Constipation Use Research Articles

Naloxegol for Treatment of Opioid-Induced Constipation in the Pediatric Intensive Care Unit.

Opioid-induced constipation is a common problem in critically ill children requiring sedation. Naloxegol is an oral U.S. Food and Drug Administration (FDA)-approved peripherally acting mu-opioid receptor antagonist for chronic opioid-induced constipation use in adults, but data on its use in children are lacking. We performed a retrospective analysis of critically ill children that had received naloxegol for opioid-induced constipation at our institution. Of the 45 patients studied, mean stool frequency increased significantly from 0.63 ± 0.12 stools per day to 1.71 ± 0.13 stools per day after starting naloxegol (95% confidence interval [CI]: [0.75, 1.4], P < .001). There was no significant difference in the mean Withdrawal Assessment Tool 1 (WAT-1) score in the 24 hours before and after receiving the first dose (95% CI: [-0.25, 0.40], P = .63). This suggests naloxegol is effective in increasing stool output in critically ill children receiving opioids without an increase in opioid-withdrawal symptoms. It may be an effective adjunctive therapy for this population.

Knowledge, attitudes, and practice of Triphala in the community

BACKGROUND: Codified and noncodified information about Ayurveda practices and formulations is available and transmitted as science or folk claims. Triphala, a well-researched Ayurveda formulation, lacks studies reporting community perception regarding its usage. This study explores Triphala’s knowledge, attitude, and practice in the community. MATERIALS AND METHODS: This exploratory cross-sectional study involving 806 residents of Pune, New Delhi, Guwahati, Kottakkal, and rural areas of Rajkot was undertaken to evaluate Triphala’s knowledge, attitude, and practice in the community. A pretested and structured questionnaire addressing Triphala’s knowledge, attitude, and practice was administered through Google forms or a personal interview method. Data were managed and analyzed by SPSS 20.0, and descriptive statistics were generated. RESULTS: A total of 30% of participants demonstrated good knowledge, and 42% demonstrated positive attitude. A total of 41.84% of respondents knew the ingredients of Triphala, 68% knew its use in constipation, 26% in health maintenance, and 22.2% in weight loss. Also, powdered dosage form (93.6%) is used predominantly through the oral route with lukewarm water (94.1%) as a vehicle. Around half of the respondents have previously used Triphala for various health conditions. The knowledge regarding the proportion of Triphala ingredients, and other formulations containing Triphala, was less at all sites. A good number of people (38.9%) are ready to consume Triphala for health maintenance. The rural area had a lower response rate compared with the urban but with similar response patterns for most domains. CONCLUSIONS: A substantial proportion of people in the general population knew the ingredients of Triphala, its use in various health conditions, route of administration, adjuvants, and cost-effectiveness. A good number of people showed readiness for the consumption of Triphala daily. However, the research component of Triphala has not sufficiently percolated. Hence, empowering the public on the utilization aspects and research evidence of Triphala would propagate the evidence-based practice of Ayurveda for scientific sustainability.

The Role of Docusate for Constipation in Older People.

Objective: To provide brief information on the effectiveness of docusate use for constipation in older people. Data Sources: PubMed search using the following terms ("docusate and chronic constipation," "docusate, chronic constipation and geriatric," "docusate, chronic constipation and older adult," "docusate and randomized controlled trial" and included relevant information related to docusate and chronic constipation in the population described. Study Selection: Studies that fit the criteria for "chronic/general constipation," "geriatric/older adults," and/or "randomized controlled trials" were included. Four studies described docusate for chronic/general constipation and older people. Not included were other studies not related to chronic/general constipation and older people (eg, surgery-related). Data Extraction: Data extraction from each study included primary outcomes related to chronic constipation and efficacy of docusate. Data also included relevant reports from other relevant trials and discussions. Data Synthesis: Docusate when compared with placebo or psyllium or sennosides in these trials did not show any benefits for constipation. Psyllium and sennosides showed to be more effective compared with docusate. No differences found between docusate versus placebo. In summary, there is a lack of data to support the use of docusate for constipation and the data presented that docusate is not effective for use in constipation. Conclusion: Docusate is commonly used for constipation despite little evidence supporting its efficacy. There is not enough randomized controlled trial and data to support the use of docusate for constipation. Pharmacists along with health care providers should reassess and reconsider whether to use it and add extra layers to an already complex medication regimen in the older adult population.

