Onset Of Constipation Research Articles

Prevalence and Factors Associated With Clozapine-Related Constipation: An Observational Study.

Despite being a very effective treatment for resistant schizophrenia and bipolar disorder, use of clozapine is limited by adverse effects. Constipation is a common but potentially life-threatening adverse effect of clozapine that is understudied. The objective was to study the prevalence and factors associated with constipation in those receiving clozapine compared with control subjects. Fifty patients in age group of 18 to 55 years receiving clozapine were compared with 50 patients in the same age group receiving medications other than clozapine. Presence of constipation was ascertained using the World Gastroenterology Organization Practice Guidelines definition. The severity of constipation was assessed using Constipation Assessment Scale and Bristol Stool Form Scale, and anticholinergic burden was assessed using Anticholinergic Burden Scale. Among clozapine-treated patients, 28 (56%) had constipation as compared with 11 (22%) in the control subjects (P < 0.001); the odds of developing constipation was 4.5 (95% confidence interval, 1.9-10.8). Kaplan-Meier survival analysis showed median time to onset of constipation in clozapine-treated patients was 60 days (SE, 13.1 days; 95% confidence interval, 34.3-85.7 days) and median dose of clozapine was 300 mg/d (interquartile range, 312 mg/d). Clozapine group had high Constipation Assessment Scale scores (P = 0.005, Cohen d = 1.17) and higher prevalence of types 1 and 2 Bristol stool types (Fisher exact P = 0.005, Cramer V = 0.59). Constipation was prevalent in more than half of patients receiving clozapine, which was severe and took longer time for recovery. Limitations include using a hospital-based sample and that dietary habits and lifestyle factors were not studied.

Investigation of Demographic and Clinical Characteristics of Children with Constipation Referring to the Pediatric Gastrointestinal Clinic, Shiraz in 2014 - 2016

Background: Constipation is one of the most common Gastrointestinal (GI) symptoms among children. The present study aimed to identify the demographic and clinical characteristics of the children suffering from constipation. Methods: This descriptive-analytical study was conducted on 987 children with constipation in Fars province from March 2015 to March 2016. The study data were collected in the pediatric GI clinic affiliated to Shiraz University of Medical Sciences and analyzed using descriptive statistics, including frequency, mean, and standard deviation (SD). Results: More than 40% of the cases who referred to the pediatric GI clinic were suffering from constipation. Totally, 987 [495 females (50.2%) and 492 males (49.8%)] out of the 1000 children with constipation met the inclusion criteria. The remaining 13 children were excluded due to non-functional constipation. The mean age of the children was 4.8 ± 2.8 years (range: 6.9 months to 17.7 years). In addition, the children’s mean age at the beginning of toilet training and defecation control was 1.9 ± 0.5 years (range: 11 months to 5 years) and 2.1 ± 0.6 years (range: 17 months to 8 years), respectively. The mean of daily physical activity was 2.3 ± 3.6 hours and 707 children (71.6%) had less than one hour of daily physical activity. In addition, 54.2% and 13.9% of the children watched TV and used computer games for more than 3 hours a day, respectively. Finally, 57.5% and 48.3% of the children reported a low consumption of vegetables and grains per week, respectively. Furthermore, having constipation for more than six months was associated with the age of onset of constipation less than two years (P = 0.003). Watching television was reported in 600 (69.7%) children with more than six months constipation (P < 0.001). Conclusions: More than 40% of the cases who referred to the pediatric GI clinic were suffering from constipation. Furthermore, having constipation for more than six months was associated with the age of onset of constipation and watching television habits.

Occurrence of Constipation during the Rehabilitation Stage in Patient with Cerebral Vascular Disease

Purpose The purpose of this study was to investigate the occurrence of first onset of constipation during the rehabilitation stage and risk factors for constipation in patients with cerebral vascular disease (CVD). Methods Participants for this retrospective study were 214 CVD patients admitted to rehabilitation units. First onset of constipation and factors influencing constipation such as dependency level were recorded for 14 days during the rehabilitation stage. Survival analysis with Cox proportional hazard model and descriptive statistics were conducted. Results Age, patients’severity, types of diet, and dependency level were different between constipation and non-constipation groups. In survival analysis, 99% of participants developed constipation within 14 days after admission to rehabilitation units. Median constipation occurrence time was 7.4 days. Patients who were immobile and had tube feedings were more likely to develop constipation 4.07 times (95% CI: 1.018~16.301, p=.047) and 2.09 times (95% CI: 1.001~4.377, p=.050) respectively compared to patients who were independent and had a regular diet, respectively. Conclusion Most CVD patients experienced constipation within 2 weeks after entering the rehabilitation stage. Constipation was linked to types of diet and dependency level. These factors associated with constipation should be considered when caring for patients in rehabilitation. 주요어: 뇌졸중, 변비, 재활, 생존분석 Key words: Stroke, Constipation, Rehabilitation, Survival analysis

