Neonatal mesenteric cyst in a 5-day-old patient: a case report.

Mesenteric cysts have been documented as a rare occurrence in children. They are mostly renowned to be benign intra-abdominal tumors with no known etiology. The symptoms are non-specific ranging from being asymptomatic to an acute abdomen. Most of the diagnoses are made below the age of 10 years with devoid of reports for the early neonatal occurrences. We report a case of an early neonatal mesenteric cyst in a 5-day-old female patient who presented with signs of intestinal obstruction markedly by abdominal distension, vomiting, and absolute constipation. Abdominal X-ray showed evidence of small bowel obstruction while abdominal ultrasound and computed tomography (CT) scan were used to reach the diagnosis of a mesenteric cyst, all laboratory baseline investigations were within a normal range. On laparotomy a 12 by 13 cm cyst that was firmly adhering to the proximal ileal wall was meticulously dissected, complete cystectomy was done with no segmental resection. Histopathologically there were no signs of malignancy and the patient successfully recovered with no signs of recurrences after being followed for a year and a half. Being a rare case in the early neonatal period with unspecific presentations; mesenteric cyst should be considered as one of the diagnoses best to be managed by surgical excision to prevent recurrences.

Investigation of functional constipation in elderly inpatients and analysis of its influencing factors: A cross-sectional study.

To investigate the prevalence of functional constipation (FC) in elderly hospitalized patients and analyze the influencing factors. This was a cross-sectional study in which 506 patients hospitalized in general surgery from February to June 2020 were selected. Information on patients' age, gender, ethnicity, body mass index, intake of vegetables, fruits, meat, and spicy foods, sleep, smoking, alcohol consumption, time of defecation, and mode of defecation was collected through questionnaires, and the factors affecting functional constipation were analyzed using binary logistic regression models; among 506 patients, 254 had FC, with a prevalence of 50.19%. Among the clinical symptoms of FC, the most common ones were straining to defecate (83.85%) and lumpy or hard stools (81.80%). Univariate analysis revealed statistically significant differences in family history of constipation (P = .033), sedentary (P = .004), self-care ability (P = .001), body mass index (P = .013), defecation time (P < .0001), spicy food intake in dietary preference (P = .001), age (P = .004), and education level (P = .016), and binary logistic regression analysis showed that defecation time and spicy food consumption were independent influencing factors of FC. For hospitalized elderly people, regular morning defecation and not eating spicy foods can more helpful to slow the occurrence of functional constipation.

Novel Role of the ALPI Gene Associated with Constipation Caused by Complement Component 3 Deficiency.

Complement component 3 (C3) deficiency has recently been reported as one of the novel causes of constipation. To identify a unique gene specific to constipation caused by C3 deficiency, the total RNA extracted from the mid colon of C3 knockout (C3 KO) mice was hybridized to oligonucleotide microarrays, and the function of the candidate gene was verified in in vitro and in vivo models. C3 KO mice used for microarrays showed definite phenotypes of constipation. Overall, compared to the wild type (WT), 1237 genes were upregulated, and 1292 genes were downregulated in the C3 KO mice. Of these, the major genes included were lysine (K)-specific demethylase 5D (KDM5D), olfactory receptor 870 (Olfr870), pancreatic lipase (PNLIP), and alkaline phosphatase intestinal (ALPI). Specifically, the ALPI gene was selected as a novel gene candidate based on alterations during loperamide (Lop)-induced constipation and intestinal bowel disease (IBD). The upregulation of ALPI expression treated with acetate recovered the expression level of mucin-related genes in primary epithelial cells of C3 KO mice as well as most phenotypes of constipation in C3 KO mice. These results indicate that ALPI plays an important role as the novel gene associated with C3 deficiency-induced constipation.

Gastrointestinal dysfunction in Parkinson's Disease: absence of anti-gliadin antibodies.

