Stool Frequency Research Articles

Cultural Adaptation and Validation of the Moroccan Version of the EORTC QLQ-CR29 in Patients with Colorectal Cancer.

The increasing incidence of colorectal cancer in Morocco has generated a need for a disease-specific quality-of-life measuring instrument. The present study aims to translate and evaluate the reliability and validity of the Moroccan Arabic version of the EORTC QLQ-C29 measure in Moroccan subjects with colorectal cancer (CRC). Methods:Following translation to Moroccan Arabic, The QLQ-C30 and QLQ-C29 were administered to 135 patients treated for colorectal cancer (CRC) at the national oncology institute of Rabat, in the period from February 2016 to June 2018. Statistical analysis included reliability, convergent, and discriminant validity as well as known-groups comparisons. Results:(89 %) patients completed the questionnaires of the EORTC QLQ C-29 and EORTC QLQ C-30. The test –retest, administered to 25 patients and the ICCs for each item ranged from 0.61 to 0.93 indicating good to excellent reproducibility. The internal consistency coefficients for body image, urinary frequency, stool frequency scales were acceptable (Cronbach’s alpha ≥ 0.70), while the blood and mucus in the stool dimensions had lower reliability (0.65). Multi-trait scaling analysis showed that multi-item scales met standards of convergent and discriminate validity. All Correlations between the EORTC QLQ C-29 and EORTC QLQ C-30 scores were low (r < 40). The known- group comparisons showed differences between group of patients based on tumor location and with/ without a stoma. Conclusion:The Moroccan Arabic Dialectal version of the QLQ-C 29 is a valid and reliable measure of health related quality of life (HRQOL) in patients with colorectal cancer.

Gastrointestinal Tolerance of Short-Chain Fructo-Oligosaccharides from Sugar Beet: An Observational, Connected, Dose-Ranging Study in Healthy Volunteers.

Dietary fibres are important in the human diet with multiple health benefits. This study aimed to determine the gastrointestinal tolerance of short-chain fructo-oligosaccharides (scFOS), well-known prebiotic fibres, at doses up to 40 g/d. An observational, connected, dose-ranging trial was conducted in 116 healthy volunteers. During the first week, the participants were instructed to consume their usual diet. During the second week, half of the subjects consumed 15 g scFOS per day, and the other half consumed 20 g scFOS per day. For the third week, the scFOS dose was doubled for all subjects. Gastrointestinal symptom severity was reported daily, as well as stool consistency and frequency. The results show that scFOS are well tolerated up to 40 g/d; all reported symptoms remained very mild from a clinical perspective. Stool consistency stayed normal, between 3 and 5 on the Bristol stool scale, confirming that no diarrhoea appeared after scFOS intake. Stool frequency also remained within the normal range. In conclusion, scFOS intake is well tolerated up to 40 g/d in healthy subjects. Thanks to their short chains and unique composition, scFOS prebiotic fibres are much better tolerated than other types of inulin-type fructans with longer chains. The digestive tolerance of fibres should be considered when added to foods and beverages.

Efficacy and safety of non-specific anti-diarrheal agents in the management of acute diarrhea in children.

Objective: To compare the efficacy and safety of racecadotril, smectite and placebo among children having acute diarrhea. Study Design: Randomized Controlled trial. Setting: Department of Pediatrics, Allama Iqbal Memorial Teaching Hospital, Sialkot. Period: January 2021 to June 2021. Material &amp; Methods: A total of 120 children (40 in each group) of both gender, aged above 6 months to 5 years with acute diarrhea were enrolled. All children were prescribed oral rehydration therapy (ORT). As co-adjuvant treatment, children in Group-A (n=40) were prescribed smectite, racecadotril in Group-B (n=40) while placebo was given in Group-C (n=40). Among all children, treatment duration was 7 days and all children were asked to follow up on 3rd, 5th and 7th day for the evaluation of stool frequency, stool consistency and dehydration status. Results: In a total of 120 children, 62 (51.7%) were male. Overall, mean age was noted to be 17.9+9.4 months. Stool frequency significantly reduced in Group-A and Group-B in comparison to Group-C at day-3 (p&lt;0.001), day-5 (p&lt;0.001) and day-7 (p=0.018). During the follow ups, need for IV rehydration was 1 (2.5%) in Group-A, 1 (2.5%) in Group-B and 6 (15.0%) in Group-C (p=0.035). Significant improvement was observed in stool grading of children in Group-A and Group-B when compared to Group-C at day-3 (p&lt;0.001), day-5 (p&lt;0.001) and day-7 (p=0.043). No side effects were recorded in any of the patients. Conclusion: Along with oral rehydration therapy, non-specific anti-diarrheal agents like smectite and racecadotril were found to have good efficacy and safety in the management of acute diarrhea in children.

