Constipation Score Research Articles

Ventral rectopexy with biological mesh: short-term functional results.

Ventral mesh rectopexy (VMR) is an established, minimally invasive, nerve-sparing procedure for the treatment of various symptomatic morphological changes in the posterior pelvic compartment. We present the short-term functional outcome and patient satisfaction after laparoscopic and robotic VMR with biological mesh. We analyzed data from 123 patients who underwent laparoscopic ventral mesh rectopexy (LVMR) or robotic ventral mesh rectopexy (RVMR) from August 2012 to January 2017. Included in these data were patient demographics, intra- and postoperative findings, Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Score Longo (ODS), Cleveland Clinic Incontinence Score (CCIS), and patient satisfaction as measured by visual analog scale (0-10). Improvements in CCCS, CCIS, and ODS were statistically significant at 6 and 12months (p < 0.001). Patient satisfaction was excellent at 6 and 12months (8.2/10 and 8.3/10, respectively). The overall complication rate was 14%, with a major complication rate of 2%. No mesh-related complications were observed. The need for surgical re-intervention because of relapse, symptom persistence or recurrence, or new symptoms was 3%. Outcome appears to be similar between LVMR and RVMR. Both LVMR and RVMR with biological mesh are safe and effective in reducing symptoms, as measured by CCCS, CCIS, and ODS, and patient satisfaction is high.

Long-term efficacy of stapled transanal rectal resection for obstructed defecation syndrome

To evaluate the long-term efficacy of stapled transanal rectal resection (STARR) in treating obstructed defecation syndrome(ODS). Clinical data of 95 female patients with ODS undergoing STARR at Department of Colorectal Surgery, Rocket Army General Hospital from February 2010 to August 2012 were analyzed retrospectively. The Cleveland constipation scoring system (CSS), Longo ODS scoring system and severe symptoms score(SSS) were used to evaluate the degree and intensity of clinical symptoms. Patient satisfaction was assessed by visual analogue scale (VAS). Clinical symptoms at postoperative 12-month were defined as short-term efficacy, and at the end of follow up (≥48 months) were defined as long-term efficacy. The mean age was 54.5 (29 to 79) years and the median follow-up was 65 (48 to 78) months. Eighty (84.2%) and 44 (46.3%) patients completed the short-term and long-term efficacy evaluation respectively. At the end of follow up, compared with the baseline levels before operation, the CSS score (14.69 vs. 6.02), ODS score (16.51 vs. 5.73) and SSS score (14.64 vs. 5.14) were significantly decreased (all P<0.01), but the VAS score (3.96 vs. 7.20, P<0.01) was significantly increased. A total of 10 patients (22.7%) developed symptomatic recurrence. The self-reported definitive satisfaction was excellent in 10 (22.7%) patients, fairly good in 17(38.6%), good in 9(20.5%), and poor in 8(18.2%). The total effective rate was 81.8%(36/44). Long-term efficacy of STARR in the treatment of ODS is good, but the rate of symptomatic recurrence is relatively high.

Radiological Changes After Resection Rectopexy in Patients with Rectal Prolapse—Influence on Clinical Symptoms and Quality of Life

BackgroundResection rectopexy is performed to correct the anatomic defect associated with rectal prolapse. The aim of the study was to determine whether the change in the radiological prolapse grade has an influence on patients’ symptoms and quality of life. MethodsThe study investigated 40 patients who underwent resection rectopexy for rectal prolapse. The following were determined before and after surgery: radiological prolapse grade, anorectal angle and pelvic floor position in defecography, clinical symptoms (Cleveland Clinic Incontinence and Constipation Scores, Kelly-Hohlschneider Score), quality of life. ResultsDefecography revealed postoperative improvement in the prolapse grade and pelvic floor position (p < 0.05). The clinical symptoms and quality of life improved in both, the total population (n = 40) and in patients with improved radiological prolapse grade (n = 30): all clinical scores (p < 0.05), SF-36 (vitality, social role, mental health p < 0.05), and Fecal Incontinence Quality of Life Scale (lifestyle, coping, embarrassment p < 0.05). Patients without improved radiological findings showed no change in their symptoms or quality of life. ConclusionOur study demonstrates that the radiological prolapse grade is improved by resection rectopexy. Correction of the anatomic defect was associated with improvement in symptoms and quality of life. Defecography may therefore be useful in the postoperative assessment of persistent symptoms or reduced quality of life.

