Constipation Symptoms Research Articles

Malignant Gastrointestinal Neuroectodermal Tumor: A Case Report and Literary Review for a Rare Differential Diagnosis

Malignant gastrointestinal neuroectodermal tumor (GNET) is an infrequent soft-tissue sarcoma, formerly referred to as clear-cell sarcoma-like gastrointestinal tumor (CCSLGT) and frequently reported in the literature as clear-cell sarcoma of the gastrointestinal tract (CCS-GI); it is characterized by an absence of melanocytic differentiation and the presence of nontumoral osteoclast-like giant cells (OLGCs). The current study reports a case of a 79 year old woman admitted to the emergency department (ED) with symptoms of constipation and intestinal obstruction; a mass was found within the ileal wall necessitating of surgical approach. Immunohistochemically, tumor cells surprisingly had the hallmark of GNETs. Unfamiliarity with tumors with the features of GNETs can easily lead to a misdiagnosis by surgical pathologist. Therefore, comprehensive evaluation, including morphology and additional studies, is required for an appropriated diagnosis. Furthermore, without a high index of suspicion, there is actually no consensus on staging or treatment.

Association between academic stress during exam period, dietary behavior and bowel symptoms among medical students in Saudi Arabia

BackgroundThe study evaluated the levels of academic stress in medical students and investigated its association with eating habits and bowel symptoms. MethodsTwo hundred and ninety seven medical students participated in the study. Medical students from all five years of study were recruited using a stratified random sampling technique. A well-structured questionnaire containing three sections on stress levels, eating habits, and bowel symptoms was self-administered. Student t-test and ANOVA were used to quantify the association between variables. ResultsThe medical students showed high levels of stress accounting for low (2%), moderate (72%), and high-stress levels (26%) during exams. Men showed higher stress levels than women. The levels of stress were similar in distribution across all years of study. Poor dietary habits were noted among the medical students. Around 66% reported skipping breakfast, and 69% consumed frequent unhealthy snacks. Reduced consumption of fruits less than three times per week (61.5%) and drinking water less than 2 L per day (82.3%) was noted. Mean dietary scores worsened as the stress levels increased (p = 0.007). Similarly, higher PAC-SYM scores were associated with higher stress levels (p < 0.001). Women showed more severe constipation symptoms than men (8.83 ± 8.0 2; 5.68 ± 5.87; p < 0.001). ConclusionsAlarming levels of academic stress were noted during the exam period. There is an urgent need to frame multidisciplinary strategies involving behavior modification, nutrition education and a special focus on stress reduction programs for the medical students.

The effect of polydextrose on fecal bulk and bowel function in mildly constipated healthy adults: a double-blind, placebo controlled study

Background &amp; Aims. Polydextrose (PDX) (8-30g/day) has been reported to increase faecal bulk and consistency, leading to easier stool passage. However, studies on its effect on defaecation frequency and colonic transit time have provided mixed results, and most focused on either healthy or highly constipated adults, leaving the question on if and how PDX could also aid mildly constipated individuals partially unanswered.Methods. We investigated the effects of PDX consumption by healthy subjects experiencing one or more symptoms of mild constipation on faecal bulk, defaecation frequency, stool consistency, ease of stool passage, and total colonic transit time to further characterize and generate additional evidence regarding the potential beneficial effects of this fibre. 51 subjects participated in a 4-week, two-center, randomized, double-blind, placebo-controlled, parallel study testing a control (CON) and a PDX treatment (18 g/d included in biscuits and drink mixtures) (registered on clinicaltrials.gov with the identifier" NCT05309837").Results. Consumption of PDX resulted in 120.7 g and 25.7 g higher faecal wet and dry weight, respectively (p &lt; 0.05). Colonic transit time was ~4 h shorter in the PDX group: although this difference did not reach significance (p &gt; 0.05) as the study was underpowered to detect a statistical difference for this secondary outcome, this result still carries a physiological importance. Consumption of PDX was well-tolerated, with some PDX volunteers reporting more mild flatulence (p &lt; 0.05).Conclusions. All in all, our study adds new evidence on how a moderate (18g) daily intake of PDX could increase faecal bulking and potentially shorten colonic transit time, making this ingredient a good candidate to be used to formulate, and reformulate, foods and beverages by replacing caloric carbohydrates with reduced caloric content, enriching food items easily consumed to enhance fibre intake and support bowel function.

Digestive, anorectal, and urogenital functions in patients with type 2 diabetes mellitus, impaired glucose tolerance and normal glucose tolerance: Association with autonomic neuropathy.

