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2.
Neurogastroenterol Motil ; 31(1): e13441, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30125427

RESUMO

BACKGROUND: Patients with functional chronic constipation (CFC) often select nonpharmacological treatments. We aimed to examine the comparative effectiveness of nonpharmacological conservative treatments in treating CFC. METHODS: We searched MEDLINE, EMBASE, Cochrane library, CINAHL, AMED, ISI web of knowledge, and conference proceedings from January 2000 to June 2016. Randomized controlled trials comparing nonpharmacological conservative treatments with placebo, sham interventions, or conventional treatments were included. Nonpharmacological conservative treatments were defined as interventions without involvement of medication or surgery. We extracted trial data in duplicate and assessed the risk of bias. We pooled continuous data using standard mean differences (SMDs) and binary data using risk ratios (RRs), and we provided their 95% confidence intervals. KEY RESULTS: We included 33 trials (4324 participants and 8 nonpharmacological treatments). Compared with placebo interventions, TENS (SMD 1.60, 95% CI 0.28-2.92), probiotic (SMD 1.40, 95% CI 0.94-1.86), and acupuncture (SMD 1.00, 95% CI 0.39-1.60) had significantly larger effect on stool frequency; acupuncture (RR 1.56, 95% CI 1.14-2.14) had significantly higher responder rate; and moxibustion (SMD 2.50, 95% CI 0.05-4.95) had significant larger effect on Bristol score. Compared with laxative, acupuncture had significantly larger effect on stool frequency (RR 2.01, 95% CI 1.16-3.49) and had lower rate of adverse events (RR 0.38, 95% CI 0.18-0.80). CONCLUSIONS: TENS and acupuncture relatively ranked the best in managing CFC, but the results should be interpreted with caution due to small study effects. Registration number: PROSPERO CRD42014006686.


Assuntos
Doenças Funcionais do Colo/terapia , Tratamento Conservador/métodos , Constipação Intestinal/terapia , Humanos
3.
Ugeskr Laeger ; 180(24)2018 Jun 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29886890

RESUMO

Many school children complain about recurrent abdominal pain. These children have diminished quality of life, increased school absence and functional disability. Despite the high prevalence and well-documented consequences for patients, their families and society, there is a remarkable lack of evidence-based treatments available. Hypnotherapeutic treatment (HT) has shown promising results. In this review, we discuss current research on HT of these patients. In conclusion, further studies are needed to confirm the effect of HT on functional abdominal pain disorder and to optimise the treatment format.


Assuntos
Dor Abdominal/terapia , Hipnose , Dor Abdominal/diagnóstico , Adolescente , Criança , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Colorectal Dis ; 19(8): 756-763, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28181378

RESUMO

AIM: Poor functional results, such as faecal incontinence (FI), low anterior resection syndrome (LARS) or high stool frequency, can occur after colorectal resections, including proctocolectomy with ileal pouch-anal anastomosis (IPAA), rectal resection and left hemicolectomy. Management of such patients is problematic, and some case reports have demonstrated the effectiveness of sacral nerve stimulation (SNS) in these situations. Our aim was to analyse the effectiveness of SNS on poor functional results and on quality of life in patients after treatment with different types of colorectal resection. METHOD: At five university hospitals from 2006 to 2014, patients with poor functional results after rectal resection, IPAA or left hemicolectomy underwent a staged SNS implant procedure. Failure was defined by the absence or insufficient improvement (< 50%) of FI episodes. RESULTS: SNS for bowel dysfunction was performed in 16 patients after rectal resection with coloanal anastomosis, left hemicolectomy with colorectal anastomosis or IPAA. Two (13%) cases of primary failure were observed after the percutaneous stimulation test. Median frequency of stool, FI episodes and urgency were significantly improved in 14 patients. Wexner and LARS scores were also significantly improved for 14 patients. When we compared results according to the type of colorectal surgery (IPAA, rectal resection or left hemicolectomy), median frequencies of stool and urgency, Wexner and LARS scores were still significantly improved. Overall success rate was 75% (12/16 patients) in intention-to-treat analysis and 86% (12/14 patients with permanent electrode) in per-protocol analysis. CONCLUSION: SNS seems to improve bowel dysfunction following rectal resection, left hemicolectomy or IPAA.


