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1.
Pediatr Allergy Immunol ; 35(6): e14163, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38825829

RESUMO

The recognition of constipation as a possible non-Immunoglobulin E (IgE)-mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE-mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non-IgE-Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review.


Assuntos
Constipação Intestinal , Hipersensibilidade Alimentar , Humanos , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Constipação Intestinal/etiologia , Criança , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/terapia , Pré-Escolar , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/terapia , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/imunologia , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Técnica Delphi , Guias de Prática Clínica como Assunto , Lactente , Alérgenos/imunologia , Animais , Prevalência
3.
Pediatr Surg Int ; 40(1): 147, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824249

RESUMO

PURPOSE: The objective was to compare the immediate effects of pharmacological versus physiotherapy intervention versus a combination of physiotherapy and pharmacological treatment, as well as the quality of life and the recurrence of symptoms in children with functional constipation after 3 months. METHODS: A total of 69 children with functional constipation between the ages of 5 and 14 years of either gender were assessed and randomly assigned to one of three groups: Group A, B, and C. Visual Analogue Scale, Bristol Stool Form Scale, frequency of defecation, PedsQL GI symptom scale, and PedsQL Generic Core Scale were used as outcome measures. Pharmacology was used to treat Group A, physiotherapy was used to treat Group B, and a combination of both was used to treat Group C. RESULTS: The study revealed statistically significant results on Visual Analogue Scale, Bristol Stool Form Scale, and frequency of defecation in all groups. However, no significant changes were observed on the PedsQL GI symptom scale and the Generic Core scale in Group A, whereas significant changes were observed in Groups B and C. CONCLUSION: In this study, we found that there were significant differences in the short- and long-term effects across all groups. More changes occurred in Group C than in Groups A and B.


Assuntos
Constipação Intestinal , Modalidades de Fisioterapia , Qualidade de Vida , Humanos , Constipação Intestinal/terapia , Constipação Intestinal/fisiopatologia , Feminino , Masculino , Criança , Pré-Escolar , Adolescente , Resultado do Tratamento , Defecação/fisiologia , Terapia Combinada
4.
World J Gastroenterol ; 30(20): 2709-2725, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38855154

RESUMO

BACKGROUND: Constipation, a highly prevalent functional gastrointestinal disorder, induces a significant burden on the quality of patients' life and is associated with substantial healthcare expenditures. Therefore, identifying efficient therapeutic modalities for constipation is of paramount importance. Oxidative stress is a pivotal contributor to colonic dysmotility and is the underlying pathology responsible for constipation symptoms. Consequently, we postulate that hydrogen therapy, an emerging and promising intervention, can serve as a safe and efficacious treatment for constipation. AIM: To determine whether hydrogen-rich water (HRW) alleviates constipation and its potential mechanism. METHODS: Constipation models were established by orally loperamide to Sprague-Dawley rats. Rats freely consumed HRW, and were recorded their 24 h total stool weight, fecal water content, and charcoal propulsion rate. Fecal samples were subjected to 16S rDNA gene sequencing. Serum non-targeted metabolomic analysis, malondialdehyde, and superoxide dismutase levels were determined. Colonic tissues were stained with hematoxylin and eosin, Alcian blue-periodic acid-Schiff, reactive oxygen species (ROS) immunofluorescence, and immunohistochemistry for cell growth factor receptor kit (c-kit), PGP 9.5, sirtuin1 (SIRT1), nuclear factor-erythroid-2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1). Quantitative real-time PCR and western blot analysis were conducted to determine the expression level of SIRT1, Nrf2 and HO-1. A rescue experiment was conducted by intraperitoneally injecting the SIRT1 inhibitor, EX527, into constipated rats. NCM460 cells were induced with H2O2 and treated with the metabolites to evaluate ROS and SIRT1 expression. RESULTS: HRW alleviated constipation symptoms by improving the total amount of stool over 24 h, fecal water content, charcoal propulsion rate, thickness of the intestinal mucus layer, c-kit expression, and the number of intestinal neurons. HRW modulated intestinal microbiota imbalance and abnormalities in serum metabolism. HRW could also reduce intestinal oxidative stress through the SIRT1/Nrf2/HO-1 signaling pathway. This regulatory effect on oxidative stress was confirmed via an intraperitoneal injection of a SIRT1 inhibitor to constipated rats. The serum metabolites, ß-leucine (ß-Leu) and traumatic acid, were also found to attenuate H2O2-induced oxidative stress in NCM460 cells by up-regulating SIRT1. CONCLUSION: HRW attenuates constipation-associated intestinal oxidative stress via SIRT1/Nrf2/HO-1 signaling pathway, modulating gut microbiota and serum metabolites. ß-Leu and traumatic acid are potential metabolites that upregulate SIRT1 expression and reduce oxidative stress.