Bisacodyl: comprehensive findings direct effective and safe use in constipation

For the first time since bisacodyl was licensed in the 1950s, an up-to-date review has provided a thorough summary of the pharmacological and clinical data concerning this prokinetic and secretagogic laxative. On the basis of the knowledge gained after numerous years of experience with the drug, the review derives practical guidance on advising patients to ensure an even more effective and safer use of bisacodyl.

Pharmacological studies on the laxative effects of Fagonia indica on rodents

This study explores the pharmacological basis for the folk use of Fagonia indica in constipation using in vivo and in vitro assays. The crude extract of F. indica contained tannins, saponins, anthraquinones, alkaloids, flavonoids, glycosides and phenols. The administration of F. indica extract (100 and 300 mg/kg) to mice caused a partially atropine-sensitive 35 and 42.6% laxation, respectively, similar to ursolic acid which showed 22 and 36% laxation at 10 and 30 mg/kg, respectively. In loperamide-induced constipation mice, F. indica (27.3 and 34.6%) and ursolic acid (15 and 28%) also displayed laxative effects at the aforementioned doses. In mice and rats ileum, F. indica, its fractions (ethyl acetate, aqueous) and ursolic acid produced atropine-sensitive stimulatory effects, while in rats ileum, F. indica and aqueous fraction showed partially atropine-sensitive effects. F. indica and ursolic acid possess laxative and species-specific gut stimulant effects predominantly involving the activation of muscarinic receptor, thus eliciting its folk use in constipation.&#x0D; Video Clip of Methodology:&#x0D; 7 min 7 sec: Full Screen Alternate

Analiza diety stosowanej u dzieci z czynnościowym zaparciem stolca

IntroductionFunctional constipation is common among children. Appropriate diet seems to be important in therapy. AimQuantity and quality of dietary components among children with functional constipation are to be assessed. Material and Methods50 children with constipation (aged 3–18) were assessed referring to the nutrition manner. 30 patients without constipation were a control group. Dietary analysis was based on the dietary history and on the Dietetyk-programme-formulated menu. ResultsConstipated children were slightly more overweight or obese than the control group (p=0.700). Fibre intake was lower in the investigated-group (0.35±0.1g/kg/d) than in the control-group children (0.55±0.1g/kg/d). Calcium intake was comparable among the constipated (813±182.4mg/d) and the controlled (941.7±176.1mg/d)(p=0.019). Differences in magnesium intake were observed as 128±91,4mg/d and 241±103.8mg/d in the investigated and the control group respectively (p=0,019). Fluid intake in the constipated group was 61±22.4ml/kg/d and 71.7±9.8ml/kg/d in the control group (p=0.012). Fruit and vegetables consumption was 334.3±118.3g/d among children with constipation and 400±84.6g/d among children without constipation. Snacking at night or before bed-time was observed among 5 constipated children (10%) and 2 children from the control group (6.5%). Snacking between meals was noticed among 40 children with constipation (80%) and 21 children without constipation (70%). Nutrition-manner analysis showed the right fibre intake among 20% constipated patients and among 47% control-group patients. ConclusionsMost children with constipation use inappropriate diet or wrong nutrition habits. Dietary advice may be indispensable in non-pharmacological treatment of children with constipation.

Complementary and alternative medicine use for constipation: a critical review focusing upon prevalence, type, cost, and users' profile, perception and motivations.

