Rectal Enema Research Articles

Chemotherapy-induced constipation among children: An observational study

Objectives Chemotherapy-induced constipation [CIC] is a common and underreported morbidity among children. There is a lack of consensus about its reporting and management. Material and Methods A prospective observational study was conducted on children receiving chemotherapy for various malignancies. Exclusion was made for preexisting gastrointestinal disorders, children in intensive care, or in an altered sensorium. Constipation assessment and Bristol stool form scales were used to assess the incidence of CIC. Result A total of 90 children were observed and CIC was reported by 41 (45.5%) cases as self-declared as well as on the constipation assessment scale. On the Bristol stool form scale, 47 (52.3%) cases had some grade of CIC. CIC was associated with vincristine, cytarabine, and L-asparaginase chemotherapy schedules. Oral laxatives were the most common remedy used and only 11 cases required rectal enema. Despite interval admission noted among 12 cases and chemotherapy schedule modification among 22 cases, the impact of CIC on the quality of life was expressed by 26.6 % of caregivers only. Conclusion CIC is a common morbidity and it needs more active surveillance.

Impact of mechanical bowel preparation on the gut microbiome of patients undergoing left-sided colorectal cancer surgery: randomized clinical trial.

Postoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal enema on the gut microbiome and postoperative complications. This open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6. Forty participants were randomized to oral preparation (20) or rectal enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species. Mechanical bowel preparation with oral preparation or rectal enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species. NCT04013841 (http://www.clinicaltrials.gov).

Treatment of Persistent Soiling in Hirschsprung Disease With Antegrade Continence Enemas

IntroductionPatients with Hirschsprung disease (HD) can experience soiling after their pull-through. We evaluated the use of antegrade continence enema (ACE) for this patient population and investigated the timing and factors associated with getting the patient clean. MethodsWe performed a single-institution retrospective review (from January 2020 to January 2023) of patients with HD and prior pull-through who had persistent soiling, failed laxative treatment or rectal enemas, and were treated with antegrade enemas. The primary outcome was time to become “clean of stool” which was defined as at least one bowel movement per day, no more than one stool accident per week, and no significant stool burden radiographically. Kaplan–Meier survival analysis was performed, and univariate cox proportional hazard regression was used to assess factors associated with time to continence. ResultsThirty patients who met the criteria underwent ACE creation at a median age of 6.5 y (interquartile range 5.3-9.8) with a median follow-up time of 11.5 mo (interquartile range 5.6-16.5). Most patients became clean by 4 mo (13 of 20, 65%) with similar results at 1-y follow-up (16 of 21, 76%). The median time to becoming clean was 4.3 mo (95% confidence interval: 1.7-15.0. Patients with hypermotility were more likely to continue to soil at 1 y (80% versus 13%, P = 0.01). There were no additional factors significantly associated with time to cleanliness. ConclusionsACE is a useful modality for HD patients with soiling. Most became clean of stool in 4 mo. The presence of hypermotility was associated with a higher incidence of persistent soiling at 1 y.

Use of N-Acetylcysteine in Preterm Neonates with Enteral Feeding Intolerance and Intestinal Obstruction: A Case Series and Review of the Literature.

(1) Background: The use of N-acetylcysteine (NAC) to relieve meconium obstruction of prematurity in the first days of life has been reported, with NAC reducing the viscosity of luminal contents by cleaving the disulfide bonds of mucoproteins. However, its use in this population should be further explored since it has been associated with hypernatremia and transient increase in transaminases and bilirubin. (2) Methods: In this retrospective study, we included neonates admitted because of enteral feeding intolerance and intestinal obstruction from 2019 to 2021 who received NAC as a rescue therapy before explorative laparotomy. (3) Results: We summarized the clinical presentation of six preterm neonates with enteral feeding intolerance and intestinal obstruction who received NAC as a rescue therapy. Four infants (66.7%) gradually improved without the need for explorative laparotomy, whereas two infants (33.3%) underwent the creation of an ileostomy. No cases of hypernatremia or hepatic derangement associated with NAC therapy were observed. (4) Conclusions: We described the use of NAC treatment by nasogastric tube and/or rectal enemas in preterm infants with enteral feeding intolerance and intestinal obstruction after a multidisciplinary assessment, but the limited sample size did not allow us to obtain definitive conclusions and further research is needed in this field, given the limited evidence about NAC treatment in preterm infants.

