Internet survey on the actual situation of constipation in the Japanese population under 70 years old: focus on functional constipation and constipation-predominant irritable bowel syndrome

The impact of sugar-sweetened beverages consumption on constipation: evidence from NHANES

BACKGROUND

The consumption of sugar-sweetened beverages (SSBs) has increased substantially over recent decades, raising concerns about its various physiological effects on bodily function. However, the relationship between SSBs intake and constipation remains insufficiently understood.

METHODS

Data from 7,979 participants sourced from the National Health and Nutrition Examination Survey (NHANES) were analyzed in this study. Dietary intake of SSBs was assessed using two 24-hour dietary recall interviews, and constipation was defined according to the Bristol Stool Form Scale (BSFS) Cards. We employed weighted logistic regression analysis to examine the relationship between SSBs consumption (quantified in grams and kilocalories) and the risk of constipation, while stratified and restricted cubic spline (RCS) analyses explored population variability.

RESULTS

After adjusting for all relevant variables, SSBs quantified in grams (SSBs-grams) (ORQ3 vs. Q1 = 1.419, 95% CI: 1.064-1.893, p = 0.019; p for trend = 0.02) and SSBs quantified in kilocalories (SSBs-kcal) (ORQ4 vs. Q1 = 1.567, 95% CI: 1.100-2.234, p = 0.015; p for trend = 0.016) showed a significant positive association with constipation. Furthermore, the weighted RCS and stratified analyses indicated that the association varied among subgroups, with a non-linear relationship between SSBs-kcal and constipation (SSBs-grams: p non-linear = 0.100, SSBs-kcal: p non-linear = 0.026).

CONCLUSIONS

Our findings indicated that increased SSBs consumption is associated with a higher risk of constipation. The results underscore the need for public health interventions aimed at reducing the intake of SSBs and promoting healthier alternatives.

Association of anxiety status and anxiety duration with constipation in adult Americans: a cross-sectional study using data from the NHANES 2007-2010

BACKGROUND

Constipated patients may exhibit anxious behaviors, but the relationship between the two remains unclear. This population-based study aims to investigate the relationships of anxiety status and anxiety duration with constipation among U.S. adults.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2007 to 2010, a cross-sectional study included 8945 participants was performed to assess the relationships of anxiety status and anxiety duration with constipation. Participants' characteristics were presented using mean or proportion. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression models. The analysis accounted for potential confounding factors, including gender, age, race/ethnicity, education level, marital status, PIR, BMI, smoking status, drinking status, chronic diseases, and dietary intake. Subgroup analyses were conducted to ensure the stability of the results. Smoothed curve fitting was applied to investigate both linear and nonlinear associations between anxiety duration and constipation risk. Threshold effects were assessed using two-piecewise linear regression models.

RESULTS

Of the 8945 participants, 922 reported constipation, with a prevalence of 10.3%. After adjusting for confounding factors, individuals with anxiety status exhibited an increased risk of constipation (OR: 1.49, 95% CI: 1.28-1.73). Stratified analyses indicated that the association between anxiety status and constipation remained relatively stable across different stratification levels. Smoothed curve fitting and threshold effect analyses revealed a linear association between anxiety duration and constipation among adults aged 20-60, while a nonlinear inverted U-shaped relationship was observed in those aged 60 and older, with an inflection point at 10 days. The two variables correlated positively on the left side of the inflection point but not on the right.

CONCLUSION

This study showed that a significant association between anxiety status and constipation among U.S. adults. Additionally, an age-dependent association between anxiety duration and constipation was observed, particularly among individuals aged 60 and older.

Electroacupuncture versus 5-HT4 receptor agonist for functional constipation: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Functional constipation (FC) has been found as a chronic gastrointestinal disease that is commonly diagnosed in patients. However, patients have a low satisfaction level with the treatment of constipation drugs (e.g., 5-HT4 agonists). A meta-analysis was performed to compare the efficacy and safety between electroacupuncture and 5-HT4 agonists.

METHODS

The included study were randomized controlled trials (RCTs), in which EA was used in the experimental group and 5-HT4 receptor agonist was used in the control group. Four English databases (PubMed, Cochrane Library, Web of Science, Embase) and 4 Chinese databases (China National Knowledge Infrastructure, CBM, WanFang, VIP) were searched. Relevant studies retrieved were published before September 30, 2024. The risk of bias was assessed by tool of Cochrane and GRADEpro. The Review Manager 5.4 was used for analyzing Data analysis, and Endnote X9 for screening studies.