69-Year-Old Man With Abdominal Pain and Obstipation

69-Year-Old Man With Abdominal Pain and Obstipation

Results of the First American Prospective Study of IV Iron in Oral Iron Intolerant Iron Deficient Gravidas

▪ INTRODUCTIONHerein we present safety and efficacy results of the first American prospective study of intravenous (IV) iron (Fe) for oral (PO) Fe intolerant patients with iron deficient anemia (IDA) in the 2nd or 3rdtrimester (IND 114696, ClinTrials.gov NCT 02038023). Anemia affects up to 42% of gravidas. Neonatal Fe deficiency (ID) is associated with low birth weight, delayed growth, development and statistically significant increment in cognitive and behavioral abnormalities up to 10 years after Fe repletion. Although PO Fe is simple to use, inexpensive, up to 70% of gravidas to whom it is prescribed report significant gastrointestinal (GI) side effects. The availability of formulations convenient to administer in a brief single setting with favorable side-effect profiles may help decrease rates of anemia in pregnancy and improve hemoglobin (Hb) responses, maternal and fetal outcomes in women intolerant of, or unresponsive to, PO Fe. METHODSWe treated 74 women with a Hb concentration <10.5 g/dl during the 2nd or <11.0 g/dl in the 3rd, with laboratory evidence of IDA (serum ferritin <20 ng/ml and/or % transferrin saturation (TSAT) <16%). A questionnaire with historical questions of metallic taste, gastric cramping, worsening or onset of constipation was administered to document PO Fe intolerance before enrollment. Women diagnosed during the 1st trimester were eligible for inclusion, however due to a lack of published 1st trimester safety, IV Fe infusion was delayed until beginning of 2nd. All received 1,000 mg LMWID (INFeD, Allergan, CA) diluted in 250 ml of normal saline. 15 minutes after a 25 mg test dose administered over 2 minutes, the remainder was infused over the balance of 1 hour. Subjects were observed for 1 hour for signs of acute hypersensitivity and called at 24, 48 hours and 7 days later to assess delayed reactions. Prior to treatment a visual linear analog scale analysis (LASA) for energy and activity was completed. 4 weeks post- infusion or post-partum depending on confinement, a follow-up visit for Hb levels, Fe parameters (TSAT and serum ferritin) and repeat LASA were performed. Paired T-test was used to assess changes in Hb and Fe parameters, and the Wilcoxin Signed-Rank Test for LASA changes. Following accrual of the final subject 58/73 were contacted and questioned for abnormalities in growth or development of their babies. RESULTS73 of 74 enrolled subjects were treated. 1 experienced a minor infusion reaction (facial flushing) and requested treatment on another day. 72 hours later, labor commenced. 2 months post-partum IV Fe was given off study. Follow-up data were available in 58/73 subjects. The mean pre and post treatment Hb concentrations were 9.8 (SD 0.74) and 10.8 (SD 1.30) g/dl respectively (P<0.00001). The mean pre and post TSATs were 11.6 (SD 8.72) and 23.2 and the mean pre and post serum ferritins were 14.2 (SD 22.96) and 129.4 (SD 89.48) ng/mL. respectively (P<0.000001 for both). Data for 58 infants was available; one was low on its growth charts for 11 months after which the curve normalized. The remaining 57, ages 6 weeks to 3 years, were all normal with no evidence of any developmental or growth lag. None were diagnosed with IDA. 6 (8%) experienced minor self-limited infusion reactions consisting of facial flushing or myalgias of the chest or back. All resolved without therapy. 5 of 6 received the planned therapy. 2 developed mild myalgias and headache 24 hours after the infusion, with complete resolution at 48 hours. 85% reported improvements on repeat LASA (P<0.01). DISCUSSIONThe high prevalence of IDA in gravidas and its association with adverse maternal and infant outcomes, with a reported 2-fold increment of preterm labor and 3-fold increase in low birth weight, is concerning. PO Fe, the current standard, is fraught with GI toxicity and poor adherence in up to 70% to whom it is prescribed. Our prospective data corroborate a litany of studies, that IV Fe is a safe, effective and convenient method of Fe repletion. No significant adverse events have been reported. 96% had significant improvements in Hb, and 85% energy and activity. No adverse fetal outcomes were observed. The improved side effect profile of IV formulations allowing Fe repletion in a single, brief visit supports moving IV iron closer to frontline. Compared to PO Fe, IV Fe has fewer side effects and nearly always effective. Our data and those of others call for large prospective studies of IV vs. PO Fe for therapy of maternal IDA. [Display omitted] DisclosuresAuerbach:AMAG Pharma: Consultancy, Research Funding; Pharmacosmos: Consultancy, Research Funding; American Regent/Luitpold: Consultancy.