The albumin to globulin ratio is associated with clinical outcome in Japanese patients with ulcerative colitis.

The albumin to globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52-14.18 and adjusted OR, 4.97; 95% CI, 2.14-12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56-11.51 and adjusted OR, 5.22; 95% CI, 1.97-14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06-21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH.

Personalized symbionic therapy of campylobacteriosis protracted course in children

Campylobacteriosis is one of the most common bacterial intestinal infections with high risks of severe and prolonged infection in childhood. The growing incidence of campylobacteriosis, the variety of clinical forms of the disease, the difficulties of timely diagnosis of the infection against the background of a high level of resistance of the microorganism to a number of antibacterial drugs determine the need to optimize the rational tactics of treating this infectious disease. One of the possible ways to overcome these difficulties is to further expand the use of probiotics and autoprobiotics. Aim: to reveal the features of the influence of autoprobiotic and probiotic E. faecium strains on clinical and laboratory parameters in children with non-smooth forms of campylobacteriosis .. Materials and methods: In the period from 2018 to 2020. In DNCIB FMBA, a comprehensive single-center prospective dynamic open observational study of 34 children with an uneven course of campylobacteriosis was carried out. For therapeutic purposes, patients were prescribed an autoprobiotic (group A; n = 15) or a probiotic strain E. faecium (group P; n = 19). Clinical and laboratory parameters and indicators of the intestinal microbiocenosis composition were assessed by real-time PCR. Results: Studies of the effect of two different approaches to prescribing probiotic strains of enterococcus to children with a protracted course of campylobacteriosis - a conditionally “reference” industrial strain E. faecium L3 and autoprobiotic strains with a comparable frequency (88.9% and 93.3% of cases, respectively) revealed their significant positive impact on the course of protracted forms of campylobacteriosis, which was expressed by the disappearance of abdominal pain syndrome, normalization of the frequency and consistency of stools, relief of hemocolitis in the absence of undesirable side effects. Analysis of the dynamics of coprograms before and after taking autoprobiotics and probiotic E. faecium L3 also did not reveal significant differences: there was an equivalent positive dynamics in the form of improvement in most of the macroscopic and microscopic characteristics of the stool. The study of the composition of the intestinal microbiota showed that after the course of administration of autoprobiotic strains of E. faecium, there was a significant increase in the content of butyrate-producing indigenous representative - F. prausnitzii, which promotes the repair of the intestinal mucosa. The studies also showed that the course use of autoprobiotic strains of enterococcus contributed to a decrease in the frequency of convalescent release of campylobacter, which suggests a sanitizing effect of autoprobiotics and does not exclude a similar effect in relation to other bacterial pathogens of intestinal infections in children.

Chinese herbal formula Tongxie Yaofang for diarrhea-predominant irritable bowel syndrome: study protocol for a randomized, multiple-blind, placebo-controlled trial

