Constipation Score Research Articles

Association between opioid usage and rectal dysfunction in constipation: A cross-sectional study of 2754 patients.

Opioid use has reached epidemic proportions. In contrast to the known effect of opioids on gut transit, the effect on rectal sensorimotor function has not been comprehensively investigated. Cross-sectional (hypothesis-generating) study of anorectal physiology studies in 2754 adult patients referred to a tertiary unit (2004-2016) for investigation of functional constipation (defined by "derived" Rome IV core criteria). Statistical associations between opioid usage, symptoms, and anorectal physiological variables were investigated. Opioids were sub-classified as prescriptions for mild-moderate or moderate-severe pain. A total of 2354 patients (85.5%) were classified as non-opioid users, 162 (5.9%) as opioid users for mild-moderate pain, and 238 (8.6%) for moderate-severe pain. Opioids for moderate-severe pain were associated with increased symptomatic severity (Cleveland Clinic constipation score 18.5 vs 15.1; mean difference 2.9 [95%-CI 2.3-3.6]; P<.001), rectal hyposensitivity (odds ratio 1.74 [95%-CI 1.23-2.46]; P=.002), functional evacuation disorders (odds ratio 1.73 [95%-CI 1.28-2.34]; P<.001), and delayed whole-gut transit (odds ratio 1.68 [95%-CI 1.19-2.37]; P=.003). Differences in anorectal variables between opioid users for mild-moderate pain and non-opioid users were not statistically significant. Hierarchical opioid use (non vs mild-moderate vs moderate-severe) was associated with decreasing proportions of patients with no physiological abnormality on testing (40.2% vs 38.1% vs 29.2%) and increasing proportions with both delayed whole-gut transit and rectal sensorimotor dysfunction (16.6% vs 17.5% vs 28.5%). Opioid use is over-represented in patients referred for investigation of constipation. Opioids for moderate-severe pain are associated with rectal sensorimotor abnormalities. Further studies are required to determine whether this association indicates causation.

The clinical research on the efficacy of Tanreiqing injection combined with routine western medicine in treating chronic obstructive pulmonary disease at acute and aggravating period with syndrome of phlegm-heat obstructing lung

Objective To evaluate effect of Tanreqing injection combined conventional western medicine therapy on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) of Phlegm heat obstructing Lung. Methods A total of 112 patients with AECOPD were randomly divided into two groups with digital table method from February 2015 to February 2018, 56 cases in each group. The control group was treated byconventional western medicine therapy, and treatment group was treated by Tanreqing injection based on control group. Both groups' treatment lasted for 2 weeks. The modified version of British Medical Reseach Council respiratory questionnaire (mMRC) was used for severity evaluation in breath difficulty. The COPD assessment test (CAT) was used for the assessment of symptoms, activity ability, psychological, social impact and sleep. The FEV1% and FEV1/FVC were recorded. The SaO2, PaO2 and PaCO2 were recorded. The phlegm heat obstructing lung symptom scores were detected. The adverse reactions were recorded. Results The total effective rate of treatment group was 94.4% (51/54), and the control group was 77.3% (41/53). There was statistically significant difference between two groups (χ2=5.138, P=0.023). After treatment, the mMRC and CAT scores in the treatment group were significantly lower than those in the control group (t value were 17.233, 17.111, respectively, all Ps<0.01); the cough, wheezing, shortness of breath, fever, dry mouth, constipation scores were significantly lower than the control group (t value were 27.717, 29.387, 27.227, 30.268, 28.430, 29.738, respectively, all Ps<0.01). After treatment, the FEV1% (52.34% ± 5.79% vs. 46.98% ± 5.72%, t=4.817), FEV1/FVC (61.36 ± 6.52 vs. 56.93 ± 5.94, t=3.675) in the treatment group were significantly higher than the control group (P<0.01); SaO2 (90.11% ± 9.53% vs. 83.56% ± 8.84%, t=3.684); the PaO2 (91.22 ± 9.79 mmHg vs. 85.18 ± 8.80 mmHg, t=3.354) significantly higher than the control group (P<0.01), and PaCO2 (44.75 ± 4.94 mmHg vs. 51.05 ± 5.46 mmHg, t=6.261) significantly lower than the control group (P<0.01). The incidence of adverse reactions in the treatment group was 11.1% (6/54), and the control group was 7.5% (4/53). There was no statistically significant difference between two groups (χ2=0.091, P=0.763). Conclusions Tanreiqing injection combined with conventional western medicine therapy can take effectsimprove levels of SaO2 and PaO2, reduce PaCO2 level of the AECOPD patients. Key words: Pulmonary disease, chronic obstructive; Acute disease; Phlegm heat obstructing Lung; Tan Re Qing Zhu She Ye; Integrated Chinese traditional and western medicine therapy; Drug-related side effects and adverse reactions

