Sensation Of Obstruction Research Articles

Gastrointestinal Symptoms in Diabetes Occur Long before Diabetic Complications

Background/Aims: Gastrointestinal (GI) manifestations are common in patients with diabetes complications, such as autonomic neuropathy. However, the prevalence of GI symptoms before the development of diabetes complications is unclear.Methods: We conducted an interview survey of functional GI disorders among patients with diabetes visiting the endocrinology clinic of a general hospital using the Rome III criteria. The survey consisted of questions regarding functional dyspepsia, irritable bowel syndrome, and functional constipation, including functional defecation disorder.Results: In total, 509 patients were included in the analysis. The patients were divided into three groups: prediabetes (n = 115), diabetes without neuropathy (n = 275), and diabetes with neuropathy (n = 119). With regard to GI symptoms, the prevalences of functional dyspepsia in the prediabetes, diabetes without neuropathy, and diabetes with neuropathy groups were 16.52%, 27.27%, and 23.53%, respectively; those of irritable bowel syndrome were 8.70%, 11.68%, and 16.81%, respectively, and those of functional constipation were 8.85%, 11.85%, and 15.25%, respectively. In the subgroup analysis, symptoms of postprandial distress syndrome (e.g., postprandial fullness and early satiety) were more prevalent than symptoms of epigastric pain. In the constipation group, symptoms of pelvic outlet obstruction (such as the sensation of anorectal obstruction or blockage and the need for manual maneuvers to facilitate defecation) were more prevalent than symptoms of slow-transit constipation.Conclusions: The prevalence of functional GI disorders increases with diabetes severity. Diabetes-related GI symptoms appear long before the onset of diabetes complications.

Sneeze-induced transvaginal small bowel evisceration and obstruction nine months after iatrogenic vaginal vault laceration: a case report

Transvaginal evisceration (TE) is the extrusion of intra-abdominal viscera through the vagina. According to the literature, few cases have been reported, most of them involving elderly women who underwent previous pelvic surgery. Here we present the case of a 72-year-old woman who was admitted to our hospital due to the sensation of vaginal obstruction that appeared after a sneeze nine months after a repair of a vault laceration following prior complex pelvic surgery. A clinical diagnosis of small bowel transvaginal evisceration with obstruction was quickly made. In this case, adhesions, bowel obstruction, and the presence of a fibrotic scar on the vaginal vault were the main obstacles to the repair. However, a multidisciplinary evaluation and a combined laparoscopic-transvaginal minimally-invasive approach proved to be safe and effective in achieving good surgical outcomes in the treatment of this condition.

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

Introduction: Functional chronic bowel constipation is a motility disorder of great relevance and prevalence worldwide. Objective: Analyze the efficiency of visceral manipulation technique in individuals with bowel constipation diagnose according to Roma III criteria. Methods: This is a crossover clinical study that included individuals of both genders aged between 20 and 40 years who had had bowel constipation symptoms for over one year. Individuals were randomized into two groups: the intervention (IG) and control (CG) groups. A four weeks washout period was given. Each volunteer underwent 24 individual osteopathic sessions, twice a week that lasted up to 30 minutes. Three intervention techniques were performed: two for the large intestine and one for the small intestine. Results: Thirty four patients were recruited but nine were excluded. Our sample consisted in 25 participants, 13 were allocated in the IG and 12 in the CG. No significant difference was found between groups for anthropometric, educational, marital status, proportion of smokers and alcoholics, and VAS for lumbar spine pain measures. Lumbar spine flexibility, was significant increased for the IG (p<0.0001). A higher proportion of patients in the IG presented reduced hard stools, effort to evacuate, incomplete evacuation feeling, anorectal obstruction sensation and manual maneuvers to facilitate evacuation after treatment (p<0.0001). A significant correlation was found between pain (VAS) and the Schober test (r=-0.41). Conclusion: This study was successful in showing that there seems to be a positive effect of the osteopathic treatment for chronic bowel constipation at short and long terms.

Endoscopic unilateral anterior ethmoid artery flap with or without cartilage graft for nasal septal perforation repair.