IntroductionDiarrhea-predominant irritable bowel syndrome (IBS-D) is a bowel disease with a high incidence. It significantly reduces the quality of life of patients and affects the patient's daily activities and mental health. No specific therapeutic medications for IBS-D have been found. Published clinical trials suggest that Chinese herbal formula Tongxie Yaofang (TXYF) for IBS-D may be effective. However, high-quality clinical evidence supporting its use in IBS-D is still lacking. This trial aims to evaluate the therapeutic effects and safety of TXYF for IBS-D in adults.Methods/designA randomized, multiple-blind, placebo-controlled trial will be conducted. It will consist of an 8-week intervention followed by a 3-month follow-up period.The target sample size is 96 IBS-D patients aged 18 to 65 years. The eligible participants will be randomly allocated to either TXYF or placebo group in a ratio of 1:1. Participants in the experimental group will take TXYF granules, while participants in the control group will be given TXYF placebo granules. The primary outcome will be the degree of IBS symptom severity measured using the scale of IBS symptom severity score. The secondary outcomes include: (a) stool frequency, and (b) stool consistency measured using the Bristol stool scale, (c) quality of life measured using the scale of IBS-quality of life, (d) anxiety measured using the self-rating anxiety scale, (e) depression measured by the self-rating depression scale, and (f) the safety of using TXYF and placebo. Safety monitoring and assessment will be undertaken throughout treatment.DiscussionChinese herbal formula TXYF consists of four Chinese herbs: Atractylodes macrocephala Koidz., Paeonia lactiflora Pall., Citrus × aurantium L., and Radix saposhnikoviae. It has been used for diarrhea for hundreds of years and may have a potential benefit in treating adults with IBS-D, but due to lack of high-quality evidence, we designed a randomized, multiple-blind, placebo-controlled trial to evaluate its therapeutic effects and safety. This trial will provide important data to guide the clinical practice of TXYF for the treatment of IBS-D in adults.Trial registrationISRCTN registry ISRCTN12453166. Registered on 23 March 2021.

Effect of Fresh Dendrobe Juice Consumption on Senile Habitual Constipation for Older People: A Four-Week Randomized Controlled Trial

Background: In Chinese medicine, it is believed that fresh dendrobe juice, which is mild in nature, can relieve the symptom of constipation. Methods: A pilot research design was conducted. Fifty-six older people with senile habitual constipation were recruited and randomly enrolled into control or experimental groups, each with 28 people. The control group was offered water routinely in a day. In addition, the experimental group received 125 mL of dendrobe juice twice a day for four weeks. Quality of life for the old people was evaluated by the Patient Assessment of Constipation Quality of Life (PAC-QOL) Score and the symptom of constipation was assessed by Wexner score. Results: The four-week intervention brought significant performance improvement in all the measured parameters in the experimental group in comparison with the control group. These included significantly more frequency and shorter durations of defecation (p &lt; 0.01, respectively), improved quality of life based on constipation score (PAC-QOL) (experimental group: 50.41 ± 3.46 vs. control group: 70.25 ± 2.35; p &lt; 0.05), and improved score on the Wexner constipation scale (experimental group: 6.56 ± 0.89 vs. control group: 15.50 ± 0.64; p &lt; 0.05). Conclusions: Fresh dendrobe beverage therapy is effective in improving stool frequency, reducing duration of defecation, and enhancing quality of life.

Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis.

To evaluate comparative outcomes of straight (end-to-end) anastomosis versus colonic J-pouch anastomosis following anterior resection. A systematic search of multiple electronic data sources was conducted, and all studies comparing straight (end-to-end) anastomosis versus J-pouch anastomosis were included. Anastomotic complications, post-operative complications, re-operation, mortality, and functional outcomes were the evaluated outcome parameters. Revman 5.3 was used for data analysis. Twenty-seven studies reporting a total number of 3293 patients who underwent straight anastomosis (n = 1581) or J-pouch (n = 1712) were included. Anastomotic leak and re-operation rates were significantly higher in the straight group compared to the J-pouch group [RD 0.03, P = 0.03] and [OR 1.87, P = 0.003], respectively. Stool frequency per 24h at 6months and 12months was lower in the J-pouch group than the straight group [MD 2.13, P = 0.003] and [MD 1.44, P = 0.00001], respectively. In addition, the use of anti-diarrheal medication is lower at 12months in the J-pouch group [MD 3.85, P = 0.03]. Moreover, the two groups showed comparable results regarding SSI, sepsis, paralytic ileus, anastomotic stricture formation, anastomotic bleeding, and mortality. J-pouch anastomosis showed lower risk for anastomotic leak and re-operation. Furthermore, better functional outcomes such as stool frequency were achieved using the colonic J-pouch reconstruction over the conventional straight end-to-end anastomosis.