Assuntos
Colectomia/efeitos adversos , Doenças Funcionais do Colo/terapia , Plexo Lombossacral , Complicações Pós-Operatórias , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Colo/cirurgia , Doenças Funcionais do Colo/etiologia , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Reto/cirurgia , Resultado do Tratamento , Adulto Jovem
5.
Forsch Komplementmed ; 23(6): 356-363, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27924798

RESUMO

BACKGROUND: Magnesium sulfate has a long tradition as a laxative. It osmotically prevents water absorption in the large bowel and thus leads to an acceleration of the intestinal transit and better stool consistency. We wanted to investigate the efficacy of a carbonated calcium/magnesium sulfate-rich natural mineral water in subjects with functional constipation (FC). PATIENTS AND METHODS: In this double-blind, randomized, placebo-controlled study, subjects with FC (Rome III criteria) received 1 l/day (4 × 250 ml) of mineral water (Ensinger Schiller Quelle) or carbonated tap water (placebo) for 6 weeks. The primary endpoint was the change in the frequency of bowel movements per week between baseline and visit 4 (after 6 weeks). The prespecified main secondary endpoint was the change in the frequency of bowel movements per week between baseline and visit 3 (after 3 weeks). RESULTS: Efficacy was analyzed in 100 subjects (intention-to-treat). After 6 weeks of treatment there was no statistical difference between the groups (p = 0.163). However, statistical significance was reached after 3 weeks, with an increase in the frequency of bowel movements per week of 2.02 ± 2.22 for the mineral water group compared to 0.88 ± 1.67 for the placebo group (p = 0.005). CONCLUSIONS: A 3-week treatment with 1 l/day of the sulfate-rich mineral water improved the frequency of bowel movements in subjects with FC compared with tap water; however, the difference was no longer significant after 6 weeks. Further evaluation in rigorously designed clinical studies will be necessary to validate the impact of sulfate-rich natural mineral water on FC.


Assuntos
Água Carbonatada/uso terapêutico , Doenças Funcionais do Colo/terapia , Constipação Intestinal/terapia , Sulfato de Magnésio/uso terapêutico , Adulto , Doença Crônica , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Alemanha , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Tech Coloproctol ; 20(1): 25-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26519287

RESUMO

BACKGROUND: Antegrade colonic enemas are used in patients with colorectal dysfunction resistant to conservative therapy. A number of different operative techniques are applied, but their effectiveness is by and large unknown. We therefore evaluated the long-term usefulness of the left-sided percutaneous endoscopic gastrostomy (PEG) tube method in adult patients. METHODS: Twenty-one patients with colorectal dysfunction underwent insertion of a PEG tube colostomy by laparotomy between 1997 and 2006. In 2014, we evaluated how many of the patients had the tube still in place, how the patients coped with the tube, and what the reasons for the removal were. RESULTS: The main indications were severe constipation or fecal incontinence mainly related to neurological diseases. In 2014, 5 out of 21 patients had the tube still in use (median follow-up 14 years, range 11-17 years) and 4 out of 5 deceased patients had had the tube in use until their death, unrelated to this treatment (median follow-up 7 years, range 0-8 years). Four out of the 5 living patients considered the benefit of the tube to be good or excellent. Tubes were removed in 11 (52%) patients for various reasons, local skin irritation being the most common. CONCLUSIONS: A left-sided PEG tube colostomy was removed in over half of the patients, but despite that, it still seems to be a viable long-term option in the treatment of individual patients with colorectal dysfunction, when conservative methods are ineffective.