The authors conducted a retrospective cohort study between June 2020 and June 2022. Our study included all adult patients with septal perforation due to trauma (operative and self-induced) lasting for more than one year. Patients underwent an endoscopic repair of a perforation and a questionnaire regarding subjective quality of life was completed at 3 months postoperatively. A total of 18 patients were included in our study. The main symptoms were crusting (100%), bleeding (38.85%), whistling (16.6%), anosmia (16.6), and nasal obstruction sensation (11%). The mean perforation size was 13.6mm, ranging between 4mm and 28mm. Number of years with the perforation (ranged between 2 and 16 years) with a mean of 4.876±1.645 years and a mode of 2 years. All cases were repaired using an endoscopic unilateral anterior ethmoid artery flap with or without cartilage.There were no intraoperative complications but postoperatively, these included pain, ranging between a score of 2 and 8 on the pain score chart, (the mean score was five and mode was four, appeared in six patients), which was treated with over-the-counter painkillers. In addition, there was one patient (5%) with a residual small perforation (2mm). All patients were happy to fill out postoperative patient satisfaction questionnaires after 3 months. The mean was 21.8889 ±1.655 points and the mode, 25 points (highest possible score), appeared four times. The lowest scoring questionnaire summated to 15 points. The endoscopic unilateral anterior ethmoid artery nasal flap with or without cartilage graft has proven to be a reliable and a valuable graft that, with proper planning, can provide excellent results with minimal morbidity for nasal septal perforation repair.

Clinical analysis of 12 cases of laryngeal neuroendocrine carcinoma

Objective: To investigate the clinical and pathological features, treatments and prognosis of laryngeal neuroendocrine carcinoma (LNEC). Methods: We conducted the retrospective analysis of the clinical data of 12 patients with LNEC admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Second Hospital of Shanxi Medical University from May 2014 to December 2021, including 9 males and 3 females, aged 50-77 years. There were 4 cases of typical carcinoid tumour (highly differentiated), 5 cases of atypical carcinoid tumour (moderately differentiated) and 3 cases of neuroendocrine small cell carcinoma (hypofractionated). The clinical features, diagnosis, treatment and prognosis of LNEC were analysed. Results: The clinical manifestations of LNEC varied according to the tumour type but did not correlate with the pathological types. The supraglottic type was characterized by sore throat, foreign body sensation in the pharynx, coughing, obstructive sensation when eating and choking on water. The treatments were determined according to the pathological types, lesion location and invasion scope. Of 12 patients 4 underwent horizontal partial laryngectomy plus elective lymphatic dissection plus postoperative radiotherapy/chemotherapy, 4 underwent vertical partial laryngectomy (3 of them with cervical lymphatic dissection), 3 underwent supported laryngoscopic plasma laryngectomy for laryngeal cancer, and 1 abandoned for treatment. With the follow-up of 8 -78 months, 5 patients were alive, 1 died from chemotherapy reactions, 3 died from other diseases, 1 died from lung metastasis, 1 died from lung infection and 1 was lost to follow-up. Conclusion: LNEC is clinically rare, the clinical manifestations are less specificity, diagnosis relies on pathological and immunohistochemical examinations, and treatment modalities and prognoses are closely related to the pathological subtypes of LNEC.

The effect of Cassia fistula L. syrup in geriatrics constipation in comparison with the lactulose: A randomized clinical trial

Ethnopharmacological relevanceCassia fistula is widely used in traditional Persian Medicine as a mild laxative. The rate of chronic constipation increases above the age of 60. Aim of the studyThis study aimed to investigate the effect of Cassia fistula syrup (CFS) on geriatric constipation. Materials and methodsThis clinical trial study was performed on 70 aged patients who were referred to the clinic of gastroenterology of Rouhani Hospital, Babol, North of Iran. Patients were randomly divided into two groups of CFS or Lactulose with a dose of 30 ccs/day. Patients were visited two weeks after entering the study to evaluate the frequency of defecation, feeling of incomplete emptying after defecation, manual maneuver, consistency of stool, and also the quality of life. ResultsThe frequency of defecation per week varied from 1.82 ± 1.16 to 8.36 ± 3.44 in the CFS group after 2 weeks of intervention that was significantly more than the Lactulose that changed from 2.16 ± 1.46 to 5.66 ± 2.96 (P-value = 0.023, partial eta square = 0.079, NNT = 4).The quality of life, the percent of straining, lumpy or hard stool, pain during defecation, and the consistency of stool based on VAS were significantly better in the CFS group. The sensation of incomplete defecation, anorectal obstruction, and manual maneuvering were not different significantly between groups. ConclusionCFS can be more effective than Lactulose on geriatric constipation.