BACKGROUND AND OBJECTIVES: Parkinson disease (PD), which is a neurodegenerative disorder, includes several gastrointestinal symptoms that are similar to those of Celiac disease (CD). However, the presence of celiac antibodies in PD patients has not yet been studied. Our aim in this study is to compare anti-transglutaminase (ATA) and antigliadin antibodies (AGA) as well as gastrointestinal symptoms and nutrition habits between patients with Parkinson's disease (PD) and healthy controls. METHODS AND STUDY DESIGN: Serum AGA IgG and IgA and the ATA antibodies IgA and IgG were studied in 102 PD patients and 91 healthy controls. Gastrointestinal symptoms, specifically constipation, were investigated using the gastrointestinal system rating scale (GSRS) and the constipation rating scale (CRS). Dietary habits were also investigated and compared between the groups. RESULTS: No significant differences were found between the two groups in terms of celiac antibodies. As expected, the hypokinetic GSRS and CRS scores were significantly higher in the PD group (p<0.001). Dietary habits, especially carbohydrate-rich diets, had a negative impact on gastrointestinal symptoms in the PD patients. CONCLUSIONS: Studies have suggested a connection between PD and CD, which infers a probable non-celiac gluten intolerance and the need to offer PD patients an elimination diet. However, the results of our study did not support any link between celiac antibodies and PD. Notwithstanding, the negative impact of a carbohydrate-rich diet in PD patients still leaves a question regarding gluten sensitivity in these patients.

Functional Bowel Disorder Management in Routine Practice with Tips for Hot Topics: Expert Opinion Review.

Functional gastrointestinal system disorders are common problems in practice. The most common symptoms are abdominal pain, gas, bloating, diarrhea, constipation, and a mixture of these, and similar symptoms can be seen in conditions such as inflammatory bowel disease, colorectal cancer, and celiac disease depending on the age of the patient, indicating the importance of differential diagnosis. The importance of patient management is shown by making a symptom-based diagnosis and making cost-effective, that is, limited advanced examinations. The pathophysiology of irritable bowel syndrome (IBS) is multifactorial, and stress is one of the leading triggers of IBS symptoms. Therefore, terminology will change to gut-brain interaction disorders in the future, and the patient-physician relationship has a special place in the treatment of functional bowel disorder. Dietary recommendation and medical treatment in IBS should be determined according to the predominant symptom and symptom severity. In addition to diet, some lifestyle changes can also be helpful in reducing IBS symptoms. Antispasmodics and antidepressants are not fast-acting. These drugs should be used for at least 2-4 weeks to see the efficacy of treatment. Drugs should be used according to the standard recommended duration and dose in intermittent treatments.

Constipation and DIOS: Diagnosis, differential diagnosis, and management.

Cystic Fibrosis (CF) is a complex disorder that requires multidisciplinary expertise for effective management. The GALAXY study estimated the prevalence of constipation to be about 25% among People with Cystic Fibrosis (PwCF), identifying it as one of the common gastrointestinal (GI) symptoms within this patient population. Quality of Life (QoL) assessments uncovered high patient dissatisfaction, highlighting the imperative need for enhanced treatment strategies. Similarly, Distal Intestinal Obstruction Syndrome (DIOS) is a unique condition exclusive to PwCF that, if left undiagnosed, can lead to considerable morbidity and mortality. Given the broad spectrum of differential diagnoses for abdominal pain, including constipation and DIOS, it is paramount for healthcare providers to possess a clear understanding of these conditions. This paper aims to delineate various differentials for abdominal pain while elucidating the pathogenesis, diagnostic criteria, and treatment options for managing constipation and DIOS in PwCF.

GDNF's Role in Mitigating Intestinal Reactive Gliosis and Inflammation to Improve Constipation and Depressive Behavior in Rats with Parkinson's disease.

Constipation is a common symptom in patients with Parkinson's disease (PD) and is often associated with depression. Enteric glial cells (EGCs) are crucial for regulating intestinal inflammation and colon motility, and their activation can lead to the death of intestinal neurons. Glial cell line-derived neurotrophic factor (GDNF) has been recognized for its neuroprotective properties in various neurological disorders, including PD. This study explores the potential of GDNF in alleviating intestinal reactive gliosis and inflammation, thereby improving constipation and depressive behavior in a rat model of PD. A PD model was established via unilateral stereotaxic injection of 6-hydroxydopamine (6-OHDA). Five weeks post-injury, AAV5-GDNF (2 ~ 5 × 10^11) was intraperitoneally injected into experimental and control rats. Fecal moisture percentage (FMP) and colonic propulsion rate (CPPR) were used to evaluate colon motility. Colon-related inflammation and colonic epithelial morphology were assessed, and depressive behavior was analyzed one week before sampling. PD rats exhibited reduced colonic motility and GDNF expression, along with increased EGC reactivity and elevated levels of pro-inflammatory cytokines IL-1, IL-6, and TNF-α. Additionally, there was an up-regulation of CX43 and a decrease in PGP 9.5 expression. The intraperitoneal injection of AAV-GDNF significantly protected colonic neurons by inhibiting EGC activation and down-regulating CX43. This treatment also led to a notable reduction in depressive-like symptoms in PD rats with constipation. GDNF effectively reduces markers of reactive gliosis and inflammation, and promotes the survival of colonic neurons, and improves colonic motility in PD rats by regulating CX43 activity. Furthermore, GDNF treatment alleviates depressive behavior, suggesting that GDNF or its agonists could be promising therapeutic agents for managing gastrointestinal and neuropsychiatric symptoms associated with PD.