Complementary and alternative medicine (CAM) is increasingly used by those suffering from constipation. This paper reports the first critical integrative review of CAM use for people with constipation focusing upon the prevalence, type and cost of CAM use, as well as CAM users' profile, perception and motivations. A comprehensive search of international literature was conducted in MEDLINE, Academic Search Complete (EBSCO), and Allied and Complementary Medicine Database (AMED). The search was limited to original research peer-reviewed English language articles concerning CAM use for constipation published with an abstract and full text between 2005 and 2015. A total of 35 papers met the inclusion criteria and were included in the review. The review shows approximately one in every three people suffering from constipation use CAM with herbal medicine the most commonly used CAM treatment for constipation and a large proportion of CAM use occurring concurrent with or in addition to conventional medical treatments. While early investigation suggests the cost of herbal medicine use in constipation care may be lower than that associated with the use other CAM modalities and conventional medications, this issue requires further research. Although a high percentage of people with constipation using CAM consider these treatments effective, there remains a need for further in-depth examination of both patient and provider perspectives as well as communication and decision-making around CAM use for constipation to inform safe, effective and coordinated care for patients with constipation.

Gut modulator effect of methanolic extract of &lt;i&gt;Solanum surattense&lt;/i&gt; explains its traditional use in constipation and diarrhea

&lt;p class="Abstract"&gt;Current research was conducted to find out the pharmacological basis of the methanolic extract of &lt;em&gt;Solanum surattense&lt;/em&gt; for its traditional uses in constipation and diarrhea. In isolated rabbit jejunum preparations, &lt;em&gt;S. surattense&lt;/em&gt; exhibited the spasmogenic effect at lower concentration (0.01-1.0 mg/mL) followed by the spasmolytic effect at next higher concentration (3-5 mg/mL) with EC&lt;sub&gt;50 &lt;/sub&gt;value of3.17 mg/mL. &lt;em&gt;S. surattense&lt;/em&gt; and verapamil (standard Ca&lt;sup&gt;2+&lt;/sup&gt; channel blocker) caused an inhibition of K&lt;sup&gt;+ &lt;/sup&gt;(80 mM)-induced contractions with EC&lt;sub&gt;50 &lt;/sub&gt;value of0.85 and 0.15 mg/mL respectively, suggesting Ca&lt;sup&gt;2+ &lt;/sup&gt;channels block-ade.Extract caused the rightward shift in Ca&lt;sup&gt;2+ &lt;/sup&gt;concentration-response curve, similar to verapamil. Among the fractions, aqueous fraction showed the spasmogenic effect while dichloromethane fraction showed spasmolytic effect. It is concluded that methanolic extract of &lt;em&gt;S. surattense&lt;/em&gt; contains spasmogenic and spasmolytic constituents, which explains its traditional uses in constipation and diarrhea.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Pharmacological evaluation of &lt;i&gt;Dactyloctenium aegyptium&lt;/i&gt;: An indigenous plant used to manage gastrointestinal ailments

&lt;p&gt;Crude extract of &lt;em&gt;Dactylotenium aegyptium&lt;/em&gt; and its fractions were evaluated to rationalize its folkloric use in gastrointestinal ailments. In spontaneous contracting rabbit jejunum preparation, D. aegyptium exert concentration-dependent spasmogenic effect (0.01-0.1 mg/mL) followed by spasmolytic effect at higher doses (0.3-3.0 mg/mL). Pretreatment of the tissue preparations with atropine resulted in suppression of the spasmogenic response. Furthermore, &lt;em&gt;D. aegyptium&lt;/em&gt; (1.0 mg/mL) caused relaxation of K&lt;sup&gt;+ &lt;/sup&gt;(80 mM)-induced spastic contractions in isolated rabbit jejunum preparations and there was non-parallel shift in Ca&lt;sup&gt;++&lt;/sup&gt; dose response curves towards right (0.1-0.3 mg/mL). These findings were found to be comparable with verapamil, a standard Ca&lt;sup&gt;++&lt;/sup&gt; channel blocker. The solvent-solvents fractionation reflected segregations of spasmogenic and spasmolytic effects in respective aqueous and dichloromethane fractions. The above-mentioned findings reflected, presence of cholinergic as well as Ca&lt;sup&gt;++&lt;/sup&gt; channel blocking activity in ethanolic extract of &lt;em&gt;D. aegyptium&lt;/em&gt; thus providing scientific basis for its folkloric use in constipation and diarrhea.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Haemogram and Serum Enzymes Activities of Newcastle Disease Virus Challenged Broiler Chickens Following Supplemental Treatment with Aloe Vera Extract