Effects of Interferential Electrical Stimulation Plus Pelvic Floor Muscles Exercises on Functional Constipation in Children: A Randomized Clinical Trial.

Functional constipation is a common condition in children. We assessed the effectiveness of combined interferential (IF) electrical stimulation and pelvic floor muscle (PFM) exercises on functional constipation in children. We conducted a single-center, double-blind randomized clinical trial study during 2014-2017 in Tehran, Iran. Ninety children, aged 5-13 years, who fulfilled Rome III criteria were enrolled and randomly assigned into two treatment groups. Case group (n=45) underwent IF electrical stimulation and PFM exercises, whereas the control group (n=45) received PFM exercises plus sham stimulation. A complete bowel habit diary (with concerning data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before, after the treatment and 6 months later for all participants. In addition, children in both groups were assessed with a constipation-related quality-of-life questionnaire before, after the end of treatment sessions, and 6 months after the treatment. Treatment success was achieved for 88.4% of children in the case group compared with 43.2% of children in the control group after the treatment (P<0.003). The median constipation score was reduced in both groups, with the cases having significantly lower scores after the treatment (4 vs. 8, P<0.000). Stool form normalized in 75.6% of the cases and 45.5% of the controls after the treatment (P<0.01). Our results showed that using IF electrical stimulation as an adjuvant therapy to the medical and rehabilitation programs significantly boosts the effects of treatment among these patients.

Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity?

MR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 302 MRI proctograms were performed between January 2012 and April 2015. 170 patients were included. Patients with a rectocele > 2 cm (p = 0.003; OR 5.756) or MRD features suggestive of puborectalis syndrome (p = 0.025; OR 8.602) were more likely to report a higher ODS score on multivariate analysis. Lack of rectal evacuation was negatively associated with an abnormal WIS (p = 0.007; OR 0.228). Age > 50 (p = 0.027, OR 2.204) and a history of pelvic floor surgery (p = 0.042, OR 0.359) were correlated with an abnormal BBUSQ incontinence score. Lack of rectal evacuation (p = 0.027, OR 3.602) was associated with an abnormal BBUSQ constipation score. Age > 50 (p = 0.07, OR 0.156) and the presence of rectoanal intussusception (p = 0.010, OR 0.138) were associated with an abnormal BBUSQ evacuation score. Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results.

Application of comprehensive nursing care with Wexner scoring system in constipation of patients with cerebral infarction

Objective To explore the effect of comprehensive nursing care strategy combined with the Wexner constipation scoring system in constipation of patients with cerebral infarction. Methods From January to December 2015, a total of 140 ischemic stroke patients recruited from the Department of Integrated Traditional and Western Medicine of Beijing Yanqing Hospital were selected as the research objects. These patients were randomly divided into two groups, the observation group with 80 cases and control group with 60 cases. Patients in the observation group received comprehensive nursing care with Wexner scoring system, and patients in the control group received conventional nursing. The observation indexes included the incidence of constipation, the severity of constipation and the quality of life of patients with constipation assessed by the Wexner score of constipation (PAC-QOL) . Results In the observation group, 38 cases of constipation occurred in 80 patients with ischemic stroke, the incidence rate was 47.5%, while 60 cases in the control group had constipation, with the incidence rate of 40 (66.7%) ; The Wexner score and PAC-QOL score of the observation group were (7.4±2.1) and (13.1±6.0) respectively, and those of the control group were (13.5±4.0) and (32.0±12.4) respectively, the differences between the two groups were statistically significant (P<0.05) . Conclusions The comprehensive nursing strategy with Wexner scoring system can reduce the incidence and the severity of constipation in patients with ischemic stroke and improve the quality of life of patients. Key words: Constipation; Cerebral infarction; Wexner scoring system; Comprehensive nursing care

Immediate results from biofeedback and anorectal electrostimulation in the treatment of paradoxical puborectal muscle contraction in women with obstructed defecation