Evaluating the Role of Mechanical Bowel Preparation in Anterior Resection Through a Prospective Randomized Single-Blinded Trial.

Introduction Mechanical bowel preparation (MBP) before colorectal surgery is a common practice to reduce bacterial levels and infection. However, recent studies and data analyses have shown that this practice may increase the incidence of postoperative septic complications. Limited information is available regarding MBP for rectal surgeries. Our study aimed to examine the impact of MBP on postoperative outcomes in patients undergoing anterior resection with primary anastomosis for rectal cancer in a single-blinded, single-center, prospective, randomized trial. Materials and methods Data were collected between September 2013 and December 2015 at the Amrita Institute of Medical Sciences, Kochi, India. All patients scheduled for elective anterior resection with primary anastomosis for cancer between 5 cm and 15 cm were included in the study. All patients were randomized into the MBP and non-MBP groups after obtaining consent using a computer-based randomizer. The MBP group underwent bowel preparation with polyethylene glycol 24 hours before the operation and received sodium phosphate rectal enemas the night before the procedure. In the non-MBP group, only dietary restriction with a low-residue diet for 48 hours was recommended. Laparoscopic and open surgeries were performed. A contrast enema with barium was performed on all patients on postoperative days 6-8 to detect an anastomotic leak. Our primary endpoint was to assess the rate of anastomotic leakage between the two groups. The secondary endpoints were surgical site infection and postoperative morbidity. Results A total of 78 patients were recruited in the trial, and 18 were excluded because the surgery was the Hartmann procedure or abdominal perineal resection. The remaining 60 patients were divided equally into the MBP and non-MBP groups. No clinically significant disparities were evident between the groups concerning the preoperative prognosticators of anastomotic leak. Among the cohort, anastomotic leakage occurred in eight patients, representing a 13.3% incidence. Remarkably, within this subset, seven patients (23.3%) were attributed to the non-MBP cohort, whereas only one patient (3.3%) belonged to the MBP group. These findings demonstrated a statistically noteworthy discrepancy. The two groups had no statistically significant difference in surgical site infection and postoperative morbidity. Conclusion Our study suggests the benefit of preoperative MBP in sphincter-preserving rectal surgery to reduce the anastomotic leak rate. Additionally, incorporating large-scale studies and meta-analyses could enhance the robustness of our conclusions.

Safety profile and effects on the peripheral immune response of fecal microbiota transplantation in clinically healthy dogs.

Fecal microbiota transplantation (FMT) is increasingly used for gastrointestinal and extra-gastrointestinal diseases in veterinary medicine. However, its effects on immune responses and possible adverse events have not been systematically investigated. Determine the short-term safety profile and changes in the peripheral immune system after a single FMT administration in healthy dogs. Ten client-owned, clinically healthy dogs as FMT recipients, and 2 client-owned clinically healthy dogs as FMT donors. Prospective non-randomized clinical trial. A single rectal enema of 5 g/kg was given to clinically healthy canine recipients. During the 28 days after FMT administration, owners self-reported adverse events and fecal scores. On Days 0 (baseline), 1, 4, 10, and 28 after FMT, fecal and blood samples were collected. The canine fecal dysbiosis index (DI) was calculated using qPCR. No significant changes were found in the following variables: CBC, serum biochemistry, C-reactive protein, serum cytokines (interleukins [IL]-2, -6, -8, tumor necrosis factor [TNF]-α), peripheral leukocytes (B cells, T cells, cluster of differentiation [CD]4+ T cells, CD8+ T cells, T regulatory cells), and the canine DI. Mild vomiting (n = 3), diarrhea (n = 4), decreased activity (n = 2), and inappetence (n = 1) were reported, and resolved without intervention. Fecal microbiota transplantation did not significantly alter the evaluated variables and recipients experienced minimal adverse events associated with FMT administration. Fecal microbiota transplantation was not associated with serious adverse events, changes in peripheral immunologic variables, or the canine DI in the short-term.