Gastrointestinal disorders including constipation and fecal incontinence are common in type 2 diabetes and may derive from diabetic autonomous neuropathy, severe intestinal bacterial overgrowth, or a dysfunctional anorectal sphincter. The present study aims to characterize the correlation between these conditions. Patients with type 2 diabetes, prediabetes and normal glucose tolerance were included. Anorectal function was assessed with high-resolution anorectal manometry. Patients were screened for autonomous neuropathy by measuring olfactory, sweat, and erectile dysfunction as well as heart rate variability. Constipation and fecal (in-)continence were evaluated using validated questionnaires. Breath tests were used to assess severe intestinal bacterial overgrowth. We included 59 participants (32 (54.2%) type 2 diabetes, 9 (15.3%) prediabetes and 18 (30.5%) normal glucose tolerance). Presence of autonomous neuropathy, severe bacterial overgrowth and symptoms of constipation and incontinence was comparable. HbA1c was correlated with an increased anorectal resting sphincter pressure (r = 0.31, P = 0.019) and constipation symptoms (r = 0.30, P = 0.031). In patients with long- standing diagnosis of type 2 diabetes significantly higher values for maximum anorectal resting pressure (∆ = +27.81 ± 7.84 mmHg, P = 0.0015) and baseline pressure (∆ = 20.50 ± 9.74 mmHg, P = 0.046) were found compared with normal glucose tolerance, but not with prediabetes. Long-standing type 2 diabetes increases anorectal sphincter activity, and constipation symptoms are associated with higher HbA1c levels. The lack of an association of symptoms with autonomous neuropathy suggests glucotoxicity as the primary mechanism.

Abstract #1406603: An Atypical Clinical Presentation of a Parathyroid Adenoma

Parathyroid adenomas usually appear as well-defined, homogeneous, hypoechoic masses on ultrasound (US). However, atypical features on US including heterogeneity, cystic changes, and calcifications raise suspicion of malignancy. We present a patient with a suspicious atypical clinical presentation of a parathyroid adenoma. A 29-year-old female presented after a fall with a new right nondisplaced proximal tibial pathologic fracture through a large lytic bone lesion. Prior to bone biopsy and operative fixation of the fracture, lab work was significant for a calcium level of 14.8 mg/dL, albumin 4 g/dL, intact parathyroid hormone (PTH) 1,176 pg/mL, 25-hydroxy vitamin D 14 ng/mL, magnesium 1.6 mg/dL, alkaline phosphatase level 483 U/L and phosphorus 2.2 mg/dL. She denied any personal or family history of hypercalcemia, nephrolithiasis, osteoporosis, excessive calcium or vitamin D intake, malignancy or symptoms of abdominal pain, nausea, vomiting, constipation, or dysuria. Of note, the patient had a prior biopsy of the left lytic hip bone lesion eight months prior. Pathology initially revealed a benign process concerning for hemangioma of the bone or fibrous dysplasia; however, retrospective review was consistent with osteitis fibrosa cystica. A thyroid US revealed a heterogeneous 3.9 x 2.4 x 3.0 cm complex solid and cystic mass in the neck posterior to the thyroid between the trachea and carotid, concerning for a malignant neoplasm. Parathyroid scan revealed an intense nodular focus of radiotracer uptake at the inferior pole of the right thyroid lobe suspicious for parathyroid neoplasm. She required intravenous (IV) normal saline, calcitonin, and IV pamidronate due to persistent hypercalcemia. She underwent a right hemithyroidectomy and inferior parathyroidectomy with a closed treatment of her tibial fracture. A pre-excision intraoperative PTH level was 1,473 with a post-excision PTH level of 114. Pathology revealed a cystic parathyroid adenoma. Hungry bone syndrome was prevented postoperatively with calcium carbonate 1 g three times daily, calcitriol 0.5 mg twice daily, and vitamin D3 50,000 IU weekly. This atypical presentation of a parathyroid adenoma is significant because it highlights similarities it can share with parathyroid carcinomas. Initial imaging was highly suspicious for features of malignancy, but surgical pathology was consistent with a parathyroid adenoma. Furthermore, this case is unique because the pathologic finding of osteitis cystica is unusual in the early biochemical diagnosis of hyperparathyroidism. Therefore, clinicians should be aware of this form of disease and include it in their differential in a patient with multiple bone cysts.