The Effect of Effleurage Abdominal Massage to Prevent Constipation in Inpatient Department Bali International Medical Centre Hospital Kuta

OBJECTIVES: The purpose of this study is to identify the use of effleurage abdominal massage to prevent constipation for patients who are hospitalized because of orthopedic surgery in Bali International Medical Centre (BIMC) Hospital Kuta. MATERIAL AND METHODS: The study is a quasi-experimental nonequivalent control group pretest-posttest design. Ten respondents were assigned to the intervention group and received standard therapy (fluid and fiber intake) with effleurage abdominal massage. Another ten respondents were assigned to the control group and received only standard therapy. Massage was applied for 15 minutes a day and continued for three days. Constipation Assessment Scale (CAS) was used to measure constipation score. Data were collected three days after therapy on each groups then analized using Wilcoxon and Mann-Whitney Test. RESULT: According to Mann-Whitney Test, there was a significant difference in constipation status after three days intervention given to each group (p = 0023). Regarding constipation status, there was no significant difference at baseline between intervention group and control group (p = 0.874). The intervention group was observed to have a lower constipation score after the effleurage abdominal massage (p = 0.047). However, the control group showed no significant difference in constipation status before and after standard intervention (p = 0.317). CONCLUSION: Effleurage abdominal massage is observed to be effective in preventing constipation in patients undergoing orthopedic surgery.

Subtotal colectomy with antiperistaltic cecosigmoidal anastomosis may be another suitable option for slow transit constipation: Experiences from Chinese people.

The objective of this paper is to demonstrate, considering the experiences from Chinese people, if slow transit constipation (STC) can be accurately diagnosed, choosing patients qualifying for surgery, subtotal colectomy with antiperistaltic cecosigmoidal anastomosis (STC-Anti-CSA) may come with more acceptable short and long-term outcomes.A retrospective study was performed at a department of colorectal and anal surgery. A cohort of 29 patients were coming with up to 5 years’ follow-up care, who were in a diverse range of age, BMI, laxative medicine histories, including both males and females. Pre-surgery work-up strictly followed a protocol designed to rule out the patients who were not suitable for surgery treatments. Classification of STC was followed after diagnosis. STC-Anti-CSA was performed in all cases. The operative time, blood loss, average post-operative length of stay (LOS), frequency of BMs, stool consistency and patients satisfaction, by using Wexner constipation score (WCS), numerical rating scale (NRS), and abdominal bloating score (ABS), over the study period were recorded.In this study, there were 14 males and 15 females, with mean age 51, and BMI from 20.14 to 31.62 kg/m2. The period of laxative medicine history was 4.8 years (2–13 years). The mean operative time was 152 ± 34 min, and the mean perioperative blood loss was 123 ± 51 mL. Average post-operative LOS (LOS) was 8 days. There were no severe post-operative complications, peri-operative mortality, anastomotic leaks, or revisions of the original surgery. Initial post-operative BMs averaged 6 times/day. During the period of 1 month to 12 months follow-up care, BMs fell down to 2 or 3 times/day. By the 1st to 3rd year follow-up care, BMs averaged 5 to 7 times/week. However, from the 4th year to 5th year, constipations recurred somehow. However, most patients were satisfied with their bowel patterns.STC-Anti-CSA can receive acceptable postoperative outcomes as long as the patients can be accurately diagnosed and classified as severe STC. Among the surgical procedures for STC, this procedure may be another suitable option, especially for Chinese people.

Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease

The hemorrhoid laser procedure with suture-pexy (HeLPexx), consisting of Doppler-guided hemorrhoidal dearterialization with laser and the addition of anal mucopexy, is a novel non-excisional procedure to treat hemorrhoids. The aim of the present study was to describe the technique and report the clinical and long-term results. A prospective study was conducted on patients with grade III hemorrhoids who had HeLPexx from January 2012 to February 2018. Pre- and postoperative assessment included a thorough clinical examination, constipation and incontinence scoring systems and a symptom questionnaire which was administered at all patients before surgery and at each follow-up visit to evaluate bleeding, prolapse, manual reduction, discomfort or pain, and impact on quality of life. Each symptom had a score between 0 and 4, (0 indicates no symptoms and 4 indicates daily symptoms). The sum of the score for each symptom constituted the Hemorrhoid Symptom Score. Resolution of symptoms, pain, morbidity, need for further medical and/or surgical therapy were also recorded. One hundred and seventy consecutive patients with grade III hemorrhoids [74 females; mean age 49.5years (range 22-79) years] were included. Median length of follow-up was 36 (range 12-72) months. Postoperative morbidity included urinary retention (7 patients, 4.1%), bleeding not requiring transfusion (1 patient, 0.6%) and thrombosis of hemorrhoidal piles (2 patients, 1.2%). The mean postoperative pain VAS score at 1week postoperatively was 1.8±1.1 (range 0-5) and 12 (7%) patients used pain medications for more than 1week postoperatively while none of the patients reported any pain by the end of the third week postoperatively. The Hemorrhoid Symptom Score significantly improved from 15.83±3.04 to 1.3±2.4 (p≤0.001) and showed a statistically significant improvement in all items. Recurrent symptoms were reported in 12 patients (7%) who required further treatment. Severe chronic constipation prior to surgery was found to be a predictive factor of failure (p = 0.04). HeLPexx appears to be safe and effective for treatment of symptomatic hemorrhoids. Further studies are needed to confirm our results.

Clinical efficacy and action mechanism of mild moxibustion combined with salt-separated moxibustion for gastrointestinal response in breast-cancer chemotherapy patients

To evaluate the clinical efficacy and partial action mechanism of mild moxibustion combined with salt-separated moxibustion for gastrointestinal discomfort caused by chemotherapy for breast cancer. A total of 48 patients were randomly divided into an observation group and a control group, 24 cases in each group. The patients in the control group were treated with intravenous infusion of tropisetron hydrochloride (5 mg), once a day for three days; the patients in the observation group were additionally treated with mild moxibustion at Zusanli (ST 36), Zhongwan (CV 12), Guanyuan (CV 4), Qihai (CV 6) and salt-separated moxibustion at Shenque (CV 8), 15 min per treatment, once a day for 7 days. Before treatment and on the 7th day of chemotherapy, the levels of pepsinogenⅠ(PGⅠ), pepsinogenⅡ (PGⅡ), the ratio of PGⅠto PGⅡ (PGR) and gastrin 17 (G-17) in serum were measured. Before treatment and on the 3rd, 5th, 7th day of chemotherapy, the gastrointestinal reactions (nausea, vomiting, constipation, diarrhea) were compared between the two groups. On the 7th day of chemotherapy, the serum levels of PGⅠ, PGⅡand G-17 in the observation group were lower than those in the control group (P<0.05), and the difference in the level of PGR in serum between the observation group and the control group was not statistically significant (P>0.05). The total scores of nausea, vomiting and constipation during chemotherapy in the observation group were significantly lower than those in the control group (all P<0.05). The mild moxibustion combined with salt-separated moxibustion could effectively improve the symptoms of nausea, vomiting and constipation caused by chemotherapy in patients with breast cancer, and its mechanism may be related to the down-regulation of the levels of PGⅠ, PGⅡ and G-17 in serum.

Laparoscopic posterior rectopexy for complete prolapse of the rectum: Our experience

Background: Total rectal prolapse is a disorder that affects both sexes in all age groups causing debilitating symptoms along with constipation, incontinence or both and results in a poor quality of life (QoL).Aim: We present our experience of laparoscopic rectopexy for procidencia in terms of change in scores of these factors following surgery and the long term results.Materials and Methods: This is a retrospective study with prospectively collected data. Fifteen patients who underwent laparoscopic rectopexy for complete rectal prolapse in our unit from January 2013 to 2016 were included. Preoperative and postoperative constipation, incontinence and QoL scores have been followed up for a period of 18 months following surgery. Other outcomes measured were major and minor complications, length of hospital stay and recurrence.Results: Almost all patients suffered from pre-operative incontinence and had a poor QoL before surgery. Improvement in incontinence following surgery was seen in 86.7% and improvement in constipation was seen in 53% of the patients. There were no major complications. Retrograde ejaculation was seen in two patients in the 20–30 year age group. One patient recovered partially in 6 months and the other was lost to follow-up. There was no incidence of recurrence in the median follow-up period.Conclusions: Laparoscopic rectopexy for rectal prolapse is associated with good post-operative outcome as far as incontinence and constipation is concerned. There is a significant improvement in QoL and associated with a low risk of recurrence. There is a risk of sexual disorders following 'posterior rectopexy' among sexually active males and can be a major source of dissatisfaction.