ObjectiveThis study was conducted to evaluate the effects of “biofeedback” (BF), electrostimulation (ES), and of the high-fiber diet associated with behavioral therapy in women with obstructed evacuation and paradoxical puborectalis contraction and to compare the results among these three modalities. MethodThirty-one women were evaluated who fulfilled the Rome III Criteria, and with an electromanometric test positive for the presence of contraction in the evacuation maneuver. These patients were randomized into three groups: group I – conventional treatment of constipation, group II – conventional treatment of constipation associated with biofeedback and group III – conventional treatment of constipation associated with electrostimulation. At the beginning of this study and after six weeks, subjective and objective parameters of the anorectal function were evaluated using the Wexner constipation scoring system, the Bristol scale, an visual analogical scale, and anorectal electromanometry. ResultsAll patients demonstrated improvement in bowel satisfaction, stool frequency, effort and feeling of incomplete evacuation, stool-type modifications, and improvement in the quality of life. On examination, there was increased mean pressure of voluntary contraction in group III (p=0.043), decreased sensitivity threshold in group II (p=0.025) and III (p=0.012) and decreased maximum rectal capacity in group II (p=0.005). Only 19.4% (n=6) had their dynamic defecation normalized, and 80.6% (n=25) expressed clinical, non-instrumental, improvement. ConclusionThe conventional treatment of constipation, biofeedback and electrostimulation show a significant subjective improvement in symptoms of obstructed evacuation and in quality of life, regardless of the reversal of the paradoxical puborectalis contraction.

Reduction of Constipating Scoring System Among Women Aged 18-25 Years Old as A Result of Decocted Trengguli (Cassia fistula L.)

Background: Constipation is a condition when someone has difficulty to defecate. Constipation is indicated by hard and large size stool as well as a decrease frequency of bowel movement. Commonly, constipation is indicated by anxiety during bowel movement due to disruption defecation. Constipation can cause severe stress resulting from discomforts for patient. The severity of the constipation can be measured using the Constipation Scoring System (CSS). CSS is a scoring system for patient, which based on the answers about the symptoms being asked in the questionnaire. One of the herbs to handle the problem of constipation that have a laxative effect is Trengguli (Cassia fistula L.) originate from the family Fabaceae. The part that can be used for a laxative is a Trengguli fruit. A decocta method to Trengguli flesh of the fruit for a laxative, since decocta method generates the highest total anthraquinone glycosides for the use of laxatives. Purpose: The purpose of this study was to prove the effectiveness of decocta pulp of trengguli for the reduction of constipation scoring system among women aged 18- 25 years old with constipation problem. Methods: The method used is quasi-experimental design using a design of one group pre-post test. The study was conducted in December at the clinic Battra Airlangga University School of Medicine with 26 responded. Data were analyzed using SPSS with the Wilcoxon test. Result: The results of this study showed that the decocta pulp of trengguli(Cassia fistula L.) has significant effectiveness with p = 0.000 with p &lt;0.05 on a decrease in constipation scoring sytem for constipation treatment among women aged 18-25 years.

Daily intake of broccoli sprouts normalizes bowel habits in human healthy subjects.

Chronic oxidative stress impairs regular defecation. Sulforaphane (SFN) enhances anti-oxidant systems, ameliorating oxidative injury. SFN inhibits overgrowth of anaerobic microflora and protects small intestine from oxidative injury. We assessed whether daily intake of SFN-rich broccoli sprouts (BS) improves defecation in humans. Forty-eight subjects, with a constipation scoring system (CSS) >2 points, were assigned to either the BS group (n = 24) or the alfalfa sprouts (AS) group (n = 24), and were requested to eat 20 g daily of raw BS or AS, respectively, for 4 weeks. BS contains 4.4 mg/g sulforaphane glucosinolates (SGS), while AS contains no SGS. CSS-based questionnaires were performed to evaluate bowel habit. Stool samples were collected to evaluate intestinal microflora using a terminal restriction fragment length polymorphism flora analysis. Intervention with BS, but not AS, caused a significant decrease in the duration of attempted defecation and the total CSS score. Intervention with BS decreased the percentage of Bifidobacterium in the stool. These results suggest that daily intake of BS improves bowel habit in human subjects. Since BS treatment enhance antioxidant enzyme activities, these effects of BS appear to relate with the SFN-mediated modulation of the intestinal motility during exposure to oxidative stress. (UMIN Clinical Trial Registration Number: UMIN-000021207)

