (SD) of 0.77 (1.0) CSBM/wk. There was no difference in the change of weekly CSBMs from baseline to the end of study between the HN019 (least-square mean change, 0.80 [95% CI, 0.54-1.05]) and placebo (least-square mean change, 0.66 [95% CI, 0.41-0.90]) groups. Although probiotics have been reported to improve bowel function, this large, well-conducted randomized clinical trial did not confirm such results. Daily consumption of B lactis HN019 at the tested dose of 4.69 × 109 CFU did not outperform placebo to increase CSBMs. Chinese Clinical Trial Registry Identifier: ChiCTR2000029215.

Voltammetric and electro-kinetic assessment of prucalopride at MnO2-rGO fabricated pencil graphite electrode

Development and design of rGO-based nanocomposite-modified carbon-based electrodes are necessary to enhance the selectivity and desired selectivity of the voltammetric sensors. In this work, a manganese dioxide-reduced graphene oxide (MnO2-rGO) fabricated pencil graphite electrode is described for the detection of prucalopride (PRU), which is used to treat chronic idiopathic constipation. A simple cost effective hydrothermal method was used to synthesize the needle-shaped MnO2. The MnO2-rGO nanocomposite was characterized using XRD, SEM, and FTIR spectroscopy to examine its microstructure and morphology. The results revealed that MnO2 needles are distributed on the flakes of the rGO, thereby enhancing the electro-catalytic activity of MnO2-rGO/PGE. The electrochemical performance of the developed MnO2-rGO/PGE was examined using CV, chronocoulometry, SWSV, and DPSV methods. The diffusion-controlled oxidation of the PRU at the MnO2-rGO/PGE produces an irreversible peak in all the voltammograms which were used to calculate several electro-kinetic parameters like electron transfer coefficient (α = 0.598), diffusion coefficient (Do = 1.62 × 10−5 cm2s−1), surface coverage (Γo = 1.55 × 10−9 molcm−2), and effective surface area. Furthermore, advanced SWSV and DPSV methods are proposed for the accurate, selective, and sensitive detection of the PRU in pharmaceutical samples. The reported values of detection limit (LOD) for the proposed SWSV and DPSV methods are 20.39 μM and 14.53 μM, respectively, which make them eco-friendly and affordable alternative tools for the quantification of the PRU in pharmaceutical samples.

A real-world study of persistence and adherence to prescription medications in patients with chronic idiopathic constipation in the United States.

At present, 4 prescription therapies have been approved by the US Food and Drug Administration for the treatment of chronic idiopathic constipation (CIC) in adults. To compare persistence with and adherence to prucalopride vs 3 other prescription medications for CIC in a US population. This retrospective, observational cohort study used data from the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (January 2015-June 2020). Inclusion criteria were patients (aged ≥18 years) with at least 1 prescription fill for prucalopride, lubiprostone, linaclotide, or plecanatide on or after April 2, 2019 (commercial availability of prucalopride), and at least 1 constipation-related diagnosis code. Persistence was assessed by time to discontinuation, and adherence was assessed by the proportion of days covered (PDC) and the proportion of patients who achieved PDC of at least 80%. Adjusted hazard ratios (HRs) for discontinuation and odds ratios for adherence were calculated. A total of 14,700 patients (mean age = 48.3 years; female = 81.9%) were included (prucalopride, n = 675; lubiprostone, n = 1,591; linaclotide, n = 11,105; plecanatide, n = 1,329). After adjusting for confounding factors, the HRs for discontinuation were significantly higher for all comparator medications compared with prucalopride after 2 months (HR [95% CI]: lubiprostone, 1.70 [1.48-1.95]; linaclotide, 1.25 [1.10-1.41]; plecanatide, 1.31 [1.13-1.51], all P < 0.001). The unadjusted mean (SD) PDC was 0.53 (0.32) with prucalopride compared with 0.41 (0.31); P less than 0.001 with lubiprostone, 0.48 (0.31), P less than 0.05 with linaclotide, and 0.48 (0.29), P = 0.98 with plecanatide. The comparator medications were all associated with lower odds of achieving PDC of at least 80% relative to prucalopride (odds ratio [95% CI]: lubiprostone, 0.52 [0.40-0.69], P < 0.001; linaclotide, 0.73 [0.58-0.93], P = 0.009; plecanatide, 0.70 [0.53-0.93], P = 0.015). The findings of this study indicate that prucalopride has higher treatment persistence and adherence compared with other CIC prescription medications. This research represents the first instance of a real-world claims study showcasing such outcomes.

Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study.

The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility. A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p-Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States). A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection. In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.

S745 Efficacy and Safety of Plecanatide in Treatment of Irritable Bowel Syndrome With Constipation and Chronic Idiopathic Constipation

S745 Efficacy and Safety of Plecanatide in Treatment of Irritable Bowel Syndrome With Constipation and Chronic Idiopathic Constipation

S733 Efficacy, Safety and Time to Response of Linaclotide in Adult Patients With Chronic Idiopathic Constipation: A Post Hoc Subgroup Analysis by Age

S733 Efficacy, Safety and Time to Response of Linaclotide in Adult Patients With Chronic Idiopathic Constipation: A Post Hoc Subgroup Analysis by Age

S770 Efficacy and Safety of Linaclotide in Patients With Chronic Idiopathic Constipation: A Post Hoc Analysis of Phase 3 Clinical Study Data Assessing Primary and Additional Endpoints by Race and Ethnicity, and by Age

S770 Efficacy and Safety of Linaclotide in Patients With Chronic Idiopathic Constipation: A Post Hoc Analysis of Phase 3 Clinical Study Data Assessing Primary and Additional Endpoints by Race and Ethnicity, and by Age

S832 Impact of Weight on the Efficacy, Time to Response, and Safety of Linaclotide in Adults With Chronic Idiopathic Constipation or Irritable Bowel Syndrome With Constipation: Post Hoc Descriptive Analysis by Body Mass Index

S832 Impact of Weight on the Efficacy, Time to Response, and Safety of Linaclotide in Adults With Chronic Idiopathic Constipation or Irritable Bowel Syndrome With Constipation: Post Hoc Descriptive Analysis by Body Mass Index

S735 Reasons for Treatment Discontinuation in Patients With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation

S735 Reasons for Treatment Discontinuation in Patients With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation

S833 How Valuable is an Electronic Stool Diary App in the Management of Chronic Idiopathic Constipation (CIC) When Using the Vibrating Capsule (VC)

S833 How Valuable is an Electronic Stool Diary App in the Management of Chronic Idiopathic Constipation (CIC) When Using the Vibrating Capsule (VC)

Safflower dietary fiber alleviates functional constipation in rats via regulating gut microbiota and metabolism

A functional constipation rat model was established by loperamide hydrochloride (LOP), and then safflower dietary fiber (SDF) was supplemented to constipated rats. The results revealed that SDF increased the serum levels of excitatory gastrointestinal active peptides such as motilin (MTL), gastrin (GAS), and substance P (SP), while concurrently decreasing the levels of inhibitory peptides like somatostatin (SS) and vasoactive intestinal peptide (VIP). SDF restored the ratio of Firmicutes/Bacteriodetes (F/B), upregulated the relative abundance of Lactobacillus and Clostridium, and downregulated the relative abundance of Oscillopira, Ruminococcus, Coprococcus, and Akkermansia; analysis of metabolites revealed that the levels of bile acid, deoxycholic acid, chenodeoxycholic acid, and taurocholic acid were notably elevated after SDF treatment, while the levels of indole-3-lactic acid, putrescine, and L-arginine were significantly decreased. Pathway enrichment analysis found that SDF regulates Taurine and hypotaurine metabolism, Primary bile acid biosynthesis, and Bile secretion. Correlation analysis between gut microbiota and metabolites revealed that Fusibacter and Actinomyces may contribute to alleviating constipation by regulating the level of bile acid in the intestine. SDF intervention increased the mRNA expressions of FABP1 and SLC1A5 in constipated rats. Furthermore, SDF exhibited notable abilities in retaining water and undergoing swelling. The above results showed that SDF helped the intestine lock water and promoted intestinal peristalsis by increasing friction. On the other hand, SDF supplementation increased the relative abundance of Lactobacillus and Clostridium, decreased the relative abundance of Oscillopira, increased the levels of various bile acids such as deoxycholic acid and chenodeoxycholic acid, further regulated intestinal lipid metabolism, up-regulated FABP1 mRNA expression, promoted intestinal cell proliferation, restored intestinal homeostasis, and thus alleviated constipation.