Influence of Titanoreine on Wound Healing and Postoperative Defecation Difficulty in Circular Mixed Hemorrhoids Patients

This study was designed to investigate the application of titanoreine after circular mixed hemorrhoids operation and its influence on wound healing and postoperative defecation difficulty. 46 cases of circular mixed hemorrhoids patients were selected and divided into two groups by random number table. The control group was treated with routine intervention after operation and the study group was treated with titanoreine. The difference of wound healing degree quantitative score before and after the intervention, the effective rate, the average healing days of wound, the first defecation time and the quantitative score of constipation symptoms were compared between the two groups. After the intervention, the quantitative scores of wound healing degree at different time points in the study group were lower than those in the control group (p<0.05, respectively), The effective rate of the study group was significantly higher than that of the control group (p<0.05). The average wound healing days in the study group were 4.1±0.6 d and 5.4±1.5 d in the control group. The average wound healing days in the study group were significantly shorter than those in the control group (t=15.021, p<0.05). The first defecation time of the study group was significantly (p<0.05) earlier than control group. The quantitative scores of constipation at different time points in the study group were significantly lower than those in the control group (p<0.05, respectively). The application of titanoreine after circular mixed hemorrhoids surgery can significantly shorten the time of wound healing, promote the wound healing faster and better, and reduce the risk of defecation difficulty.

Effects of flaxseed supplementation on functional constipation and quality of life in a Chinese population: A randomized trial.

This prospective, randomized, controlled study aimed to evaluate the effects of flaxseed supplementation on functional constipation and quality of life in adult men and women in China. 90 subjects with functional constipation diagnosed by the Rome IV criteria were enrolled. Subjects were randomly assigned to receive either 50 g/day flaxseed flour with meals (n=60) or 15 mL/day of a lactulose solution on an empty stomach (n=30) every morning for 4 weeks. Wexner constipation scores, stool consistency according to the Bristol Stool Form Scale, and bowel habits (frequency of bowel movements/week, the time spent on defecation) were the primary outcomes. The change in Patient Assessment of Constipation Quality of Life score was the secondary outcome. After 4 weeks, the bowel habits in both groups were significantly improved. The median Wexner constipation score decreased from 14 to 6.5 in the flaxseed group (p<0.001) and from 15 to 9 in the lactulose group (p<0.001). The median defecation frequency per week increased significantly (2 to 7 for flaxseed and 2 to 6 for lactulose, p<0.001 for both groups). The Patient Assessment of Constipation Quality of Life score decreased significantly (-1.34 and -0.66 for flaxseed and lactulose, respectively; p<0.001 for both groups). Flaxseed flour is somewhat more effective at increasing defecation frequency than lactulose, improving bowel movements and promoting life quality of subjects with chronic functional constipation in the Chinese population.

A common but not well-known cause in anal fissure development and treatment failure: Isotretinoin treatment for acne vulgaris

To investigate the underrecognized effects of isotretinoin as a cause of anal fissures (AF) and compare AF patients undergoing systemic isotretinoin treatment (SIT) and those not receiving this treatment. This study was conducted with 118 patients with newly diagnosed AF, 54 undergoing SIT (Group 1) and 64 not undergoing SIT (Group 2). The same clinical treatment modalities including first-line conservative and medical treatments during the first eight weeks, followed by interventional methods (botulinum injection or sphincterotomy) for unresponsive/recurrent cases were used for all patients. A comparative analysis was also performed. Age and body mass index (BMI) were statistically low in group 1 (p=0.003; p=0.032). Similarly, the VAS pain and Wexner constipation scores and the duration of symptoms were lower in group 1 than Group 2 (p=0.003, p

Efficacy and Safety of Acupuncture at Tianshu (ST25) for Functional Constipation: Evidence from 10 Randomized Controlled Trials.