RESULTS

In this paper, we included 12 studies, involving 1473 participants. We found that EA significantly improved patient assessment of cab quality of life questionnaire (PAC-QOL) (MD = -0.52, P = .03), self-rating anxiety scale (SAS) (MD = -3.00, P < .00001) and self-rating depression scale (SDS) (MD = -4.13, P < .00001) compared with 5-HT4 receptor agonists. In addition, we failed to identify any significant difference in Stool consistency, the number of weekly complete spontaneous bowel movements and weekly spontaneous bowel movements (SBMs) between the 2 groups.

CONCLUSION

EA has been indicated to be better than 5-HT4 receptor agonists since it can more effectively improve FC patients' life quality and mental state without an increased risk of adverse even. However, the previous evidence is characterized by low quality and small sample size, which should be further confirmed by high-quality and large-sample multicenter RCTs.

Factors Associated with Defecation Satisfaction among Japanese Adults with Chronic Constipation

Background: Constipation causes substantial morbidity worldwide. Methods: This survey assessed constipation-related factors in Japan using the Japanese version of the Irritable Bowel Syndrome Quality of Life (IBS-QOL-J) instrument. We also examined the relationship among laxative type, Bristol Stool Form Scale (BSFS) scores, and treatment cost. Finally, we examined differences in satisfaction scores according to laxative type, treatment type, treatment cost, and BSFS score. Results: IBS-QOL-J was higher among those taking salt and/or irritation laxatives. Those paying >JPY 5000 (USD 50.00) had the lowest IBS-QOL-J. IBS-QOL-J was significantly lower among those with a BSFS score of 1 or 2 (severe constipation). Conclusions: This study's findings suggest that a variety of factors, including treatment type and cost, are associated with defecation satisfaction. Those who had hard stools, used multiple laxatives, or spent more on treatment were less satisfied. Future strategies should target therapies that do not require multiple laxatives with lower treatment costs. Adequate defecation with a small number of appropriate laxatives at minimal cost appears to improve defecation satisfaction. It is desirable to identify appropriate laxatives and improve dietary habits and exercise routines. It is also necessary to stop blindly increasing laxative usage and properly diagnose constipation disorders such as anatomical abnormalities other than functional constipation.

Exploring the connection between caffeine intake and constipation: a cross-sectional study using national health and nutrition examination survey data

BACKGROUND

Caffeine has been reported to increase gastrointestinal motility and change intestinal microbiota. Constipation may be caused by colonic motor dysfunction and colonic microbiomeis disturbances. In this study, we aimed to explore the association between caffeine intake and constipation.

METHODS

This was a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). Caffeine intake was assessed using 24-h dietary recall method, and constipation was defined based on stool consistency or stool frequency. Logistic regression analysis was used to assess the association between caffeine intake and constipation, and results were expressed as odds ratio (OR) with 95% confidence intervals (95%CI). Subgroup analysis was performed based on age.

RESULTS

A total of 13,816 participants were finally included for analysis. After adjusting potential confounders, high intake of caffeine was found to be associated with the low odds of constipation (Q3: OR = 0.60, 95%CI: 0.49-0.74; Q4: OR = 0.77, 95%CI: 0.59-0.99; Q5: OR = 0.72, 95%CI: 0.56-0.92). The similar association was found in young people and middle-age people (P < 0.05).

CONCLUSION

High caffeine intake was associated with the low odds of constipation. Our finding indicated that individuals should develop consciousness and habit of consuming caffeinated foods and drinks to prevent and relief the constipation.

Continuous laxative use and its relationship to defecation among residents of nursing homes: A longitudinal observational study using the interRAI

AIM

To clarify the association between constipation, diarrhea, and long-term laxative use in Japanese nursing home residents.

METHODS

Data from 306 residents with chronic constipation aged over 75 years for basic characteristics, medication use, activities of daily living, and concurrent illness were collected via two consecutive 6-monthly surveys conducted using the Japanese interRAI assessment tool. We used bivariate and multivariate analyses to examine the associations between chronic constipation, diarrhea, and continuous laxative use.