Constipation Symptoms in Multiple System Atrophy Using Rome Criteria and Their Impact on Personalized Medicine.

Constipation is one of the most common non-motor symptoms in multiple system atrophy (MSA); however, it has not been evaluated according to the standard diagnostic criteria for constipation in patients with MSA. We evaluated the characteristics of constipation in patients with MSA by using Rome criteria (Rome III), which has been validated and the widely used for gastrointestinal disorders. Fifty-one patients with MSA (29 female) were enrolled in the study. Based on the Rome III criteria, constipation was diagnosed in 29 patients (56.9%); irritable bowel syndrome was not detected. Thirty-seven patients (72.5%) were aware of their constipation. The most common constipation symptom was the sensation of anorectal obstruction (68.6%). Patients’ self-awareness of constipation was most strongly correlated to the sensation of incomplete evacuation (odds ratio: 7.377, 95% confidence interval: 1.402–38.817). The number of constipation-related symptoms was correlated with the total levodopa equivalent dose (p < 0.05). Rome criteria, which can detect various constipation symptoms, are useful for evaluating constipation in MSA, and these findings may greatly impact personalized medicine.

Best Practices for the Management of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation: A Roundtable Discussion and Review.

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are highly prevalent conditions that affect a significant proportion of the US population. Pathogenic, diagnostic, and treatment paradigms for patients with constipation have changed considerably over time. A clinical roundtable consisting of experts from across the United States was convened (virtually) to discuss the burden of constipation and current evidence-based diagnostic and management tools at a mechanistic level, with a primary goal of determining realistic clinical strategies to improve outcomes in patients with CIC or IBS-C. This 4-part supplement provides a critical review and discussion of the burden of illness and strategies for the diagnosis and management of CIC and IBS-C. These common and bothersome disorders of gut–brain interaction present a spectrum of stool-related symptoms such as infrequent bowel movements, hard stools, excessive straining, and an overall sensation of incomplete evacuation or obstruction. In addition, patients commonly report a variety of non‒stool-related abdominal symptoms that are often directly related to the patients' severity of CIC or IBS-C. The overlapping symptomatology of CIC and IBS-C have a significant impact on health-related quality of life, with individuals reporting frustration, shame, and embarrassment, along with an overall sense of helplessness. Many patients cycle through multiple treatment options in an attempt to manage their abdominal symptoms and to regulate bowel frequency and stool consistency. For healthcare providers, central to the management of patients with CIC or IBS-C is the utilization of a patient-centered communication approach that ensures understanding of symptom type and intensity, accurate symptom reporting, and compliance to treatment. Although treatment strategies for patients with CIC and IBS-C can often be challenging—with many patients unaware of available treatment options and instead choosing to self-medicate with diet or over-the-counter strategies—it is vital that patients are educated about symptomatology and available treatments, actively monitored for changes in symptom severity and response to treatment, and appropriately managed to maximize clinical outcomes such as patient adherence and cost benefit. My colleagues and I hope that this supplement provides practitioners, such as gastroenterologists, and the medical community at-large with a better understanding of the burden and unmet needs of patients with CIC or IBS-C. With this recognition, we hope to improve management outcomes. CONFLICTS OF INTEREST Guarantor of the article: Darren M. Brenner, MD. Specific author contributions: Darren M. Brenner moderated and participated in the advisory board discussions, contributed to the drafting of the manuscript, provided critical revision of all manuscript drafts for important intellectual content, and approved the final version for publication. Financial support: This supplement was funded by Salix Pharmaceuticals, Inc. Potential competing interests: D.M.B. is a consultant, advisor, and/or speaker for Salix, AbbVie (Allergan), Ironwood, Takeda, RedHill, Alnylam, AlphaSigma, Bayer, Arena Pharmaceuticals, GI Health Foundation, IFFGD, and the Rome Foundation. His research is sponsored by an unrestricted grant from the Irene D. Pritzker Foundation.

