Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

Associations of thyroid hormones with chronic diarrhea and constipation in euthyroid individuals.

Background: Abnormalities in thyroid function affect bowel health. However, the relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation remain unclear. Thus, the aim of this study was to investigate the relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation in euthyroid US adults. Methods: The data for this population-based study were taken from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 datasets. The relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation were examined via multivariate regression. Smoothed curve fitting and threshold effects analysis were used to test for nonlinear relationships and inflection points. Results: This study involved 4999 participants ranging in age from 20 to 80 years. Multivariate logistic regression analysis revealed a significant positive correlation between FT3 concentrations and the risk of developing chronic diarrhea [1.37 (1.00, 1.88), P=0.049]. Multivariate linear regression analysis revealed a significant positive correlation between FT3 concentrations and the number of bowel movements [0.84 (0.39, 1.28), P<0.001]. Using smoothed curve fitting and the two-stage regression model, we found a nonlinear relationship between FT4 concentrations and chronic diarrhea, with a breakpoint of 0.79 ng/dl. Conclusions: There were associations between thyroid hormone concentrations and abnormal bowel habits, particularly between FT3 concentrations and the risk of developing chronic diarrhea. A higher FT3 level was associated with an increased risk of developing chronic diarrhea and more frequent bowel movements. To validate our results, further large-scale prospective studies are needed.

Association of chronic constipation and chronic diarrhea with renal stones: a cross-sectional study of the National Health and Nutrition Examination Survey 2007-2010.

Background: Renal stone is a highly prevalent life-long disease with a high recurrence rate. Chronic bowel diseases, including chronic gastrointestinal symptoms (chronic constipation or chronic diarrhea), are common gastrointestinal problems. We aimed to evaluate the associations of chronic constipation and chronic diarrhea with renal stones. Methods: This large-scale, cross-sectional study was performed within participants (≥20 years old) from the National Health and Nutrition Examination Survey from 2007 to 2010. Logistic regression and sensitivity analyses were conducted to clarify the association between chronic bowel diseases and renal stones. Results: A total of 8,067 participants aged ≥20 years were included. The prevalence of renal stones is 9.14%. Chronic diarrhea was positively related to the risk of renal stones [odds ratio (OR) =1.681, 95% confidence interval (CI): 1.212 to 2.330, P=0.004] after adjusting for all covariates. In participants with body mass index (BMI) over 30 kg/m2, chronic constipation was correlated with kidney stones in fully adjusted model 2 (OR =2.142, 95% CI: 1.389 to 3.303, P=0.004). Conclusions: Our findings provide evidence that chronic diarrhea is associated with an increased risk of renal stones. Chronic constipation is positively related to the risk of renal stones in participants with BMI over 30 kg/m2. Health care should focus more on bowel health status for the prevention of related diseases. More prospective cohort studies are needed.

Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study.

BACKGROUND: Colonic motility in constipation can be assessed non-invasively using MRI. OBJECTIVE: To compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response. DESIGN: Part 1: 44 healthy volunteers (HVs), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries and questionnaires and underwent oral macrogol (500-1000 mL) challenge. Whole gut transit time (WGTT), segmental colonic volumes (CV), MRI-derived Motility Index and chyme movement by 'tagging' were assessed using MRI and time to defecation after macrogol recorded. Left colonic HRCM was recorded before and after a 700 kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10 mg daily versus hyoscine 20 mg three times per day, assessing daily pain and constipation. RESULTS: Part 1: Total CVs median (range) were significantly greater in IBS-C (776 (595-1033)) and FC (802 (633-951)) vs HV (645 (467-780)), p<0.001. Patients also had longer WGTT and delayed evacuation after macrogol. IBS-C patients showed significantly reduced tagging index and less propagated pressure wave (PPW) activity during HRCM versus HV. Compared with FC, IBS-C patients were more anxious and reported more pain. Abnormally large colons predicted significantly delayed evacuation after macrogol challenge (p<0.02), impaired manometric meal response and reduced pain with bisacodyl (p<0.05).Part 2: Bisacodyl compared with hyoscine increased bowel movements but caused more pain in both groups (p<0.03). CONCLUSION: An abnormally large colon is an important feature in constipation which predicts impaired manometric response to feeding and treatment responses. HRCM shows that IBS-C patients have reduced PPW activity. TRIAL REGISTRATION NUMBER: The study was preregistered on ClinicalTrials.gov, Reference: NCT03226145.