Comparison of different probiotics in the treatment of acute diarrhea in children: A protocol for systematic review and network meta-analysis.

Acute diarrhea has a serious impact on the health and lives of children. Previous studies have shown that probiotics have positive and reliable efficacy in the treatment of acute diarrhea in children, but the efficacy of different types of probiotics varies. This study will evaluate the clinical efficacy of different kinds of probiotics in the treatment of acute diarrhea in children by means of network meta-analysis. According to the retrieval strategy, randomized controlled studies on probiotics in the treatment of acute diarrhea in children will be searched from PubMed, Embase, Web of Science, the Cochrane Library, CNQI, Wanfang, VIP, and Chinese biomedical databases. The retrieval time limit will be from the establishment of the database to January 2022. The quality level of the included studies will be assessed using the Cochrane Risk Bias Assessment Tool and the strength of evidence for outcome measures will be assessed using the Grading of Recommendation Assessment, Development, and Evaluation method. All data analysis will be performed by Revman5.3, Gemtc 0.14.3 and Stata 14.0. This study will evaluate the efficacy of different kinds of probiotics in the treatment of acute diarrhea in children by evaluating diarrhea duration, stool frequency, length of hospital stay, adverse reactions, etc. This study will provide a reliable evidence-based basis for the selection of probiotics for the treatment of acute diarrhea in children. Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. DOI 10.17605/OSF.IO/MNJAE.

Safety and tolerance of Lacticaseibacillus paracasei N1115 in caesarean-born young children: a randomised, placebo-controlled trial.

The administration of probiotics may help to improve dysbiosis and related health problems in children delivered by caesarean section. However, the effects are strain specific, and safety combined tolerance are considered a priority. The aim of this study was to evaluate the safety and tolerance of Lacticaseibacillus paracasei N1115 in caesarean-born children aged 6-24 months via a randomised, placebo-controlled intervention study. In total, 101 children were included and randomised to receive either a sachet of L. paracasei N1115 (2×1010 cfu/g, 2 g/day) or placebo (maltodextrin, 2 g/day) per day for 12 weeks. Anthropometric parameters were measured by trained nurses, and defecation characteristics, gastrointestinal symptoms, (serious) adverse events ((s)AEs), crying patterns and lifestyle behaviours were recorded by parents or guardians. Neurocognitive development was assessed by the Ages and Stages Questionnaires-3 (ASQ-3) before and after the intervention. The only difference between groups regarding defecation characteristics was a significant treatment × time effect on stool frequency (P=0.007), as the number of defecations was significantly higher in the probiotic group (around 1.2-1.3 times/day) than in the placebo group (around 1.0 times/day) in the later intervention period (P=0.035 at week 9; P=0.048 at week 10; P=0.026 at week 12). The use of L. paracasei N1115 also reduced the incidence rate of constipation (Incidence rate ratio (IRR): 0.120; 95% confidence interval (CI): 0.015, 0.967; P=0.046) and abdominal pain (IRR: 0.562; 95% CI: 0.358, 0.882; P=0.012). Changes in anthropometric parameters, including weight, height and head circumference, did not differ significantly between groups, nor did measures of crying, sleep, outdoor activity, temper, appetite or the ASQ-3 scores. No adverse events associated with consumption of the probiotic were reported. Thus, the administration of L. paracasei N1115 is safe and well-tolerated in caesarean-born children aged 6-24 months. Furthermore, it may ameliorate gastrointestinal function to some extent.

A Double-Blind, Randomized Intervention Study on the Effect of a Whey Protein Concentrate on E. coli-Induced Diarrhea in a Human Infection Model.