Bowel Dysfunction Related to Spina Bifida: Keep It Simple

Although care of urological disorders in spina bifida is well established, there is yet no agreement on a standardized approach to bowel dysfunction in this population. The purpose of this study was to assess bowel dysfunction using validated instruments and the risk factors in adults with spina bifida. A multidisciplinary team prospectively collected patient data, focusing on anorectal and urological symptoms. The study was conducted with data from a French referral center for spina bifida. A total of 228 adults with spina bifida (sex ratio men:women, 92 (40%):136 (60%)) with a median age of 34.7 years (range, 26.8-44.7 y) were assessed. Factors associated with severe fecal incontinence (Cleveland Clinic Incontinence Score ≥9) and severe bowel dysfunction (Neurogenic Bowel Dysfunction score ≥14) were assessed in a multivariate analysis model. The prevalence rates of severe fecal incontinence and severe bowel dysfunction were 60% (130/217) and 42% (71/168). Bowel dysfunction was the second most common major concern of patients after lower urinary tract dysfunction. Male sex, obesity, urinary incontinence, and a Knowles-Eccersley-Scott symptom constipation score ≥10 were independently associated with severe fecal incontinence. Patients with soft stools had significantly less severe bowel dysfunction. Neither neurologic level nor other neurologic features of spina bifida were associated with severe fecal incontinence or severe bowel dysfunction. The recruitment of patients with spina bifida through a national referral center might have resulted in selection bias, and some data were missing especially regarding BMI and Neurogenic Bowel Dysfunction score (21% and 26% of missing data). The prevalence rates of severe fecal incontinence and severe bowel dysfunction in adults with spina bifida were high and were adequately perceived by the patients. The present study emphasized the association of bowel dysfunction and fecal incontinence with obesity, urologic disorders, and stool consistency rather than neurologic features. See Video Abstract at http://links.lww.com/DCR/A394.

Laparoscopic ventral rectopexy with sacrocolpopexy for coexisting pelvic organ prolapse and external rectal prolapse.

Objectives: Pelvic organ prolapse (POP) POP is defined as the protrusion of pelvic organs from the vaginal canal. POP often coexists with internal rectal prolapse or external rectal prolapse (ERP). A series of patients with coexisting POP and ERP who underwent laparoscopic ventral rectopexy (LVR) combined with laparoscopic sacrocolpopexy (LSC) are reported here. Methods: Seven patients underwent LVR and LSC together. Fecal incontinence was assessed by the Fecal Incontinence Severity Index (FISI), constipation was assessed by the Constipation Scoring System (CSS), and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Anatomical disorders were assessed by Pelvic Organ Prolapse Quantification (POP-Q) and defecography. Results: The patients' median age was 81 (60-88) years. The median operative time was 380 (282-430) minutes. The median postoperative hospital stay was 3 (1-5) days. There were no postoperative complications. The FISI, CSS, POP-Q, and defecography findings improved postoperatively; however, the ICIQ-SF deteriorated in 2 of 5 patients. Conclusions: LVR combined with LSC for coexisting POP and ERP is feasible.

Proctographic findings and symptoms in patients with anterior rectoanal intussusception.

Objectives: Rectoanal intussusception (RAI) is a common finding on defecography in patients with defecation disorders. This study aimed to compare the proctographic findings and symptoms between patients with anterior RAI and those with circular RAI. Methods: We included 208 patients who were diagnosed as having RAI on defecography. Anorectal function was evaluated using Constipation Scoring System (CSS) and Fecal Incontinence Severity Index (FISI). Results: Twenty-four patients had anterior RAI and 184 had circular RAI. While the anterior intussusception descent or pelvic floor descent was significantly smaller in patients with anterior RAI than those with circular RAI [14.3 vs. 18.5 mm, p=0.004; 12.4 vs. 21.6 mm, p=0.005], there were no significant differences in incidences of obstructed defecation (OD) and fecal incontinence (FI) between the groups. Sixteen patients with anterior RAI and 137 patients with circular RAI had OD. There was no significant difference in the CSS scores between the groups. Twelve patients with anterior RAI and 108 patients with circular RAI had FI. No significant difference in the FISI scores between the groups. Conclusions: Approximately one tenth of the whole RAI was anterior in location, and symptoms in patients with anterior RAI were similar to those with circular RAI.

Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment

BackgroundOpioid substitution treatment (OST) is often continued long-term and, therefore, opioid-associated symptoms are of interest. Symptoms associated with methadone maintenance treatment (MMT) in men are well described, but there are fewer reports concerning symptoms associated with buprenorphine maintenance treatment (BMT) and very few reports among women. MethodRecipients of BMT (n=113) and MMT (n=184), non-opioid users (n=105) and opioid users not receiving OST (n=87) completed the Patient Assessment of Constipation (PAC-SYM) and a general symptom checklist. Multivariate analysis included other potential moderators of opioid-associated symptoms. FindingsOpioid users reported a higher frequency and severity of symptoms than non-opioid users. Constipation, dry mouth, decreased appetite, sweating and fatigue were highly prevalent in the previous 30days (51–80%). Nausea, itchy skin, trouble urinating, menstrual problems, lightheadedness, blurred vision, heart racing were also common (30–50%). Non-OST opioid users had significantly higher frequency and severity than OST recipients of nausea, vomiting, diarrhoea, decreased appetite, sweating and itchy skin. Sweating was significantly more common in MMT than BMT. Constipation scores were higher in women, otherwise most sex differences were small. Higher PAC-SYM scores were associated with vomiting (OR=1.04) and sweating (OR=1.06). Cannabis use was associated with vomiting (OR=2.19). Constipation (OR=1.07), insomnia (OR=2.5) and depression (OR=2.82) were associated with fatigue. ConclusionMen and women receiving OST report similarly high rates of somatic symptoms, though less than opioid users not receiving OST. There were few differences between BMT and MMT. Buprenorphine might be preferred where sweating is problematic. Several modifiable factors were identified.

Quality of life outcomes in children with Hirschsprung disease

BackgroundMorbidity following repair of Hirschsprung disease (HD) is common. However, quality of life (QoL) results focused on HD children are contradictory. We aimed to measure QoL outcomes in HD children using validated questionnaires. MethodsPatients with HD, managed at a large tertiary pediatric institution between 2004 and 2013, were identified. Parents completed validated questionnaires. Results were compared with published healthy population controls. QoL outcomes were measured using Pediatric Quality of Life (PedsQL) and Fecal Incontinence and Constipation Quality of Life (FIC QOL). Functional outcomes were assessed using Baylor Continence Scale, Cleveland Clinic Constipation Scoring System, and Vancouver Dysfunctional Elimination Syndrome Survey. ResultsParents of 60 HD patients [M:F 49:11; median age 6.4years (2.3–10.9)] were interviewed (59% participation). The majority (47/60, 78%) had rectosigmoid disease. There was significant reduction in psychosocial (social and emotional) QoL compared with healthy children (p=0.03). Psychosocial functioning was affected by increasing age (r=−2.72, p<0.001), fecal incontinence (r=−0.475, p=0.007), constipation (r=−1.58, p=0.006), and dysfunctional elimination (r=−2.94, p=0.004). Fecal incontinence also reduced physical functioning QoL (r=−0.306, p=0.007). Children with HD had significantly higher levels of fecal incontinence (p<0.01). ConclusionsWe have demonstrated that HD children have significant reductions in psychosocial QoL and functional outcomes. Level of evidencePrognosis Study – Level II (Prospective cohort study).

Stool consistency is significantly associated with pain perception

BackgroundCommensal as well as pathogenic bacteria can influence a variety of gut functions, thereby leading to constipation and diarrhea in severe cases. In fact, several researchers have reported evidence supporting the association between stool consistency or constipation and the Gut microbiome (GM) composition and dysbiosis. GM influences the human health and disease via the gut-brain axis. We thus hypothesized that the pathogenic bacteria increases pain perception to some extent, which means that there could be an association between stool consistency or constipation and pain perception of healthy subjects.DesignObservational study.ObjectivesThe aim of the present study was to investigate the association between stool consistency or constipation and pain perception of healthy subjects.MethodsThirty-eight healthy subjects participated in this study. The participants were assessed on their usual stool form (the Bristol Stool Form Scale: BSFS), constipation (the Cleveland Clinic Constipation score: CCS), degree of obesity, pain perception by mechanical stimulus, cold pain threshold, and a questionnaire on psychological state.ResultsThe BSFS was significantly and positively associated with pain perception, and showed a significant association with anxiety states. Furthermore, pain perception was significantly associated with anxiety states. However, there were no significant associations between the CCS and any independent variables. In addition, we found that a significant predictor to the pain perception was BSFS. Moreover, there were significant relationships among the psychological states, BSFS and obesity.ConclusionThese results suggest that the stool form is associated with pain perception and anxiety status.