RESULTS

Chronic constipation persisted in 74.5% of residents despite their continuous use of laxatives. Additionally, 14.4% experienced chronic diarrhea while on laxatives. Residents using salt laxatives had significantly lower chronic constipation than those not using salt laxatives (adjusted odds ratio [AOR] 0.52), while residents using novel laxatives had significantly higher chronic diarrhea than those not using novel laxatives (AOR 4.28).

CONCLUSIONS

Our findings reveal that bowel movement-related problems remain a concern and highlight the need for further research on the use of novel laxatives in nursing home residents. Geriatr Gerontol Int 2024; 24: 133-139.

Improving Quality of Life in The Constipated Older Person: Reflexology or Abdominal Massage? A Two-Group, Randomized Comparative Trial

This study is a randomized comparative trial designed to determine the effects of reflexology and abdominal massage on the improvement of constipation and quality of life of older persons. Participants were randomized to the reflexology group ( n = 50) or abdominal massage group ( n = 50). Data were collected by using a descriptive information form, the Standardized Mini-Mental Test (SMMT), the Katz Daily Life Activity Scale (Katz ADL), the Constipation Severity Scale (CSS), and the Constipation Quality of Life Questionnaire (CQOLQ). The comparison of the mean scores of participants from the total CSS and the total CQOLQ before and after reflexology and abdominal massage application indicated that the mean post-intervention scores on the total CSS and the total CQOLQ decreased significantly compared with preintervention scores ( p < .05). When the mean scores of the reflexology and abdominal massage groups for the total CSS and the total CQOLQ were compared, there was no significant difference between the groups ( p < .05). Both interventions improved the constipation problem of these older persons and their quality of life. The effects of both reflexology and abdominal massage were similar in improving constipation and quality of life in older persons.

Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey

Background/Aims

The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey.

Methods

Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences.

Results

Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred.

Conclusions

Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.

Upper gastrointestinal endoscopic findings in functional constipation and irritable bowel syndrome diagnosed using the Rome IV criteria: a cross-sectional survey during a medical check-up in Japan

BACKGROUND

The Rome IV criteria have been established as an international standard for diagnosing disorders of gut-brain interaction. In this study, we aimed to examine the upper gastrointestinal (GI) endoscopic findings and symptoms of subjects with functional constipation (FC) and irritable bowel syndrome (IBS) of individuals undergoing a medical check-up.

METHODS

A total of 13,729 subjects underwent a medical check-up at Osaka City University-affiliated clinic, MedCity21, between April 2018 and March 2019. Among the 5,840 subjects who underwent screening upper GI endoscopy and completed a questionnaire based on the Rome IV criteria, 5,402 subjects were consecutively enrolled after excluding subjects with a large amount of gastric residue (n = 6), those who had previously undergone partial or total gastrectomy (n = 40), or those with daily use of low-dose aspirin (n = 82), nonsteroidal anti-inflammatory drugs (n = 63), or acid secretion inhibitors (n = 308).

RESULTS

Robust Poisson regression analyses adjusted for age, sex, Helicobacter pylori infection status, alcohol intake, and smoking habits showed a significant association between FC and corpus erosion (adjusted prevalence ratio [aPR], 2.93; 95% confidence interval [CI], 1.51-5.67; p < 0.01) and red streaks (aPR, 3.83; 95% CI, 2.53-5.79; p < 0.01), whereas IBS was significantly associated with erosive gastritis (aPR, 8.46; 95% CI, 4.89-14.67; p < 0.01) and duodenitis (aPR, 7.28; 95% CI, 3.64-14.59; p < 0.01). Red streaks tended to be associated with IBS (aPR, 1.96; 95% CI, 1.00-3.83; p = 0.05). Subjects with IBS were the most to complain of both upper and lower GI symptoms and psychological symptoms, followed by those with FC and controls. IBS subjects with erosive gastritis or duodenitis had significantly more complaints of stomachache and feeling stressed than those without erosive gastritis or duodenitis (54.5% vs. 18.8%; p = 0.03 and 66.7% vs. 25.0%; p = 0.01).

CONCLUSIONS

Subjects with FC and IBS had a variety of upper GI and psychological symptoms. In the upper GI endoscopic findings, corpus erosion and red streaks were associated with FC, and erosive gastritis, duodenitis, and possibly red streaks were associated with IBS.