Infectious diseases are a major cause of morbidity and mortality worldwide. Nutritional interventions may enhance resistance to infectious diseases or help to reduce clinical symptoms. Here, we investigated whether a whey protein concentrate (WPC) could decrease diarrheagenic Escherichia coli-induced changes in reported stool frequency and gastrointestinal complaints in a double-blind, parallel 4-week intervention study. Subjects were randomly assigned to a whey hydrolysate placebo group, a low-dose WPC group or a high-dose WPC group. After 2 weeks of consumption, subjects (n = 121) were orally infected with a high dose of live but attenuated diarrheagenic E. coli (strain E1392/75-2A; 1E10 colony-forming units). Subjects recorded information on stool consistency and the frequency and severity of symptoms in an online diary. The primary outcome parameters were a change in stool frequency (stools per day) and a change in Gastrointestinal Symptom Rating Scale (GSRS) diarrhea score between the first and second days after infection. Neither dose of the whey protein concentrate in the dietary treatment affected the E. coli-induced increase in stool frequency or GSRS diarrhea score compared to placebo treatment. The composition of the microbiota shifted between the start of the study and after two weeks of consumption of the products, but no differences between the intervention groups were observed, possibly due to dietary guidelines that subjects had to adhere to during the study. In conclusion, consumption of the whey protein concentrate by healthy adults did not reduce diarrhea scores in an E. coli infection model compared to a whey hydrolysate placebo control.

Early Symptomatic Improvement After Ustekinumab Therapy in Patients With Ulcerative Colitis: 16-Week Data From the UNIFI Trial

Rapid symptomatic relief is an important treatment goal for patients with ulcerative colitis (UC). We aimed to characterize early response with ustekinumab in patients with moderate-to-severe UC during the initial 16 weeks of treatment. We performed a post hoc analysis of data from A Study to Evaluate the Safety and Efficacy of Ustekinumab Induction and Maintenance Therapy in Participants With Moderately to Severely Active Ulcerative Colitis trial. Patients (N= 961) were randomized (1:1:1) to receive intravenous 130 mg ustekinumab, approximately 6 mg/kg ustekinumab, or placebo at week 0. Symptomatic remission, absolute stool number, Mayo stool frequency and rectal bleeding subscores, partial Mayo score, C-reactive protein, and fecal calprotectin were assessed in the overall population and for patients in the biologic-naïve or prior biologic failure subgroups. A significantly greater percentage of patients in the 130-mg ustekinumab (20.0%; P= .015) or approximately 6-mg/kg ustekinumab (20.2%; P= .012) groups achieved symptomatic remission at week 2 vs placebo (12.9%). Mean [SD] changes from baseline in daily stool number on day 7 were greater in the ustekinumab groups (-1.1 [2.6] in 130 mg [P= .065] and -1.2 [2.5] in ∼6 mg/kg [P= .017]) vs placebo (-0.7 [2.7]). The percentage of patients with Mayo stool frequency subscore of 1 or less and rectal bleeding subscore of 0 increased from baseline through week 16 for both ustekinumab groups. Significant improvements in partial Mayo scores were observed by week 2 in both ustekinumab groups vs placebo (P ≤ .001). Significantly more patients in the ustekinumab groups had normalized C-reactive protein levels from week 2 to week 8 vs placebo (P ≤ .05). Similar results were observed with normalized fecal calprotectin levels between week 2 and week 4 (P ≤ .05). Ustekinumab improved symptoms in patients with UC compared with placebo in as early as 7 days, indicating rapid onset of effect after induction. ClinicalTrials.gov: NCT02407236.

Efficacy and Safety of Maintenance Ustekinumab for Ulcerative Colitis Through 3 Years: UNIFI Long-term Extension.