Changes in Microbial Ecology After Fecal Microbiota Transplantation for Recurrent C. Difficile Infection Depends on Underlying Inflammatory Bowel Disease: 2016 ACG Presidential Poster Award

Introduction: Alterations in the gut microbiota predispose to Clostridium difficile infection (CDI) and are associated with inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) effectively treats CDI and is being investigated for its ability to treat IBD. In this study, we investigated changes in gut microbiota following FMT in CDI patients with or without underlying IBD. Methods: Patients with recurrent CDI were enrolled and a fecal sample was obtained prior to FMT, day 7 and 28 post-FMT. V4 region of 16S rRNA gene was used for gut microbiota profiling using the MISEQ Illumina platform and data analyses were performed using QIIME. Results: Overall 38 CDI patients (12 with IBD) were included (Table 1). All patients responded to FMT, symptoms returned to baseline in 35; 2 IBD patients had worsening C. difficile -ve diarrhea & 1 had new onset constipation. At 2-year follow-up 5 had another CDI episode & 4 required 2nd FMT due to multiply recurrent CDI. The risk of future CDI after FMT in IBD patients was 25% vs 7.7% in non-IBD patients (p=0.16). None of the IBD patients improved IBD course or were able to withhold or de-escalate treatment.Table 1FMT led to a significant increase in alpha diversity based on Faith's phylogenetic diversity, Shannon's diversity index and observed species, at day 7 & day 28 (p < 0.05). A sustained change in unweighted and weighted UniFrac-based beta diversity following FMT at day 7 and 28 post-transplant was seen (p < 0.05) independent of underlying IBD. The Microbial Dysbiosis (MD) index values were significantly higher in patients with CDI compared to donors (p < 0.05) independent of underlying IBD. Microbial communities from all CDI patients were distinct from donor communities prior to FMT (Spearman's r>0.4 for 85% patients). Using SourceTracker, patients with IBD retained a higher proportion of their original microbial communities after FMT (p < 0.05 at day 7, and p = 0.06 at day 28) and significantly lower proportion of the new communities (p < 0.05 at day 7 and 28) compared to those without IBD. Conclusion: FMT led to a significant increase in microbial diversity in patients with recurrent CDI. CDI patients with IBD had a higher proportion of the original community after FMT and lack of improvement of their IBD course. Changes in gut microbial landscape may be important for long-term success of CDI treatment in patients with underlying IBD and potentially for improvement of IBD course.

Colite ischémique sous quétiapine associée à d’autres molécules anticholinergiques : à propos d’un cas

