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1.
Medicine (Baltimore) ; 100(7): e24662, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607803

RESUMO

BACKGROUND: As one of the important manifestations of neurogenic bowel dysfunction, constipation is characterized by high incidence and harmful effects. It has a negative impact on both physical and psychological health of patients. And there are no effective treatment options for this type of disease clinically. Therefore, this study is designed to examine the effect of the therapy of "combination 3 methods progression" in patients with neurogenic bowel dysfunction (constipated type). METHODS: This is a randomized, controlled, parallel-design clinical trial. A total of 60 patients with neurogenic bowel dysfunction (constipated type) will be randomly assigned to intervention group and control group. The control group will receive 4 weeks of usual rehabilitation care, the intervention group will receive 4 weeks of the therapy of "combination 3 methods progression" in addition to usual rehabilitation care. The primary outcome is the number of spontaneous bowel movement per week. Secondary outcomes are stool characteristics, degree of difficulty in defecation, level of anxiety, level of depression, and level of self-efficacy. DISCUSSION: The interventions of this protocol have been programmed to alleviate constipation in patients with neurogenic bowel dysfunction. Findings may provide preliminary evidence for clinical efficacy of the therapy of "combination 3 methods progression." TRIAL REGISTRATION: Chinese Clinical Trial Registry, IDF: ChiCTR2000041463. Registered on December 26, 2020.


Assuntos
Constipação Intestinal/terapia , Medicina Tradicional Chinesa/métodos , Intestino Neurogênico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Estudos de Casos e Controles , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Constipação Intestinal/reabilitação , Defecação/fisiologia , Depressão , Humanos , Incidência , Pessoa de Meia-Idade , Intestino Neurogênico/fisiopatologia , Autoeficácia , Resultado do Tratamento
2.
Am J Emerg Med ; 42: 260.e1-260.e2, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33388185

RESUMO

A mycotic aneurysm is a life-threatening disease that usually presents with nonspecific symptoms. A prompt diagnosis is essential because of the risk of aneurysm rupture and high mortality rate. We describe a case of an abdominal mycotic aortic aneurysm presenting as chronic constipation for 3 weeks, without fever or abdominal pain. Point-of-care ultrasound has the ability to detect silent abdominal aortic aneurysms and serves as a follow-up tool for patients under medical treatment.


Assuntos
Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/etiologia , Constipação Intestinal/etiologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/terapia , Ruptura Aórtica/cirurgia , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
3.
Arq Bras Cir Dig ; 33(3): e1545, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470375

RESUMO

BACKGROUND: Oblique type of anastomosis. Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung's disease. AIM: To compare circular and oblique anastomoses following Soave's procedure for the treatment of Hirschsprung's disease. METHODS: Children who underwent Saove's pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. RESULTS: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). CONCLUSION: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave's procedure.


Assuntos
Anastomose Cirúrgica/métodos , Constipação Intestinal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Incontinência Fecal/etiologia , Doença de Hirschsprung/cirurgia , Proctocolectomia Restauradora/métodos , Criança , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Seguimentos , Doença de Hirschsprung/diagnóstico , Humanos , Lactente , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
4.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472809

RESUMO

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient's abdominal pain resolved within 4 days.


Assuntos
Dor Abdominal/diagnóstico , Medicamentos Falsificados/efeitos adversos , Intoxicação por Chumbo/diagnóstico , Charlatanismo , Vômito/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Anemia/etiologia , Antieméticos/uso terapêutico , Quelantes/uso terapêutico , Clordiazepóxido/uso terapêutico , Antagonistas Colinérgicos , Constipação Intestinal/etiologia , Medicamentos Falsificados/química , Combinação de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Intoxicação por Chumbo/complicações , Intoxicação por Chumbo/tratamento farmacológico , Masculino , Parassimpatolíticos/uso terapêutico , Penicilamina/uso terapêutico , Fenetilaminas/uso terapêutico , Quinuclidinas/uso terapêutico , Tomografia Computadorizada por Raios X , Vômito/tratamento farmacológico , Vômito/etiologia
5.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500301