Assuntos
Colo , Constipação Intestinal , Modelos Animais de Doenças , Hidrogênio , Fator 2 Relacionado a NF-E2 , Estresse Oxidativo , Ratos Sprague-Dawley , Transdução de Sinais , Sirtuína 1 , Animais , Constipação Intestinal/metabolismo , Constipação Intestinal/tratamento farmacológico , Sirtuína 1/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Fator 2 Relacionado a NF-E2/metabolismo , Transdução de Sinais/efeitos dos fármacos , Ratos , Hidrogênio/farmacologia , Masculino , Colo/efeitos dos fármacos , Colo/metabolismo , Colo/patologia , Humanos , Água/metabolismo , Heme Oxigenase-1/metabolismo , Heme Oxigenase (Desciclizante)/metabolismo , Fezes/química
5.
BMJ Paediatr Open ; 8(1)2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844387

RESUMO

BACKGROUND: Therapy-resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements faecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy-resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures. AIM: To conduct a systematic review determining how paediatric interventional studies define therapy-resistant constipation. METHOD: We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy-resistant constipation were identified. Data were extracted on criteria used for defining therapy-resistant constipation and reported using a meta-narrative approach highlighting areas of convergence and divergence in the findings. RESULTS: A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least seven definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy-resistant constipation. Out of them, only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy-resistant constipation. The duration before being diagnosed as therapy-resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation while five adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children. CONCLUSION: The current literature has no explicit definition for therapy-resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary and maybe even harmful, invasive diagnostic and therapeutic interventions.


Assuntos
Constipação Intestinal , Humanos , Constipação Intestinal/terapia , Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Criança , Adolescente , Pré-Escolar
6.
Sci Rep ; 14(1): 13516, 2024 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-38866797

RESUMO

Diarrhea and constipation are common health concerns in children. Numerous studies have identified strong association between gut microbiota and digestive-related diseases. But little is known about the gut microbiota that simultaneously affects both diarrhea and constipation or their potential regulatory mechanisms. Stool samples from 618 children (66 diarrhea, 138 constipation, 414 healthy controls) aged 0-3 years were collected to investigate gut microbiota changes using 16S rRNA sequencing. Compared with healthy, children with diarrhea exhibited a significant decrease in microbial diversity, while those with constipation showed a marked increase (p < 0.05). Significantly, our results firstly Ruminococcus increased in constipation (p = 0.03) and decreased in diarrhea (p < 0.01) compared to healthy controls. Pathway analysis revealed that Ruminococcus highly involved in the regulation of five common pathways (membrane transport, nervous system, energy metabolism, signal transduction and endocrine system pathways) between diarrhea and constipation, suggesting a potential shared regulatory mechanism. Our finding firstly reveals one core microorganisms that may affect the steady balance of the gut in children with diarrhea or constipation, providing an important reference for potential diagnosis and treatment of constipation and diarrhea.


Assuntos
Constipação Intestinal , Diarreia , Microbioma Gastrointestinal , RNA Ribossômico 16S , Humanos , Constipação Intestinal/microbiologia , Diarreia/microbiologia , Pré-Escolar , Lactente , Masculino , Feminino , RNA Ribossômico 16S/genética , Fezes/microbiologia , Recém-Nascido , China , Estudos de Casos e Controles , População do Leste Asiático
7.
Eur J Gastroenterol Hepatol ; 36(7): 815-830, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38829940