Megacolon diagnosis in pregnancy: A case report and literature review.

Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. Megacolon can complicate pregnancy in terms of maternal morbidity and mortality (volvulus, ileus, systemic toxicity, bowel perforation, sepsis) and obstetrical outcomes (preterm birth, premature rupture of membranes, dystocia). Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms. A case of megacolon, first detected during pregnancy in an otherwise healthy nulliparous woman, is reported. The diagnosis was suspected on observation of a pelvic mass of unknown aetiology (mean diameter > 10 cm) constricting and dislocating the gravid uterus contralaterally during a routine mid-trimester fetal ultrasound. The diagnostic work-up and management are discussed. Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy.

Bowel burdens: a systematic review and meta-analysis examining the relationships between bowel dysfunction and quality of life after spinal cord injury.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, including profound impairments to bowel and cardiovascular function. Neurogenic bowel dysfunction (NBD) is emerging as a potential determinant of quality of life (QoL) after SCI. For individuals with high-level lesions ( > T6), bowel care-related autonomic dysreflexia (B-AD; profound episodic hypertension) further complicates bowel care. We aimed to evaluate the extent of bowel dysfunction after SCI, and the impact of bowel dysfunction on QoL after SCI. METHODS: We searched five databases to identify research assessing the influence of NBD or B-AD on QoL after SCI. Metrics of bowel dysfunction (fecal incontinence [FI], constipation, time to complete, and B-AD) and QoL data were extracted and synthesised. Where possible, meta-analyses were performed. RESULTS: Our search identified 2042 titles, of which 39 met our inclusion criteria. Individuals with SCI identified problems with NBD (74.7%), FI (56.9%), and constipation (54.6%), and 49.3% of individuals with SCI > T6 experienced B-AD. Additionally, 40.3% of individuals experienced prolonged defecation ( > 30 min). Moderate/severe deterioration in QoL due to NBD was reported by 55.5% of individuals with SCI, with negative impacts on physical, emotional, and social health-related QoL associated with inflexibility of bowel routines, fear of accidents, and loss of independence. CONCLUSION: Bowel dysfunction and bowel care challenges are prevalent and disabling for individuals with SCI, with a profoundly negative impact on QoL. Improving bowel management is a key target to improve QoL for those living with SCI.

Helicobacter pylori infection is a risk factor for constipation in patients with Parkinson's disease: A multicenter prospective cohort study.

BACKGROUND AND AIMS: Constipation is one of the most common nonmotor symptoms (NMSs) of Parkinson's disease (PD). The infection rate of Helicobacter pylori (HP) is greater in PD patients. This study was a multicenter prospective cohort study in which propensity score matching (PSM) was used to determine whether HP infection was a risk factor for constipation in patients with PD. METHODS: A total of 932 PD patients with 13C-urea breath test for HP were included in the study. The PSM was estimated with the use of a nonparsimonious multivariate logistic regression model, with HP infection as the dependent variable and all the baseline characteristics as covariates. A total of 697 patients composed the study cohort, including 252 (36.2 %) patients in the HP-positive (HPP) group and 445 (63.8 %) patients in the HP-negative (HPN) group. Before PSM, there were differences in several of the baseline variables between the two groups. After PSM, 250 HPP patients were matched with 250 HPN patients and the standardized differences were less than 0.1 for all variables. RESULTS: The present results demonstrate that HP infection is a risk factor for constipation in patients with PD [RR (95 % CI) 1.412 (1.155-1.727), P < 0.001]. Subgroup analyses revealed that HP infection was both a risk factor for constipation in Hoehn-Yahr scale (1,1.5) group and Hoehn-Yahr scale (2-5) group [OR (95 % CI) 1.811 (1.079-3.038), P < 0.025; OR (95 % CI) 2.041 (1.177-3.541), P < 0.011]. CONCLUSIONS: The results of our prospective cohort study suggest that Helicobacter pylori infection is a risk factor for constipation in patients with PD. TRIAL REGISTRATION: ChiCTR2300071631.