RESUMO

A 75-year-old man was hospitalised for bronchoscopy with biopsy due to a suspicious pulmonary mass at chest tomography. He had significant dyspnoea, constipation, nausea, vomiting, anorexia and a 33% loss of weight in the past 3 months. Biopsy revealed a pulmonary squamous cell carcinoma, which was inoperable. Tramadol used at home for 3 months was replaced by morphine on admission. The patient remained constipated despite prokinetics and laxatives, leading to the diagnostic hypothesis of paraneoplastic motility disorder and opioid-induced constipation. Abdominal tomography ruled out the possibility of mechanical obstruction. As complications, the patient presented superior vena cava syndrome and opioid (morphine) intoxication. The patient died a few days later. The management of this case highlights the importance of multidisciplinary care and the challenges of palliative oncology care. Paraneoplastic motility disorder must always be considered among the mechanisms of intestinal dysfunction in patients with advanced oncological disease.


Assuntos
Carcinoma de Células Escamosas/complicações , Constipação Intestinal/etiologia , Gastroparesia/etiologia , Neoplasias Pulmonares/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/etiologia , Idoso , Antieméticos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico por imagem , Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/fisiopatologia , Fármacos Gastrointestinais/uso terapêutico , Gastroenteropatias/diagnóstico , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Motilidade Gastrointestinal , Gastroparesia/diagnóstico , Gastroparesia/tratamento farmacológico , Gastroparesia/fisiopatologia , Glicerol/uso terapêutico , Humanos , Lactulose/uso terapêutico , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Metoclopramida/análogos & derivados , Metoclopramida/uso terapêutico , Morfina/efeitos adversos , Constipação Induzida por Opioides/diagnóstico , Cuidados Paliativos , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/fisiopatologia , Tramadol/efeitos adversos
6.
Med Clin North Am ; 105(1): 55-73, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246523

RESUMO

Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.


Assuntos
Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Adulto , Colonoscopia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Efeitos Psicossociais da Doença , Fibras na Dieta/uso terapêutico , Exame Retal Digital , Feminino , Humanos , Laxantes/uso terapêutico , Masculino , Manometria , Pessoa de Meia-Idade , Atenção Primária à Saúde , Qualidade de Vida , Fatores de Risco
7.
PLoS One ; 15(12): e0244680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382780

RESUMO

OBJECTIVE: We determined the effectiveness of a multi-strain probiotic (Hexbio®) containing microbial cell preparation MCP®BCMC® on constipation symptoms and gut motility in PD patients with constipation. METHODS: PD patients with constipation (ROME III criteria) were randomized to receive a multi-strain probiotic (Lactobacillus sp and Bifidobacterium sp at 30 X 109 CFU) with fructo-oligosaccaride or placebo (fermented milk) twice daily for 8 weeks. Primary outcomes were changes in the presence of constipation symptoms using 9 items of Garrigues Questionnaire (GQ), which included an item on bowel opening frequency. Secondary outcomes were gut transit time (GTT), quality of life (PDQ39-SI), motor (MDS-UPDRS) and non-motor symptoms (NMSS). RESULTS: Of 55 recruited, 48 patients completed the study: 22 received probiotic and 26 received placebo. At 8 weeks, there was a significantly higher mean weekly BOF in the probiotic group compared to placebo [SD 4.18 (1.44) vs SD 2.81(1.06); (mean difference 1.37, 95% CI 0.68, 2.07, uncorrected p<0.001)]. Patients in the probiotic group reported five times higher odds (odds ratio = 5.48, 95% CI 1.57, 19.12, uncorrected p = 0.008) for having higher BOF (< 3 to 3-5 to >5 times/week) compared to the placebo group. The GTT in the probiotic group [77.32 (SD55.35) hours] reduced significantly compared to placebo [113.54 (SD 61.54) hours]; mean difference -36.22, 95% CI -68.90, -3.54, uncorrected p = 0.030). The mean change in GTT was 58.04 (SD59.04) hour vs 20.73 (SD60.48) hours respectively (mean difference 37.32, 95% CI 4.00, 70.63, uncorrected p = 0.028). No between-groups differences were observed in the NMSS, PDQ39-SI, MDS-UPDRS II and MDS-UPDRS III scores. Four patients in the probiotics group experienced mild reversible side effects. CONCLUSION: This study showed that consumption of a multi-strain probiotic (Hexbio®) over 8 weeks improved bowel opening frequency and whole gut transit time in PD patients with constipation.