Efficacy of a prebiotic formulation for treatment of functional constipation and associated gastrointestinal symptoms in adults: A randomised controlled trial

ObjectivesFunctional constipation is the result of a complex interplay between the gastrointestinal tract, the gut microbiome, the nervous system, along with diet and lifestyle factors. This study aimed to evaluate the efficacy of a prebiotic formulation containing plant-based extracts rich in dietary fibre and polyphenols in the management of functional constipation and associated gastrointestinal symptoms. DesignThis 3-week randomised controlled study assessed the effect of a prebiotic formulation (6 g powder taken in water twice daily), by comparison with a capsule designed to have minimal effect on gastrointestinal function, on indicators of bowel health in healthy adults with low fibre intake and meeting the Rome IV criteria for functional constipation. MethodsParticipants were informed that they may receive one of two products, either a powder or a capsule, both of which contained prebiotics. The primary outcome was change in frequency of complete spontaneous bowel movements. Secondary outcomes assessed were gastrointestinal symptoms, quality of life and mood using the PAC-SYM, PAC-QoL, and DASS-21. Safety and tolerability were also assessed. ResultsThere was a significant improvement in bowel movements (p < 0.001) and improved stool consistency (p < 0.01) in participants taking the prebiotic powder formulation compared to those taking the capsule. Accompanying this was a significant reduction in overall gastrointestinal symptoms (p < 0.001) including abdominal (p < 0.001), rectal (p = 0.004) and stool (p = 0.002) symptoms, and a significant improvement in quality of life (p 0.001). There was a significant reduction in mean score for depression, anxiety, and stress for participants in both groups, which indicated a significant improvement in mood during the study that was unrelated to bowel function. ConclusionsThe results showed that the prebiotic powder formulation taken twice per day for 21 days was effective in reducing clinical symptoms of functional constipation in individuals reporting a low fibre intake.

Partially-hydrolyzed guar gum plus simethicone in patients with irritable bowel syndrome: a real-life survey

BACKGROUND: Irritable bowel syndrome (IBS) is a common medical condition characterized by different phenotypes. Constipation and excessive gas production are prevalent in IBS patients, but diarrhea also frequently affects them. Conventional therapies do not modify the IBS natural history. However, a new medical device containing partially hydrolyzed gum guar (PHGG) and simethicone is currently on the market. The present real-life survey investigated this product in IBS patients.METHODS: A large number of Greek gastroenterologists (N.=114) enrolled an ample sample of IBS patients. For three months, patients took the compound (PHGG 5 g and simethicone 100 mg) one sachet daily. A questionary evaluated IBS symptoms (abdominal pain, distention, flatulence, constipation, diarrhea, urgent bowel movement, and incomplete bowel movement) scored on a seven-level scale. Patients were evaluated at baseline and after 4, 8, and 12 weeks.RESULTS: The survey included 1190 patients (683 females and 507 males; mean age of 45.8 years). The medical device significantly reduced all symptoms (P<0.001). Constipation and gas-related symptoms (flatulence, distention, and abdominal pain) were the IBS complaints that obtained the highest reduction. The treatment was well tolerated and received high compliance (more than three-quarters took the product for more than 90 days as satisfied).CONCLUSIONS: This real-life survey demonstrated that PHGG plus simethicone could be suitable for managing IBS patients.

Effects of Dietary Fibre on People with Constipation

Constipation is common in modern society and affects people's quality of life. The symptoms of constipation vary from person to person. The frequency of bowel movements, the state of the bowel movement and the shape of the stool are some symptoms that determine whether a person is constipated. Constipation is classified as either primary or secondary constipation. Fibre is a compound of plant origin classified as soluble or insoluble fibre. Its function is to maintain a healthy digestive system, with insoluble fibre increasing bowel movements and faecal output to relieve constipation. Dietary fibre is the fibre that people obtain through eating. The prevalence varies from age group to age, as well as dietary fibre intake. In childhood, consuming "age + 5g" of dietary fibre is recommended. According to studies, adding a certain amount of dietary fibre can help children improve the symptoms of chronic constipation. In the adult population, the number of recommendations varies from country to country, and women are more likely than men to suffer from chronic constipation. According to studies, dietary fibre intake can improve the symptoms of constipation in adult patients. However, some patients with unique constipation need to reduce dietary fibre intake to relieve the symptoms of constipation. For the elderly, the prevalence is higher, and 20-25g is a more suitable nutritional fibre intake. And increasing dietary fibre intake can positively impact elderly patients with constipation.

Interferential therapy for chronic constipation in adults: The CON-COUR randomizedcontrolled trial.