Objective To evaluate the evidence for the efficacy and safety of acupuncture at Tianshu (ST25) for functional constipation (FC). Methods We systematically searched seven databases to identify randomized controlled trials of acupuncture at ST25 alone or in combination with conventional therapy in the treatment of FC. Risk ratios (RRs) and mean differences (MDs) were calculated using RevMan 5.3 with 95% confidence interval (CI). Results The study included ten trials with 1568 participants. Meta-analysis showed that the Cleveland Constipation Score (CCS) for deep needling was significantly lower than that for lactulose (deep needling with low-frequency dilatational wave: MD −0.58, 95% CI −0.94 to −0.22; deep needling with sparse wave: MD −3.67, 95% CI −6.40 to −0.94; deep needling with high-frequency dilatational wave: MD −3.42, 95% CI −5.03 to −1.81). Furthermore, CCS for shallow needling with high-frequency dilatational wave was lower than that for lactulose (MD −1.77, 95% CI −3.40 to −0.14). In addition, when deep needling was combined with high-frequency dilatational wave, the weekly frequency of spontaneous defecation (FSD) was significantly higher than that for lactulose (MD 1.57, 95% CI 0.93 to 2.21). Colonic Transit Time (CTT) scores were significantly higher when deep needling was combined with sparse wave (MD −14.36, 95% CI −18.31 to −10.41) or high-frequency dilatational wave (MD −11.53, 95% CI −19.25 to −3.81). The time of first defecation after treatment (TFD) of the shallow needling therapy was significantly longer than that of the lactulose (MD 13.67, 95% CI 5.66 to 21.67). The CCS 6 months after treatment (CCS6m) for deep needling was significantly lower than that for lactulose (MD −4.90, 95% CI −5.97 to −3.84). Moreover, the FSD 6 months after treatment (FSD6m) for shallow needling was significantly higher than that for lactulose (MD 0.49, 95% CI 0.02 to 0.97). The adverse event (AE) rate for lactulose was significantly higher than that achieved with the needling treatments, and this held true for both deep needling therapy (RR 0.41, 95% CI 0.23 to 0.72) and shallow needling therapy (RR 0.33, 95% CI 0.15 to 0.77). Conclusions The meta-analysis demonstrates that acupuncture at ST25 appears to be more effective than lactulose in the treatment of functional constipation. This was found to be especially true for deep needling with high-frequency dilatational wave, which had a greater impact on improving CCS, FSD, CTT, and CCS6m. Additionally, acupuncture at ST25 was shown to be safer than conventional treatment, with the rate of AE being significantly lower for both deep needling and shallow needling. The trial is registered with https://www.crd.york.ac.uk/prospero/(CRD42019141017)).

Potential role of fecal microbiota in patients with constipation.

BackgroundWe evaluated the safety and efficacy of fecal microbiota transplantation (FMT) for chronic functional constipation (CFC) ineffectively treated by conventional constipation medication.MethodsThirty-four patients with CFC underwent FMT treatment (three rounds, via gastroscopy). Clinical scales, including the Wexner constipation score as the main index of efficiency, were completed at baseline; after each treatment, and at 2 and 3 months of follow up. Secondary evaluation indices included the self-assessment of constipation symptoms, patient assessment constipation quality-of-life questionnaire, Bristol stool form scale, and Zung’s self-rating depression and anxiety scales. Gastrointestinal motility, motilin, gastrin, nitric oxide (NO), and 5-hydroxytryptamine (5-HT) were assessed before and after treatment. Intestinal flora changes were assessed by 16S ribosomal ribonucleic acid (rRNA) sequencing.ResultsThere were no serious adverse reactions. The clinical cure rate was 73.5% (25/34), clinical remission rate was 14.7% (5/34), and the inefficiency rate was 11.8% (4/34). Clinical scale data indicated that the FMT treatment was effective. Furthermore, FMT treatment promoted intestinal peristalsis, increased gastrointestinal motility, and increased serum NO and 5-HT levels. The 16S rRNA sequencing data indicated that high abundances of Bacteroides, Klebsiella, Megamonas, Erysipelotrichaceae and Epulopiscium may be the cause of constipation, and high abundances of Prevotella, Acidaminococcus and Butyricimonas may be the main factors in curing constipation.ConclusionTreatment with FMT regulates the intestinal microflora and changes the abundance of CFC-associated bacterial flora to improve constipation.

Study of Dahuang-Huanglian-Xiexin decoction combined with conventional western medicine in patients with type 2 diabetes