Assuntos
Constipação Intestinal/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Doença de Parkinson/fisiopatologia , Probióticos/uso terapêutico , Idoso , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Método Duplo-Cego , Feminino , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Probióticos/administração & dosagem , Inquéritos e Questionários , Resultado do Tratamento
9.
Arch. argent. pediatr ; 118(5): 350-357, oct 2020. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122544

RESUMO

La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio


Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community


Assuntos
Humanos , Doença de Hirschsprung/cirurgia , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/terapia , Pediatria , Doença Crônica , Constipação Intestinal/dietoterapia , Constipação Intestinal/etiologia , Enterocolite/dietoterapia , Enterocolite/etiologia , Incontinência Fecal/dietoterapia , Incontinência Fecal/etiologia
10.
Lancet Gastroenterol Hepatol ; 5(11): 996-1007, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32805205

RESUMO

BACKGROUND: The laxative drug lubiprostone improves intestinal permeability in healthy volunteers. We aimed to assess efficacy and safety of lubiprostone in patients with non-alcoholic fatty liver disease (NAFLD) with constipation via attenuation of intestinal permeability. METHODS: This randomised, double-blind, placebo-controlled, phase 2a study in Yokohama City University Hospital, Japan, recruited patients (aged 20-85 years) with NAFLD and constipation, alanine aminotransferase (ALT) at least 40 U/L, liver stiffness (≤6·7 kPa), and hepatic fat fraction at least 5·2% when assessed by MRI-proton density fat fraction. Eligible patients were randomly assigned (11:10:9) by a computer-based system and stratified by age and sex to receive 24 µg lubiprostone, 12 µg lubiprostone, or placebo, orally, once per day for 12 weeks. The primary endpoint was the absolute changes in ALT at 12 weeks. Efficacy analysis was done by intention to treat. Safety was assessed in all treated patients. This trial was registered with University Hospital Medical Information Network Clinical Trials Registry (UMIN000026635). FINDINGS: Between March 24, 2017, and April 3, 2018, we screened 288 patients, of whom 150 (52%) were randomly assigned to treatment: 55 patients were assigned to receive 24 µg lubiprostone, 50 to receive 12 µg lubiprostone, and 45 to receive placebo. A greater decrease in the absolute ALT levels from baseline to 12 weeks was seen in the 24 µg lubiprostone group (mean -13 U/L [SD 19]) than in the placebo group (1 U/L [24]; mean difference -15 U/L [95% CI -23 to -6], p=0·0007) and in the 12 µg lubiprostone group (-12 U/L [21]) than in the placebo group (mean difference -13 U/L [-22 to -5], p=0·0023). 18 (33%) of 55 patients in the 24 µg group had at least one adverse event, as did three (6%) of 47 patients in the 12 µg group and three (7%) of 43 in the placebo group. The most common adverse event was diarrhoea (17 [31%] of patients in the 24 µg group, three [6%] in the 12 µg group, none in the placebo group). No life-threatening events or treatment-related deaths occurred. INTERPRETATION: Lubiprostone was well tolerated and reduced the levels of liver enzymes in patients with NAFLD and constipation. Further studies are necessary to better define the efficacy and tolerability of lubiprostone in patients with NAFLD without constipation. FUNDING: Mylan EPD G.K.


Assuntos
Alanina Transaminase/sangue , Diarreia , Fígado , Lubiprostona , Hepatopatia Gordurosa não Alcoólica , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/etiologia , Diarreia/induzido quimicamente , Diarreia/diagnóstico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Monitoramento de Medicamentos/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Laxantes/administração & dosagem , Laxantes/efeitos adversos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Testes de Função Hepática , Lubiprostona/administração & dosagem , Lubiprostona/efeitos adversos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(28): e21145, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664145