RESUMO

Currently, there are increasingly diverse treatment modalities for chronic functional constipation (CFC). This study aims to compare the relative efficacy and safety of chemical drugs, fecal microbiota transplantation (FMT), probiotics, dietary fiber, and acupuncture in the treatment of patients with CFC. We searched relevant randomized controlled trials (RCTs) published in five databases up to November 2023. Network meta-analysis (NMA) was carried out using R Studio 4.2.1. Cumulative ranking probability plots, assessed through the surface under the cumulative ranking (SUCRA), were employed to rank the included drugs for various outcome measures. We included a total of 45 RCT studies with 17 118 patients with CFC. From the SUCRA values and NMA results FMT showed the best utility in terms of clinical efficacy, Bristol stool form scale scores, patient assessment of constipation quality of life scores, and the treatment modality with the lowest ranked incidence of adverse effects was electroacupuncture. Subgroup analysis of the chemotherapy group showed that sodium A subgroup analysis of the chemical group showed that sodium picosulfate 10 mg had the highest clinical efficacy. FMT is more promising in the treatment of CFC and may be more effective in combination with the relatively safe treatment of acupuncture.


Assuntos
Terapia por Acupuntura , Constipação Intestinal , Fibras na Dieta , Transplante de Microbiota Fecal , Probióticos , Constipação Intestinal/terapia , Constipação Intestinal/microbiologia , Humanos , Transplante de Microbiota Fecal/efeitos adversos , Fibras na Dieta/uso terapêutico , Probióticos/uso terapêutico , Probióticos/efeitos adversos , Doença Crônica , Terapia por Acupuntura/métodos , Resultado do Tratamento , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Qualidade de Vida , Laxantes/uso terapêutico
8.
PLoS One ; 19(5): e0302430, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38776319

RESUMO

AIMS: Shorter and longer sleep durations are associated with adverse health consequences. However, available evidence on the association of sleep duration with constipation is limited, especially in patients with diabetes, who are at a high risk of both conditions. This study aimed to examine the association between sleep duration and constipation in patients with type 2 diabetes. METHODS: A total of 4,826 patients with type 2 diabetes were classified into six groups according to sleep duration: <4.5, 4.5-5.4, 5.5-6.4, 6.5-7.4, 7.5-8.4, and ≥8.5 hours/day. The odds ratios for the presence of constipation, defined as a defecation frequency <3 times/week and/or laxative use, were calculated using a logistic regression model. RESULTS: Shorter and longer sleep durations were associated with a higher likelihood of constipation than an intermediate duration (6.5-7.4 hours/day). This U-shaped association persisted after adjusting for confounding factors, including lifestyle behavior, measures of obesity and glycemic control, and comorbidities. Broadly identical findings were observed when decreased defecation frequency and laxative use were individually assessed. CONCLUSIONS: This study shows a U-shaped association between sleep duration and constipation in patients with type 2 diabetes, and highlights the importance of assessing sleep duration in daily clinical practice.


Assuntos
Constipação Intestinal , Diabetes Mellitus Tipo 2 , Sistema de Registros , Sono , Humanos , Constipação Intestinal/epidemiologia , Constipação Intestinal/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Sono/fisiologia , Japão/epidemiologia , Fatores de Tempo , Fatores de Risco , Duração do Sono
9.
J Trauma Nurs ; 31(3): 164-170, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38742725

RESUMO

BACKGROUND: Hospitalized patients are well described as having a high prevalence of constipation. While the risks associated with constipation in trauma patients are well known, the prevalence rate is not. OBJECTIVE: This study aims to measure the prevalence of constipation and associated risk factors in trauma patients. METHODS: This study is a single-center analytic cross-sectional study on constipation in hospitalized trauma patients aged 18-65 years, admitted from January 2021 to July 2021 to the trauma service at The Royal Melbourne Hospital, a Level I major trauma and teaching hospital servicing the state of Victoria, Australia. Exclusion criteria include patients with traumatic brain injury, blunt or penetrating abdominal or spinal injuries, pregnancy, and gastrointestinal comorbidities. RESULTS: A total of N = 99 patients were studied, of which n = 78 (78.8%) were male with a median (interquartile range) age of 46 years (33-58). The overall prevalence of constipation was 76%. The univariate analysis demonstrated higher constipation rates in males and patients with multisystem injuries. However, in the multivariate analysis, mode of toileting and mobility were not associated with constipation after adjusting for confounding factors. CONCLUSION: This study demonstrated a high prevalence of constipation in all trauma patients. There is a strong association between the development of constipation in patients with multisystem injuries when compared to those with single system.