Long-term Outcomes of Botulinum Toxin Injection Into the External Anal Sphincters: An Effective New Treatment of Chronic Functional Constipation in Children

BackgroundBotulinum toxin (BT) is a well-recognised treatment of chronic functional constipation (FC) and soiling refractory to medical treatment. The aims of this study were to assess the short and long-term outcomes of BT injection into the external anal sphincter muscles (EAS) for chronic FC treatment. MethodsWe studied 196 children unresponsive to medical management of chronic FC, soiling, painful defecation and withholding behaviour (Rome III criteria) from April 2011 to January 2023. All patients underwent anorectal manometry (ARM) and endosonography-guided BT injection (Dysport® or Botox®) 10 units/kg body weight (maximum 200 units) into the EAS muscles at 3 and 9 o’clock positions and colonic transit study. Outcomes were measured using a validated symptom severity (SS) score questionnaire pre-operatively, at 3–6 months and 12–24 months follow up including: defecation frequency and pain, soiling, laxative(s), general health, behaviour, symptom improvement and faecaloma. Sum of scores ranged from 0 (best) to 65 (worst). We used Wilcoxon signed-rank test for matched-pairs related analysis and data presented as median (range) and p value < 0.05 was considered significant. Results196 patients (104 male) with a median age of 7 (1–16) years underwent anorectal investigations and BT injection into the external anal sphincters during 12 year study period. The median short and long term follow-up was 4 (1–27) months and 16 (5–60) months, respectively. 26 (13 %) patients had autism and 14 (7.1 %) had attention deficit hyperactivity disorder (ADHD). Median anal sphincter resting pressure was of 55 (20.5–113) mmHg. The pre-operative total SS score improved from median 31/65 (4–57) before BT treatment to median 15/65 (0–49) at 4-month after BT injection and median 16/65 (0–56) at 16-month follow-up, p < 0.001. 80 % (104/130) of patients showed significant short-term and 79 % (71/90) showed long-term improvement of their chronic FC symptoms following BT injections. 9 % (18/196) children required second BT injection for symptom recurrence and 18.3 % (36/196) required formation of an antegrade colonic enema (ACE) stoma. ConclusionBT injection is an effective and safe new treatment of chronic FC unresponsive to conventional medical treatments. In our experience, 80 % of children have significant improvement of their symptoms and 9 % require repeat BT injection during a long term follow-up.

S823 Kiwifruit and Kiwifruit Extracts for Treatment of Constipation in Healthy Plus Functional Constipation Including Irritable Bowel Syndrome Type Constipation Patient: A Meta-Analysis

S823 Kiwifruit and Kiwifruit Extracts for Treatment of Constipation in Healthy Plus Functional Constipation Including Irritable Bowel Syndrome Type Constipation Patient: A Meta-Analysis

Clinical study on the treatment of functional constipation in infants and younger children with pediatric Tuina based on Baliao points

Clinical study on the treatment of functional constipation in infants and younger children with pediatric Tuina based on Baliao points

Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis.