Assuntos
Doenças Funcionais do Colo/terapia , Endoscopia Gastrointestinal/métodos , Enema/métodos , Gastrostomia/métodos , Adulto , Idoso , Colo Sigmoide/cirurgia , Constipação Intestinal/terapia , Incontinência Fecal/terapia , Feminino , Seguimentos , Gastrostomia/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Artigo em Alemão | MEDLINE | ID: mdl-25478715

RESUMO

Relationship Pattern of Mothers with Functional Constipated Infants The present article investigates whether or not mothers of infants with functional constipation have a specific relationship pattern. This question is addressed by analyzing the data collected at the day care clinic for infant regulation disorders with appropriate methods like the questionnaire for the assessment of adjustment of mothers with children in infancy (EMKK, Engfer u. Codreanu, 1984) described here. The evaluation of data was performed in two ways: first with regard to the clinical study group of mothers with infants (age range from one to five years) suffering from functional constipation, and then compared to a clinical control group of mothers with infants who are coping with regulation disorders (by definition per Papousek, Schieche, Wurmser, 2010). With this comparison differences between the two groups are made visible and clinical interventions can be deduced accordingly. If the groups do not differ in their pattern described by the EMKK, the possible interventions can be adopted from the well-studied area of regulation disorders. The focus on analyzing the data of mothers with functional constipated infants serves as an important starting point for providing the best possible alignment of clinical intervention.


Assuntos
Doenças Funcionais do Colo/psicologia , Constipação Intestinal/psicologia , Relações Mãe-Filho , Adaptação Psicológica , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/psicologia , Transtornos de Adaptação/terapia , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/psicologia , Sintomas Afetivos/terapia , Pré-Escolar , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/terapia , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Hospital Dia , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/psicologia , Deficiências do Desenvolvimento/terapia , Feminino , Humanos , Lactente , Masculino , Comportamento Materno/psicologia , Psicometria , Inquéritos e Questionários
9.
Ther Umsch ; 71(9): 551-8, 2014 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-25154691

RESUMO

The most important reason for functional diarrhea in clinical practice is diarrhea-predominant irritable bowel syndrome (IBS) which is characterized by chronic intermittent diarrhea and abdominal pain. The pathophysiology underlying IBS is complex and includes visceral hypersensitivity, abnormal gut motility and autonomous nervous system dysfunction as well as genetic and psychosocial factors. Treatment should be tailored to the individual's symptoms and involves general measures, pharmacological treatments, dietary interventions, psychotherapy and complementary and alternative approaches. The following manuscript will give an overview over pathophysiology, reasonable investigations and treatment of IBS.


Assuntos
Doenças Funcionais do Colo/diagnóstico , Diarreia/etiologia , Encéfalo/fisiopatologia , Doenças Funcionais do Colo/fisiopatologia , Doenças Funcionais do Colo/terapia , Diagnóstico Diferencial , Diarreia/fisiopatologia , Diarreia/terapia , Sistema Nervoso Entérico/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Humanos , Intestinos/inervação , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/terapia
12.
Am J Clin Hypn ; 55(2): 160-7, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23189520

RESUMO

The river approach has been used effectively in the treatment of irritable bowel syndrome within the U.K. National Health Service (Gonsalkorale, Houghton, & Whorwell, 2002; Whorwell, 2006) and in single case studies (Galovski & Blanchard, 2002; Zimmerman, 2003; Kraft & Kraft, 2007). Zimmerman (2003) pointed out that this metaphor was extremely powerful in that it linked the altered motility of the digestive system to an emotional disturbance: by encouraging his patient to imagine a smooth flowing river, he helped her to come to terms with her emotional conflict and, in turn, to experience normal gut activity. The author reviews this approach to treatment and offers an alternative which utilizes process suggestions, accessing questions and truisms while providing clients with the space to imagine their own tailor-made scene.


Assuntos
Doenças Funcionais do Colo/terapia , Hipnose , Metáfora , Transtornos Somatoformes/terapia , Sugestão , Feminino , Humanos
13.
Gastroenterol Clin North Am ; 41(4): 805-19, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23101688

RESUMO

Irritable bowel syndrome (IBS) and chronic constipation (CC) are common problems worldwide and are associated with significant impact on activities of daily living and quality of life. Recent interest, in IBS in particular, has focused on the potential roles of the microbiota and its interaction with the host's immune system. Recently, high-quality clinical trials have been performed on prebiotics and probiotics in IBS or CC. Although strategies that seek to modify the microbiota, such as the use of probiotics, offer much promise in IBS and CC, more high-quality trials and, studies of longer duration are required.