Assuntos
Constipação Intestinal , Humanos , Masculino , Feminino , Constipação Intestinal/epidemiologia , Pessoa de Meia-Idade , Adulto , Prevalência , Estudos Prospectivos , Estudos Transversais , Fatores de Risco , Vitória/epidemiologia , Ferimentos e Lesões/epidemiologia , Idoso , Adulto Jovem , Estudos de Coortes , Adolescente
10.
BMC Public Health ; 24(1): 1273, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724957

RESUMO

OBJECTIVE: This study aims to investigate the relationship between obesity and constipation among American adults. METHODS: Our study leveraged data from the National Health and Nutrition Examination Survey (NHANES). This comprehensive approach enabled us to summarize the weighted prevalence rates of obesity in adults. To further deepen our understanding, we employed a variety of analytical methods. These included multivariable logistic regression, subgroup analysis and restricted cubic splines. Through these methodologies, we were able to effectively evaluate the correlation between various obesity indicators and constipation, offering new insights into this complex relationship. RESULTS: The weighted prevalence of constipation stands at 9.42%. Notably, an increased risk of constipation is linked with a BMI (body mass index) exceeding 28 kg/m2, WSR (waist-stature ratio) that is either between 58.3 and 64.8 or above 64.8, as well as a LAP (lipid accumulation products) ranging from 50.8 to 90.1. In contrast, a reduced risk of constipation is associated with WWI (weight-adjusted-waist index) that falls between 0.015 and 0.020, exceeds 0.020, and without the presence of central obesity (P < 0.05). Restricted cubic spline analysis, a significant non-linear relationship was discerned between BMI, WSR, and LAP in relation to constipation. CONCLUSIONS: This pioneering large-scale study explores the relationship between various obesity indices and constipation. It reveals that reducing the BMI, WSR, LAP and waist circumference can decrease the risk of constipation. Conversely, a higher value of WWI correlates with a lower constipation risk, and this remains true even after adjusting for a wide range of variables.


Assuntos
Índice de Massa Corporal , Constipação Intestinal , Inquéritos Nutricionais , Obesidade , Humanos , Constipação Intestinal/epidemiologia , Obesidade/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Prevalência , Fatores de Risco , Idoso , Adulto Jovem
11.
Rev Gastroenterol Peru ; 44(1): 21-25, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38734908

RESUMO

INTRODUCTION: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. OBJECTIVE: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. MATERIALS AND METHODS: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometricfindings before and after 10 biofeedback sessions. RESULTS: 21 patients were included(71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence.Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapysignificantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. CONCLUSIONS: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipationand fecal incontinence; in our center, the response is similar to that of the world literature.


Assuntos
Biorretroalimentação Psicológica , Constipação Intestinal , Incontinência Fecal , Humanos , Incontinência Fecal/terapia , Constipação Intestinal/terapia , Constipação Intestinal/fisiopatologia , Biorretroalimentação Psicológica/métodos , Feminino , Colômbia , Masculino , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Adulto , Manometria
12.
Korean J Gastroenterol ; 83(5): 179-183, 2024 05 25.
Artigo em Coreano | MEDLINE | ID: mdl-38783618

RESUMO

Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. In clinical practice, healthcare providers need to check for 'alarm features' indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation. If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.


Assuntos
Constipação Intestinal , Constipação Intestinal/diagnóstico , Humanos , Doença Crônica , Manometria , Colonoscopia , Exame Retal Digital , Defecografia , Trânsito Gastrointestinal
13.
Korean J Gastroenterol ; 83(5): 184-190, 2024 05 25.
Artigo em Coreano | MEDLINE | ID: mdl-38783619