Background and AimsThe UNIFI long-term extension [LTE] study reports the efficacy and safety of subcutaneous 90 mg ustekinumab through 3 years of maintenance therapy.MethodsPatients randomised to ustekinumab every 12 weeks [q12w] or every 8 weeks [q8w] at maintenance baseline [N = 348] and randomised ustekinumab-treated patients in the LTE [N = 284] were evaluated. Symptomatic remission [Mayo stool frequency = 0/1, rectal bleeding = 0] was assessed. Safety included all LTE patients [N = 188 placebo and N = 457 ustekinumab].ResultsAmong patients randomised to the ustekinumab q12w and q8w groups at maintenance baseline, 54.1% and 56.3% achieved symptomatic remission at Week 152, respectively. Overall, 20% of patients discontinued ustekinumab, 10% of biologic-naïve and 30% of biologic-exposed patients. Among patients in symptomatic remission at Year 3, 94.6% and 98.0% of patients were also corticosteroid free, respectively. Corticosteroid-free symptomatic remission rates in the ustekinumab q12w and q8w groups were 51.2% and 55.1% at Week 152, respectively. Remission rates were higher for biologic-naïve patients than for those with a history of biologic failure. Biochemical evidence of response was demonstrated by stable, decreased C-reactive protein and faecal calprotectin measurements over 3 years. From Weeks 96 to 156, no deaths, major adverse cardiovascular events, or tuberculosis occurred. Nasopharyngitis, ulcerative colitis, and upper respiratory tract infection were most frequently reported. One ustekinumab-treated patient with a history of basal cell carcinoma [BCC] reported two BCCs. One patient in the q8w ustekinumab group, who was receiving concomitant 6-mercaptopurine, experienced serious adverse events of neutropenic sepsis and oral herpes.ConclusionsEfficacy of ustekinumab in patients with ulcerative colitis was confirmed through 3 years. No new safety signals were observed.

A pilot randomized placebo-controlled study on modified MaZiRenWan: a formulated Chinese medicine to relieve constipation for palliative cancer patients

BackgroundConstipation is a common problem among advanced cancer patients; however, many of them find limited effective from current therapies. Thus, we aimed to test the effect of a traditional Chinese herbal formula, modified MaZiRenWan (MZRW), by comparing with placebo among palliative cancer patients with constipation.MethodsThis is a randomized, double-blind, placebo-controlled trial. Participants aged over 18 were recruited and randomized to MZRW or placebo group in addition to current prescriptions (including ongoing laxatives treatment) for two weeks. Exclusion criteria included cognitive impairment, presence of a colostomy or gastrointestinal obstruction and estimated life expectancy of less than one month. Individualized modification of MZRW was allowed according to the traditional Chinese medicine (TCM) pattern of patient. The primary outcome was the global assessment of improvement, which reflected whether the constipation had improved, remained the same or worsened.ResultsSixty patients, with mean age 75.2 years (range 47–95 years), were randomized to MZRW or placebo group. Among the MZRW group, 59.3% (16/27) had improvement in the global assessment score, as compared with 28.6% (8/28) of the placebo group (p-value = 0.022). Besides, the MZRW group had significant increase in stool frequency, and reduction in constipation severity and straining of defecation (p-value < 0.05). No serious adverse event was reported due to the research medication.ConclusionThis pilot trial suggests modified MZRW is well-tolerated and effective for relief of constipation in patients with advance cancer. It could be considered as a potential treatment option for constipation in palliative care.Trial registration: The trial had been registered in ClinicalTrials.gov with identifier number NCT02795390 [https://clinicaltrials.gov/ct2/show/NCT02795390] on June 10, 2016.

Effect of Probiotics on Rotavirus and Non-Rotavirus Diarrhea in Infants: Randomized Controlled Trial

Objective: In this trial, we have observed efficacy of two different probiotics in Rotavirus and non-Rotavirus diarrhea in infants of 6 months to 12 months. Method: The study was done to observe efficacy of two different probiotic strains in Rotavirus and non- Rotavirus diarrhea in infants. The study included the infants suffering from acute severe diarrhea. 105 infants were selected and they were divided randomly into three groups. There were 35 infants in one group. The samples of stool were sent to microbiology lab for Rotavirus testing. The treatment plan was standard treatment of diarrhea for infants in group A. The treatment plan for infants of group B and group C included same standard management of diarrhea, in addition they also received probiotics Enterococcus faecium SF68 and Saccharomyces boulardii respectively. Results: There was reduction in stool output and improvement in consistency of stool in infants of group B and C as compared to infants of group A. There was decrease in stool frequency in non-Rotavirus diarrhea in infants of group B and C while there was no significant difference between groups regarding Rotavirus diarrhea. Conclusion: Probiotics helped to decrease the stool output in non-Rotavirus diarrhea. There was not any significant difference in groups regarding Rotavirus diarrhea. How to cite: Khan FA, Irum z, Khan MZ, Yousaf N, Piracha MI, Zaheer S. Effect of Probiotics on Rotavirus and Non- Rotavirus Diarrhea in Infants: Randomized Controlled Trial. Esculapio - JSIMS 2022;18(03):248-252 Keywords: Rotavirus, Non-Rotavirus, Saccharomyces boulardii,, Enterococcus faecium Sf68