Chronic constipation (CC) is a frequent condition, and the first-line treatment includes dietary rules, the use of laxatives, and biofeedback for evacuation disorders. However, almost half of the patients are dissatisfied with their current treatment. We report the first double-blind randomized multicenter trial assessing the effectiveness of transabdominal electrical stimulation by interferential therapy (IFT) in the treatment of CC in adults. A prospective, multicenter, randomized, double-blind, sham-controlled, parallel-group, phase 3 trial was conducted at 7 centers in France. The primary endpoint was 8-week efficacy as defined by the number of complete spontaneous bowel movements during the last 4weeks of the 8-week stimulation period. Secondary endpoints included the evaluation of the effects of IFT on symptoms (Patient Assessment of Constipation Symptoms questionnair (PAC-SYM)), quality of life (QOL) (Patient Assessment of Constipation Quality of Life), Colonic transit time (CTT), anorectal manometry, and patient satisfaction. The proportion of 8-week responders was not significantly different between the two groups (73.2% in the IFT group vs. 67.1% in the sham group). After 8weeks of stimulation, the mean overall PAC-SYM score and the mean reduction in the overall PAC-SYM score were significantly greater in the IFT group than in the sham group. No differences were observed concerning CTT, anorectal manometry, or patient satisfaction. Although the primary endpoint was not reached, IFT can significantly alleviate the symptoms and improve the QOL of CC patients. It can be assumed that new treatments require different modes of evaluation and that the assessment of patient-reported outcomes may become a priority among therapeutic targets of CC. Trial registration number NCT02381665.

Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial

ABSTRACT Dietary fibers/probiotics may relieve constipation via optimizing gut microbiome, yet with limited trial-based evidences. We aimed to evaluate the effects of formulas with dietary fibers or probiotics on functional constipation symptoms, and to identify modulations of gut microbiota of relevance. We conducted a 4-week double-blinded randomized placebo-controlled trial in 250 adults with functional constipation. Intervention: A: polydextrose; B: psyllium husk; C: wheat bran + psyllium husk; D: Bifidobacterium animalis subsp. lactis HN019 + Lacticaseibacillus rhamnosus HN001; Placebo: maltodextrin. Oligosaccharides were also included in group A to D. 16S rRNA sequencing was used to assess the gut microbiota at weeks 0, 2, and 4. A total of 242 participants completed the study. No time-by-group effect was observed for bowel movement frequency (BMF), Bristol stool scale score (BSS), and degree of defecation straining (DDS), while BSS showed mean increases of 0.95–1.05 in group A to D (all P < 0.05), but not significantly changed in placebo (P = 0.170), and 4-week change of BSS showed similarly superior effects of the interventions as compared placebo. Group D showed a marginal reduction in plasma 5-hydroxytryptamine. Group A resulted in a higher Bifidobacterium abundance than placebo at week 2 and 4. Fourteen genera showed intervention-specific increasing or decreasing trends continuously, among which Anaerostipes showed increasing trends in groups B and C, associated with BMF increase. Random forest models identified specific baseline microbial genera panels predicting intervention responders. In conclusion, we found that the dietary fibers or probiotics may relieve hard stool, with intervention-specific changes in gut microbiota relevant to constipation relief. Baseline gut microbiota may predispose the intervention responsiveness. ClincialTrials.gov number, NCT04667884.

Parkinson's disease patients combined with constipation tend to have higher serum expression of microRNA 29c, prominent neuropsychiatric disorders, possible RBD conversion, and a substandard quality of life.

The symptom of constipation has been confirmed as an early diagnose criteria for Parkinson's disease (PD). Furthermore, evidences suggest that pathogenesis of PD initiates in gut, rather than brain. If so, identifying biomarkers for constipation in PD might have potentials to assist early diagnosis and initial treatment. We first identified that microRNA 29c (miR-29c) was dysregulated both in PD and constipation patients through bioinformatics analysis. Then, serological analysis of the expression of miR-29c in 67 PD patients with constipation (PD-C), 51 PD patients without constipation (PD-NC), and 50 healthy controls (HC) was carried out by qPCR. Demographic and clinical features were also compared. Patients in PD-C group were further classified into two groups: those with prodromal stage constipation (PD-C-Pro) (n = 36) and those with clinical stage constipation (PD-C-Clinic) (n = 31), to explore their different characteristics. The levels of miR-29c in PD-C group were higher than that in PD-NC group, both higher than HC group. PD-C-Pro group's miR-29c levels were statistically higher compared with PD-C-Clinic group's. What is more, PD-C group had higher scores of MDS-UPDRS-I, NMSS, NMSS3, NMSS4, NMSS6, NMSS9, SCOPA-AUT, HAMD, HAMA, RBDSQ, CSS, and PACQOL compared with PD-NC party. Relative to the PD-C-Clinic, patients in PD-C-Pro group had higher MDS-UPDRS-I, NMSS, NMSS3, HAMD, and HAMA scores, and were more likely to have RBD. Our results indicated that miR-29c seems to be an underlying cause for developing constipation in patients with PD and PD-C identifies a group of patients with more severe non-motor impairment, prominent neuropsychiatric disorders, and possible RBD conversion as well as a substandard quality of life. We further confirmed that there is a close relationship between symptoms representing the same pathological origin, especially constipation and RBD.