GI factors, potential to predict prostate motion during radiotherapy; a scoping review

Purpose

A scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation.

Methods

The scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed.

Results

A preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors.

Conclusion

A comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.

Association between overall dietary quality and constipation in American adults: a cross-sectional study

Background

Constipation seriously affects people’s life quality, and dietary adjustment has been one of the effective methods. Overall dietary quality has been reported to be associated with some diseases, while its association with constipation has not been reported. This study aims to explore the association between overall dietary quality and constipation.

Methods

A cross-sectional study was designed and data were extracted from National Health and Nutrition Examination Survey (NHANES). Overall dietary quality was assessed by healthy eating index-2015 (HEI-2015), and constipation was defined by either stool consistency or stool frequency. The association between overall dietary quality or components of HEI-2015 and constipation was assessed using logistic regression, with results expressed as odds ratio (OR) and 95% confidence intervals (95%CI). Subgroup analysis was conducted according to age and gender.

Results

A total of 13,945 participants were eligible, with 1,407 in constipation group and 12,538 in non-constipation group. Results showed that higher adherence to HEI-2015 was associated with reduced odds of constipation (OR: 0.98, 95%CI: 0.98–0.99) after adjusting potential confounders. Further, we found higher intake of total fruits, whole fruits, total vegetables, greens and beans, whole grains, total protein foods, seafood and plant proteins, and higher fatty acids ratio decreased the odds of constipation, while higher intake of sodium increased the odds (all P < 0.05). We also found negative association between HEI-2015 and constipation in participants with male sex, female sex, age ≥ 65 years, and age < 65 years (all P < 0.05).

Conclusion

We found higher adherence to HEI-2015 decreased the odds of constipation, suggesting that increasing HEI-2015 adherence may be one of effective methods to alleviate constipation.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14360-w.

Characterization of Circular RNA Expression Profiles in Colon Specimens of Patients with Slow Transit Constipation

BACKGROUND

Slow transit constipation (STC) is a clinical syndrome characterized by a decreased urge to defecate and delayed colonic transit. Circular RNAs (circRNAs) are a recently discovered class of regulatory RNAs that have emerged as critical biomarkers and regulators of various diseases. However, the expression profiles and mechanisms underlying circRNA regulation in human STC tissues have not been explored.

METHODS

High-throughput RNA sequencing technology was used to compare the differences in circRNA expression profiles in colon samples taken from patients with STC or controls. Bioinformatics analyses were performed on the host genes of the differentially expressed circRNAs (DE-circRNAs), a competing endogenous RNA network was constructed, and the expression levels of some DE-circRNAs were verified using quantitative real-time polymerase chain reactions (qRT-PCR).

RESULTS

There were 190 DE-circRNAs identified in the STC group. Bioinformatics analysis predicted that the DE-circRNAs were enriched in the relaxation of smooth muscle, actin binding, actin cytoskeleton organization, dilated cardiomyopathy, and cardiac muscle contraction. These results suggest that muscle diseases may be related to the pathogenesis of STC. The expression levels of the 12 most differentially expressed circRNAs were verified using qRT-PCR. In addition, circRNA-microRNA-mRNA regulatory networks were constructed using the 8 most significant circRNAs. Some mRNAs predicted to be closely related to smooth muscle function were found in these networks.

CONCLUSIONS

This study provides a helpful blueprint for researchers to select candidate circRNAs for further study of the pathogenesis of STC and screen potential biomarkers or targets for use in the diagnosis and treatment of STC.

Background factors involved in the epidemiology of functional constipation in the Japanese population: a cross-sectional study

Background

Functional constipation (FC), a functional bowel disorder with symptoms of constipation, has considerable impact on quality of life. As data regarding its prevalence and epidemiology are lacking, this study aimed to evaluate the prevalence, population composition, lifestyle, quality of life, and clinical characteristics of these individuals by comparing people with and without FC. These parameters were also compared among individuals with strong and weak awareness of constipation.

Methods

An internet survey was conducted among 10,000 individuals aged 20–69 years from the general Japanese population; they were registered with an internet survey company. The following data were obtained: age, sex, educational history, occupation, residence, history of other diseases, lifestyle (including smoking/drinking habits using the Japanese Health Practice Index, medication use, symptoms of constipation according to the Rome III criteria, stool types according to the Bristol stool scale, and use of laxatives, including the place of purchase and cost per month or acceptable cost per month. The 8-item Short Form Health Survey Questionnaire was also used; FC was diagnosed based on Rome III criteria. All respondents were classified according to their awareness of constipation (i.e. strong or weak), and their characteristic features were compared.