Objective To evaluate the effects of the classical prescriptions Dahuang-Huanglian-Xiexin decoction combined with conventional western medicine on the lipid metabolism disorder and changes of intestinal microflora in patients with type 2 diabetes mellitus (T2DM). Methods A total of 120 patients who met the inclusion criteria were divided into the two group according to the treatment order, with 60 patients in each group. Both groups were given conventional hypoglycemic therapy, the control group was given bifidobacteria lactobacillus triple viable tablets, and the treatment group was given Dahuang-Huanglian-Xiexin decoction on the basis of the control group. Both groups were treated with 14 days for one course and 4 courses in total. The number of gram-positive coccus (G+c), gram-negative coccus (G-c), gram-positive bacillus (G+b) and gram-negative bacillus (G-b) in each 500 bacteria were observed under oil microscope, and the cocci/bacillus ratio were calculated. The TC and TG were detected by oxidase method, and HDL and LDL were detected by automatic biochemical analyzer. The FPG, 2 hPG and HbA1c were detected by automatic biochemical analyzer. TCM symptom scores were calculated. Results After treatment, the abdominal distension, congestion discomfort, and constipation score were significantly lower than the control group (t values were 3.685, 3.551 and 3.708, respectively, all Ps<0.05); Serum TG, TC and LDL-c levels were significantly lower than the control group (t values were 3.602, 3.581 and 3.421, respectively, all Ps<0.05); HDL-c level was significantly higher than that of the control group (t=3.358, P=0.046); Serum FPG, 2 hPG and HbA1c levels were significantly lower than the control group (t values were 3.502, 3.271 and 3.708, respectively, all Ps<0.05). After treatment, the G-c (271.47/500 ± 22.63/500 vs. 266.81/500 ± 22.36/500, t=3.792), G+b (81.26/500 ± 6.52/500 vs. 73.19/500 ± 6.94/500, t=3.511), G-b (183.76/500 ± 16.19/500 vs. 164.37/500 ± 15.83/500, t=3.306) levels in the treatment group significantly higher than those in the control group (P<0.05). After treatment, both c/b levels was (0.65 ± 0.13 vs. 0.87 ± 0.21, t=3.325) decreased significantly (P<0.05). Conclusions Dahuang-Huanglian-Xiexin decoction combined with conventional western medicine can improve the clinical symptoms of T2DM patients, reduce blood glucose and lipid levels, and inhibit the body mass and improve insulin resistance by adjusting the structure of intestinal flora, increasing probiotics and reducing pathogenic bacteria. Key words: Diabetes mellitus, type 2; Lipid metabolism disorders; Intestinal microflora; Dahuang-Huanglian-Xiexin decoction; Therapies, investigational

Efficacy analysis of Altemeier and Delorme procedures for the rectal prolapse

Objective: To evaluate the quality of life after Altemeier and Delorme procedures for rectal prolapse patients. Methods: A retrospective cohort study was performed. Clinical data of patients with full-thickness rectal prolapse undergoing surgical treatment in the Sixth Affiliated Hospital, Sun Yat-sen University from February 2013 to January 2018 were retrospectively analyzed. Patients who had no preoperative imaging data, who suffered from internal rectal intussusception, or who did not undergo Altemeier and Delorme operations were excluded. Sixty-seven patients were enrolled, including 32 males with median age of 20.5 (13, 34) years and 35 females with median age of 65.0 (50, 77) years. According to different procedures, patients were divided into the Altemeier group (48 cases) and the Delorme group (19 cases), who received standard Altemeier and Delorme operations respectively. The maximal prolapse length of preoperative squat position, the Longo constipation score, Wexner incontinence score, EQ-5D-5L score, postoperative complications and recurrence rate were analyzed and compared between two groups. Results: The maximal prolapse length of preoperative squat position in Altemeier group and Delorme group was (7.3±3.3) cm and (4.9±2.1) cm respectively with significant difference (t=2.907, P=0.005). The operations in both groups were successfully completed. The operation time and postoperative hospital stay of Altemeier group were longer than those of Delorme group [(112.3±47.0) minutes vs. (80.7±35.4) minutes, t=2.637, P=0.010; (11.3±5.0) days vs. (8.6±3.0) days, t=2.177, P=0.033]. The median follow-up period was 26 (13, 45) months. In the last follow-up, compared to pre-operation, the Longo constipation score [9.0 (6.0, 14.0) vs 4.0 (1.0, 6.5), Z=-4.989, P<0.001], Wexner incontinence score [0 (0, 5.5) vs. 0 (0, 2.0), Z=-3.325, P<0.001] and EQ-5D-5L score [45.0 (40.0, 57.5) vs. 80.0 (70.0, 87.5), Z=-5.587, P<0.001] were all improved obviously in the Altemeier group, meanwhile Longo constipation score [6.0 (5.0, 14.0) vs. 3.0 (1.0, 7.0), Z=-2.186, P=0.029], Wexner incontinence score [0 (0, 12.0) vs. 0 (0, 4.0), Z=-2.325, P=0.020] and EQ-5D-5L score [50.0 (35.0, 60.0) vs. 75.0 (65.0, 90.0), Z=-3.360, P=0.001] in the Delorme group were all improved obviously as well. The postoperative morbidity of complication between the two groups was not significantly different [10/48 (20.8%) vs. 4/19 (21.1%), χ(2)=0.049, P=0.826]. Sixteen patients (28.0%) relapsed after operation, including 10 patients in the Altemeier group and 6 patients in the Delorme group, without statistically significant difference (P=0.134). Conclusions: Both the Altemeier and Delorme procedures are effective treatments for rectal prolapse, which can improve the postoperative quality of life. Delorme procedure has the advantages of shorter operation time and faster postoperative recovery in patients with mild prolapse.