Aloe products have been promoted for use in constipation, coughs, diabetes, arthritis, immune-system deficiencies and many other conditions, but the clinical efficiency in chickens is unknown. Therefore, the study was designed to determine the haemogram and serum enzymes activities of Newcastle Disease Virus (NDV) challenged broilers following supplementation of Aloe vera. One hundred and forty day-old broilers were grouped into seven 20 broilers/group, were treated with different concentrations of the extract for 30 days. Both vaccinated and unvaccinated groups were challenged with 0.2 saline suspension of 106 ELD50 intradermal inoculation of NDV challenged strain up to the 30th day. Increase in serum protein, aspartate transaminase, creatinine, urea and gamma globulin levels among challenged group was concentration dependent (50 mg>100 mg>150 mg) but not statistically significant (P>0.05). Lymphocytosis among supplemented and challenged group was concentration dependent (50 mg>100 mg>150 mg) and statistically significant (P<0.05). Control group lymphocyte count was within normal range (55-70%). Heterophil and lymphocyte (H/L) ratio was lower in supplemented and challenged group. Oral intake of Aloe vera modulated leucocytes proliferation of the broilers and enhanced the cell differentiation in favour of the lymphocyte. Serum enzymes activities in broilers challenged with NDV following supplementation with A. vera juice were positively influenced, and modulated the excessive leakage of protein, globulin, creatinine and alkaline phosphatase in infected birds. This extract may therefore be seen as a good immunomodulator.

Amoora rohituka: A multicentric clinical verification study conducted by CCRH

Amoora rohituka or Andersonia has been used by Indian physicians as a medicine for splenic disorders since longtime. In Ayurvedic literatures it has been mentioned as an alterative, astringent and a tonic for liver and spleen enlargement. In Homoeopathy, it has been used for conditions like constipation, prolonged fevers associated with enlargement of spleen and liver; headache and burning pain in eyes, face, hands, feet, stomach, nausea & vomiting etc. A total of 4706 patients participated in this multicenteric clinical study at various Units/Institutes under Central Council for Research in Homoeopathy to confirm the uses of Amoora rohituka as mentioned in the homoeopathic materia medica and to evolve its clinical drug picture. This study not only confirms its therapeutic use in constipation , headache, fever, enlargement of liver and spleen and burning pain in different parts of the body etc. as noted in literature, but has also delineated the characteristics, which would help in differentiating Amoora rohituka from other similar remedies given in homoeopathic materia medica. Besides, a set of other symptoms were also relieved by the same drug, given for other purpose and emerged as clinical symptoms.

Gut modulatory, blood pressure lowering, diuretic and sedative activities of cardamom

Ethnopharmacological relevance Cardamom ( Elettaria cardamomum) is traditionally used in various gastrointestinal, cardiovascular and neuronal disorders. Aim of the study To rationalize cardamom use in constipation, colic, diarrhea, hypertension and as diuretic. Materials and methods Cardamom crude extract (Ec.Cr) was studied using in vitro and in vivo techniques. Results Ec.Cr caused atropine-sensitive stimulatory effect in isolated guinea-pig ileum at 3–10 mg/ml. In rabbit jejunum preparations, Ec.Cr relaxed spontaneous and K + (80 mM)-induced contractions as well as shifted Ca ++ curves to right, like verapamil. Ec.Cr (3–100 mg/kg) induced fall in the arterial blood pressure (BP) of anaesthetized rats, partially blocked in atropinized animals. In endothelium-intact rat aorta, Ec.Cr relaxed phenylephrine (1 μM)-induced contractions, partially antagonized by atropine and also inhibited K + (80 mM) contractions. In guinea-pig atria, Ec.Cr exhibited a cardio-depressant effect. Ec.Cr (1–10 mg/kg) produced diuresis in rats, accompanied by a saluretic effect. It enhanced pentobarbital-induced sleeping time in mice. Bio-assay directed fractionation revealed the separation of spasmogenic and spasmolytic components in the aqueous and organic fractions respectively. Conclusion These results indicate that cardamom exhibits gut excitatory and inhibitory effects mediated through cholinergic and Ca ++ antagonist mechanisms respectively and lowers BP via combination of both pathways. The diuretic and sedative effects may offer added value in its use in hypertension and epilepsy.