Results

The data of 3000 respondents were evaluated; 262 (8.7%) had FC, which was common among older adults, women, and homemakers. FC was associated with changes in the frequency of bowel movement, sensation of incomplete or scanty evacuation, and the use of manual maneuvers; these are consequential clinical symptoms of FC. These individuals frequently skipped breakfast, had insufficient sleep, had more severe constipation, and had purchased laxatives in pharmacies or online more often than those without FC. A strong awareness of constipation was significantly more prevalent among women and homemakers. A history of anemia and cardiovascular disease was significantly more frequent in the strong awareness group, whereas a history of hypertension was more frequent in the weak awareness group.

Conclusions

Appropriate and comprehensive management should be provided for FC, based on the understanding of its characteristic features and considering the symptoms and lifestyle.

A questionnaire-based survey on the etiopathogenesis of chronic constipation during a medical check-up in Japan

The study group of the Japanese Society of Gastroenterology released evidence-based clinical practice guidelines for chronic constipation (CC) in 2017, and irritable bowel syndrome (IBS) was treated as one of the causes of CC. We examined the differences in characteristics between IBS and non-IBS subjects with CC who underwent a medical check-up in Japan. A total of 10,658 subjects participated in this study, and we focused on 467 subjects who fulfilled the diagnostic criteria of CC using a questionnaire survey. The number of IBS subjects was 21, and they had sleep disorders, were more symptomatic (e.g., abdominal pain, abdominal bloating/distension, feeling stressed, annoyance, lack of motivation, fatigue upon waking, and feeling depressed), and had more episodes of sensation of incomplete evacuation and anorectal obstruction/blockage during defecation than non-IBS subjects. Furthermore, stool frequency of IBS subjects was significantly different from non-IBS subjects. Multivariate ordinal logistic regression analysis revealed that the factors associated with a higher stool frequency were IBS [odds ratio (OR), 2.46; 95% confidence interval (CI), 1.00–6.05; p = 0.049], male sex (OR, 1.97; 95% CI, 1.20–3.23; p = 0.007), and regular exercise (OR, 1.80; 95% CI, 1.05–3.07; p = 0.033). These findings suggest that IBS has unique characteristics in subjects with CC.

Internet Survey of Japanese Patients With Chronic Constipation: Focus on Correlations Between Sleep Quality, Symptom Severity, and Quality of Life

Background/Aims

Chronic constipation and lifestyle factors can affect sleep quality. We evaluated the relationship between chronic constipation and sleep in the Japanese population.

Methods

This cross-sectional internet-based survey included 3000 subjects with constipation, classified according to sleep status (good/poor). Primary endpoints were Bristol stool form scale (BSFS) score and correlations between sleep disorder criteria of the Pittsburgh Sleep Quality Index (PSQI) and sleep status (good/poor sleep). Secondary endpoints included correlations between quality of life (QOL) and mood, medical, lifestyle, and sleep factors.

Results

The proportion of participants with BSFS category 4 (normal stool) was significantly higher in the good sleep group (P < 0.001). Sleep disturbance (P < 0.05), sleep quality, and duration, use of hypnotic medication, and daytime dysfunction of PSQI (all P < 0.001) significantly correlated with poor sleep. In the poor sleep group, QOL was significantly worse and anxiety and depression levels were significantly higher (all P < 0.001) compared with the good sleep group. Anemia and smoking (both P < 0.05), recent body weight increases, and poor eating habits (all P < 0.001) were significantly higher in the poor sleep group. Male sex, onset associated with change in frequency of stools, sensation of incomplete evacuation for at least 25% of defecations, and manual maneuvers to facilitate at least 25% of defecations correlated with poor sleep.

Conclusions

Subjects with constipation and poor sleep experienced severe symptoms and had poor QOL. These data support the need for a multifocal treatment approach, including lifestyle advice and pharmacotherapy.

Prevalence and risk factors of functional constipation in the Rome IV criteria during a medical check-up in Japan

BACKGROUND AND AIM

Functional constipation (FC) is one of the functional bowel disorders with symptoms of constipation in the Rome IV criteria. This study aimed to examine the epidemiology of FC in a large-scale survey of individuals undergoing a medical check-up in Japan.