IntroductionThe aim of this paper is to underline the need for systematic monitoring of patients treated with anticholinergic antipsychotic drugs. We present the clinical history of a 34-year-old adult, treated with quetiapine in combination with other drugs with anticholinergic effects. Case reportA 34-year-old male adult had been suffering from bipolar disorder since 2001. He was treated with risperidone, but he was not compliant due to adverse effects, including decreased libido and erectile dysfunction. On June 5th 2012, it was decided to administrate 600mg per day of quetiapine in combination with tropatepine consequent to an episode of agitation and aggressiveness. On June 14th 2012, while the patient was receiving diazepam and valproic acid, loxapine oral solution was introduced. On June 23th, the patient started mentioning digestive disorders, such as diffuse abdominal pain with constipation but continued to pass gaz. On June 25th, at 6:30 am, he declared abdominal pain, which worsened at 8:15 am despite administration of analgesics, followed by malaise and onset of vomiting. His laboratory tests showed leukocytosis 11.2G/L with neutrophils 7.7G/L. The abdomen's radiograph without preparation showed small bowel and colonic air-fluid levels. The result of the CT scan confirmed an occlusive syndrome affecting the whole small gut and colon. At 1 pm, the patient's condition worsened. He received an intramuscular injection of 100mg of loxapine and an opioid treatment, including tramadol and morphine. At 2:30 pm, the clinical condition further deteriorated with an onset of generalized abdominal contracture, the absence of abdominal breathing, sweating, tachycardia at 104 beats per minute, and hypothermia of 34.5°C. He was transferred to an intensive care unit. Laboratory tests showed metabolic acidosis, elevated liver enzymes and acute renal failure. He received volume expansion and was treated by renal replacement therapy and antibiotics. He was intubated and transferred to the operating room. At laparotomy, both colonic necrosis with perforation and necrosis of the small bowel were seen. The patient underwent total colectomy with small bowel resection, distal ileostomy and closure of the rectal stump. The onset of septic and hemorrhagic state required further surgery on June 26th. The evolution was characterized by multi-organ failure with acute anuric renal failure, multiple cardiac arrests, and systemic bacterial and fungal infection. On July 24th, this unfavorable outcome lead to death. In summary, the patient had an occlusive syndrome due to neuroleptics and complications, including mesenteric ischemia with necrotizing colitis. Discussion/conclusionQuetiapine, like all antipsychotics, has anticholinergic effects, including cardiac, psychiatric and digestive disorders. The combination of anticholinergic drugs decreases intestinal peristalsis. Without any prompt management, this decrease can result in a colonic ischemia or necrosis. In patients treated with neuroleptics, the onset of constipation must alert medical staff. Systematic monitoring of bowel movements should be performed in any patient receiving anticholinergic drugs.

Clinical characteristics and correlative factors of constipation in patients with Parkinson's disease

Objective To investigate the characteristics and the correlative factors of constipation in Parkinson's disease (PD) patients. Methods The demographic information, clinical features and history of medications of 193 patients with idiopathic PD consulting in the outpatient department of the First Affiliated Hospital, Anhui Medical University were collected. Patients were evaluated using following scales: Unified Parkinson's Disease Rating ScaleⅢ(UPDRS Ⅲ), Hoehn-Yahr stage, Bristol Scoring Scale, Cleveland Constipation Scoring Scale (CCS), Scale for Outcomes in PD-autonomic for Autonomic Symptoms, Simple Food Frequency Questionnaire, Hamilton Depression Scale (HAMD), Mini Mental State Examination. The patients were divided into constipation group and non-constipation group based on Rome Ⅲ Criteria for Diagnosis of Functional Constipation, and the correlative factors of constipation were compared and analyzed between the two groups. The severity of constipation and influencing factors were also compared between patients with early onset constipation (occurred before present of motor symptoms) and patients with late onset constipation (occurred after present of motor symptoms). The impacts of anti-PD medication adjustments on constipation were assessed by observing the alteration of constipation severity in 41 PD patients. Results The incidence of constipation was 56.4% (109/193) in our cohort of PD patients, and 21.1% (23/109) of constipation was severe according to the assessing by CCS. The spectrum of constipation symptoms included defecation straining (89.9%, 98/109), poor stool output(67.9%, 74/109), reduced stool frequency (63.3%, 69/109) and dryness of stool (60.5%, 66/109). The age, disease duration, scores of Hoehn-Yahr stage, UPDRS Ⅲand HAMD, levodopa equivalent dose (LED), frequency of urination disturbance in constipation group were significantly higher than those in non-constipation group, while the daily quantities of vegetable and water intake in constipation group were significantly lower than those in non-constipation group. Age and HAMD scores were the independent risk factors of constipation (OR=1.049, 95% CI 1.014-1.086, P=0.006; OR=1.316, 95% CI 1.185-1.461, P=0.000). Among the 109 constipation patients, the course of PD, scores of Hoehn-Yahr stage, UPDRSⅢ and LED were positively correlated with the severity of constipation (r=0.269, 0.338, 0.315, 0.341, 0.371, all P<0.05), with HAMD score being the independent risk factor of constipation severity (OR=1.175, 95% CI 1.044-1.322, P<0.05). The severity of constipation and risk factors of constipation in patients with early onset constipation were not distinct from those with late onset constipation. Conclusions The incidence of constipation increases with the increment of age, disease duration, Hoehn-Yahr stage, UPDRSⅢ scores, LED, HAMD scores, urination disorder severity and the decrement of daily water and vegetable intakes. The severity of constipation is positively related to the severity of motor symptoms, the daily dose of anti-PD drugs and depression levels. PD patients with early onset constipation are not distinct from the patients with late onset constipation in terms of severity and risk factors. The influences of anti-PD drugs on constipation are variable depending on the specific drug used and individual constitution. Individualized treatment regimes are proposed with respect to the management of constipation according to the specific risk factors in PD patients. Key words: Parkinson disease; Constipation; Depression; Sickness impact profile; Controlled clinical trial

Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria.