Exploring Use of Peristeen® Transanal Irrigation for Pediatric Bowel Management

Introduction: Children born with certain anorectal malformations, spinal anomalies, and other conditions may require rectal enemas as a non-surgical bowel management option. The purpose of this study was to explore benefits and problems using Peristeen® transanal irrigation for bowel management, and to determine factors that influence whether Peristeen® is preferred over previous methods used as a non-surgical method for bowel management. Methods: An IRB-approved cross-sectional survey was conducted. Children and their caregivers, trained on use of Peristeen®, were invited to participate via MyChart® and mail to reflect on their experience with bowel management programs. Participants completed a 33-item confidential online survey. Results: Of the 49 eligible participants invited to participate, 13 completed the survey. The mean age child for children was 12.2 years. Most frequently identified diagnoses were imperforate anus (39%) and spina bifida (31%). Ninety-two percent used gravity enemas prior to switching to Peristeen®. Most frequently identified barriers for use of gravity enemas were taking too long (61%) and pain or cramping (54%). These barriers were reported less frequently related to Peristeen® use. Barriers reported most frequently for Peristeen® included holding balloon in rectum (31%) and bathroom space or layout (31%). Median time to administer Peristeen® was 45 min compared to 60 min with gravity enema. Discussion: Overall, Peristeen® users were satisfied with the system and reported barriers less frequently. Cost and use of Peristeen® was reported as a significant barrier. Further studies are needed to compare various options for transanal irrigations.

P1203 Fecal transplantation for Ulcerative Colitis from diet conditioned donors followed by dietary intervention results in favorable gut microbial profile and decreased gut inflammation compared to fecal transplantation alone

Abstract Background Several fecal microbial transplantation (FMT) approaches for ulcerative colitis (UC) have been investigated with conflicting results. We have recently published the clinical outcomes from the CRAFT UC Trial using FMT with the UC Exclusion Diet (UCED), a novel diet for active UC, compared with FMT alone. Here we aimed to compare the two FMT strategies in terms of microbial profile and functional outcomes. Methods Subjects recruited to the CRAFT UC study with available pre- and post-intervention fecal samples were included. Seven donors received diet conditioning for 14 days in line with the UCED principles. Group 1 received single donor standard FMT by colonoscopy on Day 1 and rectal enemas on Days 2 and 14 without dietary conditioning of the donor (N=11). Group 2 received FMT as above but with dietary pre-conditioning of the donor and UCED for the patients (N=10). Pre- and post-intervention fecal samples were assessed by DNA shotgun metagenomic sequencing to obtain microbial compositional and functional data. Data was analyzed using a multivariable linear regression mixed effects model and spearman correlation. Benjamini-Hochberg correction was used for multiple testing with p-values<0.05 and q-values<0.2 considered significant. Results Following diet conditioning, donors had significant depletion in microbial metabolic pathways involved in the biosynthesis of sulfur-containing amino acids. Only patients in Group 2 receiving FMT from diet conditioned donors followed by the UCED showed significant shifts towards the donors’ microbial composition (ADONIS: R2=0.15, p=0.008). Eubacterium sp AF228LB was significantly increased post-intervention in Group 2 (β-coefficient 2.66, 95% CI 2.1 to 3.3) and was also inversely correlated with fecal calprotectin levels (rho=-0.52, p=0.035). Moreover, microbial metabolic pathways involved in gut inflammation and barrier function including ribonucleotides biosynthesis (β-coefficient 0.29, 95% CI 0.07 to 0.51) and branched chain amino acids (β-coefficient 0.44, 95% CI 0.16 to 0.72) were enriched post intervention only in Group 2 and were significantly correlated with decrease in fecal calprotectin (rho=-0.78, p=0.01 and rho=-0.58, p=0.09, respectively). Conclusion FMT from diet conditioned donors followed by the UCED diet led to microbial alterations associated with favorable microbial compositional and functional profile related to sulfur metabolic pathways, which translated to decreased gut inflammation. Our findings support further exploration of additive benefit of dietary intervention for both donors and patients undergoing FMT as a potential treatment of active UC.