Do patients receiving pelvic radiation and anti-emetics experience diarrhea and/or constipation?

Pelvic radiation may cause radiation enteritis, which commonly manifests as diarrhea. Radiation to the abdomen or pelvis may also cause radiation-induced nausea and vomiting (RINV) which is often treated with anti-emetics such as serotonin (5-HT3) receptor antagonists (RA). However, a common side effect of these anti-emetic medications is constipation. Both diarrhea and constipation can have a significant impact on patient quality of life (QOL). The objective of this study was to assess the prevalence of diarrhea and constipation in patients receiving pelvic radiation and anti-emetics. Patients undergoing pelvic radiation between January 2011 and March 2017 at Sunnybrook Odette Cancer Centre were enrolled in three prospective clinical trials studying the efficacy of various anti-emetics for RINV prophylaxis. Patients completed QOL questionnaires which included a single question about severity of constipation at baseline, day 5 and 10 during radiation if applicable, and day 5 and 10 after completion of radiation; severity was measured on a 4-point Likert scale ranging from 1= "not at all" to 4= "very much". Patients also recorded severity of diarrhea throughout baseline, treatment, and 10 days follow-up via daily diaries; responses were qualitative ranging from "no diarrhea" to "severe diarrhea" on a 4-point scale. Fifty-nine patients received pelvic radiation across the three trials. The average constipation score at baseline was 1.69 [standard deviation (SD) 0.93], and increased up to 2.33 (SD 1.03) at day 10 during treatment. Following treatment, the average score decreased to 1.61 (SD 0.80) at day 10 follow-up with the majority of patients reporting no constipation at this time (57.7%). The average diarrhea score at baseline was 1.03 (SD 0.18) and remained stable throughout treatment and follow-up. A vast majority of patients reported no diarrhea after day 10 follow-up (96.4%). Constipation was more prevalent than diarrhea during radiation treatment and up to day 10 after radiation to the pelvis. Approximately 42% of patients will have constipation on day 10 post radiation. Further research is needed to assess the causes of constipation including analgesics, and the effect on QOL during and shortly after palliative radiation to the pelvis.

Vonoprazan 10 mg daily is effective for the treatment of patients with proton pump inhibitor-resistant gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is commonly treated by primary care physicians. Although proton pump inhibitors (PPI) have been the mainstay of GERD treatment for two decades, in some patients GERD is refractory to standard dose PPI for more than eight weeks and is referred to as PPI-resistant GERD. Vonoprazan, a novel competitive acid blocker, became available in Japan for the treatment of patients with GERD, and has greater acid inhibition than existing PPIs. The aim of the present study was to determine the effect of vonoprazan 10 mg daily on PPI-resistant GERD. We retrospectively reviewed 24 patients with PPI-resistant GERD treated with vonoprazan 10 mg daily. The Izumo scale was used to evaluate the effect of vonoprazan before and one month after treatment, which reflects quality of life related to gastrointestinal symptoms. The overall rates of improvement and resolution of GERD symptoms were 88% (21/24) and 42% (10/24), respectively, and the score was significantly decreased (before 5.8±1.7, at one month 1.9±1.9, P<0.001). To evaluate the influence of esophageal erosions despite prior PPI treatment, the patients were divided into erosive (n=6) and non-erosive groups (n=18). Vonoprazan achieved 100% (6/6) improvement in the erosive group and 83% (15/18) in the non-erosive group. Patients in the erosive group had a significantly higher rate of resolution than in the non-erosive group [83% (5/6) vs 28% (5/18), P=0.017]. No adverse events occurred. Other GI symptoms in patients with PPI-resistant GERD were evaluated. The scores for epigastric pain, postprandial distress, constipation and diarrhea were unchanged during the treatment period. In conclusion, vonoprazan 10 mg daily is effective for the treatment of patients with PPI-resistant GERD. Vonoprazan resolves GERD symptoms in patients with erosions more than in those without erosions. This is the first report on the effect of vonoprazan 10 mg on PPI-resistant GERD.

Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception.