METHODS

A total of 13 729 subjects who underwent a medical check-up at MedCity21 between April 2018 and March 2019 were given a questionnaire that inquired about bowel habits. Among them, 10 658 subjects participated in this study, and FC was diagnosed based on the Rome IV criteria.

RESULTS

The number of subjects who fulfilled diagnostic criteria of FC was 220, and the prevalence of FC was 2.1%. Compared with subjects with non-FC, those with FC were more complaining of abdominal bloating and distension, feeling stressed, getting annoyed, lack of motivation, fatigue upon waking, and feeling depressed. The risk of FC was significantly lower among subjects who drank alcohol more than 5 days a week, exercised for more than 30 min at least twice a week for more than 1 year, and were getting enough rest by sleeping, whereas it was significantly higher among women and subjects who were eating faster than other people.

CONCLUSIONS

The prevalence of FC in Japanese subjects during a medical check-up was relatively low compared with that in Western countries. Subjects with FC had troublesome symptoms, and it might be suggested that female sex, lack of regular exercise with moderate activity, insufficient rest by sleeping, and eating faster were a risk of FC.

Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis

BACKGROUND

Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs.

FINDINGS

Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used.

INTERPRETATION

Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability.

FUNDING

None.

Questionnaire Survey of Bowel Habit in Japanese Medical Personnel

OBJECTIVES

This study aims to clarify the bowel habit, change of bowel movement throughout the cycle of menstruation, and toilet use in Japanese medical personnel.

METHODS

A questionnaire survey was completed by Japanese medical personnel after listening to lectures on bowel disorders. Constipation was defined according to Rome III criteria, whereas diarrhea was defined as Bristol stool form scale type 6 and 7.

RESULTS

In total, 463 persons (mean age, 35.6 years, range 20-91, male/female/no answer: 132/324/7) have completed the questionnaire. Constipation was significantly more often observed in females (male/female: 3%/31%, p > 0.001, Chi-squared test), while diarrhea was noted to be less in females (male/female: 1%/7%). Constipation was observed in 20% of participants in their 20s, and the constipation rate was observed to gradually increase with age. It was observed in 45% of participants in their 70s or older. Bowel movement changed to constipation around menstruation in 18% of females and changed to diarrhea in 43% of females. Constipation often occurred before menstruation and diarrhea during menstruation. Only 2% of participants used a Japanese-style toilet, and 5% of participants claimed that they were unable to pass a stool on a Japanese-style toilet.

CONCLUSIONS

Constipation was significantly more frequent in females and increased with age among female Japanese medical personnel. Change of bowel movement occurred in 61% of females around menstruation. Five percent of participants were unable to pass stools on a Japanese-style toilet.

Mucosa-associated gut microbiome in Japanese patients with functional constipation

The number of patients with chronic constipation is increasing in Japan. We investigated the gut mucosa-associated microbiome in Japanese patients with functional constipation. Diagnosis was made according to the Rome IV criteria. Mucosal samples were obtained by gentle brushing of mucosa surfaces. The gut microbiome was analyzed using 16S rRNA gene sequencing. There were no significant differences in bacteria α-diversity such as richness and evenness. The PCoA indicated significant structural differences between the constipation group and healthy controls (p = 0.017 for unweighted and p = 0.027 for weighted). The abundance of the phylum Bacteroidetes was significantly higher in the constipation group. The abundance of the genera Streptococcus, Fusobacterium, Comamonas, and Alistipes was significantly higher in the constipation group. The abundance of the genera Acinetobacter, Oscillospilla, Mucispirillum, Propinibacterium, and Anaerotruncus was significantly lower in the constipation group. In the constipation group, the proportion of genes responsible for sulfur metabolism, selenocompound metabolism, sulfur relay system was significantly higher and the proportion of d-arginine and d-ornithine metabolism and flavonoid biosynthesis was significantly lower. In conclusion, we identified differences of the mucosa-associated microbiome between Japanese patients with functional constipation and healthy controls. The mucosa-associated microbiome of functional constipation was characterized by higher levels of Bacteroidetes (Alistipes).