RESUMO

Chronic constipation is a common disease that can impair the quality of life, with a prevalence of 14% globally and 16.5% in South Korea. Straining, hard stools, the sensation of incomplete evacuation, the sensation of anorectal blockage, and manual maneuvers to facilitate defecation are the related symptoms of chronic constipation. On the other hand, medications commonly referred to as laxatives are the essentials of treatment for constipation compared to non-pharmacological treatment, such as lifestyle modifications, biofeedback, or surgery. Unfortunately, there is still an unmet need to determine if pharmacological treatment for constipation is being administered appropriately. Therefore, there are many disadvantages as to whether the indications and side effects of laxatives are adequately considered and prescribed as the primary treatment modality for constipation in a real clinical situation in Korea. Laxatives are generally recommended as the next step for patients in whom organic causes have been excluded and have not responded to initial non-pharmacologic therapies such as dietary fiber intake and exercise. Laxatives can be classified as bulk-forming laxatives, osmotic laxatives, stimulant laxatives, and other novel laxatives. On the other hand, there are distinct mechanisms underlying constipation, and appropriate administration is the most decisive. Therefore, the present investigators prepared this review to discuss appropriate pharmacological strategies for chronic constipation in Korea. Moreover, this paper also includes suggestions for appropriate pharmacological treatment options for special patient populations.


Assuntos
Constipação Intestinal , Laxantes , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/terapia , Humanos , Laxantes/uso terapêutico , Doença Crônica , Fibras na Dieta/uso terapêutico
14.
Korean J Gastroenterol ; 83(5): 191-196, 2024 05 25.
Artigo em Coreano | MEDLINE | ID: mdl-38783620

RESUMO

Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.


Assuntos
Biorretroalimentação Psicológica , Constipação Intestinal , Constipação Intestinal/terapia , Humanos , Doença Crônica , Terapia por Estimulação Elétrica , Toxinas Botulínicas/uso terapêutico
15.
Neurogastroenterol Motil ; 36(6): e14808, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703048

RESUMO

BACKGROUND: Even if understanding of neuronal enteropathies, such as Hirschsprung's disease and functional constipation, has been improved, specialized therapies are still missing. Sacral neuromodulation (SNM) has been established in the treatment of defecation disorders in adults. The aim of the study was to investigate effects of SNM in children and adolescents with refractory symptoms of chronic constipation. METHODS: A two-centered, prospective trial has been conducted between 2019 and 2022. SNM was applied continuously at individually set stimulation intensity. Evaluation of clinical outcomes was conducted at 3, 6, and 12 months after surgery based on the developed questionnaires and quality of life analysis (KINDLR). Primary outcome was assessed based on predefined variables of fecal incontinence and defecation frequency. KEY RESULTS: Fifteen patients enrolled in the study and underwent SNM (median age 8.0 years (range 4-17 years)): eight patients were diagnosed with Hirschsprung's disease (53%). Improvement of defecation frequency was seen in 8/15 participants (53%) and an improvement of fecal incontinence in 9/12 patients (75%). We observed stable outcome after 1 year of treatment. Surgical revision was necessary in one patient after electrode breakage. Urinary incontinence was observed as singular side effect of treatment in two patients (13%), which was manageable with the reduction of stimulation intensity. CONCLUSIONS: SNM shows promising clinical results in children and adolescents presenting with chronic constipation refractory to conservative therapy. Indications for patients with enteral neuropathies deserve further confirmation.


Assuntos
Constipação Intestinal , Terapia por Estimulação Elétrica , Incontinência Fecal , Humanos , Adolescente , Criança , Feminino , Masculino , Constipação Intestinal/terapia , Terapia por Estimulação Elétrica/métodos , Pré-Escolar , Incontinência Fecal/terapia , Incontinência Fecal/fisiopatologia , Estudos Prospectivos , Resultado do Tratamento , Plexo Lombossacral , Defecação/fisiologia , Qualidade de Vida , Doença de Hirschsprung/terapia
16.
Complement Ther Med ; 82: 103045, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38705493