The Efficacy and Safety of an Ayurvedic Petsaffa Formulation in Subjects with Constipation: An Open-Label, Non-Randomized Clinical Study

Constipation is a common gastrointestinal complaint among 16% of the world's population. Several conventional treatments are recommended; however, these sometimes do not provide satisfactory results for many patients or cause unpleasant side effects. In this context, Ayurvedic medicine can be an alternative, cost-effective and satisfactory treatment for constipation. Hence, this clinical study aimed to evaluate the efficacy and safety of an Ayurvedic PetSaffa formulation in subjects with functional constipation. Design, Setting, Participants and Intervention: This open-label, non-randomized clinical study was conducted to evaluate the safety and efficacy of an Ayurvedic PetSaffa formulation in healthy volunteers with functional constipation. Subjects were selected based on inclusion and exclusion criteria. Participants received PetSaffa granules for 21 days. Outcome parameters of the study, including frequency of bowel movements, constipation score, constipation symptoms, gas, acidity, and serum level of SGPT, were evaluated at screening and after 21 days of treatment. Results: A total of 120 participants completed the 21-day treatment. At the end of the treatment period, all clinical outcomes, including frequency of bowel movement and constipation score, were significantly (p&lt;0.001) improved. The analysis of constipation symptoms' frequencies and severity also significantly (p&lt;0.001) improved without any significant adverse effects. Additionally, PetSaffa granules also reduced gas and acid symptoms. As part of the safety study, serum levels of SGPT were within the normal range before and after treatment. Conclusion: The study intervention, PetSaffa granules, significantly improved bowel movements, gas and acidity symptoms without causing any adverse effects. Therefore, the Ayurvedic PetSaffa granules are a clinically effective and safe alternative for the treatment of functional constipation.

Functional constipation: A commonand often overlooked cause for abdominal pain in children.

The most common causes for chronic pain abdomen in pediatric practice are functional abdominal pain disorders, a subgroup of functional gastrointestinal disorders under the Rome IV classification. Constipation is usually associated with painful defecation, but abdominal pain as a predominant or presenting symptom of functional constipation (FC) is not very well recognized. We conducted this study to ascertain the prevalence of FC in chronic pain abdomen and proportion of FC children presenting with predominant complaints of pain abdomen. Prevalence of FC and functional abdominal pain was ascertained separately over a1-year in children > 4 years of age in our hospital. The number of children with FC presenting with abdominal pain was noted. Abdominal pain site and duration werenoted in the FC group and werecompared with those in the functional abdominal pain group to find out any significance. Diagnosis was based on Rome IV criteria, but relevant investigations to rule out organic pathology were done whenever clinically indicated. The prevalence of abdominal pain was 22% in our gastroenterology service and that of FC was 27%. Among the children presenting with chronic abdominal pain, FC was seen in 10% of the patients and functional abdominal pain disorders in 34%. Among children presenting with constipation, 12% had pain as the sole complaint. However, some form of pain or pain as one of the symptoms was seen in 47.5%. FC is a major cause for abdomen pain in children and is often overlooked. Not attributing pain to constipation may delay the diagnosis, which may have poor prognosis.

Naloxegol (Movantik®) Provides Rapid Response and Sustained Improvement of Opioid-Induced Constipation Symptoms in Older Adults