Non-pharmacological interventions to improve constipation amongst older adults in long-term care settings: A systematic review of randomised controlled trials

Constipation is a highly prevalent condition amongst older adults in long-term care settings and laxatives are not always the solution. We aimed to examine the characteristics and the effects of non-pharmacological interventions to improve constipation amongst older adults in long-term care settings. Eligible studies were identified using PubMed, CINAHL, Scopus, Web of Science, Cochrane and EMBASE (up to April 2019). We included 7 studies with a total of 657 patients. Five interventions improved the number of bowel movements (i.e. laxative tea, fermented oat drink, patient education, probiotics and multi-component intervention). The administration of probiotic capsules and fermented oat drinks also improved stool form. Auricular acupressure improved constipation symptoms and constipation-related quality of life. After appraising the trials' methodological quality and risk of bias, we cannot recommend any non-pharmacological interventions to improve constipation amongst older adults in long-term care settings until more robust studies have been conducted.

Association between the severity of constipation and sarcopenia in elderly adults: A single-center university hospital-based, cross-sectional study

The aim of the present study was to investigate the association between the severity of constipation and sarcopenia in elderly adults. We conducted a single-center university hospital-based, retrospective cross-sectional study of consecutive outpatients aged ≥65 years from 2017 to 2020. Patients were included in the study if all of the following information were available from medical records: Patient's profile (age, sex, body mass index), laxative/prokinetics use, evaluation of sarcopenia, nutritional status, and questionnaires concerning the severity of constipation [Constipation Scoring System (CSS)], abdominal symptom-related quality of life (QOL) (Izumo scale) and stool shape [Bristol Stool Form Scale (BSFS)]. Multiple regression analysis of risk factors for high CSS score was performed. The results revealed that of the 310 eligible study subjects, [149 men (48.1%) and 161 women (51.9%); mean age, 75.7±6.1 years; mean body mass index, 23.0±3.6 kg/m²], sarcopenia was noted in 83 cases (26.8%). The CSS score was significantly higher in the sarcopenia group than that noted in the non-sarcopenia group (4.9±4.9 vs. 3.6±3.6, P=0.009). The CSS score was significantly associated with the albumin level (r=-0.148), lymphocyte count (r=-0.118), CONUT score (r=0.130), reflux-related QOL score (r=0.155), upper abdominal pain-related QOL score (r=0.171), fullness-related QOL score (r=0.299), constipation-related QOL score (r=0.615), diarrhea-related QOL score (r=0.235) and BSFS score (r=-0.114). In multiple regression analysis, independent predictors for CSS score were sarcopenia [standardized partial regression coefficient (β)=0.107, P=0.032], constipation-related QOL score (β=0.537, P<0.001), laxative/prokinetics use (β=0.211, P<0.001) and BSFS score (β=-0.098, P=0.031) (R²=0.436). In conclusion, sarcopenia, constipation-related QOL score, laxative/prokinetics use and BSFS score are associated with the severity of constipation in elderly adults.

Differences in efficacy and safety of lubiprostone used for idiopathic vs opioid-induced constipation: meta-analysis of East Asian and Western populations

Several secretagogues, such as lubiprostone, have been developed for the treatment of constipation in the last 10 years. It is unclear whether the efficacy of lubiprostone for spontaneous bowel movement (SBM) and the adverse events are similar between idiopathic and opioid-induced constipation and between East-Asian and Western populations. We conducted a meta-analysis to compare efficacy and safety of lubiprostone in two populations with idiopathic vs opioid-induced constipation. The PubMed and Cochrane databases were searched for relevant randomized control trials (RCTs) investigating the efficacy and safety that were published in English up to March 2019. Compared with the placebo groups in idiopathic and opioid-induced constipation, the lubiprostone groups significantly improved in 24-h SBM frequency [relative risk: 1.28, 95% confidence interval, 1.11-1.49, and 1.23, 1.14-1.32] and weekly frequency >3 SBM/week (1.68, 1.41-2.01, and 1.43, 1.01-2.04), respectively. Although the incidence of adverse events was similar between idiopathic and opioid-induced constipation, the incidence of nausea in Western populations with idiopathic constipation was significantly higher (29.2%) than that in East-Asian populations (10.0%, p<0.001). In conclusion, lubiprostone effectively improved SBM frequency, irrespective of the etiology of constipation and population. The incidence of nausea was significantly higher in Western populations.