Langerhans Cell Histiocytosis Masked by Constipation: A Case Report and Literature Review.

Langerhans cell histiocytosis (LCH) is a rare histiocytic neoplastic disorder that presents in all age groups, although it often affects young children. Patients typically present with lytic bone lesions and an erythematous rash, though other systems such as the digestive, endocrine, lymphatic, and respiratory systems can be involved.  We present a case of LCH that was masked by symptoms of constipation. The patient was a three-year-old female who presented with a primary complaint of constipation accompanied by abdominal and back pain. Further investigation identified an L3 lesion on lumbar spine magnetic resonance imaging, for which a pediatric neurosurgeon performed an open reduction and internal fixation. Pathology confirmed the diagnosis of LCH. This was followed by one year of chemotherapy. To date, she has not had a recurrence of LCH.  This case demonstrates the importance of generating a broad differential diagnosis and determining and treating the etiology of a patient's symptoms rather than the symptoms alone. Physicians must maintain a high index of suspicion for rare diagnoses when symptoms have persisted and more common etiologies have been ruled out. A thorough neurological exam should be performed for all patients with constipation due to an unknown etiology, especially when accompanied by back pain. Although the patient did not present with gastrointestinal (GI) involvement of LCH, nonspecific GI symptoms such as diffuse abdominal pain and bloody diarrhea have been associated with this rare diagnosis. We thoroughly review the literature regarding both GI involvement of LCH and cases of LCH that present with accompanying GI symptoms. Additionally, we highlight the clinical treatment options of LCH.

Lacticaseibacillus paracasei NCU-04 relieves constipation and the depressive-like behaviors induced by loperamide in mice through the microbiome-gut-brain axis.

Constipation is a prevalent gastrointestinal condition that significantly affects patients' physical and mental well-being, yet current treatments often lack safety and efficacy. Emerging evidence highlights the critical role of the microbiota-gut-brain axis (MBGA) in managing constipation, paving the way for probiotics as an adjuvant treatment to improve constipation symptoms. In this study, we isolated a gut probiotic strain, Lacticaseibacillus paracasei NCU-04, and investigated its improvement effects on loperamide-induced constipation in mice. We demonstrated that L. paracasei NCU-04 exhibited excellent probiotic properties, including robust growth, strong antibacterial and antioxidant capacities, and a lack of hemolytic activity in vitro. The administration of L. paracasei NCU-04 effectively improved the defecation-related indicators such as the fecal water content, time to the first black stool defecation, and intestine transit rate, suggesting enhanced gut immobility in constipated mice. Additionally, L. paracasei NCU-04 significantly reduced colon inflammation induced by loperamide. Further, L. paracasei NCU-04 increased levels of colonic motilin, 5-hydroxytryptamine (5-HT), and c-kit, while decreased that of aquaporin 3, vasoactive intestinal peptide, and peptide YY. Notably, L. paracasei NCU-04 effectively upregulated the expression of 5-HT and its receptor (i.e., 5-HT4R) in the brains of constipated mice. High-throughput sequencing revealed that L. paracasei NCU-04 restored the diversity and composition of the gut microbiota disturbed by loperamide, and significantly increased the relative abundance of Prevotella and Lactobacillus genera in the stool, while decreased that of Odoribacter, Rikenella, and Parabacteroides. Importantly, L. paracasei NCU-04 also effectively improved the depression-like behaviors associated with constipation, possibly through 5-HT mediated MGBA. These results suggest that L. paracasei NCU-04 may offer a promising approach for treating constipation and its related depressive symptoms, supporting its potential as a functional food or adjuvant therapy for human health.

Navigating Solitary Rectal Ulcer Syndrome: A Surgeon's Conundrum With Rectal Carcinoma in a Young Adult.

Solitary rectal ulcer syndrome is a rare, chronic, and benign disorder. It can be observed as ulcers in the rectal mucosa, solitary or multiple lesions. It can often be misdiagnosed with other intestinal morbidities, due to its clinical similarities. It can be diagnosed by clinical symptoms, radiological tools, and histopathological examination. Management is carried out by conservative methods such as lifestyle and dietary modifications with medical and surgical therapy. This is a case of a 37-year-old female with a major complaint of per-rectal bleeding. Proctoscopy revealed an irregular-ulcerated mass in the rectum, which was managed conservatively. The patient showed improved symptoms after a colonoscopy, at a six-month follow-up.

Recurrence of Sigmoid Volvulus Associated With Constipation: A Retrospective Cohort Study.

Introduction Sigmoid volvulus is a gastrointestinal condition characterized by twisting the sigmoid colon, leading to obstruction and potentially severe complications. It is associated with factors such as advanced age, constipation, and the use of certain medications. Despite treatment, recurrence is common and significantly impacts patients' quality of life. This study aimed to identify factors influencing the recurrence of sigmoid volvulus to develop effective preventive strategies. Methods A retrospective cohort study was conducted at Fuchu Hospital, Osaka, including 44 patients diagnosed with sigmoid volvulus between May 2013 and May 2023. Data on variables such as age, gender, constipation, cardiac and neuropsychiatric diseases, hypertension, diabetes mellitus, sigmoid colon overgrowth, and BMI were collected from electronic medical records. Recurrence was defined as two or more diagnoses of sigmoid volvulus during the study period. Logistic regression analysis was used to identify significant predictors of recurrence. Results Of the 44 patients, 20 experienced recurrences. Single regression analysis identified constipation, neuropsychiatric disorders, and sigmoid colon overgrowth as significant factors. Logistic regression analysis confirmed constipation as an important predictor of recurrence (OR: 8.84, 95% CI: 2.05-38.1, p=0.0034). The area under the receiver operating characteristic (ROC) curve for the model was 0.804 (95% CI: 0.67-0.938), indicating good predictive accuracy. Conclusion Constipation is a significant risk factor for the recurrence of sigmoid volvulus, likely due to chronic fecal overload leading to elongation and dilation of the sigmoid colon. Effective management of constipation is crucial in preventing recurrence. Future prospective studies with larger sample sizes are needed to validate these findings and explore additional preventive measures.

Antegrade Continence Enemas for Pediatric Functional Constipation: A Systematic Review.

BACKGROUND: Despite optimal conservative and medical treatment, some children with functional constipation (FC) continue to experience symptoms. Antegrade continence enema (ACE) surgery has been suggested as the primary surgical option after less invasive pharmacological and non-pharmacological interventions have not been effective. The purpose of this systematic review was to assess the outcomes of ACE for children with FC. METHODS: Electronic databases were searched (inception-March 2024) for studies evaluating ACE surgery performed in children with FC. The primary outcome was treatment success (as defined in the original manuscript), including at least defecation frequency and/or fecal incontinence frequency. Secondary outcomes were cessation of ACE, complications, health-related quality of life (HRQoL) and patient/parent satisfaction. Quality of evidence was evaluated based on tools from the New-Ottawa Scale and Joanna Bridge Institute. RESULTS: Thirteen studies were included, representing 477 children with FC treated with either an appendicostomy or a cecostomy. Reported treatment success rates varied widely, ranging from 32% to 100%. ACE treatment was stopped in 15% due to treatment success and in 8% due to treatment failure, leading to more invasive surgery. Complication rates ranged from 6% to 100%, requiring surgical intervention in 0% to 34%. An improvement in HRQoL following ACE treatment was reported in all three studies that assessed HRQoL. The two studies assessing patient/parent satisfaction, reported high satisfaction rates. CONCLUSION: Reported treatment success and complication rates following ACE surgery for children with FC vary widely. This systematic review highlights the necessity for uniform definitions and treatment guidelines for ACE surgery in children with FC. LEVEL OF EVIDENCE: III.

Integrated serum pharmacochemistry, 16S rDNA sequencing, and metabolomics to reveal the material basis and mechanism of Shouhui Tongbian capsule against diphenoxylate-induced slow transit constipation in rats.

BACKGROUND: Slow transit constipation (STC) is highly prevalent and has rising incidence. Shouhui Tongbian capsule (SHTB) is a traditional Chinese Medicine formula with extensive and highly efficacious usage in STC treatment, however, its mechanism of action, especially the regulation of microbiome and lipid metabolites, remains unclear. METHODS: After quality control of SHTB using LC‒MS to obtain its material basis, we tried to elucidate the cohesive modulatory network of SHTB against STC using hyphenated methods from microbiomics, lipidomics, mass spectrometry imaging (MSI) and molecular methods. RESULTS: SHTB could repair intestinal barrier damage, reduce systemic inflammation and increase intestinal motility in a diphenoxylate-induced STC rat model. Based on 16S rDNA sequencing results, SHTB rehabilitated the abnormal changes in Alloprevotella, Coprococcus, Marvinbryantia, etc., which were associated with STC symptoms. Meanwhile, microbial functional prediction showed that lipid metabolism was improved with SHTB administration. The differential lipids, including fatty acids, lysophosphatidylcholine, phosphatidylcholine, sphingomyelin triglyceride and ceramide, that are closely related to STC disease and SHTB efficacy. Furthermore, SHTB significantly reversed the abnormal expression of these key target enzymes in colon samples, including CTP-phosphocholine cytidylyltransferase, CTP-phosphoethanolamine cytidylyltransferase, phosphatidic acid phosphatase, acid sphingomyelinase etc. CONCLUSIONS: Combined analysis demonstrated that SHTB reducing lipid accumulation and recovery of intestinal microbial homeostasis was the critical mechanism by which SHTB treats STC.

Can depression lead to chronic constipation, or does chronic constipation worsen depression? NHANES 2005-2010 and bidirectional mendelian randomization analyses.

BACKGROUND: Depression and chronic constipation often co-occur, but the reciprocal influence between the two remains unclear. The purpose of this study is to explore the potential association between depression and chronic constipation. METHODS: This study initially utilized data from National Health and Nutrition Examination Survey (NHANES) 2005-2010 to explore the correlation between depression scores and chronic constipation, assessing the non-linear relationship between the two. Subsequently, we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the causal relationship between depression and major depression with chronic constipation. The Inverse Variance Weighting (IVW) method served as the primary reference, supplemented by sensitivity tests. Finally, a reverse MR analysis was performed to assess the presence of any reverse causation. The STROBE-MR checklist for the reporting of MR studies was used in this study. RESULTS: In the NHANES analysis, survey-weighted logistic regression revealed a significantly positive correlation between depression scores and chronic constipation (OR = 1.04, 95% CI = 1.02-1.07, p = 0.002), even after adjusting for the included covariates. The nonlinear analysis using Restricted Cubic Splines (RCS) enhanced the robustness of the association (P-non-liner = 0.01). The MR analysis also confirmed the causal relationship between depression (OR = 11.43, 95% CI = 1.85-70.67, p = 0.008) and major depression (OR = 1.12, 95% CI = 1.03-1.22, p = 0.007) with chronic constipation, passing rigorous sensitivity tests. No evidence of reverse causation was observed in the reverse MR analysis (P > 0.05). CONCLUSIONS: Depression is positively correlated with the risk of chronic constipation. Therefore, enhancing attention to chronic constipation in patients with depression may be effective in clinical practice.

Composite Functional and Quality of Life Outcomes in Adults Operated for Cloacal Malformation.

INTRODUCTION: Composite long-term outcomes of cloacal malformations remain unclear. We aimed to evaluate bowel and bladder control, sexual function, reproductive health, and quality of life in adulthood. METHODS: A Nordic multi-center cross-sectional observational study evaluating the outcome of adult patients with cloacal malformations was performed. Patient characteristics were retrieved from case records. Established questionnaires were sent to the patients to evaluate bowel- bladder- and sexual function and quality of life. RESULTS: Thirty-four of 48 (70%) eligible patients with median age 28 years (18-45) responded. Eight (24%) patients had a common channel >3 cm. Imaging-confirmed spinal and sacral abnormalities were present in 4 and 17 patients respectively. 85% (n = 29/34, four patients with permanent urinary diversions after bladder neck closure excluded) reported no urinary leakage without physical activity or urge to urinate. Three patients had a permanent enterostomy. 42 % (n = 11/26) reported acceptable bowel function according to Bowel Function Score (with eventual ongoing bowel management). The median Profile of Female Sexual Function Score was below normative values. Quality of life was comparable to the reference population, but thirty percent scored within the distress domains. Eight patients (24%) had been pregnant (15 pregnancies), resulting in seven live births, but the need of assisted reproduction techniques (40%, n = 6/15) and miscarriage (40%, n = 6/15) was common. CONCLUSIONS: Adequate spontaneous bowel control was rare, while most patients were dry for urine without additional procedures. Cloacal malformation also have a negative impact on sexual function health related quality of life and reproductive health. Long-term follow-up is crucial, not only regarding bowel and bladder function, but also for sexual and reproductive function, which may be important negative factors for health-related quality of life. LEVEL OF EVIDENCE: Level IV.

Analysis of relevant influencing factors for recurrent urinary tract infections in children: exploring predictive factors and intervention measures.

OBJECTIVE: To analyze the factors influencing recurrent urinary tract infections (UTIs) in children and explore predictive factors and intervention measures. METHODS: Data of 158 children with UTIs treated at the Longyan First Affiliated Hospital of Fujian Medical University from January 2020 to June 2023 were analyzed. Among them, 122 children without recurrent UTIs were included in a non-recurrent group, while the remaining 36 were included in a recurrent group. The quality of life prior to treatment and six weeks after treatment, the immunoglobulin A (IgA) and immunoglobulin G (IgG) levels after treatment, the relationship between the quality of life after six weeks of treatment and the levels of IgA and IgG were analyzed. Multivariate logistic regression analysis was conducted to identify factors impacting the recurrence of UTIs, and receiver operating characteristic (ROC) curves were generated to predict recurrent UTIs based on independent risk factors. RESULTS: Before treatment, no notable difference was observed in Short Form 36 Health Survey (SF-36) scores between the non-recurrent group and the recurrent group (P>0.05). After treatment, the SF-36 scores notably increased in the non-recurrent group (P<0.0001), while there was no notable increase in the recurrent group (P>0.05). However, the difference in SF-36 scores after treatment was significant between the two groups (P<0.0001). In addition, there was a significantly positive correlation between IgA levels and quality of life after 6 weeks of treatment (P<0.05). The recurrent group showed significantly lower IgA and IgG levels than the non-recurrent group (P<0.05). Multivariate logistic regression analysis identified anemia, urinary system malformation, constipation, decreased IgA level, and decreased IgG level as independent risk factors for recurrent UTIs in children. ROC curves-based analysis of independent risk factors demonstrated that urinary system malformation had a better performance in predicting recurrent UTIs in children than the other four factors. CONCLUSION: Urinary system malformation, constipation, anemia, decreased IgA and IgG levels are all identified as independent risk factors for recurrent UTIs in children, and urinary system malformation is a better predictor for recurrent UTIs in children than the other four factors.

Symptoms of constipation in autistic adults: A systematic literature review on diagnostic methods and presence of actual symptoms.

LAY ABSTRACT: Autistic people often experience gastrointestinal issues, with constipation being one of the most common concerns. However, there are currently no specific guidelines for diagnosing constipation in autistic adults. This makes it harder for healthcare providers to identify and treat the condition effectively. In this review, we analysed nine studies from 2012 to 2022 to understand the various methods used to diagnose constipation in autistic adults and their symptoms. We found that most studies used different approaches, such as questionnaires, standardized criteria, or observation. In addition, many studies focused on children and adolescents, leaving a gap in understanding symptoms in autistic adults. The studies highlighted symptoms that were not covered by official diagnostic criteria, such as sleep disturbances and challenging behaviours. This indicates a need for healthcare providers to consider a broader range of signs when diagnosing constipation in autistic people. Our review suggests that more research focusing on adults is needed to create tailored tools for diagnosing constipation in autistic adults. This will help improve accuracy and ensure better treatment outcomes. Understanding the unique ways constipation can present in autistic people is crucial for developing effective care strategies. For healthcare providers, this review emphasizes the importance of recognizing a wide range of symptoms when assessing constipation in autistic people. For policymakers, it highlights the need for age-specific guidelines to ensure that autistic adults receive the care and support they need. Further research will help refine these diagnostic tools and ultimately lead to better healthcare practices for autistic people.

Yunpi Rougan Prescription in Treating Constipation-Predominant IBS: Clinical Observation and Gut Microbiota Effects.

BACKGROUND: Constipation-predominant irritable bowel syndrome (IBS-C) is a chronic functional intestinal disease that can significantly reduce patients' quality of life. OBJECTIVE: This study aims to evaluate the clinical effect and mechanism of YunPi RouGan (YPRG) prescription on IBS-C patients with liver-depression and spleen-deficiency syndrome. METHODS: 42 IBS-C patients receiving treatment at Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from May 2022 to March 2023 were recruited and randomly assigned to either the treatment or control group, with 21 patients in each group. The patients received either a YPRG prescription or a linalotide capsule for 4 weeks. A series of scales were utilized to evaluate the clinical symptoms, psychological aspects, and quality of life in IBS patients. Meanwhile, fresh fecal samples were collected to analyze the changes in gut microbiota by 16SrDNA sequencing. RESULTS: In terms of clinical treatment, both YPRG prescription and the first-line drug linaclotide have similar effects for IBS-C. However, YPRG prescription has demonstrated significant improvements in several symptoms, such as abdominal distension and belching. Furthermore, it has been shown to upregulate the diversity of gut microbiota and induce changes in the types of dominant microbiota in IBS-C patients. At the phylum level, Firmicutes and Bacteroides increased, while Proteobacteria, actinobacteria, and desulphurobacteria decreased. At the genus level, Bacteroides, Spirillum, Clostridium praxis, Roxella, Para-salmonella, Haemophilus, koala bacillus, Micrococcus rare, Spirillum, and Streptococcus increased significantly. CONCLUSION: The effect of YPRG prescription on improving the clinical symptoms of IBS-C may be attributed to its potential to regulate gut microbiota.

Investigation of the prevalence of functional constipation and its related factors for in older outpatients.

Background: Functional constipation (FC) is a geriatric syndrome that is common in the older adult's population and can seriously affect the quality of life and may be a frequent cause of hospital visits. In this study, we planned to investigate the relationship between FC and its related factors for in older outpatients. Patients and methods: Participants aged 65 and over who applied to the geriatrics outpatient were included in the study. The diagnosis of FC was made according to the presence of the Rome IV criteria. Frailty was screened by the using FRAIL scale, ≥ 3 a score of were evaluated as frail. Participants quality of life was evaluated by Euro-Quality of Life Visual Analog Scale (EQ-VAS). Results: The study included 602 participants. FC prevalence was found 28.7%. In univariate analyses, FC was found related to age, having a diagnosis of depression or Parkinson diseases, frailty, urinary incontinence, sleep disorders, number of chronic diseases, and EQ-VAS. In multivariate analyses, FC was not found to be associated by the frailty while the number of chronic diseases [OR=1.212, 95%CI (1.084-1.355), p=0.001] and EQ-VAS were found to be related [OR=0.988, 95%CI (0.978-0.997), p=0.012]. Conclusion: In the results of this study, FC was not found to be associated by frailty in older outpatients but it emerged as a syndrome that should be screened frequently in patients with a high number of chronic diseases and a low general quality of life.

The associations between modifiable risk factors and constipation: a comprehensive mendelian randomization study.