There has been an increase in randomized controlled trials (RCTs) comparing probiotics with various maintenance therapies, such as polyethylene glycol, lactulose, and mineral oil, to treat functional constipation in children. The aim was to compare probiotics with all other oral maintenance therapies for functional constipation in children and rank all treatments in terms of effectiveness in a network meta-analysis. RCTs were identified through systematically searching the MEDLINE, Scopus, EMBASE, and Cochrane Library databases, trial registries, and forward and backward citation searching. Within-study risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and confidence in the estimates was assessed using the CINeMA (Confidence in Network Meta-Analysis) framework. Random-effects network meta-analyses were conducted. Data were pooled from 41 and 29 RCTs for network meta-analysis of defecation frequency and treatment success, respectively. Probiotics did not significantly increase the number of bowel movements per week when compared with any conventional treatment or placebo. A combination of mineral oil and probiotics was the most effective treatment for increasing defecation frequency (mean difference: 3.13; 95% confidence interval [CI]: 0.64, 5.63). The most effective treatments for increasing the risk of treatment success as compared with placebo were mineral oil (relative risk [RR]: 2.41; 95% CI: 1.53, 3.81) and a combined treatment of polyethylene glycol and lactulose (RR: 2.45; 95% CI: 1.21, 4.97). Confidence in the estimates ranged from very low to moderate. Currently, there is no evidence to suggest that probiotics should be used as a standalone treatment for functional constipation in children. More high-quality studies are needed to evaluate different strains of probiotics and their potential benefit as an additional treatment component to conventional treatments. Mineral oil and polyethylene glycol were the most effective treatments to increase defecation frequency and treatment success rates and should remain the first line of treatment for children with functional constipation. PROSPERO registration no.

The effect of mother’s and infant nutrition on functional constipation in children between 1-4 months

The effect of mother’s and infant nutrition on functional constipation in children between 1-4 months

Application of traditional Chinese medicine nursing technology: Traditional Chinese medicine ironing combined with traditional Chinese medicine massage in improving functional constipation in elderly patients.

To explore the therapeutic effect of traditional Chinese medicine (TCM) nursing technology combined with TCM massage on elderly patients with functional constipation (FC). Ninety elderly patients with FC admitted to our hospital from January 2022 to February 2023 were selected and randomly divided into 3 groups. The control group was treated with conventional Western medicine, observation group 1 was treated with TCM massage on the basis of the control group, and observation group 2 was treated with medicine ironing combined with TCM massage on the basis of the control group. Compare 3 groups of TCM syndrome scores, clinical efficacy, complete spontaneous bowel movements (CSBM) per week, Bristol fecal trait scale, and safety. There was a statistically significant difference in clinical effective rates among the 3 groups (96.67%, 83.33%, 66.67%) (P < .05), and the observation group 2 was higher than the observation group 1 and higher than the control group. After treatment, the TCM syndrome scores of the 2 groups were lower than those of the observation group 1 and the control group; And observation showed that the TCM syndrome score of group 1 was lower than that of the control group (P < .05). After treatment, the increase in scores of CSBM and Bristol fecal traits in the 2 groups was higher than that in the observation group and control group, and the increase in scores of CSBM and Bristol fecal traits in the observation group was higher than that in the control group (P < .05). There was no statistically significant difference in the incidence of adverse reactions among the 3 groups (10.00%, 6.67%, 20.00%) (P > .05). The application of TCM nursing techniques such as TCM ironing and TCM massage in elderly patients with FC has a significant clinical effect, which can effectively improve clinical symptoms, defecation frequency, and fecal characteristics, and has high safety.

Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children.

What is Known Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction.What is New In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes. BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying. Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use. In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.

Investigation of functional constipation in elderly inpatients and analysis of its influencing factors: A cross-sectional study.

To investigate the prevalence of functional constipation (FC) in elderly hospitalized patients and analyze the influencing factors. This was a cross-sectional study in which 506 patients hospitalized in general surgery from February to June 2020 were selected. Information on patients' age, gender, ethnicity, body mass index, intake of vegetables, fruits, meat, and spicy foods, sleep, smoking, alcohol consumption, time of defecation, and mode of defecation was collected through questionnaires, and the factors affecting functional constipation were analyzed using binary logistic regression models; among 506 patients, 254 had FC, with a prevalence of 50.19%. Among the clinical symptoms of FC, the most common ones were straining to defecate (83.85%) and lumpy or hard stools (81.80%). Univariate analysis revealed statistically significant differences in family history of constipation (P = .033), sedentary (P = .004), self-care ability (P = .001), body mass index (P = .013), defecation time (P < .0001), spicy food intake in dietary preference (P = .001), age (P = .004), and education level (P = .016), and binary logistic regression analysis showed that defecation time and spicy food consumption were independent influencing factors of FC. For hospitalized elderly people, regular morning defecation and not eating spicy foods can more helpful to slow the occurrence of functional constipation.