The impact of nasal adhesions on airflow and mucosal cooling – A computational fluid dynamics analysis

Nasal adhesions are a known postoperative complication following surgical procedures for nasal airway obstruction (NAO); and are a common cause of surgical failure, with patients often reporting significant NAO, despite relatively minor adhesion size. Division of such nasal adhesions often provides much greater relief than anticipated, based on the minimal reduction in cross-sectional area associated with the adhesion. The available literature regarding nasal adhesions provides little evidence examining their quantitative and qualitative effects on nasal airflow using objective measures. This study examined the impact of nasal adhesions at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD). A high-resolution CT scan of the paranasal sinuses of a 25-year-old, healthy female patient was segmented to create a three-dimensional nasal airway model. Virtual nasal adhesions of 2.5 mm diameter were added to various locations within the nasal cavity, representing common sites seen following NAO surgery. A series of models with single adhesions were created. CFD analysis was performed on each model and compared with a baseline no-adhesion model, comparing airflow and heat and mass transfer. The nasal adhesions resulted in no significant change in bulk airflow patterns through the nasal cavity. However, significant changes were observed in local airflow and mucosal cooling around and immediately downstream to the nasal adhesions. These were most evident with anterior nasal adhesions at the internal valve and anterior inferior turbinate. Postoperative nasal adhesions create local airflow disruption, resulting in reduced local mucosal cooling on critical surfaces, explaining the exaggerated perception of nasal obstruction. In particular, anteriorly located adhesions created greater disruption to local airflow and mucosal cooling, explaining their associated greater subjective sensation of obstruction.

Effect of acupressure on constipation in patients with advanced cancer.

Constipation is a common and distressing symptom for patients with advanced cancer. Few reports have focused on the symptoms of constipation in patients with advanced cancer. The aim of this study was to investigate the effect of a short-term acupressure intervention on patients with advanced cancer. This study used a non-randomized, pre-post study design to assess the effect of acupressure intervention. A total of 30 patients with advanced cancer were recruited from the hospice unit of a medical center in southern Taiwan. In addition to routine care, patients in the intervention group received an 8-min acupressure treatment daily for 3 consecutive days. Three acupoints were used in this study: Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25). Analysis of covariance was used to compare the differences in symptoms of constipation between the two groups, adjusted for baseline values. Effect sizes were calculated using partial eta squared (η2). Significant improvements in symptoms of constipation (partial η2 = 0.40, p < 0.001 for straining during defecation; partial η2 = 0.30, p = 0.002 for hard stools; partial η2 = 0.42, p < 0.001 for sensation of incomplete evacuation; and partial η2 = 0.29, p = 0.002 for sensation of anorectal obstruction), Bristol stool form scale scores (partial η2 = 0.40, p < 0.001), comfort levels during defecation (partial η2 = 0.82, p < 0.001), and colonic motility (partial η2 = 0.85, p < 0.001) were observed in patients receiving acupressure intervention compared with the controls. Findings from this study indicated that short-term acupressure was effective in alleviating symptoms of constipation among patients with advanced cancer. Further, randomized controlled trials are warranted to confirm the results.

Effect of an herbal capsule on chronic constipation among menopausal women: A randomized controlled clinical trial.

Objective:Chronic constipation is frequently observed in postmenopausal women. An herbal combination including clover plants, Roman anis or Anisone, green anis or fennel, green raisins, Alhagi maurorum, violets, Terminalia chebula, senna and golqand has been introduced in traditional books as an effective laxative. Thus, the present study aimed to assess the effectiveness of the combined herbal capsule on chronic constipation in postmenopausal women.Materials and Methods:This triple blinded, randomized placebo-controlled trial was conducted on 64 postmenopausal women. Individuals were randomly assigned to combined the herbal capsule and placebo groups. The herbal capsule included cloves (4 units), Anise and Anison (6 units each), violet flowers (12 units), Terminalia Chebula and fresh green raisins (25 units each), senna leaves, Alhagi maurorum, and Golqand (50 units each). Constipation questionnaire and the individual’s assessment of constipation symptoms scale were used for data collection. Results:The mean frequency of bowel movements in the herbal capsule group was significantly higher than the placebo group (mean difference=4.2; 95% confidence interval: 0.3 to 4.5; p<0.001). Straining during defecation, stool amount, incomplete defecation, sensation of obstruction during defecation, and need for manipulation to facilitate removal of stools were significantly reduced in the herbal capsule group compared to the placebo group (p<0.001). The amount and consistency of defecation was also improved in the two study groups, but a significant difference was observed between the groups (p<0.001). The mean score of constipation symptoms in the herbal capsule group was significantly reduced compared to the placebo group (-15.4; -11.5 to -19.29; p<0.001).Conclusion:Consumption of herbal capsules improved chronic constipation in postmenopausal women.