Assuntos
Doenças Funcionais do Colo/microbiologia , Doenças Funcionais do Colo/terapia , Metagenoma/fisiologia , Probióticos/uso terapêutico , Doença Crônica , Constipação Intestinal/microbiologia , Constipação Intestinal/terapia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/fisiopatologia , Humanos , Síndrome do Intestino Irritável/microbiologia , Síndrome do Intestino Irritável/terapia
14.
Nurs Times ; 108(18-19): 24-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22708193

RESUMO

This article discusses the prevalence, causes and impact of bowel dysfunction among adults, and suggests that anal irrigation may be considered as a viable alternative for selected patients who experience long-standing problems, where previous treatments have proved ineffective. Two case studies demonstrate the positive benefits of anal irrigation, and discuss some of the incidental findings such as fewer urinary tract.


Assuntos
Canal Anal , Doenças Funcionais do Colo/terapia , Irrigação Terapêutica , Doenças Funcionais do Colo/fisiopatologia , Humanos
15.
ANZ J Surg ; 82(6): 420-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22571474

RESUMO

BACKGROUND: Restoration of bowel continuity after a temporary loop ileostomy following rectal resection often produces impaired bowel function. The purpose of this clinical trial was to assess the efficacy of a probiotic, VSL#3 (VSL Pharmaceuticals Inc., Gaithersburg, MD, USA), in improving bowel function following ileostomy closure. METHODS: Between March 2005 and April 2008, a prospective, double-blind, placebo-controlled randomized trial of a probiotic preparation was conducted across four South Australian hospitals. Sixty-three patients who underwent a loop ileostomy reversal were randomized to receive 4-week treatment of either probiotic therapy (n= 31) or placebo (n= 32). Bowel symptomology was collected through a patient-completed bowel diary and the Gastrointestinal Quality of Life Index (GIQLI). RESULTS: Completion rates of the 4-week therapy regime were similar for both groups: 18 active versus 20 placebos. There was no statistically significant difference in the number of patients who withdrew or had adverse events in the two treatment groups. Reasons for patient withdrawal from the study were similar for both groups. Repeated measures analysis of variance showed no statistically significant difference between the GIQLI scores for the two treatment groups. CONCLUSIONS: The use of the probiotic preparation, VSL#3, did not alter the post-operative bowel function of patients undergoing loop ileostomy reversal.


Assuntos
Doenças Funcionais do Colo/terapia , Ileostomia , Complicações Pós-Operatórias/terapia , Probióticos/uso terapêutico , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Funcionais do Colo/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Neoplasias Retais/cirurgia , Inquéritos e Questionários , Síndrome , Resultado do Tratamento
16.
Eur J Gastroenterol Hepatol ; 24(1): 1-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21915059

RESUMO

The nature and determinants of the placebo response are widely unknown, as are the underlying psychological and biological mechanisms. Placebo response rates in functional bowel disorders (functional dyspepsia, irritable bowel syndrome) trials are similar to those in nonintestinal pain conditions and are comparable with other organic gastrointestinal diseases (duodenal ulcer, inflammatory bowel diseases). In this narrative review, different methodologies (meta-analyses, reanalyses, and experimental setups) are discussed that have been applied to the study of the placebo response in functional dyspepsia and the irritable bowel syndrome.


Assuntos
Doenças Funcionais do Colo/terapia , Efeito Placebo , Humanos , Metanálise como Assunto , Dor/prevenção & controle , Projetos de Pesquisa , Resultado do Tratamento
17.
Curr Opin Pharmacol ; 11(6): 624-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22019567

RESUMO

Colonic motor abnormalities are implicated in several gastrointestinal disorders including constipation, irritable bowel syndrome and functional diarrhoea. Defining the colonic abnormalities is difficult and several novel techniques including, high-resolution fibre optic manometry, wireless motility capsules, ultrasound and magnetic resonance imaging have emerged to help in the diagnosis of these conditions. Coupled with the developing techniques are the novel treatments that look to restore normal colonic motility. These treatments include pharmacological agents (pharmabiotics, serotonin agonist, secretagogues) and medical devices (sacral nerve stimulation, transcutaneous electrical stimulation and biofeedback). This review summarizes the novel techniques used to record and define colonic motor abnormalities and the current status of the emerging treatments used to treat them.


Assuntos
Colo/fisiopatologia , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/terapia , Motilidade Gastrointestinal , Colo/efeitos dos fármacos , Doenças Funcionais do Colo/tratamento farmacológico , Doenças Funcionais do Colo/fisiopatologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Diarreia/fisiopatologia , Diarreia/terapia , Terapia por Estimulação Elétrica/métodos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/terapia , Probióticos/uso terapêutico
18.
Swiss Med Wkly ; 141: w13239, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21805410

RESUMO

BACKGROUND: Evaluating the effects of a commercially available synbiotic preparation (contains both prebiotic and probiotic elements) on functional constipation in males. METHODS: In a randomised controlled trial, a total of 66 adult men with functional constipation were equally allocated to receive a synbiotic mixture or a placebo. The synbiotic mixture or placebo was given as capsules with the same shape and colour, and patients received the capsules twice a day for 4 weeks. RESULTS: A total of 60 patients (31 in the synbiotic group) completed the study. At baseline evaluation, there was no significant difference between the mean stool frequency per week in synbiotic and placebo groups [mean difference of 0.11 times (95% CI: -0.31-0.55), p = 0.58]. However, mean stool frequency increased significantly at weeks 2 [mean difference of 1.32 times (95% CI: 0.21-2.43)] and 4 [mean difference of 1.58 times (95% CI: 0.18-2.99)] in the synbiotic group compared with the placebo group (p = 0.02). A significant difference (p = 0.006) was found at weeks 2 [mean difference of 0.83 (95% CI: 0.20-1.45)] and 4 [mean difference of 0.91 (95% CI: 0.3-1.51)] between the synbiotic and placebo groups regarding the Bristol stool form score. No adverse effect was seen in the synbiotic group. CONCLUSION: The results of this study indicated that this specific commercial product seemed to be effective in increasing stool frequency and improving consistency in this sample of males with functional constipation. However, further studies with longer follow ups, and including females and elderly patients are required to confirm the efficacy of this product for treatment of functional constipation.


Assuntos
Doenças Funcionais do Colo/terapia , Constipação Intestinal/terapia , Defecação/fisiologia , Simbióticos , Adulto , Apetite , Constipação Intestinal/fisiopatologia , Fezes , Humanos , Irã (Geográfico) , Masculino , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
20.
J Eval Clin Pract ; 17(3): 515-9, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21569182

RESUMO

RATIONALE, AIMS AND OBJECTIVES: As with many functional disorders, rumination syndrome poses a great dilemma when approached via standard of care. This case report illustrates how rumination syndrome may be effectively approached using the systems medicine. METHOD: The patient's treatment involved two distinctively different treatment cycles. Initially she was treated in an academic tertiary inpatient and outpatient multidisciplinary program with a primary symptom-based focus with little improvement. She subsequently sought care at a systems-based integrative medicine clinic within an academic family medicine centre, which identified the inciting events, diagnosed the current pathology and developed a stepwise treatment plan. RESULTS: The patient is now rumination free. CONCLUSION: Chronic or refractory diseases, especially when regarded as 'functional' may be approached by a systems medicine methodology, which allows physicians to fine-tune the vast amount of specific pieces of knowledge to achieve an integrated approach to managing the whole person.


Assuntos
Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/terapia , Medicina de Precisão/métodos , Biologia de Sistemas , Adolescente , Criança , Doença Crônica , Diagnóstico Diferencial , Dietoterapia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos
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