D1 MTE2 Case 4: A case of men - 1

Mr. GR, 40 year man presented to us in 2019 with frequent loose stools and generalised tiredness. He has T2DM (7 years, HbA1c-6.7%), CAD (AWMI-PTCA-2013), well-controlled hypertension and his father had primary hyperparathyroidism (all four removed), nephrolithiasis, T2DM, received renal transplant. Five years back, Mr. GR was diagnosed to have Neuroendocrine tumour following distal pancreatectomy and splenectomy on histopathology. Later in 2019, when his scans were repeated for recurrent abdominal symptoms, the new diagnosis of primary hyperparathyroidism was made (PTH-135 [14-65 pg/mL], Corrected Calcium-11.1 [8.5-10.2 mg/dL], Vitamin D-40 [30-40 ng/mL], 24-hour urinary calcium-328 [100-300 mg/day]). Sestamibi scan showed right inferior parathyroid adenoma. He had abdominal issues with elevated Chromogranin A- 6880 (<93 ng/mL) and Gastrin-730 (0-180 pg/mL), Ga 68-DOTATATE scan revealed overexpressing-somatostatin receptor peripancreatic node and pulmonary metastasis. He was started on Octreotide (2 weeks S/C TID following which monthly LAR injection was given for duration of 12 months. His latest reports showed Chromogranin A-325.7, Gastrin-346, Corrected Calcium-11, PTH-136. Presently, he is asymptomatic, improved with no abdominal issues with moderate glycaemic control (HbA1c-6.7%, FBS-121 mg/dl). How would we move forward with the management of this patient?

Determination of Pathophysiological Anti-Diarrhoeal Activity of the Aqueous Stem Bark Extract of Ficus platyphylla

This study was motivated by the report of a survey of herbal remedies used by Fulani herdsmen in the management of cow diarrhoea in Plateau State, Nigeria. The report identified F. platyphylla stem bark amongst major herbs. Activity of aqueous stem extract of F. platyphylla against diarrhoea caused by physiological changes and by pathological infections was herein determined. Thirty albino rats were fasted for 18 hours. They were grouped into six and induced with diarrhoea using castor oil. The first two groups received distilled water (1 ml) and loperamide (5 mg/kg), while other groups were administered plant extract 50, 100, 200 and 400 mg/kg body weight respectively. The severity of diarrhoea was assessed hourly for 4 hrs. Gastrointestinal motility experiment was carried out using atropine sulphate (5 mg/kg). In vitro anti-diarrhoeal test was carried out against E. coli clinical and laboratory isolates versus antibiotics. The extract inhibited defecation moderately, and regulated frequency of wet stool better than loperamide, the lowest dose (50 mg/kg b. w.) competed favourably with the loperamide. This dose produced the most remarkable activity considering the latent period, total stool frequency, purging indices and percentage inhibition of defecation. The dose showed remarkable activity in the propulsion of charcoal meal through gastrointestinal tract as displayed in the inhibition of diarrhoea. The results of in vitro anti-diarrhoeal test against E. coli showed that the plant extract was inactive on the microorganism. The results from the present study validated the anti-diarrhoeal potential of F. platyphylla via its physiological action.