Respiratory Epithelial Adenomatoid Hamartoma

&#x0D; A 65-year-old man consulted with a history of chronic snorting with a sensation of obstruction in the left side of the nasopharynx particularly when in supine position. A few days prior to consult, the patient had blood-tinged nasal discharge, thus this admission. No other symptoms were reported.&#x0D; &#x0D; Nasal endoscopy showed a sessile exophytic lesion with a vaguely nodular surface, seen as a polypoid nasopharyngeal mass on Computed Tomography scan. (Figure 1)&#x0D; &#x0D; Excision of the mass was performed. Received in the surgical pathology laboratory was a 1.8 x 1.5 x 0.6 cm red to brown, rubbery to firm, vaguely ovoid mass with a nodular external surface. Cut section showed a light gray solid surface. &#x0D; &#x0D; Microscopic examination shows a broad-based exophytic mass with invaginations of the surface epithelium and proliferated glands within the stroma. (Figure 2) The glands are tubular or variably dilated - many are lined by a respiratory-type epithelium with goblet cells and a thickened basement membrane, while the tubular glands are lined by a monolayered cuboidal epithelium. (Figure 3) Based on these features, we signed the case out as a respiratory epithelial adenomatoid hamartoma (REAH).&#x0D; &#x0D; REAH is a benign proliferation of sinonasal tract glands derived from the surface epithelium.1 It occurs primarily in male adults, with a median age in the sixth decade of life. Most cases arise in the posterior nasal septum, while less common sites of involvement include other parts of the nasal cavity, the nasopharynx, and paranasal sinuses.2 Common symptoms include nasal obstruction, stuffiness, and epistaxis.1,3,4&#x0D; &#x0D; REAH presents as a polypoid lesion and may measure up to 6 cm in widest diameter.1 Microscopically, there is a proliferation of small to medium-sized glands dispersed in abundant stroma. Invagination of the glands from the surface epithelium may be seen.3 The glands are round to oval, lined by respiratory-type epithelium with admixed goblet cells. Thickened basement membranes surround some of the glands, and smaller seromucinous glands lined by cuboidal epithelium may also be admixed among the latter. Other alterations may include squamous, chondroid, and osseous metaplasia.1,4&#x0D; &#x0D; Rarely, REAH may occur synchronously with inverting sinonasal papillomas or inflammatory polyps.1 It may be mistaken for these two entities along with sinonasal low-grade adenocarcinomas. Careful attention to the typical morphology including absence of an infiltrative growth pattern and atypia allow distinction from these entities particularly the malignant mimics.3 A related entity is a seromucinous hamartoma with which REAH is believed to form a morphological spectrum.1&#x0D; &#x0D; REAH is benign and complete excision confers cure.1 Malignant transformation has not been reported.1,3,4

The risk of long‐term bowel dysfunction after resection for sigmoid adenocarcinoma: a cross‐sectional survey comparing complete mesocolic excision with conventional surgery

To investigate whether complete mesocolic excision (CME) might carry a higher risk of bowel dysfunction and subsequent reduction in quality of life compared with conventional resection. A cross-sectional questionnaire study based on data from a national survey regarding long-term bowel function and a population-based cohort study comparing CME (study group) with conventional resection (control group). A total of 622 patients undergoing elective resection for Stage I-III sigmoid adenocarcinoma at four university colorectal centres between June 2008 and December 2014 were eligible to receive the questionnaire in mid-November 2015. Primary outcomes were four or more bowel movements daily, nocturnal bowel movements, unproductive call to stool, obstructive sensation and impact of bowel function on quality of life (QOL). One hundred and twenty-seven (69.0%) and 289 (66.0%) patients in the study and control groups, respectively, responded to the questionnaire after medians of 4.41 [interquartile range (IQR) 2.50, 5.83] and 4.57 (IQR 3.15, 5.82) years, respectively (P = 0.048). CME was not associated with: increased risk of four or more bowel movements daily [adjusted OR 1.14 (95% CI 0.59-2.14; P = 0.68)], nocturnal bowel movements [adjusted OR 1.31 (0.66-2.53; P = 0.43)], unproductive call to stool [adjusted OR 0.99 (0.54-1.77; P = 0.97)] or obstructive sensation [adjusted OR 1.01 (0.56-1.78; P = 0.96)]. While one in five patients in both groups had moderate to severe impact of bowel function on QOL, there was no association with CME. For patients with sigmoid cancer, CME is associated with neither higher risk of bowel dysfunction nor impaired QOL.