RESUMO

INTRODUCTION: Constipation is a common nonmotor symptom of Parkinson disease (PD). Constipation can also impact patient's quality of life. Chinese herbal medicines have been used for the treatment of constipation in PD. This trial will evaluate the efficacy and safety of a Chinese herbal formula Bushen Yisui and Ziyin Jiangzhuo (BYZJ) for the treatment of constipation in PD. METHODS AND ANALYSIS: This randomized, double-blind, placebo-controlled, multicenter clinical trial will involve 4 hospitals in Beijing, China. The study will aim to recruit 90 PD patients with constipation between 30 and 80 years-of age with a score of 1 - 4 on the Hoehn and Yahr scale. Once recruited, Patients will be randomized into a BYZJ group or a placebo group in a 2:1 ratio. The trial will include a 1-week run-in period, a 4-week double-blind treatment period, a 4-week and a 12-week follow-up period. All patients will be educated about PD-related constipation during the run-in period. BYZJ granules and simulated granules will be administered twice daily for 4 weeks to the BYZJ group and the placebo group respectively. Assessments will be performed during run-in period, before the start of treatment (baseline, week 0), and at 4, 8, and 16 weeks. The primary outcome will be measured with the Constipation Severity Instrument, and secondary outcomes will be evaluated with the Patient Assessment of Constipation Quality of Life questionnaire, Bristol Stool Form Scale, Movement Disorders-Unified Parkinson Disease Rating Scale, Nonmotor Symptoms Scale, PD Sleep Scale, Parkinson Fatigue Scale-16. Laxative use (dose and frequency) will also be recorded. Intention-to-treat and per-protocol set analyses will be used to compare symptom improvement between the 2 groups. Any adverse events will be recorded. DISCUSSION: If found effective and safe, BYZJ formula will be one of Chinese herb to treat constipation and even other nonmotor or motor symptoms in PD patients. The results will sustain the broader use of BYZJ formula in PD.


Assuntos
Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Medicamentos de Ervas Chinesas/uso terapêutico , Doença de Parkinson/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-32545800

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional diseases of the gastrointestinal tract. A typical symptom is changed bowel patterns: diarrhea, constipation, or alternation of the two. Abdominal pains vary in intensity and location, with periods of exacerbation and remission, causing disorganization in everyday life and work. Educational intervention could be one strategy to improve the well-being of IBS patients. Only a few trials have examined this hypothesis. The aim of this study was to examine the effect of an educational program combined with elements of behavioral therapy, individualized for each patient, on quality of life (QOL) and severity of pain of patients with IBS. METHODS: In total, 150 IBS patients and 100 healthy persons in the control group were included. QOL (36-Item Short Form Health Survey, SF-36) and pain severity (Visual Analogue Scale) were measured at baseline and six months after education of IBS patients. RESULTS: At baseline, patients with IBS showed highly significantly worse QOL. In the IBS group, significantly higher physical component summary (PCS) and mental component summary (MCS) scores were noted for 35- to 50-year-old patients compared to other patients. Six months after education and behavioral therapy, significant improvement in QOL and a significant decrease in the subjective perception of pain severity were noted compared to values before therapeutic education. CONCLUSION: An educational program combined with elements of behavioral therapy, individualized for patients with IBS, is an important part of therapy for these patients.


Assuntos
Síndrome do Intestino Irritável , Educação de Pacientes como Assunto , Qualidade de Vida , Dor Abdominal , Adulto , Constipação Intestinal/etiologia , Diarreia/etiologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
Indian J Gastroenterol ; 39(2): 147-152, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32406008

RESUMO

OBJECTIVES: Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon. METHODS: All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation. RESULTS: Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59. CONCLUSIONS: Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.