Presence of cholinergic and calcium antagonist constituents in Saussurea lappa explains its use in constipation and spasm

This study was carried out to provide a scientific basis for the traditional use of Saussurea lappa, in constipation and spasms. Isolated tissue preparations were used to see if the aqueous-methanol crude extract of the S. lappa root (Sl.Cr) contains gut stimulatory and inhibitory constituents. In isolated guinea-pig ileum, a quiescent preparation, Sl.Cr caused a concentration-dependent (0.3-5.0 mg/mL) spasmogenic effect, with the maximum effect reaching 91% of the acetylcholine maximum. A further increase in concentration caused a declining effect, indicating the presence of spasmolytic constituent(s). The spasmolytic effect was more marked in the spontaneously contracting rabbit jejunum and in the atropinized preparations. The spasmolytic effect was mediated through calcium channel blocking (CCB) activity, as evident by its inhibitory effect against high K(+) (80 mm)-induced contraction and displacement of the Ca(++) concentration-response curves to the right. These data indicate that the crude extract of Sl.Cr contains gut stimulatory constituent(s) of cholinergic-type providing a scientific basis for its use in constipation. The presence of spasmolytic constituents of CCB-type more evident in the spontaneous contracting gut preparation may explain its use in spasms.

Presence of cholinergic and calcium channel blocking activities explains the traditional use of Hibiscus rosasinensis in constipation and diarrhoea

The aqueous-ethanolic extract of the aerial parts of Hibiscus rosasinensis Linn. (Malvaceae) was studied for the possible presence of spasmogenic and spasmolytic constituents to rationalize its traditional use in gastrointestinal disorders. The crude extract (Hr.Cr) caused a concentration-dependent (1–10 mg/mL) spasmogenic effect in isolated guinea-pig ileum, which was blocked in the presence of atropine (0.1 μM). In spontaneously contracting rabbit jejunum, the plant extract exhibited a weak stimulatory effect at lower doses (0.03–0.30 mg/mL) followed by an inhibitory effect at higher doses (1.0–3.0 mg/mL). Pretreatment of the tissues with atropine blocked the stimulatory effect resulting in the potentiation of the spasmolytic effect. Hr.Cr (0.03–1.0 mg/mL) also showed an inhibitory effect on K + (80 mM)-induced contractions. The calcium channel blocking activity was confirmed when Hr.Cr shifted the Ca 2+ concentration–response curves to the right, similar to verapamil. Activity-directed fractionation revealed that the spasmolytic component(s) was separated in the ethyl acetate, while the spasmogenic in the petroleum ether fraction. The aqueous fraction exhibited a combination of weak spasmogenic and spasmolytic effects. These data indicate that the crude extract contains spasmogenic and spasmolytic constituents mediating their effect through cholinergic receptors activation and blockade of Ca 2+ influx, respectively, which may explain its traditional use in constipation and diarrhoea.

Pharmacological Studies on Aerial Parts of Calotropis Procera

The decoction of the aerial part of Calotropis procera is commonly used in Saudi Arabian traditional medicine for the treatment of variety of diseases including fever, joint pain, muscular spasm and constipation. The present investigation was undertaken to confirm its claimed activity in traditional medicine. The ethanol extract of the plant was tested on laboratory animals for its antipyretic, analgesic, anti-inflammatory, antibacterial, purgative and muscle relaxant activities. The results of this study showed a significant antipyretic, analgesic and neuromuscular blocking activity. On smooth muscle of guinea pig ileum, the extract produced contractions which was blocked by atropine supporting its use in constipation. The extract failed to produce significant anti-inflammatory and antibacterial activities. Our phytochemical studies on the aerial parts of C. procera showed the presence of alkaloids, cardiac glycosides, tannins, flavonoids, sterols and/or triterpenes. However, the chemical constituents responsible for the pharmacological activities remains to be investigated. The safety evaluation studies revealed that the use of extract in single high doses (up to 3 g/kg) does not produce any visible toxic symptoms or mortality. However, prolong treatment (90 days) causes significantly higher mortality as compared to control group.