Adult acute rhinosinusitis guidelines worldwide: similarities and disparities.

Acute rhinosinusitis (ARS) is a common respiratory infection that poses a major public healthcare burden with respect to antibiotic consumption and related morbidity. Position statements and national ARS guidelines have been published worldwide, aiming to define diagnostic criteria and outline treatment options. Our objective was to analyze the similarities and disparities between such guidelines. We conducted an electronic database search for ARS guidelines using relevant keywords between January 1, 1989, through December 31, 2017. Overall, 25 guidelines from 39 countries were retrieved: 8 from 8 developed countries, and 17 from 31 developing countries. Representative guidelines from developing and developed countries from America, Europe, Africa, Asia, and Oceania were evaluated. We compared the bibliographic data, diagnostic criteria, and treatment recommendations of selected guidelines. In most developed countries, otorhinolaryngological societies published ARS guidelines, whereas the Ministry of Health formulated the guidelines or adopted generic guidelines prepared by an international organization in developing countries. Many similarities in the diagnostic criteria were found, such as purulent nasal discharge and nasal obstruction sensation. In contrast, maxillary culture as a diagnostic tool was mentioned in developed countries, while it was generally ignored in developing countries. The watchful waiting (WW) policy and abstaining from immediate antibiotics was unanimously adopted in developed countries, which was only partly embraced in developing countries. The recommended universal first-line antibiotic therapy is amoxicillin, with or without clavulanic acid, whereas options for second-line and third-line antibiotic therapies varied. ARS guidelines from different countries have many similarities. Specific recommendations are tailored to local epidemiology and healthcare accessibility.

Intranasal trigeminal function in patients with empty nose syndrome.

Trigeminal nerve mediates the perception of nasal airflow. This study examines whether impaired intranasal trigeminal function is a part of the paradoxical nasal obstruction sensation in patients with empty nose syndrome (ENS). Prospective case-control study in a tertiary hospital. Three groups were examined: 1) ENS patients with previous bilateral near total inferior turbinectomy, 2) patients who underwent near total inferior turbinate removal (ITR) without ENS symptoms, and 3) control participants. All participants examined with active anterior rhinomanometry, olfactory testing (extended Sniffin' Sticks test), and trigeminal testing (lateralization task using menthol and odorless solvent). Seventy-one participants were included (21 ENS patients, 18 ITR patients, and 31 controls). Analyses revealed that ENS patients had significantly lower scores on trigeminal lateralization testing than the ITR group and controls. The ENS group had also significantly lower scores in olfactory testing than controls. No statistical differences were found in rhinomanometry between groups. The gender factor was not associated with the chemosensory testing; however, this was not the case with the age factor, as trigeminal test results were negatively correlated. This study demonstrates significantly impaired intranasal trigeminal function in ENS patients when compared with ITR patients and controls. Further prospective studies are needed to clarify the role of preoperative trigeminal function of these patients and the contribution of surgery to this impairment. 3b. Laryngoscope, 127:1263-1267, 2017.

A Randomized Clinical Trial on Treatment of Chronic Constipation by Traditional Persian Medicine Recommendations Compared to Allopathic Medicine: A Pilot Study.