RESUMO

OBJECTIVE: This study aimed to evaluate the clinical efficacy and safety of probiotics supplementation in the treatment of Parkinson's disease (PD). METHODS: We searched China National Knowledge Infrastructure (CNKI), Weipu (VIP) database, Wanfang Database, Sinomed (CBM), PubMed, Embase, Cochrane library and Web of Science databases for eligible studies from inception to January 4th, 2024. Randomized controlled trials (RCTS) comparing the effects of probiotic supplements and placebo in patients with PD. Meta-analysis was conducted with the software Review Manager 5.4. The quality assessment was performed according to Cochrane risk of bias tool. RESULTS: A total of 11 RCTs with 756 PD patients were included in this study. We found that probiotics could increase the number of complete bowel movements (CBMs) per week and improved the scores of Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) (SMD = 0.73, 95 % CI: 0.54 to 0.92, P < 0.00001, I2 = 45 %; SMD = - 0.79, 95 % CI: - 1.19 to - 0.39, P < 0.001, I2 = 55 %, respectively) compared with the placebo group. However, there was no significant difference between the two groups in improving fecal traits and defecation efforts in PD patients (SMD = 0.87, 95 % CI: 0.01 to 1.74, P = 0.05, I2 = 94 %; SMD = 1.24, 95 % CI: - 1.58 to 4.06, P > 0.05, I2 = 98 %, respectively). In terms of PD composite scale scores: after treatment, there was no significant difference in Movement Disorder Society-Unified-Parkinson Disease Rating Scale Ⅲ score (MDS-UPDRSⅢ) between the probiotic group and the placebo group (SMD = - 0.09, 95 % CI: - 0.35 to 0.16, P > 0.05, I2 = 0 %). CONCLUSIONS: In conclusion, based on the overall results of the available RCTs studies, our results suggested the potential value of probiotics in improving constipation symptoms in PD patients. Therefore, probiotics may be one of the adjuvant therapy for PD-related constipation patients. The findings of this study provide more proof supporting the effectiveness of probiotics, encouraging probiotics to be utilized alone or in combination with other therapies in clinical practice for PD patients. However, more well-designed RCTs with large sample sizes are required.


Assuntos
Constipação Intestinal , Doença de Parkinson , Probióticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/terapia , Suplementos Nutricionais , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/terapia , Probióticos/uso terapêutico , Qualidade de Vida
17.
Medicine (Baltimore) ; 103(21): e38287, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38787996

RESUMO

This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort of 25 patients, focusing on demographic characteristics, clinical presentation, location and size of the lipoma, concomitant pathologies, and treatment methods. The average age of the patients was 67.3 years, with 36% being male and 64% female. The majority of lipomas were located in the ascending colon (52%), and their median size was 2 cm. The predominant presenting symptom was constipation, affecting 83.3% of the symptomatic patients. Surgical resection was undertaken in only 1 patient due to obstruction. Statistically significant differences were observed between symptomatic and asymptomatic patients regarding various parameters, including the size of the lipoma (P = .033). Colon lipomas are generally benign and frequently asymptomatic but may necessitate different treatment approaches depending on their size, location, and the presence of symptoms. Further studies are imperative to refine treatment strategies and enhance patient care outcomes.


Assuntos
Neoplasias do Colo , Lipoma , Humanos , Lipoma/cirurgia , Lipoma/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Idoso , Neoplasias do Colo/cirurgia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Constipação Intestinal/diagnóstico , Adulto
18.
Sci Rep ; 14(1): 11819, 2024 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783080

RESUMO

Chronic constipation, diarrhea, and fecal incontinence have high incidence, potential disability, and socioeconomic impact, imposing a heavy burden on the quality of life. We aim to explore the association between cardiovascular health (CVH) and bowel health from National Health and Nutrition Survey 2005-2010. CVH is assessed using Life's Essential 8 (LE8). Chronic constipation, chronic diarrhea, and fecal incontinence are assessed based on Bristol Stool Form Scale classification, bowel movements, and bowel leakage. Better health behaviors (odds ratio [OR]: 0.71, 95% confidence interval [CI] 0.53-0.94, p = 0.02) and worse health factors (OR: 1.45, CI 1.03-2.04, p = 0.04) were associated with less chronic constipation. Less chronic diarrhea is correlated with better CVH (OR: 0.53, 95% CI 0.35-0.79, p = 0.003) and health factors (OR: 0.61, CI 0.46-0.81, p = 0.001). Meanwhile, the proportion of chronic diarrhea significantly decreases when the health behaviors score exceeds 59.42. Lower fecal incontinence was associated with better health behaviors (OR: 0.63, CI 0.44-0.90, p = 0.01) CVH. Better CVH and health behaviors are both linked to lower all-cause mortality in participants with chronic constipation and chronic diarrhea. A higher health behaviors score is also associated with less all-cause mortality in patients with fecal incontinence. Maintaining CVH at the population level contributes to intestinal health, achieving the dual management of both while saving on healthcare costs. However, further prospective research is needed to confirm these associations.


