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Mathias RM, Chu MKW, Edwards S, Day AS, Ma C, Jairath V, Bryant RV. Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation. Aliment Pharmacol Ther 2024; 60:6-16. [PMID: 38745540 DOI: 10.1111/apt.18029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Constipation can be diagnosed clinically using the Rome criteria. Ultrasound (US), which lacks the radiation exposure of conventional X-ray, holds promise as a non-invasive tool to evaluate colonic contents and constipation. AIM To examine the role of US in the assessment of constipation. METHODS We performed a systematic search of Embase (OVID, 1984), Medline (Ovid, 1946), Cochrane Central, ClinicalTrials.gov and Australia New Zealand Clinical Trials Registry from database inception to 26 January 2024 according to PRISMA guidelines and prospectively registered with PROSPERO. All studies using US to assess constipation or colonic contents in either adults or children were included. Rectal diameter measurements were pooled in meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scales and Joanna Briggs Institute checklists. RESULTS Of 12,232 studies screened, 51 articles (6084 patients; 3422 children) describing US to assess symptoms in patients with constipation were included. Most studies used Rome criteria to diagnose constipation. Rectal diameter was associated with clinical constipation in 29 paediatric studies (3331 patients). Meta-analysis showed the mean rectal diameter of constipated patients was significantly higher than controls (mean difference 12 mm, 95% confidence intervals (CI): 6.48, 17.93, p < 0.0001, n = 16 studies). Other features of constipation on US included posterior acoustic shadowing and echogenicity of luminal contents. CONCLUSION US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.
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Affiliation(s)
- R M Mathias
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - M K W Chu
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A S Day
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - C Ma
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alimentiv Inc., London, Ontario, Canada
| | - V Jairath
- Alimentiv Inc., London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - R V Bryant
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Gau JT, Patel P, Pan JJ, Kao TC. Analyzing fecal loading and retention patterns by abdominal X-rays of hospitalized older adults: A retrospective study. Aging Med (Milton) 2022; 5:38-44. [PMID: 35309161 PMCID: PMC8917260 DOI: 10.1002/agm2.12199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 12/17/2022] Open
Abstract
Background Aging may affect ascending colon (AC) differently from descending colon (DC) and increase the risk of fecal loading (FL) in AC. Methods Patients aged ≥65 years admitted to a community hospital were analyzed by abdominal x‐ray for fecal loads and stool retention patterns. FL was scored between 0 and 5 (severe) on each segment of colon with a possible total score 20. Mean segment scores ≥3.5 were designated as high scores for both AC and DC. Logistic regression was performed between groups to identify factors associated with FL patterns. Results Groups identified were high FL in both AC and DC (N = 21, 17.2%), FL predominantly in AC (N = 38, 31.1%), low FL in both AC and DC (N=60, 49.2%), and FL low in AC and high in DC (N = 3, 2.5%). Among 71 patients with total FL scores ≥13 (indicating significant stool retention), 37 (52.1%) had the FL predominantly in AC. Patients prescribed antibiotic(s) prior to hospitalization had lower odds of FL predominantly in AC (adjusted odds ratio = 0.18, 95% confidence interval = 0.04–0.84) compared to the group of low FL in both AC and DC with the adjustment of confounders. Conclusion This study found that 52.1% of those with significant stool retention on x‐ray had the FL predominantly in AC. Antibiotic use was associated with lower odds of having FL predominately in AC. This study provided insights of FL distribution in colon and AC could be an area for significant stool burden in older adults with stool retention.
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Affiliation(s)
- Jen-Tzer Gau
- Department of Primary Care/geriatric medicine Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) Athens Ohio USA.,Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) Athens Ohio USA
| | - Parth Patel
- Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) Athens Ohio USA.,Present address: SUNY Upstate Medical University Hospital Syracuse New York USA
| | - Jen-Jung Pan
- Gastroenterology, Hepatology and Liver Transplantation Banner-University Medical Center Phoenix Phoenix Arizona USA
| | - Tzu-Cheg Kao
- Uniformed Services University of the Health Sciences Bethesda Maryland USA
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Pleasant V, Sammarco A, Keeney-Bonthrone G, Bell S, Saad R, Berger MB. Use of X-ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms. Dig Dis Sci 2019; 64:3589-3595. [PMID: 31388854 DOI: 10.1007/s10620-019-05770-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS There is currently no gold standard for evaluating stool burden in the colon for patients with gastrointestinal symptoms. We aim to examine the relationship between fecal loading on single view abdominal X-ray imaging and gastrointestinal symptoms such as constipation, diarrhea, bloating, and accidental bowel leakage in adult outpatients. METHODS This retrospective, cross-sectional study examined patients seen at University of Michigan from 2005 to 2017. Chart review of demographic information, reported gastrointestinal symptoms, past medical history, and abdominal radiographic imaging was performed. Bivariate analysis was performed to assess associations between these characteristics and fecal loading. Factors independently associated with fecal loading were identified using logistic regression. Significance was established at p < 0.05. RESULTS In total, 319 patients who had an X-ray were included in the final analysis, with 84.0% demonstrating fecal loading on the initial X-ray and most reporting constipation as a symptom (n = 214, 84.3%, p = 0.0334). In logistic regression, a chief complaint of constipation had higher odds of being associated with fecal loading on X-ray compared to diarrhea (adjusted OR 6.41; CI 1.51-27.24, p = 0.0118). Bloating as a reported symptom was statistically significant with an adjusted OR of 2.56 (CI 1.10-5.96, p = 0.0286). CONCLUSIONS Constipation (as a chief complaint) and bloating (as a symptom) were associated with fecal loading on X-ray imaging, while accidental bowel leakage and diarrhea were not.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Anne Sammarco
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Obstetrics and Gynecology, Rush University Medical Center, 1725 W. Harrison St., Ste 1138, Chicago, IL, 60612, USA
| | | | - Sarah Bell
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Richard Saad
- Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mitchell B Berger
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Main Line HealthCare Urogynecology Associates, Riddle Hospital, Health Center 3, 1098 W. Baltimore Pike, Ste. 3404, Media, PA, 19063, USA
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Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Dana 535, Boston, MA, 02215, USA.
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