Long-term efficacy analysis of laparoscopic-assisted anorectoplasty for high and middle imperforate anus

Objective: To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia. Methods: A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P>0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure. Results: Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t=1.343, P=0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t=6.021, P=1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ(2)=4.436, P=0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ(2)=7.308, P=0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ(2)=1.802, P=0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t=2.599, P=0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t=2.462, P=0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t=2.389, P=0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t=2.079, P=0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t=1.015, P=0.312] was not statistically significantly different. Conclusions: Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.

Effect of hot compress of the abdomen with stir-frying with coarse salt and Fructus Evodiae on abdominal distension, gastrointestinal reactions and mental status of patients with nephrotic syndrome

Objective To explore the effect of hot compress of the abdomen with stir-frying with coarse salt and Fructus Evodiae on abdominal distension, gastrointestinal reactions and mental status of patients with nephrotic syndrome(NS). Methods A total of 120 patients with primary NS who were admitted to the hospital from October 2015 to February 2018 were selected. By the random number table method, they were divided into control group and observation group, 60 cases of each group. The control group was treated with prednisone, low molecular dextran and was given routine nursing intervention. On this basis, the observation group was given hot compress of the abdomen with stir-frying with coarse salt and Fructus Evodiae combined with psychological counseling intervention. The relief of abdominal distension, gastrointestinal symptoms, mental status and quality of life scores before and after intervention were compared between the two groups. Results The apparent relief efficiency of abdominal distension in the observation group was higher than that in the control group, and the difference was statistically significant (P 0.05). Scores of nausea and constipation in both groups were decreased after intervention, and the differences was statistically significant (P<0.05). The scores of the observation group were lower than those of the control group, and the difference was statistically significant (P<0.05). The HAMA and HAMD scores of both groups were decreased after intervention, and the differences were statistically significant (P<0.05). The scores of observation group were also lower than those of the control group, and the differences were statistically significant (P<0.05). SF-36 scores of both groups were increased after intervention, and the differences were statistically significant (P<0.05), and the score of observation group was higher than that of the control group, and the difference were statistically significant (P<0.05). Conclusion Hot compress of the abdomen with stir-frying with coarse salt and Fructus Evodiae combined with psychological counseling can effectively relieve abdominal distension and gastrointestinal reactions in patients with NS and regulate their psychology, which is conductive to improving quality of life of patients. Key words: Stir-frying with coarse salt and Fructus Evodiae; Psychological counseling; Nephrotic syndrome; Abdominal distension; Gastrointestinal reactions

Evaluación de los indicadores antropométricos, bioquímicos, estreñimiento, ansiedad y depresión en adultos mayores de un asilo del estado de Morelos

Introduction: The changes of aging, lead to anthropometric and biochemical changes, which together with changes in lifestyle habits make constipation one of the most common pathologies in older adults, in the same way this population has proven to be more Vulnerable to anxiety and depression. General Objective: To evaluate the anthropometric, biochemical, constipation, anxiety and depression parameters in older adults of an asylum in the state of Morelos. Methodology: Cross-sectional study. 24 older adults (men and women; age ≥65 years) were interviewed, institutionalized in the Casa Hogar “Las Palomas” in Cuernavaca Morelos. To assess the signs associated with constipation, a questionnaire was conducted based on ROME III criteria, the assessment of anxiety and depression status was used (HADS). Anthropometric measurements were taken (Weight, height, body circumferences (waist, hip, arm and calf) and a fasting blood sample to determine glucose, cholesterol and triglycerides.SPSS v20.0 was used in the statistical analysis.Prevalence (%), confidence intervals, means and standard deviations Results: In our study population we observed significant differences in the anxiety score (p = 0.004) and depression (p = 0.016) according to gender. However, in the constipation score, no significant differences were obtained according to gender. Conclusion: Older adults are a vulnerable group that requires special attention to physical and mental health. Timely multidisciplinary interventions are required that favor the health and quality of life of older adults.

Scientific solution to a complex problem: physiology and multidisciplinary team improve understanding and outcome in chronic constipation and faecal incontinence.