IntroductionColorectal polyps are known precursors of colorectal cancers. The increase in utilization of colonoscopy in Nigeria has meant a rise in the recently reported incidence of these lesions. The aim of this study is to evaluate the clinicopathological profile of colorectal polyps biopsied during the inaugural 12 month period of colonoscopy from a private endoscopy suite in Nigeria.MethodsThis is a retrospective review of all the clients who had polyps diagnosed at colonoscopy over a 12 month period (August 2014 –July 2015) at a private endoscopy suite in Lagos, Nigeria. This analysis of prospectively collected data was performed using clinical information from the endoscopy logs and pathology database system of a private endoscopy suite based in Lagos, Nigeria.ResultsA total of 125 colonoscopies were carried out over the stated period. Of these, 14 individuals had a total of 18 polyps- 4 clients (28.6% of the persons with polyps) had two polyps each. The polyp detection rate was 11.2% while the polyp per colonoscopy rate was 14.4%. Of these clients, males were 10 in number; giving a male to female ratio of 2.5:1. Their ages ranged from 37 to 77 years (mean= 57.3 years). The presenting complaint at colonoscopy was hematochezia in 11 (78.6%), new onset constipation in 2 (14.2%) and peri-anal pain in 1 patient (7.1%). The polyps were distributed as follows; 2 (11.1%) in the ascending colon, 1 (5.6%) each in the transverse and descending colons, 8 (44.4%) in the sigmoid colon, 6(33.3%) located in the rectum. Hence, there was left sided (15 of 18= 83.3%) preponderance. Pathologically, tubular (adenomatous) polyp with or without low grade dysplastic changes was diagnosed in 6 of the 18 polyps (giving an adenoma detection rate of 4.8%), 4 (22.2%) were inflammatory polyps, 1 (5.6%) was malignant and another had the rare inflammatory fibroid polyp. Five (27.8%) of the specimens were reported as non-specific colitis.ConclusionThe study supports the present wisdom that polyps are clearly less prevalent in our environment when compared to the Western world. The increased prevalence with advancing age, in male subjects and of left sided lesions, is also in keeping with previous results from our environment. A case is also advanced for the increased deployment of endoscopy as a tool for the detection of these polyps and ultimately, the reduction of colorectal cancer in our population.

Hematospermia and Cloacogenic Transitional Cell Carcinoma: A Twist on Significance and Meaning.

A 52-year-old gentleman presented with recurrent hematospermia. Further history revealed recent onset of constipation and difficulty voiding. Rectal examination revealed a firm, polypoid mass and colonoscopy showed suspicious, ulcerated lesions of the rectal mucosa with narrowing of the rectal vault. Pathology demonstrated transitional cell carcinoma of the rectum. While transitional cell carcinoma is a common genitourinary cancer, its presence in the anus and rectum is exceedingly rare. Furthermore, hematospermia is generally not associated with malignancy. This case is a remarkable example of two pathologic processes presenting in rare form and underscores the value of a thorough investigation of hematospermia when associated with other clinical symptoms.

Some Risk Factors of Chronic Functional Constipation Identified in a Pediatric Population Sample from Romania.

We conducted an observational study over a 1-year period, including 234 children aged 4–18 years and their caregivers and a matching control group. 60.73% of the children from the study group were males. Average age for the onset of constipation was 26.39 months. The frequency of defecation was 1/4.59 days (1/1.13 days in the control group). 38.49% of the patients in the sample group had a positive family history of functional constipation. The majority of children with functional constipation come from single-parent families, are raised by relatives, or come from orphanages. Constipated subjects had their last meal of the day at later hours and consumed fast foods more frequently than the children in the control sample. We found a statistically significant difference between groups regarding obesity/overweight and constipation (χ 2 = 104.94, df = 2, p < 0.001) and regarding physical activity and constipation (χ 2 = 18.419; df = 3; p < 0.001). There was a positive correlation between the number of hours spent watching television/using the computer and the occurrence of the disease (F = 92.162, p < 0.001, and 95% Cl). Children from broken families, with positive family history, defective dietary habits, obesity and sedentary behavior, are at higher risk to develop chronic functional constipation.

Response and Recurrence Rate After Treatment With Polyethylene Glycol Versus Polyethylene Glycol Plus Lactulose in Children With Chronic Functional Constipation: A Randomized Controlled Trial

Background: Constipation is a common symptom in children and can cause significant distress to parents. Objectives: The aim of this study was to investigate the response and recurrence rate after treatment with polyethylene glycol alone versus polyethylene glycol plus lactulose in children with chronic functional constipation. Patients and Methods: In this randomized controlled trial study, 200 patients aged 1 to 12 years with functional constipation based on the ROME III criteria, were divided into two identical therapeutic groups; group I received polyethylene glycol (PEG) alone and group II received PEG and lactulose. Participants were treated for one month and responsive patients were followed prospectively at 3, 6, and 12 months to assess the recurrence. Results: The response rate to treatment was 70% in group I and 87% in group II (P value 0.003). Recurrence rate was 15.9% in group I and 10.3% in group II (P value 0.3). Factors such as positive family history, sex, age onset of constipation, low fiber diet, toileting, and fecal incontinence did not significantly contribute to success rate of treatment or recurrence rate in the both groups. Conclusions: There was no significant lower recurrence rate of constipation with PEG and lactulose combination therapy over PEG alone. Therefore, changing treatment from lactulose plus PEG to PEG alone would result in better compliance of patients for long-term therapy and would be cost effective.

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.

Incidence and predictors of new-onset constipation during acute hospitalisation after stroke.

We investigated new-onset constipation in patients with stroke compared with orthopaedic conditions and explored the predictors associated with constipation during acute hospitalisation. This was a prospective matched cohort study of 110 patients comparing stroke patients (n = 55) with orthopaedic patients (n = 55) admitted to a large tertiary acute hospital. Both cohorts were matched by age and sex. The incidence of new-onset constipation which occurred during a patient's acute hospitalisation was determined. Demographics, comorbidity, clinical factors, laboratory parameters and medications were evaluated as possible predictors of constipation. The incidence of new-onset constipation was high for both stroke (33%) and orthopaedic patients (27%; p = 0.66). Seven stroke patients (39%) and four orthopaedic patients (27%) developed their first onset of constipation on day 2 of admission. Mobility gains (RR 0.741, p < 0.001) and the use of prophylactic laxatives (RR 0.331, p < 0.01) had a protective effect against constipation. Bedpan use (RR 2.058, p < 0.05) and longer length of stay (RR 1.032, p < 0.05) increased the risk of developing new-onset constipation. New-onset constipation is common among patients admitted for stroke and orthopaedic conditions during acute hospitalisation. The early occurrence, on day 2 of admission, calls for prompt preventive intervention for constipation.

Evaluation of two Bacillus subtilis strains isolated from Korean fermented food as probiotics against loperamide-induced constipation in mice

Probiotics are live microbes that confer health benefits on the host when administered in adequate amounts. To evaluate the probiotic potential of Bacillus subtilis isolated from Korean fermented foods, we investigated the resistance to biological barriers and improvement of loperamide-induced constipation. The values of resistance to gastric acidity of B. subtilis CBD2 and KMKW4 strains were 55.34±2.12 and 64.58±2.95%, respectively, whereas the survival rate of B. subtilis KMKW4 (31.17±5.78%) in bile acids was superior to that of CBD2 (8.62±2.09%). These strains also demonstrated adhesiveness to intestinal epithelial HT-29 cells and an inhibitory activity against pathogenic microflora. Furthermore, B. subtilis CBD2 and KMKW4 strains improved gastrointestinal activity when tested in a loperamide-induced mouse model of constipation. Pre-treatment with CBD2 and KMKW4 strains before the onset of constipation improved fecal output and gastrointestinal transit in loperamide-treated mice. These strains also showed inhibitory effects on the activity of β-glucosidase and tryptophanase, harmful enzymes of intestinal microflora. Taken together, these finding show that B. subtilis CBD2 and KMKW4 have high adaptability to gastrointestinal environment, and the ability to inhibit pathogenic microflora and prevent constipation, suggesting their activity as potential probiotics.