Acupuncture for constipation in Parkinson's disease: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Parkinson's disease (PD) is the second most common neurological disease worldwide, and there is a potential interaction between PD and constipation. PD constipation often causes significant trouble for patients and seriously affects their quality of life. Acupuncture is widely used for treating constipation and has been clinically proven. However, it is unclear whether the current evidence is sufficient to support acupuncture to improve PD constipation. METHODS: We searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, Wan Fang Data Knowledge Service Platform, and Chinese Scientific Journal Database (VIP database) for randomized controlled trials from inception through July 1, 2023. Randomized controlled trials (RCTs) included acupuncture, sham acupuncture, and medication for PD constipation. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis. RESULTS: The 11 studies included a total of 960 patients. The results showed that acupuncture or acupuncture combined with conventional treatment seemed to have advantages in improving complete spontaneous bowel movements (WMD: 1.49, 95% CI: 0.86, 2.11; P < .00001), Patient-Assessment of Constipation Quality of Life questionnaire (WMD: -11.83, 95% CI: -15.67, -7.99; P < .00001), the chronic constipation severity scale (CCS) (SMD: -0.99, 95% CI: -1.40, -0.58; P < .01), and c(RRP) (WMD: 2.13, 95% CI: 0.44, 3.82; P < .05). CONCLUSION: The present results show that compared with conventional treatment, acupuncture combined with conventional treatment seems to increase the number of spontaneous defecations in PD patients, improve quality of life, increase rectal resting pressure, and alleviate the severity of chronic constipation. Thus, acupuncture has the potential to treat PD constipation. However, due to the study's limitations, higher-quality RCTs are needed for verification.

Association between dietary inflammatory index and energy-adjusted dietary inflammatory index and constipation in US adults.

BACKGROUND: Diet and inflammation are associated with constipation. Dietary inflammation index (DII) and energy-dietary inflammation index (E-DII) have not been evaluated together with constipation. Therefore, this study was conducted to further observe the relationship between DII and E-DII and constipation in American adults. METHODS: Data were extracted from the National Health and Nutrition Examination Survey (NHANES) for 12,400 adults aged 20 years and older between 2005 and 2010. DII and E-DII were obtained by employing data from the two 24-h dietary recall of the participants. Constipation was defined and categorized using the Bristol Stool Form Scale. RESULTS: In the logistic regression model, the relationship between DII and E-DII and constipation remained positive after adjusting for confounding factors (odds ratio [OR] = 1.13; 95% confidence interval [CI]: 1.07-1.20 in DII logistic regression model III; odds ratio [OR] = 1.09; 95% confidence interval [CI]: 1.03-1.17 in E-DII logistic regression model III). Constipation was more common in quartile 4 (DII: 2.87-5.09; E-DII: 1.78-8.95) than in quartile 1 (DII: -5.11-0.25; E-DII: -2.60-0.11) (OR = 1.79, 95% CI: 1.30-2.47 in DII and OR = 1.75, 95% CI: 1.25-2.46 in E-DII for all participants; OR = 2.04, 95% CI: 1.39-3.00 in DII OR = 2.20, 95% CI: 1.39-3.47 in E-DII for males; OR = 1.86, 95% CI: 1.08-3.22 and OR = 1.80, 95% CI: 1.06-3.06 for females). These results were confirmed using multiple imputations. CONCLUSIONS: The findings of this study show that a high DII and E-DII were associated with an increased incidence of constipation among US adults.

Complications in spinal cord injury persons with "traditional" colostomy: a case series.

INTRODUCTION: Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications. CASE PRESENTATION: We present four cases of SCI/D persons treated with Hartmann's procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes. DISCUSSION: Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann's, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients' characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.

Immune-related colitis presenting with constipation.

Anticancer immunotherapies modulate the body's immune system to recognise and eradicate cancerous cells. However, stimulation of the body's immune system can also lead to a number of adverse effects when those immune cells target non-cancerous cells in the form of autoimmunity. One relatively common example of this off-target action is colitis.We present three patients who presented atypically with colitis, consequently, leading to a delayed diagnosis. These cases highlight the diverse ways a relatively common immune-related adverse event can present.

Transanal proximal rectosigmoidectomy: a single-center experience in surgically treated severe medically refractory idiopathic constipation.