Assuntos
Malformações Anorretais/complicações , Malformações Anorretais/diagnóstico , Colo/patologia , Constipação Intestinal/etiologia , Adolescente , Fatores Etários , Biópsia/métodos , Criança , Pré-Escolar , Doença Crônica , Colo/diagnóstico por imagem , Constipação Intestinal/diagnóstico , Constipação Intestinal/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Manometria , Reto/patologia , Reto/fisiopatologia , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 99(19): e20098, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384482

RESUMO

Bacillus coagulans (PROBACI) bacteria have been examined for efficacy against infectious or inflammatory bowel diseases. The aim of this observational and cross-sectional study was to evaluate the effects of PROBACI against various functional bowel symptoms.Thirty-eight enrolled patients (36.5 ±â€Š12.6 years) with functional bowel disorders in a gastrointestinal clinic were administered PROBACI (300-mg formulation containing 1 × 10 colony-forming units of B coagulans) twice/day over a 4-week period. Abdominal pain, abdominal distention, and global assessment were evaluated using a 5-point visual analog scale. The defecation characteristics, discomfort level, and effort required for defecation were recorded. The gut-microbiota composition in terms of the Firmicutes/Bacteroidetes ratio was analyzed by 16S-ribosomal RNA gene sequencing with stool samples at days 0, 14, and 28 post-treatment.The 38 patients achieved significant improvements in abdominal pain (2.8 ±â€Š0.5 to 3.3 ±â€Š0.7, P = .0009), abdominal distention (2.5 ±â€Š0.7 to 3.2 ±â€Š0.8, P = .0002), and global assessment (2.7 ±â€Š0.6 to 3.6 ±â€Š0.7, P = .0001) from days 0 to 14. Compared with the diarrhea group, the constipation group achieved greater improvements in terms of discomfort during defecation (2.5 ±â€Š0.7 to 3.1 ±â€Š0.7, P = .02) and normalization of defecation style (50% vs 7.1%, P = .007) by day 28. A difference was observed in the Firmicutes/Bacteroidetes ratio between the constipation-dominant group (118.0) and diarrhea-dominant group (319.2), but this difference was not significant.PROBACI provided control of abdominal pain, less discomfort during defecation, and a more normalized defecation style, especially in the constipation-dominant group.


Assuntos
Bacillus coagulans , Terapia Biológica/métodos , Constipação Intestinal/terapia , Adulto , Constipação Intestinal/etiologia , Estudos Transversais , Feminino , Gastroenteropatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
Complement Ther Clin Pract ; 39: 101108, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379648

RESUMO

OBJECTIVES: The aim of this study was to evaluate complementary and alternative medicines (CAM) used by cancer patients to cope with chemotherapy-induced constipation, and attitudes of the patients toward CAM. METHODS: This descriptive study was conducted in an adult oncology unit of a university hospital with 214 cancer patients receiving chemotherapy. Data were collected with the Patient Identification Form and Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ). RESULTS: Of the participants, 21.5% had information about CAM, the main source of information was the internet and social media (54.8%), and 31.8% used CAM in coping with chemotherapy-induced constipation. The most common method was phytotherapy (97.1%). The most commonly used herb was apricot (39.4%); the HCAMQ mean score was 34.3 (±4.6). CONCLUSION: Cancer patients frequently use CAM to cope with chemotherapy-induced constipation and the most common CAM used by patients is phytotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Neoplasias , Fitoterapia , Adulto , Idoso , Terapias Complementares/estatística & dados numéricos , Constipação Intestinal/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Prunus armeniaca , Inquéritos e Questionários
17.
Zhongguo Zhen Jiu ; 40(5): 493-7, 2020 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-32394656

RESUMO

OBJECTIVE: To verify the clinical effect of acupoint embedding therapy on post-stroke constipation. METHODS: The multi-central randomized controlled trial was adopted. 210 patients of post-stroke constipation were divided into an acupoint embedding group (105 cases, 4 cases dropped off) and a sham-embedding group (105 cases, 6 cases dropped off). In the acupoint embedding group, the acupoint embedding therapy was used at Tianshu (ST 25), Daheng (SP 15), Xiawan (CV 10), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4) and Daju (ST 27). In the sham-embedding group, the sham-embedding therapy was given, in which, the acupoint selection, needle devices and manipulation were the same as the acupoint embedding group. But, no absorbable surgical suture was used in the needle tube. The treatment was given once every two weeks and 4 treatments were required in either group. It was to compare the weekly average complete spontaneous bowel movements (CSBMs) during treatment (from the 3rd to the 8th week) between the two groups, the weekly average spontaneous bowel movements (SBMs), Bristol stool form score (BSFS), the score of the patient assessment of constipation quality of life questionnaire (PAC-QOL) and the score of defecation difficulty before and after treatment. RESULTS: The percentage of the cases with weekly average CSBMs ≥ 3 times in the patients of the acupoint embedding group was higher markedly than the sham-embedding group [91.1% (92/101) vs 43.4% (43/99), P<0.01]. Compared with the values before treatment, the weekly average SBMs and BSFS scores after treatment were all increased obviously in the two groups (P<0.01), and PAC-QOL score and the score of defecation difficulty were reduced remarkably (P<0.01). After treatment, the increase range of SBMs and BSFS scores, as well as the decrease range of PAC-QOL score and the defecation difficulty score in the acupoint embedding group were all higher than the sham-embedding group respectively (P<0.05). CONCLUSION: The acupoint embedding therapy remarkably increases the spontaneous bowel movements, improves in feces form and defecation difficulty and strengthens the quality of life in the patients of post-stroke constipation.