Laparoscopic ventral mesh rectopexy (LVMR) has become a well-established treatment for symptomatic high-grade internal rectal prolapse. The aim of this study was to identify proctographic criteria predictive of a successful outcome. One hundred and twenty consecutive patients were evaluated from a prospectively maintained pelvic floor database. Pre- and post-operative functional results were assessed with the Wexner constipation score (WCS) and Fecal Incontinence Severity Index (FISI). Proctogram criteria were analyzed against functional results. These included grade of intussusception, presence of enterocele, rectocele, excessive perineal descent and the orientation of the rectal axis at rest (vertical vs. horizontal). Ninety-one patients completed both pre- and post-operative follow-up questionnaires. Median pre-operative WCS was 14 (range 10-17), and median FISI was 20 (range 0-61), with 28 patients (31%) having a FISI above 30. The presence of an enterocele was associated with more frequent complete resolution of obstructed defecation (70 vs. 52%, p=0.02) and fecal incontinence symptoms (71 vs. 38%, p=0.01) after LVMR. Patients with a more horizontal rectum at rest pre-operatively had significantly less resolution of symptoms post-operatively (p=0.03). These data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms.

Effect of renal transcatheter arterial embolization on quality of life in patients with autosomal dominant polycystic kidney disease

Currently, there are few strategies for improving the quality of life (QOL) in patients with autosomal dominant polycystic kidney disease (ADPKD) and massive kidneys. Renal transcatheter arterial embolization (TAE) reduces kidney volume, but its impact on QOL in ADPKD patients on hemodialysis is unknown. This study investigated the influence of renal TAE on QOL in ADPKD patients with massive kidneys receiving hemodialysis. This prospective observational study enrolled 188 ADPKD patients on hemodialysis (92 men and 96 women; mean age 56.7 ± 9.1 years) who underwent renal TAE at Toranomon Hospital between August 2010 and July 2014. The 36-item Short Form Health Survey (SF-36) and our original 15-item questionnaire were used to evaluate QOL. Using a linear mixed model, the least squares mean values of the SF-36 physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) before renal TAE were calculated as 38.21 [95% confidence interval (CI) 36.50-39.91], 48.45 (47.05-49.86) and 43.04 (40.70-45.37), respectively. These values improved to 42.0 (40.22-43.77; P < 0.001 versus before TAE), 51.25 (49.78-52.71; P = 0.001) and 49.67 (47.22-52.12; P < 0.001), respectively, 1 year after renal TAE. Scores for abdominal fullness, poor appetite and heartburn showed marked improvement after renal TAE, while scores for fever, bodily pain and sleep disorder also improved slightly, but significantly. Scores for constipation and use of analgesics/sleeping medications/laxatives did not improve significantly. All of the SF-36 scores and the scores for specific symptoms (except bodily pain, snoring and constipation) were significantly correlated with the sequential decrease of the height-adjusted total kidney volume. In ADPKD patients on hemodialysis, renal TAE was effective in improving abdominal fullness, appetite, heartburn and SF-36 scores (MCS and RCS scores), but not for sleep disturbance, constipation and physical strength (PCS score).

Does the duration of symptoms of anal fissure impact its response to conservative treatment? A prospective cohort study

BackgroundConservative treatment is the first line of treatment for anal fissure. The current study aimed to evaluate the impact of symptom duration on the response of anal fissure to conservative treatment. Patients and methodsThis prospective study was conducted on sixty patients with acute or chronic anal fissure who were treated conservatively with bulking agents, Sitz baths, and topical glyceryl trinitrate (GTN) 0.2%. Pain and constipation were assessed prior to treatment and at 6 weeks after therapy using visual analogue scale (VAS) and Wexner constipation score. Adverse effects as headache and postural hypotension were also queried. ResultsThe mean pre-treatment VAS for acute fissure was significantly higher than chronic fissure (8.8 ± 0.96 Vs 5.8 ± 1.12), also the post-treatment VAS for acute fissure was significantly lower at 6 weeks of treatment (0.47 ± 0.8 Vs 2.5 ± 1.3). The baseline Wexner constipation score was comparable in both groups; however, at six weeks of treatment it declined more significantly in patients with acute fissure. Patients with acute fissure achieved significantly better healing than chronic fissure (80% Vs 40%). Healing rates decreased from 100% in patients with symptoms < one month to 33.3% in patients with symptoms >6 months. ConclusionConservative treatment including topical GTN 0.2% significantly hastened healing and relieved pain and other symptoms of acute more than chronic anal fissure. Healing rates of anal fissure in response to conservative treatment showed remarkable decrease in proportion to the duration of complaint.