Assuntos
Doenças Cardiovasculares , Constipação Intestinal , Diarreia , Incontinência Fecal , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Constipação Intestinal/epidemiologia , Diarreia/epidemiologia , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Doenças Cardiovasculares/epidemiologia , Idoso , Adulto , Qualidade de Vida , Comportamentos Relacionados com a Saúde , Doença Crônica , Inquéritos Nutricionais
19.
BMC Public Health ; 24(1): 1366, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38773415

RESUMO

BACKGROUND: Oxidative stress is closely related to gut health. Exposures to oxidative stress in one's diet and lifestyle can be evaluated by the oxidative balance score (OBS). However, the relationship between OBS and intestinal habits is unknown. This study aimed to investigate the relationships between OBS and intestinal habits (chronic diarrhea and chronic constipation) and the underlying mechanisms involved. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2010, we included a total of 8065 participants. Twenty dietary and lifestyle factors were selected for the OBS calculates. Chronic constipation and chronic diarrhea were defined using the Bristol stool form scale (BSFS) types 1 and 2 and the BSFS 6 and 7, respectively. Multivariate logistic regression, subgroup analysis, and restricted cubic splines (RCS) analysis were used to evaluate the relationship between OBS and defecation habits. Finally, we used mediation analysis to explore the indirect effects of oxidative stress and inflammatory markers on these associations. RESULTS: After adjusting for all the covariates, multivariate logistic regression analysis revealed that OBS was negatively correlated with diarrhea (OR = 0.57; 95%CI = 0.39-0.83; P = 0.008)and positively correlated with constipation (OR = 1.75; 95%CI = 1.19-2.25; P = 0.008). The RCS showed a nonlinear relationship between OBS and diarrhea (P for nonlinearity = 0.02) and a linear relationship between OBS and constipation (P for nonlinearity = 0.19). Mediation analysis showed that the C-reactive protein (CRP) concentration and white blood cell (WBC) count mediated the correlation between OBS and diarrhea by 6.28% and 6.53%, respectively (P < 0.05). CONCLUSIONS: OBS is closely related to changes in patients' defecation habits. Oxidative stress and inflammation may play a role in the relationship between the two. This result emphasizes the importance of the public adjusting their lifestyle and dietary habits according to their own situation. However, further prospective studies are needed to analyze the relationship between oxidative stress and changes in defecation habits.


Assuntos
Constipação Intestinal , Diarreia , Inquéritos Nutricionais , Estresse Oxidativo , Humanos , Constipação Intestinal/epidemiologia , Estresse Oxidativo/fisiologia , Feminino , Diarreia/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto , Doença Crônica , Estilo de Vida , Idoso , Estudos Transversais
20.
Food Funct ; 15(11): 6118-6133, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38764333

RESUMO

Constipation is a major gastrointestinal (GI) symptom worldwide, with diverse causes of formation, and requires effective and safe therapeutic measures. In the present study, we used loperamide hydrochloride to establish a constipation model and assessed the effect of Bifidobacterium on constipation and its possible mechanism of relief. The results showed that B. longum S3 exerted a constipation-relieving effect primarily by improving the gut microbiota, enriching genera including Lactobacillus, Alistipes, and Ruminococcaceae UCG-007, and decreasing the bacteria Lachnospiraceae NK4B4 group. These changes may thereby increase acetic acid and stearic acid (C18:0) levels, which significantly increase the expression levels of ZO-1 and MUC-2, repair intestinal barrier damage and reduce inflammation (IL-6). Furthermore, it also inhibited oxidative stress levels (SOD and CAT), decreased the expression of water channel proteins (AQP4 and AQP8), significantly elevated the Gas, 5-HT, PGE2, and Ach levels, and reduced nNOS and VIP levels to improve the intestinal luminal transit time and fecal water content. Collectively, these changes resulted in the alleviation of constipation.


Assuntos
Ácido Acético , Bifidobacterium longum , Constipação Intestinal , Microbioma Gastrointestinal , Loperamida , Probióticos , Ácidos Esteáricos , Loperamida/efeitos adversos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/metabolismo , Animais , Camundongos , Probióticos/farmacologia , Ácidos Esteáricos/metabolismo , Masculino , Microbioma Gastrointestinal/efeitos dos fármacos , Modelos Animais de Doenças , Intestinos/microbiologia
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