Rektal Enema Çoklu Suş Probiyotik Tedavisi Gıda Alerjisi Olan Köpeklerde Kaşıntı, Dermatoloji Triajı ve Diamin Oksidaz Düzeylerini Azaltabilir: Kohort Çalışması

Rektal Enema Çoklu Suş Probiyotik Tedavisi Gıda Alerjisi Olan Köpeklerde Kaşıntı, Dermatoloji Triajı ve Diamin Oksidaz Düzeylerini Azaltabilir: Kohort Çalışması

Ameliorative effects of androstenediol against acetic acid-induced colitis in male wistar rats via inhibiting TLR4-mediated PI3K/Akt and NF-κB pathways through estrogen receptor β activation

5-androstenediol (ADIOL) functions as a selective estrogen receptor β (ERβ) ligand with a protective effect against many diseases. So, we conducted a novel insight into its role in acetic acid (AA)-induced colitis and investigated its effect on TLR4-Mediated PI3K/Akt and NF-κB Pathways and the potential role of ERβ as contributing mechanisms. Methods: Rats were randomized into 5 Groups; Control, Colitis, Colitis + mesalazine (MLZ), Colitis + ADIOL, and Colitis + ADIOL + PHTPP (ER-β antagonist). The colitis was induced through a rectal enema of acetic acid (AA) on the 8th day. At the end of treatment, colons were collected for macroscopic assessment. Tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), nuclear factor kappa b (NF-κB), toll-like receptor (TLR4), and phosphorylated Protein kinase B (pAKT) were measured. Besides, Gene expression of interleukin-1beta (IL-1β), metalloproteases 9 (Mmp9), inositol 3 phosphate kinase (PI3K), Neutrophil gelatinase-associated lipocalin (NGAL), ERβ and NLRP6 were assessed. Histopathological and immunohistochemical studies were also investigated. Results: Compared to the untreated AA group, the disease activity index (DAI) and macroscopic assessment indicators significantly decreased with ADIOL injections. Indeed, ADIOL significantly decreased colonic tissue levels of MDA, TLR4, pAKT, and NF-κB immunostainig while increased SOD activity and β catenin immunostainig. ADIOL mitigated the high genetic expressions of IL1β, NGAL, MMP9, and PI3K while increased ERβ and NLRP6 gene expression. Also, the pathological changes detected in AA groups were markedly ameliorated with ADIOL. The specific ERβ antagonist, PHTPP, largely diminished these protective effects of ADIOL. Conclusion: ADIOL could be beneficial against AA-induced colitis mostly through activating ERβ.

Endoscopy and rectal enema for fecal collection in wild sea turtles (Chelonia mydas, Eretmochelys imbricata) in a field setting.

Forty-seven free-ranging sea turtles (46-Chelonia mydas, 1- Eretmochelys imbricata) were examined via novel use of an endoscopy combined with a rectal enema to obtain large fecal sample volumes. The cloaca was insufflated using an endoscope, after which the bladder and rectum separated, allowing access to the colon. Environmental conditions and location influenced the performance of the procedure initially, but after several attempts the procedure was successfully initiated. In all cases, fecal samples were obtained, and the animals were released to their respective locations. Fecal sample collection using this approach enhances the ability to obtain diagnostic information and perform other scientific analyses of sea turtles.

Online Correction of Intrafraction Motion during Volumetric Modulated Arc Therapy for Prostate Radiotherapy: A Cohort Study Quantifying the Frequency of Shifts and Analysis of Men at Highest Risk.