PO-0105 Early Onset Constipation - What Are The Lessons Learnt?

Background and aims Constipation developing at Aims Evaluate the outcome of EOC and role of rectal biopsy. Methods We reviewed all children diagnosed as EOC between 2008–2013 referred to the Gastroenterology clinic. We analysed 31 case notes and recorded their demographics, investigations and outcome. Results Of 31 children, 61% female, all caucasian except one mixed race. Age of onset reported as since birth in 61% and 1–5 months in 39%. 14/31 children were referred for rectal biopsy when clinically suspected to have HD. 3 were positive (all preterm) and 1 anteriorly placed anus missed on routine neonatal examination. The need for further investigation was driven by red flag symptoms. Passing meconium was delayed in only 8%. Children on hydrolysed milk prior to referral reported no benefit. All were treated with 1/2 laxatives and intermittent suppository. Over 4–12 months 65% fully recovered, (4 underwent surgery) and 13% were controlled with medication. Conclusion EOC is common and has significant impact on the QoL for infant and carer. No association between delayed meconium and HD was noted. The importance of vigilance for diagnosing HD especially in pre-terms must be stressed, also educating trainees about abnormally placed anus. Change in hydrolysed formulae may not be an option but support, advice and medication is the key to success.

Isolated ileal heterotopic pancreas in a child: A clinically undetected cause of ileoileal intussusception

Introduction: Pancreatic heterotopia has been described most frequently in stomach and duodenum. Isolated occurrence of heterotopic pancreas in ileum is exceptional and is usually discovered incidentally during surgery. In rare cases, heterotopic pancreas has been reported as a lead point of ileoileal intussusception. case report: A one-year-old boy was presented with recent onset of constipation and abdominal distention. radiologic investigation suggested a diagnosis of midgut volvulus with ileoileal intussusception. resection anastomosis of the intussusception was performed. Histologic examination of the resected specimen showed heterotopic pancreas in the wall of intussusceptum at its tip. No other significant pathology was found. conclusion: Ileal heterotopic pancreas is a rare cause of intussusception at any age and is usually not evident clinically. Hence, careful examination of the lead point of intussusceptum in resection specimens is mandatory to delineate the underlying etiology of these cases.

New onset of constipation during long-term physical inactivity: a proof-of-concept study on the immobility-induced bowel changes.

BackgroundThe pathophysiological mechanisms underlining constipation are incompletely understood, but prolonged bed rest is commonly considered a relevant determinant.AimsOur primary aim was to study the effect of long-term physical inactivity on determining a new onset of constipation. Secondary aim were the evaluation of changes in stool frequency, bowel function and symptoms induced by this prolonged physical inactivity.MethodsTen healthy men underwent a 7-day run-in followed by 35-day study of experimentally-controlled bed rest. The study was sponsored by the Italian Space Agency. The onset of constipation was evaluated according to Rome III criteria for functional constipation. Abdominal bloating, flatulence, pain and urgency were assessed by a 100mm Visual Analog Scales and bowel function by adjectival scales (Bristol Stool Form Scale, ease of passage of stool and sense of incomplete evacuation). Daily measurements of bowel movements was summarized on a weekly score. Pre and post bed rest Quality of Life (SF-36), general health (Goldberg’s General Health) and depression mood (Zung scale) questionnaires were administered.ResultsNew onset of functional constipation fulfilling Rome III criteria was found in 60% (6/10) of participants (p=0.03). The score of flatulence significantly increased whilst the stool frequency significantly decreased during the week-by-week comparisons period (repeated-measures ANOVA, p=0.02 and p=0.001, respectively). Stool consistency and bowel symptoms were not influenced by prolonged physical inactivity. In addition, no significant changes were observed in general health, in mood state and in quality of life at the end of bed restConclusionsOur results provide evidence that prolonged physical inactivity is relevant etiology in functional constipation in healthy individuals. The common clinical suggestion of early mobilization in bedridden patients is supported as well.

Abdominal recto(colpo)pexy for rectal prolapse: is a new era coming?