PURPOSE: To present the functional results after a transanal proximal rectosigmoidectomy in patients with severe idiopathic constipation in which medical treatment has failed. METHODS: Patients with severe idiopathic constipation who underwent transanal proximal rectosigmoidectomy (TPRS) at Children's Hospital Colorado between June 2019 and March 2024 were included in the study. We compared multiple pre- and post-operative outcome measures and the patient's bowel regimen before and after resection. RESULTS: Fourteen patients underwent TPRS, 10 of whom were male. The average age at the time of surgery was 10.1 years (range 5-19). Seven patients have moderate to severe autism. Constipation-related clinic visits, family calls, procedural intervention, emergency room visits, and hospitalizations notably decreased frequency after TPRS. Laxative dosages and enema volume requirements were also reduced after surgery. Before surgery, all the patients suffered from daily fecal accidents, while post-operatively, all were completely free of stool accidents. CONCLUSION: In our experience, for patients who suffer from severe medically refractory idiopathic constipation, TPRS has provided improvement in their symptoms and decreased the complications inherent to this chronic disease. Parents and patients attest to a profound positive transformation in their quality of life after surgery.

Estimating minimal clinically important difference (MCID) for gastrointestinal symptoms in cystic fibrosis.

BACKGROUND: Minimal clinically important difference (MCID) is important to establish as a meaningful outcome in research when using patient reported outcome measures (PROMs). We determined the MCID using the distribution-based approach for three measurements used as part of the GALAXY study, which is an observational prospective study on gastrointestinal (GI) symptoms in cystic fibrosis (CF). METHODS: Four hundred and two persons with cystic fibrosis (PwCF) participated in the GALAXY study, all with baseline values available for all questionnaires. Mean age was 20.9 years (2.1- 61.1) with 75 females and 94 males under the age of 18 (42.04 %) and 118 females and 115 males aged 18 or older (57.99 %). MCID was measured for Patient Assessment of Constipation Symptoms (PAC-SYM), Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM), Patient Assessment of Constipation-Quality of Life (PAC-QOL) and their subscales. Two distribution-based approaches, defined as multiplications of the standard deviation (SD) or standard error of the mean (SEM), were used to approximate the MCID. RESULTS: The two distribution-based approaches for determining the MCID estimates produced comparable results in trends in MCIDs across the subscales and total scores. In general, MCID estimates of subscales for all three measurements were higher than their total score MCIDs. The one-half SD- and SEM-based MCID estimates for total scores of each questionnaire are as follows: PAC-SYM: 0.26 and 0.14; PAGI-SYM: 0.32 and 0.15; PAC-QOL: 0.27 and 0.18, respectively. CONCLUSION: This paper establishes initial MCIDs estimated by the distribution-based approach for the PAC-SYM, PAGI-SYM and PAC-QOL that can now be used to evaluate interventional studies that may impact gastrointestinal symptoms in PwCF.

Association of Constipation with Modes of Delivery: A Retrospective Questionnaire-based Study.

INTRODUCTION AND HYPOTHESIS: Pelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information regarding the mode of delivery in relation to constipation is limited. We hypothesise that women with a history of vaginal delivery report constipation more often than women with a history of caesarean section. METHODS: This was a retrospective cross-sectional multicentre study conducted in the Netherlands. All included patients (n = 2,643) completed the Groningen Defecation and Fecal Continence questionnaire to assess bowel problems of the last 6 months. Parametric tests, Chi-squared, univariable and multivariable regression analyses were performed. RESULTS: Among 2,643 parous women, 2,248 delivered vaginally (85.1%) and 395 (14.9%) by caesarean section. Altogether, 649 women (24.6%) suffered from constipation. Women in the vaginal delivery group were constipated more often than women in the caesarean section group (25.5% versus 19.0%, p = 0.005). For women who had delivered vaginally, multivariable regression analysis showed an odds ratio for constipation of 1.47 (95% confidence interval, 1.109-1.938, p = 0.007). The odds ratio for constipation in women with a spontaneous perineal tear was 1.4 times higher than in women with an intact perineum (p = 0.030). Furthermore, the vaginal delivery group reported difficulties regarding bowel emptying (p = 0.048), straining (p = 0.027), incomplete defecation (p = 0.043), not able to defecate daily (p = 0.018), manually assisted defecation (p = 0.015) and had higher Renzi scores (p = 0.043) more often. CONCLUSIONS: Women in the vaginal delivery group have higher prevalences and odds ratios for constipation. Furthermore, a perineal tear during vaginal delivery increases the odds ratio for constipation.