We have previously described our early experience using fiducial markers to correct for intrafraction motion during radiation therapy (RT) to the prostate using the TrueBeam Advanced imaging package. We sought to further characterize the utility of this approach in a larger cohort, and analyze factors associated with intrafraction motion. A total of 132 men with fiducial markers treated with RT for intact prostate cancer at a single center were treated with a VMAT technique using 2-3 arcs. All patients underwent planning CT after a rectal enema and same day placement of 3 fiducial markers (Gold Anchor). Triggered kV images were acquired every 10 seconds using an onboard imaging system. Intrafraction motion correction was considered if any two fiducial markers were observed beyond a 3 mm tolerance margin. A manual 2D-3D match was performed using the fiducial markers from the single triggered kV image to obtain a couch shift. Shift data were extracted from the record and verify system and expressed as a single 3-dimensional translation. Shift percent was defined as the number of instances of a >3 mm intrafraction correction divided by the total number of fractions for a given patient. Clinical variables were evaluated, including body mass index, hormone therapy (ADT), prostate, rectal bladder volumes, and rectal width (transverse dimension of rectum at the mid-gland of prostate on simulation CT). Across 2659 fractions, intrafraction motion correction was performed 582 times, in 463 fractions (17%). 101/132 patients (77%) had at least one shift during their treatment course, and 48/132 patients (36%) had shifts with an average magnitude of at least 5 mm. The median shift was 3.6 mm (range, 0-2.4 cm; IQR, 1.5-5.4 mm). 25% of men had a shift percent >20% (SP>20%). Univariate analysis revealed that only larger rectal volume or width, smaller prostate size, and use of ADT were associated with SP>20% (p<0.05). Men with rectal width in the top quartile (>3.6 cm) were more likely to have intrafraction motion corrected with SP>20% (47% vs 18%, p = 0.0016), and similarly men with rectal volume in the top quartile (>112 cc) were more likely to have SP>20% (44% vs 19%, p = 0.0067). On multivariate analysis, only rectal parameters (e.g., top quartile rectal width, HR 3.9, p = 0.0024) were correlated with a higher frequency of intrafraction motion. Intrafraction motion occurs in a significant percentage of men undergoing prostate RT with VMAT, and is correctable utilizing a common feature. On multivariate analysis, rectal volume and width were associated with larger shift percent. Treatment approaches which do not account for intrafraction motion should consider including methods of immobilization, or larger PTV margins in order to avoid marginal miss of the prostate.

State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies.

Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion. Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.

Protocol for treatment of constipation with polyethylene glycol 3350 plus electrolytes in critically ill children

Introduction and objectivesNo studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. MethodsWe conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). ResultsThe sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events. ConclusionsThe PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.

Protocolo de tratamiento con polietilenglicol 3350 con electrolitos para el estreñimiento en el niño crítico

Introduction and objectivesNo studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350+E) for constipation in critically ill children. MethodsWe conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350+E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). ResultsThe sample included 56 patients with a mean age of 48.2±11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350+E and 12 (21.4%) with rectal enemas. The proportion of patients who responded well to treatment was greater in the PEG 3350+E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P=.151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350+E was more effective in children aged less than 2 years (100%) compared to older children (100% vs. 65.4%; P<.01), with no significant differences in the development of adverse events. ConclusionsThe PEG 3350+E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation.

Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.

State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations.

Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.

Clinical Effects of Faecal Microbiota Transplantation as Adjunctive Therapy in Dogs with Chronic Enteropathies—A Retrospective Case Series of 41 Dogs

Chronic enteropathies (CE) are common in dogs, but not all affected dogs respond to standard therapy. Successful responses to faecal microbial transplantation (FMT) in dogs with non-responsive CE have been reported in two case series. The objective of this retrospective study was to describe the clinical effects of FMT as an adjunctive therapy in a larger population of dogs with CE. Forty-one dogs aged 0.6-13.0 years (median 5.8) under treatment for CE at one referral animal hospital were included. Dogs were treated with 1-5 (median 3) FMTs as a rectal enema at a dose of 5-7 g/kg body weight. The canine inflammatory bowel disease activity index (CIBDAI) was compared at baseline versus after the last FMT. Stored faecal samples (n = 16) were analysed with the dysbiosis index. CIBDAI at baseline was 2-17 (median 6), which decreased to 1-9 (median 2; p < 0.0001) after FMT. Subsequently, 31/41 dogs responded to treatment, resulting in improved faecal quality and/or activity level in 24/41 and 24/41 dogs, respectively. The dysbiosis index at baseline was significantly lower for good responders versus poor responders (p = 0.043). Results suggest that FMT can be useful as an adjunctive therapy in dogs with poorly responsive CE.

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery