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1.
Med Clin North Am ; 104(3): 439-454, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312408

RESUMO

Anorexia and cachexia, nausea and vomiting, and constipation are gastrointestinal symptoms that commonly accompany serious illness. Basic science and clinical research continue to improve the understanding of their pathophysiology. Thorough assessment necessitates history, physical examination, and laboratory and diagnostic testing. Pharmacologic management attempts to counteract or reverse the underlying pathophysiologic mechanisms that accompany each symptom, which may benefit from a multimodal approach to achieve adequate control. Future improvements in management require investments in clinical research to determine the efficacy of novel agents along with comparator studies to better understand which treatments should be used in what sequence or combination.


Assuntos
Anorexia/tratamento farmacológico , Caquexia/tratamento farmacológico , Constipação Intestinal/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Anorexia/epidemiologia , Anorexia/fisiopatologia , Biomarcadores/metabolismo , Caquexia/epidemiologia , Caquexia/fisiopatologia , Terapia Combinada/métodos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Estado Terminal , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Humanos , Inflamação/metabolismo , Inflamação/prevenção & controle , Náusea/epidemiologia , Náusea/fisiopatologia , Cuidados Paliativos/métodos , Exame Físico/métodos , Exame Físico/normas , Qualidade de Vida/psicologia , Receptores de Neurotransmissores/efeitos dos fármacos , Vômito/epidemiologia
2.
Support Care Cancer ; 28(1): 23-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31396746

RESUMO

PURPOSE: The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer. METHODS: These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The recommendations were categorised by the level of evidence and a "category of guideline" based on the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible"). RESULTS: The group produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. CONCLUSIONS: These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.


Assuntos
Constipação Intestinal/terapia , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Progressão da Doença , Prática Clínica Baseada em Evidências/normas , Humanos , Oncologia/métodos , Oncologia/normas , Neoplasias/epidemiologia , Neoplasias/patologia , Sociedades Médicas/normas
3.
J Opioid Manag ; 15(5): 375-387, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849029

RESUMO

OBJECTIVES: Assessment of opioid-induced constipation (OIC) prevalence and relationship with demographic, clinical, and drug predictors in our daily practice. DESIGN: Observational and retrospective study. SETTING: Chronic pain (CP) center of Bologna's Teaching Hospital, Italy. SUBJECTS: Mixed consecutive CP opioid-user outpatients (n = 128). MAIN OUTCOME MEASURE(S): OIC was assessed with the Bowel Function Index (BFI) in three consecutive visits. Absolute difference and Student's t-test were used to compare BFI scores. Predictors (opioid compound and type, morphine-equivalent daily-dose [MEDD], and laxatives) were retrieved from the patients' charts. BFI and predictors relationships were checked by multinomial logistic regression (MLR); independent predictors of BFI scores were assessed with χ2 analysis. RESULTS: Of the 384 evaluations, 85 percent were on strong opioids with a MEDD range of 11-50 mg per day in the majority (60 percent) and 64 percent showed moderate constipation; 42 percent did not use laxatives while 24 percent used macrogol with significant decrease in the BFI. MLR showed that oxycodone was associated with a risk for moderate constipation. Lactulose and glycerin suppositories were associated with severe constipation. Non-opioid users and cancer patients were associated with normal bowel function and severe constipation, respectively. CONCLUSIONS: OIC was found in almost all evaluations of weak or strong opioidusers (97 percent); moderate to severe OIC was found in 72 percent of the evaluations. Cancer patients were associated with severe constipation. Macrogol was superior to other laxatives. In our experience, macrogol relieved constipation in those on the combination of oxycodone and naloxone and in those on fentanyl patches. Lactulose and glycerol suppositories were associated with severe constipation.


Assuntos
Dor Crônica , Constipação Intestinal/induzido quimicamente , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Constipação Intestinal/epidemiologia , Preparações de Ação Retardada , Combinação de Medicamentos , Humanos , Naloxona , Oxicodona , Prevalência , Estudos Retrospectivos
4.
Nihon Shokakibyo Gakkai Zasshi ; 116(11): 913-926, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31708504

RESUMO

Although chronic constipation is highly prevalent, its definition remains unclear. Therefore, the prevalence varies depending on reports, and the understanding of actual situations is unclear. Hence, we performed an internet survey on constipation among the Japanese general population to study the background factors and actual situations. Preliminary study on the awareness of constipation was conducted among 10000 people in which 9523 of them was asked if they had constipation at the time of the survey. In this population, 51.5% realized that they had constipation. Multivariate analysis showed the significant association of constipation to age, sex, and past histories or complications of diabetes, hemorrhoids, and cerebrovascular diseases. In a main research composed of 3000 general Japanese population, approximately 30.9% of the subjects reported the use of laxatives to treat constipation, and 43.8% of them were found to use irritant laxatives. Moreover, 67.5% of the subjects purchased laxatives at a pharmacy. The frequency of bowel movement less than 3 times per week was manifested in 36.3% of the subjects, and more than once per week in 21.4%. The percentage of hard (Bristol Stool Form Scale [BSFS] Type 1-2), normal (BSFS Type 3-5), and diarrhea stools (BSFS Type 6-7) was 33.1%, 60.0%, and 6.9%, respectively. The quality of life (QOL) of the subjects with hard and diarrhea stools evaluated by SF-8 was significantly lower than that of those with normal stools. Furthermore, the actual monthly cost for the therapeutic drugs used for treating constipation was less than 1000 yen in 75% of the subjects. Analysis of the IBS-QOL-J indicated that the ≥5000 yen payable group had the lowest satisfaction of defecation among the study groups. At present, many Japanese patients with constipation have not been receiving enough treatment for constipation. Therefore, appropriate medication by physicians as well as instruction to patients is required.


Assuntos
Constipação Intestinal/epidemiologia , Qualidade de Vida , Humanos , Internet , Japão/epidemiologia , Inquéritos e Questionários
5.
Nutrients ; 11(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31480563

RESUMO

OBJECTIVES: To determine the association between home enteral nutrition (HEN) administration modality and its complications in patients. METHODS: This is a prospective multicenter longitudinal study including 15 Spanish hospitals, from April 2015 to March 2017. A 4-month follow-up period was conducted for each patient by home visit. The study subjects were adult patients who began their nutrient intake by tube feeding, known as HEN, during the recruitment period. The variables studied included the type and modality of HEN administration and its related complications, such as vomiting, regurgitation, constipation, diarrhea, and abdominal distention. Mechanical complications and bronchoaspiration were also evaluated. Descriptive variables were used for fitting. RESULTS: The study consisted of 306 patients; 4 were lost due to death. Specific HEN modalities protected against constipation (odds ratio (OR) = 0.4) and regurgitation (OR = 0.4). The use of a nasogastric tube (NGT) resulted in a lower risk of diarrhea compared to percutaneous endoscopic gastrostomy (PEG) (OR = 0.4) but resulted in a higher risk of tube obstruction (OR = 7.4). The use of intermittent gravity versus bolus feeding was a protection factor against vomiting (OR = 0.4), regurgitation (OR = 0.3), constipation (OR = 0.3), diarrhea (OR = 0.4) and abdominal distension (OR = 0.4). The increase in the number of doses was a risk factor for the incidence of regurgitation (OR = 1.3). CONCLUSIONS: Gastrointestinal complications were the most frequent problems, but an adequate choice of the formula, route, feeding modality, number of doses, administration time, and dose volume can reduce the risk of these complications.


Assuntos
Constipação Intestinal/etiologia , Diarreia/etiologia , Nutrição Enteral/efeitos adversos , Gastroenteropatias/etiologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Vômito/etiologia , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/epidemiologia , Diarreia/epidemiologia , Nutrição Enteral/métodos , Feminino , Alimentos Formulados , Gastroenteropatias/epidemiologia , Gastrostomia/efeitos adversos , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Tempo , Vômito/epidemiologia
6.
World J Gastroenterol ; 25(31): 4414-4426, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496621

RESUMO

Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.


Assuntos
Dor Abdominal/epidemiologia , Constipação Intestinal/epidemiologia , Diarreia/epidemiologia , Dispepsia/epidemiologia , Incontinência Fecal/epidemiologia , Doenças Inflamatórias Intestinais/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Diarreia/diagnóstico , Diarreia/etiologia , Diarreia/terapia , Dispepsia/diagnóstico , Dispepsia/etiologia , Dispepsia/terapia , Incontinência Fecal/diagnóstico , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Motilidade Gastrointestinal/fisiologia , Humanos , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/terapia , Prevalência , Índice de Gravidade de Doença
7.
Enferm. intensiva (Ed. impr.) ; 30(3): 127-134, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182971

RESUMO

Objetivo: Valorar la incidencia y factores de riesgo asociados al estreñimiento en pacientes adultos, en estado crítico. Diseño: Estudio prospectivo de cohortes. Ámbito: Unidad de cuidados intensivos (UCI) de un hospital de alta complejidad de noviembre de 2015 a octubre de 2016. Sujetos: Se realizó un seguimiento a los adultos que fueron hospitalizados durante al menos 72 h en la UCI, desde su ingreso en dicha unidad hasta su salida. Intervenciones: Ninguna. Mediciones y resultados principales: En los 157 pacientes seguidos, la incidencia de estreñimiento fue del 75,8%. El análisis univariado mostró que los pacientes con estreñimiento eran más jóvenes, habían usado más sedación y habían tenido más problemas respiratorios y posoperatorios como causas de hospitalización. Los pacientes sin estreñimiento habían sido hospitalizados más veces debido a motivos gastrointestinales. El uso de fármacos vasoactivos, la ventilación mecánica y la hemodiálisis fue similar entre los pacientes con estreñimiento y aquellos sin estreñimiento. El análisis multivariado, los días de administración de docusato + bisacodilo (HR0,79; IC95%: 0,65-0,96), de omeprazol o ranitidina (HR: 0,80; IC95%: 0,73-0,88) y de lactulosa (HR: 0,87; IC95%: 0,76-0,99) fueron factores independientes de protección para el estreñimiento. Conclusión: El estreñimiento es muy incidente en los adultos críticos. Los días de administración de fármacos que actúan sobre el tracto digestivo (Lactulosa, docusato + bisacodil y omeprazol y/o ranitidina) son capaces de prevenir este desenlace


Objective: To assess the incidence and factors associated with constipation in adult critical care patients. Design: Prospective cohort study. Setting: Intensive care unit (ICU) of a high-complexity hospital from November 2015 to October 2016. Patients: Adults who were hospitalized for at least 72 h in the ICU were followed from their admission to the ICU until their departure. Interventions: None. Measurements and main results: In the 157 patients followed up, the incidence of constipation was 75.8%. The univariate analysis showed that constipated patients were younger, used more sedation and showed more respiratory and postoperative causes for hospitalization, while non-constipated patients were hospitalized more for gastrointestinal reasons. The use of vasoactive substances, mechanical ventilation and haemodialysis was similar between the constipated and non-constipated patients. Multivariate analysis, days of use of docusate + bisacodyl (HR: .79; 95% CI: .65-.96) of omeprazole or ranitidine (HR: .80; 95%CI: .73-.88) and lactulose (HR: .87; 95%CI: .76-.99) were independent protection factors for constipation. Conclusion: Constipation has a high incidence among adult critical care patients. Days of drug use acting on the digestive tract (lactulose, docusate + bisacodyl and omeprazole and/or ranitidine) are able to prevent this outcome


Assuntos
Humanos , Adulto , Cuidados Críticos , Constipação Intestinal/epidemiologia , Fatores de Risco , Estudos Prospectivos , Estudos de Coortes , Seguimentos , Análise de Dados
8.
Dtsch Med Wochenschr ; 144(16): 1145-1157, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416107

RESUMO

The most relevant risk factors for the development of chronic constipation are neurologic disorders such as Parkinson's disease, immobility, and some drugs, in particular opioids. A proctologic exam and exclusion of red flags form part of the basic assessment. The currently available laxatives are effective and safe, habituation and tolerance (tachyphylaxis) being an exception. Also long-term intake of laxatives is of no concern when taken in recommended doses (no relevant hypokalemia!). Though the newer compounds (e. g., prucalopride, linaclotide, lubiprostone) are not more effective than the older ones, developing new drugs with alternative mode of action is reasonable since there are patients not satisfied with the currently available substances. Macrogol, Bisacodyl, and sodium picosulfate are the laxatives of first choice. Their selection depends on the individual preference of the patient. Opioids often induce constipation which can be ameliorated by laxatives or PAMORAs (peripherally acting µ-opioid antagonists).


Assuntos
Constipação Intestinal , Analgésicos Opioides/efeitos adversos , Doença Crônica , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Humanos , Laxantes/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Doença de Parkinson/complicações , Fatores de Risco
9.
Medicine (Baltimore) ; 98(32): e16777, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393401

RESUMO

OBJECTIVE: To analyze the clinical results of transanal endorectal pull-through (TERPT) and transabdominal approach (TAB) in the treatment of Hirschsprung disease. METHODS: We searched all publications in the PubMed, MEDLINE, EMBASE, and Cochrane library databases between January 2003 and November 2018. The study included randomized controlled trials (RCTs) and observational clinical studies (OCSs), to compare the surgery duration, length of postoperative hospital stay, incidence of postoperative incontinence/soiling, constipation, and enterocolitis between the TERPT and TAB groups. Mantel-Haenszel method was used for continuous variables, the combined odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous variables were used. RESULTS: In the 87 studies, we include 1 case of RCTs and 9 cases of OCSs. Including 392 cases of TERPT and 332 cases of TAB groups. TERPT has a short postoperative hospitalization [mean difference (MD) = -6.74 day; 95% CIs; -13.26 to -0.23; P = .04], and a low incidence of postoperative incontinence (ORs = 0.54; 95% CIs, 0.35-0.83; P = .006) and constipation (ORs = 0.50; 95% CIs, 0.28-0.90; P = .02). There was no difference in duration of surgery (MD = -30.59 min; 95% CIs, -98.01-36.83; P = .37) and incidence of postoperative enterocolitis (ORs = 0.78; 95% CIs, 0.53-1.17; P = .23). CONCLUSION: TERPT is superior to TAB in terms of hospitalization time, postoperative incontinence, and constipation. However, there are still a large number of RCTs to verify, and more trials are expected to be testified in the future.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença de Hirschsprung/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/epidemiologia , Pré-Escolar , Constipação Intestinal/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Enterocolite/epidemiologia , Incontinência Fecal/epidemiologia , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia
10.
Nutrients ; 11(6)2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31174310

RESUMO

Dietary patterns may have a role in the prevention of functional gastrointestinal disorders (FGIDs). The current study aimed at examining the association between FGIDs and adherence to the Mediterranean diet (MD) among elementary school children (ESC), as well as high school students (HSS). In a prospective cohort study, data from 1116 subjects (387 ESC and 448 HSS) aged 6-18 years were collected. FGID identification was based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII). Adherence to the MD was assessed using the KIDMED Index. Full data were available on 835/1116 questionnaires. Based on Rome III criteria, 184/835 participants (22%) were identified with FGID (122 (66%) with functional constipation (FC)). The prevalence of FGIDs (p = 0.001) was significantly higher in HSS (13-18 years). The KIDMED score in the cohort was 5.7 ± 2.5. Subjects with FGIDs demonstrated a lower KIDMED score compared to the non-FGID group, both in the cohort, as well as in the ESC and HSS subgroups (FGID vs. non-FGID: p = 0.001, p = 0.007, and p = 0.032, respectively). Multivariate analysis highlighted the KIDMED score as a significant predictor of FGIDs and FC after controlling for the age subgroups. We conclude that good adherence to the MD is associated to lower prevalence of FGIDs, while adolescents display a significantly higher prevalence of FGIDs compared to children.


Assuntos
Constipação Intestinal/prevenção & controle , Dieta Mediterrânea , Comportamento Alimentar , Adolescente , Criança , Constipação Intestinal/dietoterapia , Constipação Intestinal/epidemiologia , Feminino , Gastroenteropatias/dietoterapia , Gastroenteropatias/epidemiologia , Gastroenteropatias/prevenção & controle , Grécia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Estudos Prospectivos , Instituições Acadêmicas , Inquéritos e Questionários
11.
Afr Health Sci ; 19(1): 1716-1726, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31149002

RESUMO

Background: There is a growing interest in vortioxetine in major depressive disorder (MDD). Objectives: This meta-analysis aimed to assess the efficacy and safety of 10 mg/day (mg/d) vortioxetine compared to placebo for MDD in adult. Methods: Eight randomly controlled trials (RCTs) about the treatment of 10 mg/d vortioxetine in adult patients with MDD were identified and 2354 patients were included in meta-analysis. Results: According to the results, 10 mg/d vortioxetine showed significant differences in response rates (OR=1.88, 95% CI=1.40-2.53, P<0.0001), remission rates (OR=1.54, 95% CI=1.27-1.86, P<0.00001), change from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) total score (SMD=-3.50, 95%CI=-4.83 to -2.17, P<0.00001), clinical global Impression-Global Improvement (CGI-I) total score (SMD=-3.40, 95% CI=-4.69 to -2.11, P<0.00001), and change from baseline in Sheehan Disability Scale (SDS) total score (SMD=-2.09, 95% CI=-2.64 to -1.55, P<0.00001). But 10 mg/d vortioxetine was easier induced nausea (OR=4.18, 95% CI=3.21-5.44, P<0.00001) and constipation (OR=1.88, 95% CI=1.14 to 3.09, P=0.01). Conclusion: 10 mg/d vortioxetine was more effective, but easily induced nausea and constipation when compared to placebo for MDD in adult.


Assuntos
Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Vortioxetina/administração & dosagem , Vortioxetina/uso terapêutico , Antidepressivos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Humanos , Náusea/induzido quimicamente , Náusea/epidemiologia , Placebos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vortioxetina/efeitos adversos
12.
BMC Public Health ; 19(Suppl 4): 529, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196015

RESUMO

BACKGROUND: Urinary incontinence (UI) is known to be more prevalent among women and is associated with decline in quality of life. The aim of our study was to investigate the prevalence, risk factors of urinary incontinence and its impact on quality of life among community dwelling older women living in urban and rural populations. METHODS: This study was conducted based on secondary data analysed from the third phase of the longitudinal study "Neuroprotective Model for Health Longevity among Malaysian Elderly" (LRGS TUA). Stratification of urban and rural study areas were in accordance to that determined by the Department of Statistics. A total of 814 community dwelling older women (53% urban, 47% rural), aged 60 years and above, across four states within Peninsular Malaysia were included in this analysis. Interview-based questionnaires were used to obtain respondents' sociodemographic details and clinical characteristics. The Timed Up and Go test and Handgrip Strength tests were used to assess physical function. Urinary incontinence was self-reported, and quality of life of those with incontinence was assessed using the King's Health Questionnaire (KHQ). RESULTS: Prevalence of urinary incontinence was 16% and 23% among older women living in urban and rural areas, respectively. Ethnicity was significantly associated with incontinence among older women in both urban and rural population (p < 0.05). Chronic constipation, functional mobility and muscle strength were associated with UI in participants from rural setting (p < 0.05). Binary logistic regression analysis showed that risk of incontinence is lower among Chinese [OR 0.430, 95% C.I: 0.224-0.825, p = 0.011] compared to Malay older women living in urban population. Within the rural population, respondents with chronic constipation [OR: 3.384, 95% C.I: 1.556-7.360, p = 0.002] were found to be at a higher risk of UI. In terms of quality of life, respondents in rural areas experienced more role, physical, social, emotional limitations and sleep disturbance as compared to their urban counterparts (p < 0.05). CONCLUSION: UI is more prevalent and had a more profound impact on quality of health among older women in the rural setting. The risk factors of UI were ethnicity and chronic constipation among urban and rural older women respectively. It is important to provide holistic strategies in the prevention and management of UI among older women especially within the rural population.


Assuntos
Vida Independente/estatística & dados numéricos , População Rural/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/complicações , Constipação Intestinal/epidemiologia , Feminino , Avaliação Geriátrica , Força da Mão , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Malásia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores de Risco , Estudos de Tempo e Movimento , Incontinência Urinária/etiologia
13.
BMC Gastroenterol ; 19(1): 75, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113366

RESUMO

BACKGROUND: Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. METHODS: The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. RESULTS: Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). CONCLUSIONS: The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.


Assuntos
Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Autorrelato , Adulto Jovem
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 382-388, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006195

RESUMO

Objective: To examine the association between the frequencies of bowel movement (BMF) and the risk of colorectal cancer (CRC). Methods: In this study, 510 134 participants from the China Kadoorie Biobank (CKB) were included, after excluding those who reported as having been diagnosed with cancer at the baseline survey. The baseline survey was conducted from June 2004 to July 2008. The present study included data from baseline and follow-up until December 31, 2016. We used the Cox proportional hazards regression models to estimate the HR and the 95%CI of incident CRC with BMF. Results: During an average follow-up period of 9.9 years, 3 056 participants were documented as having developed colorectal cancer. In the site-specific analysis, 1 548 colon cancer and 1 475 rectal cancer were included. Compared with participants who had bowel movements on the daily base, the multivariable-adjusted HR (95%CI) for those who had more than once of BMF were 1.24 (1.12-1.39) for CRC, 1.12 (0.95-1.31) for colon cancer, and 1.37 (1.18-1.59) for rectal cancer. We further examined the association between BMF and CRC, according to the stages of follow-up, the corresponding HR (95%CI) for CRC, colon and rectal cancer were 1.59 (1.36-1.86), 1.43 (1.14- 1.80), and 1.76 (1.41-2.19) for the first five years, while such associations became statistically insignificant in the subsequent follow-up (P for all interactions were <0.05), as time went on. As for CRC, colon or rectal cancers among participants who had lower bowel movements, the risks were not significantly different from those who had bowel movements everyday. Conclusions: Participants who had BMF more than once a day, appeared an increased risk of CRC in the subsequent five years. Since abnormal increase of bowel movements is easily recognizable, programs should be set up on health self- management and early screening for CRC.


Assuntos
Neoplasias do Colo/epidemiologia , Constipação Intestinal/complicações , Defecação , Neoplasias Retais/epidemiologia , Adulto , China/epidemiologia , Neoplasias do Colo/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Constipação Intestinal/epidemiologia , Humanos , Modelos de Riscos Proporcionais , Neoplasias Retais/patologia , Fatores de Risco
15.
Korean J Gastroenterol ; 73(4): 207-212, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31030457

RESUMO

Background/Aims: The epidemiology of functional gastrointestinal disorders (FGIDs) in developed and developing countries involves a high prevalence of constipation and irritable bowel syndrome. This study examined the prevalence of functional gastrointestinal disorders in schoolchildren and adolescents in Colombia using the Rome III criteria. Methods: A cross-sectional study was performed on Colombian children between 8 and 17 years old. The Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version self-report form was answered by students from two schools. The prevalence of FGID was calculated and correlation tests were conducted among the variables analyzed. Results: A total of 864 children with a mean age of 12.5±2.5 years were analyzed; 50.7% were female. Two hundred and fifty-nine children (30%) had at least one FGID, and of these, 163 were female (62.9%). Sixty-nine children had two or more FGIDs (8%). Functional constipation was the most prevalent disorder (13.2%), followed in order by abdominal migraine (8.3%), irritable bowel syndrome (6.9%), and aerophagia (3.1%). A significantly higher prevalence of FGID was observed in females (p=0.000). No significant difference was observed between the age groups or type of school they attended. Conclusions: The overall prevalence of FGID in the sample was 30%, with functional constipation being the most common. These results are similar to those of other prevalence studies reported elsewhere.


Assuntos
Gastroenteropatias/diagnóstico , Adolescente , Criança , Colômbia/epidemiologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Estudos Transversais , Feminino , Gastroenteropatias/epidemiologia , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Masculino , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Inquéritos e Questionários
16.
World J Gastroenterol ; 25(14): 1729-1740, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31011257

RESUMO

BACKGROUND: Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined. AIM: To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders. METHODS: We performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D). RESULTS: We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group (P < 0.001), which significantly correlated with low vitamin D levels (r = - 0.57, P < 0.001; r = 0.21, P = 0.01; r = - 0.48, P < 0.001; r = - 0.57, P < 0.001; r = - 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001). CONCLUSION: Vitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.


Assuntos
Constipação Intestinal/etiologia , Gastroenteropatias/etiologia , Trânsito Gastrointestinal/fisiologia , Qualidade de Vida , Deficiência de Vitamina D/complicações , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Estudos de Casos e Controles , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/psicologia , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/psicologia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue
17.
Nutr Hosp ; 36(1): 25-31, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30839224

RESUMO

Introduction: Objective: to investigate the association between intestinal constipation, lifestyle and eating habits in four to seven year old children. Methods: a cross-sectional study with a sample of 152 children aged four to seven years old. Intestinal constipation was characterized according to the Rome IV criteria. Excess weight was classified by the body mass index. Variables that could be associated with constipation, such as maternal constipation, lifestyle, food and water intake, were selected. In the analysis, the prevalence ratio using Poisson regression, with a robust variance and statistical significance was set at p < 0.05. Results: the prevalence of intestinal constipation was 32.2% (n = 49), of which 34.7% (n = 17) of the children were overweight. As for lifestyle, 73% of the children did not practice any regular physical activities and approximately 60% spent more than two hours a day in sedentary activities, such as watching television or playing electronic games. A statistically significant association was found between constipation and daily school time equal to or greater than 4.5 hours (p = 0.007), non-consumption of fruits (p = 0.003) and greens (p = 0.007) and regular intake of fried food (p = 0.003). Conclusion: an association between intestinal constipation and unhealthy habits, such as non-consumption of fruits and vegetables, and regular consumption of fried food was observed. Preventing intestinal constipation requires changes in the lifestyle and eating habits of the children and family.


Assuntos
Constipação Intestinal/epidemiologia , Comportamento Alimentar , Estilo de Vida , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Ingestão de Líquidos , Ingestão de Alimentos , Exercício Físico , Feminino , Frutas , Humanos , Masculino , Prevalência , Comportamento Sedentário , Verduras
18.
J Opioid Manag ; 15(1): 69-76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30855724

RESUMO

BACKGROUND: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC. METHODS AND PATIENTS: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (>1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine. The degree of constipation was evaluated using the Bowel Function Index (BFI). RESULTS: Out of 180 enrolled patients (median age: 61.5 years, 66.7 percent women, mean treatment duration: 3 years), 57.2 percent suffered from nociceptive pain, 33.9 percent from mixed pain, and 8.9 percent from neuropathic pain. The most commonly prescribed opioids were oxycodone/naloxone (44.4 percent) and tapentadol (37.8 percent). At the time of the study, 73.9 percent of patients had constipation (BFI > 29), and 21.7 percent had severe constipation (BFI > 69). In a multiple linear regression analysis, previous constipation, morphine equivalent dose, treatment with fentanyl and interaction between morphine equivalent dose and hydromorphone were associated with more severe constipation. CONCLUSIONS: Most patients receiving long-term treatment with opioids present symptoms of constipation. The bowel function profile was more favorable for tapentadol and oxycodone, with no differences between them, even though morphine equivalent doses were on average higher in the tapentadol group.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica , Constipação Intestinal/induzido quimicamente , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Constipação Intestinal/epidemiologia , Estudos Transversais , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona , Oxicodona , Qualidade de Vida
19.
J Nutr Sci Vitaminol (Tokyo) ; 65(1): 38-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814410

RESUMO

Functional constipation negatively affects school-related quality of life for children and adolescents. We investigated the association between functional constipation, defined according to the Rome criteria version III, and dietary habits. The subjects of this cross-sectional study were 1,140 5th graders and 1,054 8th graders attending schools in Shunan City, Japan in 2012. Functional constipation was defined as having two or more symptoms of constipation. Dietary habits were assessed using a brief questionnaire. Self-reported biological, demographic and lifestyle information was obtained. Using multiple logistic models, dose-dependent associations among subgroups stratified with quintiles of nutrient and food intake were examined. The prevalence of functional constipation ranged from 3.7% to 8.3% across the grades. The most prevalent symptom was pain or hard stools. There was a link between higher rates of functional constipation and lower levels of dietary fiber intake, vegetables, and fruits (ptrend=0.010-0.030). Associations with vegetables and fruits attenuated when controlling for dietary fiber intake (ptrend=0.074-0.150). When 5th and 8th graders were separately analyzed, intake of dietary fiber, water from foods, and vegetables had beneficial effects on functional constipation in 8th graders (ptrend=0.005-0.038), and fruit intake had a beneficial effect in 5th graders (ptrend=0.012). Modification of dietary habits may have a positive effect in reducing functional constipation in school-age children. Diets rich in fiber, vegetables, and fruits, have the potential to improve functional constipation in Japanese children and adolescents.


Assuntos
Constipação Intestinal/epidemiologia , Dieta/efeitos adversos , Adolescente , Criança , Constipação Intestinal/etiologia , Estudos Transversais , Inquéritos sobre Dietas , Fibras na Dieta , Ingestão de Alimentos , Comportamento Alimentar , Feminino , Frutas , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Prevalência , Qualidade de Vida , Instituições Acadêmicas , Verduras
20.
J Coll Physicians Surg Pak ; 29(3): 284-286, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823961

RESUMO

A cross-sectional study was conducted in the Gastroenterology Clinics of The Aga Khan Hospital and Jinnah Postgraduate Medical Centre in Karachi. All patients complaining of constipation were included. Patients with alarm features were excluded. Interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Form Scale. Out of 396 participants, 186 (47.0%) had FC and 209 (52.7%) had IBS-C. Based upon Bristol Stool Form Scale, only 214 (54%) reported to have slow transit constipation (BSS <2). A higher proportion of women reported severe form of constipation as compared to men (81.5%, n=150 vs. 65.1%, n=138 p<0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105 p=0.003). Proper understanding of patient's symptoms is essential for optimizing individual patient management.


Assuntos
Atitude Frente a Saúde , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Síndrome do Intestino Irritável/fisiopatologia , Adulto , Distribuição por Idade , Compreensão , Constipação Intestinal/epidemiologia , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Incidência , Síndrome do Intestino Irritável/epidemiologia , Masculino , Pessoa de Meia-Idade , Paquistão , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores Socioeconômicos
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