Naloxegol (Movantik®), an oral peripherally acting mu-opioid receptor antagonist (PAMORA) has demonstrated rapid and predictable relief of OIC in patients treated with opioids for chronic non-cancer pain in two phase 3 trials (KODIAC 4/5; NCT01309841/NCT01323790). In subjects ≥65 yrs, naloxegol (25mg, 12.5mg) demonstrated significantly better response rates, clinically relevant early symptom relief, and predictable efficacy compared with PBO. Improvements in SBMs, CSBMs, straining, and stool consistency were rapid and sustained across 12 weeks. Naloxegol is effective and safe in individuals ≥65 yrs with non-cancer pain experiencing OIC.Aim: Naloxegol, an oral peripherally acting mu-opioid receptor antagonist (PAMORA) has demonstrated rapid and predictable relief of opioid-induced constipation (OIC) in patients treated with opioids for chronic non-cancer pain in two phase 3 trials (KODIAC 4/5; NCT01309841/NCT01323790). This analysis evaluates the speed and predictability of response, and the rapid and sustained impact of naloxegol on OIC symptoms in subjects aged ≥65 yrs. Methods: Data were pooled from the KODIAC 4/5 intent-to-treat populations (N=1337). Subjects ≥65 yrs treated once daily with naloxegol 25mg, 12.5mg, or placebo (PBO) were evaluated. Response definition: ≥3 SBM/wk and increase of ≥1 SBM/wk over baseline for ≥9 of 12 weeks, and ≥3 of the final 4 weeks. For each SBM, patients documented complete evacuation (CSBM) (Yes/No), degree of straining (scale 1=not at all, 5=extreme), and stool consistency via the Bristol Stool Scale (1=hard, 7=watery). Results: This analysis evaluated 148 subjects ≥65 yrs (11.1% of the overall population). In these older adults, a significantly higher response rate was achieved with naloxegol (25mg, 50.9%, p=0.037; 12.5mg, 53.3%; p=0.036) vs PBO (32.0%). Corresponding HRs (2.52, p< 0.001; 1.90, p=0.005) indicated significant, ∼two-fold reduction in time to first SBM with naloxegol vs PBO. Time to first CSBM was ∼50% shorter for naloxegol vs PBO for both regimens (Hazard Ratios: 1.66, p=0.019; 1.45, p=0.103). Rapid, statistically significant, and clinically relevant symptom improvement (straining and stool consistency) was generally sustained from weeks 1-12 for naloxegol vs PBO. The most common AEs were GI-related and similar across regimens. Conclusion: In subjects ≥65 yrs, naloxegol (25mg, 12.5mg) demonstrated significantly better response rates, clinically relevant early symptom relief, and predictable efficacy compared with PBO. Improvements in SBMs, CSBMs, straining, and stool consistency were rapid and sustained across 12 weeks. Naloxegol is effective and safe in individuals ≥65 yrs with non-cancer pain experiencing OIC.

Naloxegol (Movantik®) Provides Rapid and Sustained Improvement of Opioid-Induced Constipation Symptoms Irrespective of Opioid Dose

AimNaloxegol (Movantik), an oral peripherally acting mu-opioid receptor antagonist has demonstrated rapid relief of opioid-induced constipation (OIC) in patients with chronic non-cancer pain in two phase 3 trials (KODIAC 4/5; NCT01309841/NCT01323790). This analysis aims to characterize the OIC symptom burden and evaluate the efficacy of naloxegol in treating symptoms of OIC based on daily opioid dosages. This is the first naloxegol analysis based on a lower opioid dose cutoff of 100 MEU/day. MethodsData were pooled from the KODIAC 4/5 intent-to-treat populations (N=1337). Subjects treated with placebo (PBO) and naloxegol (12.5mg, 25mg) QD were evaluated based on opioid dose ranges (lower dose, ≤100mg; higher dose, >100mg MEU/day). OIC symptoms assessed include number of spontaneous bowel movements (SBM/wk), complete evacuation (CSBM), straining (scale 1=not at all, 5=extreme) and stool consistency (Bristol Stool Scale: 1=hard, 7=watery). ResultsBaseline OIC symptom burden (SBM/wk, CSBM/wk, straining, stool consistency) was similar between lower (n=764) and higher (n=567) opioid dose subgroups. Naloxegol (12.5mg, 25mg) provided significant improvement vs PBO in SBMs/wk in the lower and higher opioid dose subgroups; ≤100 MEU (mean SBM/wk: 2.41, 2.91 vs 1.99, respectively; p<0.05) and ˃100 MEU (mean SBM/wk: 2.81, 3.53 vs 2.05, respectively; p< 0.05). A significant improvement in CSBMs/wk vs PBO was demonstrated in the lower dose subgroup for naloxegol 25mg (mean CSBM/wk: 1.48, 1.97 vs 1.38; p=0.54 and p<0.05, respectively) and in the higher dose subgroup for both naloxegol regimens (mean CSBM/wk: 1.90, 2.36 vs 1.20, respectively; p<0.05). In both dose subgroups, rapid symptom improvement in SBM, CSBM and stool consistency were seen within the first week with naloxegol (p<0.05). ConclusionsRegardless of opioid dose, naloxegol (12.5mg, 25mg) provided rapid and sustained improvement of clinically relevant OIC symptoms. These data suggest that all patients should routinely be assessed for OIC, as lower opioid doses often induce constipation.