There is a lack of diagnostic credibility to direct focused management for children with chronic constipation (CC) and faecal incontinence (FI). The aim is to assess the impact of an innovative Children's Anorectal Physiology Service (CAPS) focusing on improving outcomes in children with CC/FI. Prospective data: demographics, bowel and quality of life (QoL)/risk of distress questionnaires. Diagnostics: awake high-resolution anorectal manometry (AHRAM), endoanal ultrasound and transit marker studies (TMS). Total patients: 112; 66 males (59%); median 9years (17months to 16years). Patient groups included: 89 (79%) had functional CC/FI; 9 (8%), Hirschsprung's disease; 12 (11%), anorectal malformations and 2 (2%), trauma. St Marks Incontinence score (SMIS) abnormal in 91 (81%) and Cleveland Constipation Score (CCS) in 101 (90%) patients. Anorectal manometry: 94 (84%) awake and 18 (17%) under anaesthesia. Play specialist input 37 (33%) patients. AHRAM abnormal 65 (58%): sphincter dysfunction 36 (32%) and altered rectal sensation: hyposensitive 22% (20/91); 21% (19/91) hypersensitive. TMS normal in 64 (57%), 17 (15%) slow transit and 27 (24%) rectal evacuatory disorder. Risk of distress in 38% and poor QoL in 55% patients which correlated with abnormal SMIS (p = 0.02). Patient/parent satisfaction improved significantly (p < 0.05). Scientific investigations combined with multidisciplinary team improve patient satisfaction and reduces patient self-report illness severity. A complex problem requires a scientific solution.

Impact of TRREMS on symptoms of obstructed defecation due to rectocele: predictive factors and outcomes.

The aim of this study was to evaluate the impact of the transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS) on the treatment of obstructed defecation due to rectocele and to identify the predictive factors for unsuccessful results. Consecutive patients with obstructed defecation symptoms (ODS) associated with rectocele who had the TRREMS procedure were included. Each patient was assessed by echodefecography, manometry, and colonic transit time as well as the Cleveland Clinic constipation score (CCS) before therapy and at follow-up after 6months. Reduction in the CCS score was calculated as a ratio. Factors correlated with a decrease in the CCS were analyzed in a univariate analysis. A total of 81 patients were included. Nineteen patients had postoperative complications that were not severe: 7 (8.6%) had tenesmus, 6 (7.4%) stenosis (4 treated with digital dilatation and 2 with endoscopic stricturectomy), 4 (4.9%) residual mucosal prolapse treated with rubber band ligation, 1 (1.2%) early bleeding, and 1(1.2%) thrombosis. Seventy-nine (97.5%) patients had a significant clinical response with significant reduction of the CCS constipation score from median 13 (range 17-10) to 4 (range, 8-2) (p = 0.0001); only 2 patients (2.5%) had an unsatisfactory response, complaining of straining and vaginal digitation during the evacuatory effort. Patients with anismus previously treated with biofeedback had a lower reduction ratio of the CCS score compared with patients without anismus (61.2 ± 2.8% versus 70.9% ± 1.5, p = 0.0006). There were no significant differences in the reduction of the CCS according to age, parity, type of delivery, previous hysterectomy, post-menopausal status, rectal mucosal prolapse and/or associated rectal intussusception, grade of rectocele and presence of complications. The TRREMS procedure significantly improved evacuation disorders in this study. Appropriate selection of patients is key for the success of this approach. Anismus even if previously treated with biofeedback, was the main predictive factor of unsuccessful treatment.

Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

BackgroundIrritable bowel syndrome (IBS) is prevalent in patients with morbid obesity. After Roux-en-Y gastric bypass (RYGB) chronic abdominal pain is common, however the etiology is largely unknown. We aimed to study the change in the prevalence of IBS-like symptoms 2 years after RYGB and possible preoperative predictors of such symptoms. Secondly, to evaluate changes in symptoms of constipation and diarrhea, and Health related quality of life (HRQoL).MethodsPatients with morbid obesity were included at two obesity centers in South-Eastern Norway. IBS was diagnosed according to the Rome III criteria. Predictors were evaluated in a multivariable logistic regression analysis.ResultsOf 307 participants operated with RYGB, 233 (76%) completed the study questionnaires. Preoperatively 27/233 participants (12%) had IBS, 2 years after RYGB 61/233 (26%) had IBS-like symptoms (p < 0.001). Eleven participants with IBS preoperatively (41%) did not report such symptoms after RYGB. New onset IBS-like symptoms was identified in 45/206 (22%) after RYGB. Fibromyalgia, low LDL levels, high vitamin B1 levels and IBS before RYGB were independent preoperative predictors of IBS-like symptoms at the follow-up visit. Symptom scores for constipation preoperatively and 2 year after RYGB were 1.5 (0.9) and 1.8 (1.2), and for diarrhea 1.4 (0.9) and 1.8 (1.1), respectively (p < 0.001). We observed a significant improvement in the physical component score for all participants. However, participants with new onset IBS-like symptoms had a significant worsening of the mental component score.ConclusionsThe prevalence of IBS-like symptoms doubled 2 years after RYGB, and these symptoms were associated with reduced HRQoL. Preoperative IBS and fibromyalgia were strong predictors of postoperative IBS-like symptoms.