Assuntos
Terapia por Acupuntura , Constipação Intestinal/terapia , Acidente Vascular Cerebral/complicações , Pontos de Acupuntura , Constipação Intestinal/etiologia , Humanos , Qualidade de Vida , Resultado do Tratamento
18.
Aliment Pharmacol Ther ; 51(12): 1332-1341, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406112

RESUMO

BACKGROUND: Linaclotide, a guanylate cyclase C agonist relieves irritable bowel syndrome with predominant constipation (IBS-C) symptoms, but how it improves pain in humans is unknown. AIMS: To investigate the effects of linaclotide and placebo on the afferent and efferent gut-brain-gut signalling in IBS-C patients, in a randomised clinical trial. METHODS: Patients with IBS-C (Rome III) and rectal hypersensitivity were randomised (2:1) to receive linaclotide (290 µg) or placebo for 10 weeks and undergo bi-directional gut and brain axis assessment using anorectal electrical stimulations and transcranial/transspinal-anorectal magnetic stimulations. Rectal sensations were examined by balloon distention. Assessments included abdominal pain, bowel symptoms and quality of life (QOL) scores. Primary outcomes were latencies of recto-cortical and cortico-rectal evoked potentials. RESULTS: Thirty-nine patients participated; 26 received linaclotide and 13 received placebo. Rectal cortical evoked potentials latencies (milliseconds) were significantly prolonged with linaclotide compared to baseline (P1:Δ 19 ± 6, P < 0.005; N1:Δ 20 ± 7, P < 0.02) but not with placebo (P1:Δ 3 ± 5; N1:Δ 4.7 ± 5,P = 0.3) or between groups. The efferent cortico-anorectal and spino-anorectal latencies were unchanged. The maximum tolerable rectal volume (cc) increased significantly with linaclotide compared to baseline (P < 0.001) and placebo (Δ 29 ± 10 vs 4 ± 20, (P < 0.03). Abdominal pain decreased (P < 0.001) with linaclotide but not between groups. Complete spontaneous bowel movement frequency increased (P < 0.001), and IBS-QOL scores improved (P = 0.01) with linaclotide compared to baseline and placebo. There was no difference in overall responders between linaclotide and placebo (54% vs 23%, P = 0.13). CONCLUSIONS: Linaclotide prolongs afferent gut-brain signalling from baseline but both afferent and efferent signalling were unaffected compared to placebo. Linaclotide significantly improves rectal hypersensitivity, IBS-C symptoms and QOL compared to placebo. These mechanisms may explain the effects of linaclotide on pain relief in IBS-C patients. ClinicalTrials.Gov: Registered at Clinical trials.gov no NCT02078323.


Assuntos
Dor Abdominal/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Intestinos/efeitos dos fármacos , Síndrome do Intestino Irritável/tratamento farmacológico , Peptídeos/uso terapêutico , Dor Abdominal/etiologia , Dor Abdominal/microbiologia , Adulto , Encéfalo/fisiologia , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/etiologia , Constipação Intestinal/microbiologia , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/fisiologia , Humanos , Intestinos/fisiologia , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/microbiologia , Masculino , Pessoa de Meia-Idade , Placebos , Qualidade de Vida , Reto/efeitos dos fármacos , Reto/fisiologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Resultado do Tratamento
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