A Pilot Feasibility Study of a Combined Supervised- and Home-Based Exercise to Improve Cancer-Related Symptoms in 1-3 Colorectal Cancer Patients

PURPOSE: To assess the feasibility of a home-based exercise program specifically developed to improve bowel/defecatory and physical function in stage 1–3 colorectal cancer patients.METHODS: A total of 15 (56.7 years, 6 men and 9 women) stage 1–3 colorectal cancer survivors were recruited. Participants in the exercise group met with an exercise therapist once a week, 6 times over 6 weeks, where 1-hour exercise sessions (12 different resistance exercises, 10–15 reps, 2–3 sets) and an education session were provided. Participants in the exercise group were then asked to carry out the same exercises daily, at home. Their compliance was monitored through daily exercise logs. Participants in the control group did not receive any exercise education or intervention. Anthropometric measurements, physical function, and quality of life were assessed at baseline and at the 6th week in both groups. In-depth interviews were conducted with participants in the exercise group for a qualitative study.RESULTS: All 15 participants completed the trial and their data were included in the analyses. Stool frequency, flatulence, and embarrassment were significantly improved in the exercise group (pre vs. post, p&lt;.05), while flatulence and embarrassment were significantly improved in comparison to the control group (between-group p-value=.014, and .025 respectively). Through in-depth interviews, participants reported that their body composition, physical fitness, and physical function improved, while symptoms such as fatigue, insomnia, stool frequency, flatulence, and embarrassment reduced after participation in the exercise program.CONCLUSIONS: Our pilot feasibility study showed that home-based exercises provided to colorectal cancer survivors were feasible based on their compliance and qualitative data. In addition, participation in the current exercise program resulted in improvement in their bowel and defecatory function and quality of life.

Proctocolectomy and ileal pouch-anal anastomosis for the treatment of collagenous colitis.

The role of surgery for collagenous colitis (CC) is unexplored. Either diverting stoma, subtotal colectomy with ileo-rectal anastomosis, and proctocolectomy with ileal pouch-anal anastomosis (IPAA) have been proposed. However, the optimal surgical strategy still needs to be defined. The aim of this short report is to report our experience with two cases of IPAA for CC. Two patients affected by histologically proven CC with watery diarrhea refractory to several lines of medical treatment underwent a laparoscopic proctocolectomy with IPAA at a tertiary referral hospital for the treatment of Inflammatory Bowel Disease in Belgium. A longer rectal cuff was left in place because of the absence of macroscopic inflammation of the rectal mucosa and the consequent negligible risk of cuffitis. No postoperative complications (90days) occurred. Definitive pathological examination confirmed the diagnosis of CC. At six months, pouchoscopy revealed no signs of inflammation. One year after surgery, mean Öresland and Pouch Functional Score were 10.5 (8-13) and 11.5 (9-14). Functional outcomes after IPAA for CC were barely satisfactory. A high stool frequency not responding to high doses of anti-diarrheals was observed. This has also previously been reported for CC patients receiving a diverting stoma. Proctocolectomy and IPAA for medical refractory CC leads to acceptable short-term gastrointestinal functional outcomes which seems to be particularly affected by high stool frequency. For this reason, pouch surgery might not be the optimal indication for collagenous colitis.

The Efficacy of Mebeverine in the Treatment of Irritable Bowel Syndrome-A Systematic Review.

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal tract disorder, affecting 10–20% of adults worldwide. Mebeverine is an antispasmodic agent indicated for the symptomatic treatment of abdominal pain caused by intestinal smooth muscle spasms and intestinal functional disorders in the course of IBS. The aim of this article was to perform a systematic literature review and update previous overviews of the efficacy and safety of mebeverine treatment in IBS. Methods: Major electronic medical databases, PubMed, EMBASE and Cochrane, were systematically searched from January 1965 to January 2021. Results: Twenty-two studies met our inclusion criteria, including 19 randomised trials, two observational retrospective studies, and one non-randomised, single-blinded study. Six studies reported a significant decrease in abdominal pain after mebeverine treatment (p-values ranging from <0.05 to <0.001). Only three studies showed no improvement after mebeverine treatment in terms of the severity of abdominal pain or discomfort. Some of the included studies also showed significant improvements in abnormal bowel habits, abdominal distension, as well as stool frequency and consistency. Adverse events were rare and associated mainly with IBS symptoms. Conclusions: Mebeverine is an effective treatment option in IBS, with a good safety profile and low frequency of adverse effects.