An empowerment-based, healthy dietary behavioral intervention to ameliorate functional constipation.

To explore the boost effect on ameliorating functional constipation in elderly patients through empowerment-based, healthy dietary behavioral intervention. In this randomized parallel group study, elderly patients with functional constipation were recruited and assigned to the experimental and control groups at a ratio of 1:1. The control group received routine intervention. The experimental group received 3-month empowerment-based intervention. The results were evaluated based on the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) and Cleveland Clinic Constipation Score (CCS). GraphPad Prism (Version 9) software was used for the statistical analysis. As the world's population ages, functional constipation in the elderly has attracted widespread attention. The practical behavioral intervention to ameliorate constipation are worth exploring. Sixty elderly patients with functional constipation. The study results showed no significant difference in the baseline data between the two groups (P > 0.05). After the intervention, the scores of HLPCQ (77.90 ± 14.57 vs. 61.11 ± 13.64) and CCS (7.48 ± 3.73 vs. 9.70 ± 3.07) in the experimental group were significantly higher than those in the control group (P < 0.05). The results showed that empowerment-based intervention can effectively strengthen the healthy dietary behavior of elderly patients. Through patient empowerment, the subjective initiative and willingness to communicate were boosted in the experimental group. Their symptoms of functional constipation improved considerably better than in the control group.

Effectiveness of auricular acupressure on constipation and related quality of life among the older people in the residential care home: a randomized clinical trial

IntroductionConstipation can be one of the biggest health problems for the older people that has negative effects on their quality of life. Some studies have reported that new non-pharmacological interventions such auricular acupressure have promising results in the management of constipation. This study was performed to investigate the effect of auricular acupressure on constipation and health-related quality of life in the older people living in the residential care home.MethodsSample of this randomized clinical trial consisted of 53 older people with chronic constipation living in a residential care home in the southeast of Iran (Kerman city). The participants were randomly assigned to intervention (n = 27) and control (n = 26) groups. Auricular acupressure was applied to seven auricular acupoints (large intestine, rectum, San Jiao, spleen, lung, sympathetic, and subcortex) using Vaccaria seeds for the intervention group and for the control group, seedless auricular plasters were used at the seven auricular acupoints for 10 days. Data were collected before the intervention, end of the intervention, and 10-day follow-up using demographic and clinical, Patient Assessment of Constipation-Symptom, and Patient Assessment of Constipation-Quality of Life questionnaires. The SPSS-22 software was used for data analysis.ResultsThe difference between groups and times was significant in constipation and related quality of life and scores. The mean score of constipation at the end of intervention was 0.41 less in the intervention group than the control group (P < 0.0001). This mean score, in the intervention group also on the 10-day follow-up was 0.09 less than the control group (P = 0.004), which indicates a decrease in the severity of constipation symptoms. In the intervention group, mean score of quality of life related to constipation at the end of intervention and the 10-day follow-up was 0.56 and 0.19 less than the control group (Decrease in the mean score of quality of life related to constipation indicates an improvement in the quality of life) (P < 0.0001).ConclusionThe results showed the positive effect of auricular acupressure on reducing the severity of constipation symptoms and improving the quality of life in old patients living in the residential care home. This non-pharmaceutical practice can be used by nurses as an inexpensive, safe, acceptable, and non-invasive nursing care for older people with constipation in homes, medical centers, or nursing homes.

A randomized, double-blind, controlled human study: The efficacy of exopolysaccharides in milk fermented by Weissella confusa VP30 (VP30-EPS) to ameliorate functional constipation

A randomized, double-blind, controlled human study was conducted to examine the effect of consuming exopolysaccharide (EPS) in milk fermented by Weissella confusa VP30 (VP30) on functional constipation. A total of 64 constipated adults, diagnosed by Rome III criteria for functional constipation, were randomized to receive either EPS-enriched VP30 fermented milk (VP30-EPS, n = 32) or an original VP30 fermented milk as a control fermented milk (CFM, n = 32) for 4 weeks. Questionnaires, which addressed defecation symptoms, dietary frequency and a dietary diary, were required to be completed every two weeks. Compared to the original VP30 fermented milk, EPS-enriched VP30 fermented milk was more effective in increasing defecation frequency, defecation volume, and fecal type during the 4-week treatment. The findings suggest that enrichment with EPS could improve indicators of bowel movement in individuals suffering from functional constipation. Constipation symptoms such as flatulence, pain, and bloating did not change to any statistically significant degree. The VP30-EPS group exhibited a greater decrease in the sum of symptoms scores from baseline to 4th week than the CFM group, which was marginally significant (p = 0.059). Changes in ammonia production and short chain fatty acid content were not statistically significant. Gut microbiome analysis showed the proportion of Bacteroidetes in the VP30-EPS group increased slightly while Firmicutes in the VP30-EPS group decreased slightly and Prevotella increased. To the best of our knowledge, this is the first study that shows the functional effect of reducing functional constipation through human clinical studies by applying EPS produced by a Weissella strain to a fermented dairy food.