OBJECTIVE: Early identification of modifiable risk factors is crucial for the prevention of constipation. This study systematically investigated the relationship between genetically predicted modifiable risk factors and constipation. METHODS: The inverse variance weighting (IVW) method was employed as the primary analytical approach. For similar exposure indicators, the multivariate Mendelian randomization (MVMR) method was used to adjust for potential biases in univariate MR analysis. The robustness of the results was further evaluated using the MR-Egger intercept test, Cochran's Q test, and leave-one-out analysis. Bonferroni correction was applied to reduce the false positive rate in the results. RESULTS: The IVW analysis indicated a significant causal association between genetically predicted gastroesophageal reflux disease [OR (95% CI) = 1.192 (1.079-1.315), P = 0.0005], atorvastatin use [OR (95% CI) = 16.995 (3.327-86.816), P = 0.0007], and constipation. Additionally, there was a potential causal association between education level [OR (95% CI) = 0.859 (0.767-0.964), P = 0.009], major depressive disorder [OR (95% CI) = 1.206 (1.041-1.399), P = 0.013], hypothyroidism [OR (95% CI) = 2.299 (1.327-3.985), P = 0.003], and aspirin use [OR (95% CI) = 4.872 (1.174-20.221), P = 0.029] with constipation. No causal associations were found for the other included indicators. Sensitivity analysis demonstrated the absence of evidence for heterogeneity and pleiotropy in any positive results. CONCLUSION: This study identified several risk factors that could be targeted for the prevention of constipation, offering valuable insights for public health policies.

Association between visceral adiposity index and bowel habits and inflammatory bowel disease: a cross-sectional study.

Obesity has become a global public health problem, and its relationship with gastrointestinal diseases has become a major concern. The visceral adiposity index (VAI) is a novel index to assess the distribution and content of visceral fat, and this study aimed to investigate the association between VAI and bowel habits (chronic diarrhea, chronic constipation) and inflammatory bowel disease (IBD). The 2005-2010 National Health and Nutrition Examination Survey (NHANES) dataset was used for the cross-sectional survey. Bowel habits and IBD were defined by self-report. Multiple logistic regression models were used to test the linear association of VAI with bowel habits and IBD. Fitted smoothed curves and threshold effects analyses were used to characterize nonlinear relationships. This cross-sectional study included 10,391 adults (≥ 20 years). After adjusting for covariates, there was a significant negative association between VAI and chronic constipation (OR [95% CI]: 0.97 [0.95, 1.00]) but no significant association with IBD (OR [95% CI]: 0.97 [0.87, 1.07]). Additionally, there was a nonlinear association between VAI and chronic diarrhea with a breakpoint of 3.08, with a positive correlation between the two on the left side of the breakpoint and no statistical significance on the right side. Subgroup analyses and interaction tests showed that maintaining sleep health was associated with a low risk of chronic constipation. Elevated VAI levels were negatively associated with chronic constipation, and elevated levels were positively associated with chronic diarrhea at VAI < 3.08. This reminds us that maintaining moderate levels of visceral fat may prevent the onset of chronic constipation and circumvent the risk of chronic diarrhea. Notably, maintaining healthy sleep may play a positive role in reducing chronic constipation.

Inadequate management of opioid-induced constipation in European cancer pain patients: results of a real-world, multicentre, observational study ("E-StOIC").

PURPOSE: The objectives of the study were to determine the prevalence of (uncontrolled) OIC, relevant medications / interventions employed by healthcare professionals, and the additional strategies utilised by patients, amongst European patients with cancer pain. METHODS: This study was a prospective observational study conducted at 24 research sites in ten European countries. Cancer patients receiving opioid analgesics for at least a week were recruited, and asked to complete a questionnaire including background information, single question (Are you constipated?), Rome IV diagnostic criteria for OIC, Bowel Function Index (BFI), and Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL). Participants were characterised as having / not having OIC on the basis of the Rome IV diagnostic criteria. RESULTS: 1200 participants completed the study. 59.5% met the Rome IV diagnostic criteria for OIC: only 61.5% that met these criteria self-reported constipation. 72% participants were prescribed a regular conventional laxative / peripherally acting mu-opioid receptor antagonist (PAMORA). However, only 66% took their prescribed laxatives every day. Many participants had utilised other strategies / interventions to manage their OIC. Furthermore, 27% had needed to use suppositories, 26.5% had needed to use an enema, and 8% had had a manual evacuation. The use of PAMORAs, and other novel effective medications, was relatively uncommon. CONCLUSION: The results of this study suggest that management in Europe is often inadequate, and this undoubtedly relates to a combination of inadequate assessment, inappropriate treatment, and inadequate reassessment.

Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study.

Background: Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions. Methods: A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis. Results: Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services. Conclusion: Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.