Much water has flown under the bridge since abdominal rectopexy was introduced to treat rectal prolapse but just recently it has regained popularity. Morbidity and risk related to general anesthesia were the major drawbacks making this surgical treatment often unsuitable for more fragile patients. On the other hand, transperineal techniques tend to be associated with less morbidity but a higher recurrence rate. Furthermore, worsening constipation or new onset constipation following abdominal approaches are functional sequelae difficult to prevent and to treat. Indeed postoperative constipation mainly affects functional outcome and is present in up to 52 % of patients [1]. Sigmoid resection associated with rectopexy has been proposed to reduce the risk of postoperative constipation [2] although the risk of anastomotic dehiscence and infection of nonabsorbable implants limit its application. It has been widely demonstrated that the laparoscopic approach is superior to the open approach in terms of morbidity, recovery time, hospitalization [3] and costs [4]. Age no longer seems to be a limit to the laparoscopic abdominal approach: postoperative complications do not differ significantly, and recurrence rates are low in the elderly [5]. It has also been shown that procedures with preservation of the lateral ligaments and limited lateral and posterior rectal dissection, including the ‘‘old’’ Orr-Loygue operation, are associated with good functional outcomes, minimizing postoperative constipation and not increasing recurrence, both in overt rectal prolapse and in rectal intussusception [6]. Since laparoscopic ventral rectopexy (LVR) was introduced by D’Hoore et al. in 2004 [7], several studies have been published confirming positive results in terms of constipation and fecal incontinence for both full rectal prolapse and rectoanal intussusception [5, 8, 9]. A limited rectal mobilization is performed only unilaterally reducing the risk of inferior hypogastric nerve injury and therefore leading to a lower incidence of postoperative constipation [7, 9]. Recently, we described a modification of LVR involving mesh fixation to the sacral hollow instead of the sacral promontory with a favorably low risk of postoperative constipation and excellent functional results [10]. Rectocolpopexy perfectly complies both with Petros’ ‘‘integral theory’’ about the perineal suspension system [11] and DeLancey’s studies on urogenital suspension systems [12]. The frequent association of complete rectal prolapse and rectoanal intussusception with middle compartment prolapse, rectocele and enterocele has been widely documented by both defecography and open magnetic resonance defecography studies [13, 14]. Tension-free rectal prolapse treatment and simultaneous suspension of the vagina with reinforcement of DeLancey support levels I and II antagonize the forces exerted on the central perineal tendon, addressing middle vaginal compartment disorders. The paper from Maggiori et al. [15], published in this issue, describes LVR results in 33 patients. This prospective study evaluates functional outcome and quality of life over a long period of time: a mean follow-up period of 42 months. The improvements in constipation and fecal incontinence, as well as quality of life, were statistically significant and, above all, they remained stable or even improved over the time. The longterm recurrence rate was favorably low: 6 %. One of the main fears and predictable complications was mesh erosion or extrusion through the vaginal or rectal wall. If this is a problem for transperineal approaches, there seems to be virtually no risk of these complications with the abdominal route. A. Infantino (&) A. Lauretta Department of Surgery, Santa Maria dei Battuti Hospital, Via Savorgnano, 2, 33078 San Vito al Tagliamento, PN, Italy e-mail: ainfantino@libero.it

Nursing and study on correlation among cognitive dysfunction and post-stroke constipation

Objective To understand the status of cognitive dysfunction among new onset constipation after stroke and to explore the relationship between them.Methods With a self-designed questionnaire,the general information of 723 inpatients from 10 hospitals in Guangzhou were collected,including general demographic information,stroke situation,defecation situation and Mini-mental State Examination (MMSE)etc.Results The incidence of new-onset constipation,cognitive dysfunction(PSCD)after stroke was respectively 34.6％ and 62.4％.Among whom 31.0％ in ischemic stroke,44.8％ in hemorrhagic stroke,47.4％ in cerebral hemorrhage and infarction.There was statistical significance between stroke type and constipation,and ischemic stroke had statistical significance compared to other two types.During the acute phase reached 41.6％,the recovery phase 31.5％ and the sequelae phase 22.6％.The rates of constipation patients with cognitive dysfunction were higher than patients without cognitive dysfunction,and the difference in directional force,memory,attention and calculation force,reading and expression was statistically significant respectively,among which expression was the most relevant.The difference in the incidence of constipation among different cognitive dysfunction groups was statistically significant,and they were positively correlated,compared with normal cognitive function,the light,medium and severe cognitive dysfunction was 1.519,2.879,3.064 times respectively.Conclusions Medical staff need to be alerted to the possibility that patients with impared cognitive function may be at greater risk of constipation.The preventive and treatment measures should be emphasized in order to improve patients' cognitive function. Key words: Stroke; Constipation; Cognitive dysfunction