Efficacy of faecal microbiota transplantation in patients with progressive supranuclear palsy-Richardson's syndrome: a phase 2, single centre, randomised clinical trial

Faecal microbiota transplantation (FMT) has demonstrated efficacy in treating gastrointestinal (GI) diseases, such as Clostridium difficile infection (CDI) and inflammatory bowel disease (IBD). GI dysfunction is a frequent and occasionally dominating symptom of progressive supranuclear palsy-Richardson's syndrome (PSP-RS). However, it is not known whether FMT has clinical efficacy for PSP-RS. This 36-week, randomised, placebo-controlled, parallel-group, phase 2 clinical trial was performed at a university tertiary referral hospital in China. From August 15 2021 to December 31 2021, a total of 68 newly diagnosed patients with PSP-RS (male 40 [59%], female 28 [41%]) who had never received any antiparkinsonian medications were enrolled and randomly assigned to receive either healthy donor FMT (n=34, FMT group) or a mixture of 0.9% saline and food colouring (E150c) as sham transplantation (n=34, placebo group) through transendoscopic enteral tubing (TET). Two days after oral antibiotics, participants received 1 week of transplantation. After an interval of 4 weeks, retransplantation was performed. Then, the last transplantation was given after another interval of 4 weeks, and the participants were followed up for 24 weeks (week 36). Clinicaltrials.gov identifier: ChiCTR-2100045397. Among 68 patients who were randomised (mean age, 67.2 (SD 5.1); 40 [59%] were male, 28 [41%] were female), 63 participants completed the trial. Efficacy analyses were performed on the intention-to-treat (ITT) analysis set. At week 16, the mean PSP Rating Scale (PSPRS) scores (the primary outcome) improved from 40.1 (SD 7.6) to 36.9 (SD 5.9) in the FMT group, whereas the scores changed from 40.1 (SD 6.9) to 41.7 (SD 6.2) in the placebo group, for a treatment benefit of 4.3 (95% CI, 3.2-5.4) (P<0.0001). After 3-cycle intervention, symptoms of constipation, depression, and anxiety (the secondary outcome) improved significantly at week 16 in the FMT group compared with the placebo group, the majority of which were maintained at the 24-week follow-up (week 36). Our findings suggest that, compared with placebo, FMT treatment significantly improved motor and nonmotor symptoms in patients with PSP-RS, as well as reduced intestinal inflammation and enhanced the intestinal barrier by regulating the intestinal microbiota composition. The National Natural Science Foundation of China (No. 82122022, 82171248, 81873791, and 82230084), Natural Science Foundation of Henan Province for Excellent Young Scholars (no. 202300410357), and Henan Province Young and Middle-Aged Health Science and Technology Innovation Talent Project (YXKC2020033).

Slowed gastrointestinal transit is associated with an altered caecal microbiota in an aged rat model.

Gastrointestinal (GI) motility is largely dependent upon activity within the enteric nervous system (ENS) and is an important part of the digestive process. Dysfunction of the ENS can impair GI motility as is seen in the case of constipation where gut transit time is prolonged. Animal models mimicking symptoms of constipation have been developed by way of pharmacological manipulations. Studies have reported an association between altered GI motility and gut microbial population. Little is known about the changes in gut microbiota profile resulting specifically from pharmacologically induced slowed GI motility in rats. Moreover, the relationship between gut microbiota and altered intestinal motility is based on studies using faecal samples, which are easier to obtain but do not accurately reflect the intestinal microbiome. The aim of this study was to examine how delayed GI transit due to opioid receptor agonism in the ENS modifies caecal microbiota composition. Differences in caecal microbial composition of loperamide-treated or control male Sprague Dawley rats were determined by 16S rRNA gene amplicon sequencing. The results revealed that significant differences were observed at both genus and family level between treatment groups. Bacteroides were relatively abundant in the loperamide-induced slowed GI transit group, compared to controls. Richness and diversity of the bacterial communities was significantly lower in the loperamide-treated group compared to the control group. Understanding the link between specific microbial species and varying transit times is crucial to design interventions targeting the microbiome and to treat intestinal motility disorders.