Background:The aim of this study was to compare the efficacy and side effects of lactulose plus traditional Persian medicine with only lactulose on the functional chronic constipation.Methods:Participants included 20 patients (10 in each group) aged 18–80 years, with major inclusion criteria of ROME III. They were assigned into two parallel therapeutic groups, including the intervention group (lactulose plus traditional Persian medicine [TPM] advices) and control group (only lactulose) through a block randomization. Weekly follow-up was done for 1 month for both groups.Results:After the intervention, the frequency of bowel habit increased significantly in patients of both groups (P = 0.001), and the frequency of hard stool defecation, sensation of painful defecation, sensation of incomplete evacuation, sensation of anorectal obstruction, and manual maneuver for evacuation were decreased significantly in patients of both groups (P < 0.001 for all comparisons and 0.025 for manual maneuver). However, the only significant difference between the two groups was more reduction in the sensation of painful defecation in the lactulose group versus lactulose plus TPM advices (P = 0.014).Conclusions:Based on the pilot study, no significant difference was shown between TPM with lactulose and lactulose only in the management of chronic functional constipation. However, the easy recommendations of TPM can be useful in improving chronic constipation.

The Effect of Probiotic Yogurt on Constipation in Pregnant Women: A Randomized Controlled Clinical Trial.

BackgroundProbiotics can alter the colonic microbiota and might improve bowel function.ObjectivesThe aim of this study was to evaluate the effect of the consumption of yogurt, enriched with Bifidobacterium and Lactobacillus 4.8 × 1010 (CFU) on the symptoms of constipated pregnant women.Materials and MethodsThis triple-blind randomized controlled trial was conducted on 60 constipated pregnant women who were diagnosed by the ROME III criteria in Tabriz, Iran from December 2014 to July 2015. Participants were randomly put into two groups including the treatment and the control group through block randomization. The treatment group received 300 g of yogurt enriched with Bifidobacterium and Lactobacillus 4.8 × 1010 colony forming units (CFU) (n = 30) while the control group received conventional yogurt (n = 30) for 4 weeks. The defecation frequency, stool consistency, straining during defecation, sensation of anorectal obstruction, sensation of incomplete evacuation and manual manoeuvres to facilitate defecation were primary outcomes while the amount of defecation, stool colure, and quality of life were secondary outcomes.ResultsThe frequency of defecation was increased from 2.1 (0.8) at baseline to 8.3 (4.4) in the probiotic yogurt group vs. 2.3 (0.7) at baseline to 8.1 (4.3) in the conventional yogurt group at the end of 4th week. These results were based on the repeated measure ANOVA test and there was no statistically significant difference between the two groups (mean difference: 0.1; Confidence Interval 95%: -1.4 to 1.7; P = 0.872). Constipation symptoms including straining, anorectal obstruction, manipulation to facilitate defecation, consistency of stool and color of stool were improved significantly (P < 0.05) in both groups. In addition, the amount of defecation was significantly increased in both groups (P < 0.05), while incomplete evacuation was significantly reduced in the treatment group (P = 0.01). There was no statistically significant difference between the groups in the mean scores of physical (P = 0.726) and mental (P = 0.678) aspects of quality of life after the intervention with the adjusting of baseline scores.ConclusionsConsumption of 300 g/day probiotic and conventional yogurt can play a role in improving the symptoms of constipation during pregnancy.

Improvement of Constipation in Leukemia Patients Undergoing Chemotherapy Using Sweet Potato.

Leukemia patients undergoing chemotherapy commonly develop constipation, which is difficult to treat using routine methods. The aim of this study was to determine whether sweet potato can alleviate constipation in leukemia patients undergoing chemotherapy. Leukemia patients receiving their first chemotherapy were randomized to an intervention group (n = 57) or a control group (n = 63). The control and intervention groups were managed by using routine nursing methods and routine methods plus dietary sweet potato consumption (eating sweet potato 200 g/d, from admission to discharge), respectively. Related data regarding patients' defecation were collected on the second and fifth days after chemotherapy initiation, which included rates of constipation, frequency and duration of purgative usage, constipation status assessed by Rome III criteria, and scores on defecation satisfaction. On the second day, the rate of constipation and the rate of having first defecation within 24 hours after chemotherapy initiation were significantly improved in the intervention group, but the difference of the defecation satisfaction and "almost no loose stools without purgative use" in Rome III criteria were not significantly changed. On the fifth day, except for "the sensation of anorectal obstruction" and "requirement of manual assistance" in Rome III criteria, other items regarding defecation were significantly improved. This study demonstrates that sweet potato had a positive impact on the prevention of constipation and the defecation satisfaction in leukemia patients receiving their first chemotherapy. As sweet potato is inexpensive, abundant, tasty, and easy to prepare, it can be widely used in leukemia patients undergoing chemotherapy.

Effect of progesterone therapy versus diet modification on constipation during pregnancy

Background: Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy. Aim: To compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy. Subjects and Methods: Women aged ≥18 years with functional constipation according to the Rome III criteria from obstetrics outpatients’ clinic and midwife practices included in this study. Participants divided into two groups; control group managed with diet modifications and study group pregnant women with threatened miscarriage and advised to take vaginal progesterone ≥1 week. Participants completed a nonvalidated questionnaire created by the authors during the whole week before intake of progesterone or diet modifications and after treatment phase. Independent Student’s t‑test and Chi‑square (X 2 ) test were used for statistical analysis to compare between two studied groups. Primary outcome measures; change in defecation frequency. Results: Sensation of anorectal obstruction and sensation of incomplete evacuation were significantly less in Group B (progesterone therapy) compared to Group A (diet modification) (54% [154/281] and 62.98% [177/281] vs. 89.76% [614/684] and 91.08% [623/684], respectively) (P = 0.04 and 0.03, respectively). Straining during defecation and manual maneuvers to facilitate evacuation were significantly less in Group B compared to Group A (63.7% [179/281] and 19.9% [56/281] vs. 94.59% [647/684] and 86.54% [592/684], respectively) (P < 0.01 and 0.02, respectively). Episodes of abdominal pain and presence of reflux episodes were also significantly less in Group B compared to Group A (18.5% [52/281] and 17.43% [49/281] vs. 84.11% [589/684] and 75% [513/684], respectively) (P = 0.01 and 0.03, respectively). Conclusions: Estrogen, rather than progesterone, may be a detrimental factor of constipation during pregnancy via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm the data of this study. KEY WORDS: Constipation, diet modification, pregnancy, progesterone

Sa1383 Efficacy of Multidisciplinary Approach for the Management of Severe Constipation: A 4-Year Experience

Background: Chronic constipation is one of the most common gastrointestinal disorders throughout theworld. Many patients with severe constipation are resistant to pharmacological treatments and operations. Objective: To evaluate the efficacy of multidisciplinary approach in patients with severe constipation through a long-term follow-up.Methods: Three hundred and ninety-one patients diagnosed with constipation according to Rome III criteria accepted multidisciplinary treatment or standard medical treatment between March, 2010 and April, 2013. The multidisciplinary constipation clinic in a tertiary care setting with dietary modification, exercise therapy, bowel habit adjustment, abdominal breathing exercise and drug therapy. Constipation symptoms, quality of life (SF-36), anxiety and depression were assessed before enrollment and after therapy. Results: Two hundred and eighty-eight subjects were treated by multidisciplinary treatment and 235 subjects complete the follow-up. The mean age of patients was 50.6 ± 16.0 years. 74.7% of patients were female. The mean duration of follow-up was 2.3 years. The weekly bowel movements was higher in the multidisciplinary group than the medication group(5 (3, 7) vs. 3.0 (2, 4), P<0.001). There was significant improvement on Bristol score (3 (3, 3) vs. 3 (2, 3), P=0.032), straining effort (4 (3, 5) vs. 8 (6.75, 9.0), P<0.001) and straining time(10 (7, 13) vs. 15 (10, 17), P=0.002). Significant improvement was also noted with multidisciplinary treatment on straining at defecations(31.1% vs. 59.8%, P=0.005), Hard stools(24.3% vs. 52.4%, P=0.005) and sensation of anorectal obstruction(8.5% vs. 35.4%, P<0.001). The proportion of patients with laxative/ enema use was lower in multidisciplinary group than the medication group(27.6% vs. 63.4%, P<0.001). Meanwhile, the score of quality of life (N=13) were significant higher compared with baseline. Multidisciplinary treatment also reduced score of anxiety (33.07±6.31 vs. 35.13±4.05, P=0.032)and depression(37.59±9.45 vs. 44.07±6.77, P<0.001)(N=44).Conclusion: This study suggest that multidisciplinary approach improves long-term constipation symptoms. Improvement in quality of life was also seen in patients attending themultidisciplinary constipation clinic.