Constipation in old age

Multi-omics revealed that the postbiotic of hawthorn-probiotic alleviated constipation caused by loperamide in elderly mice

Background

Constipation is a prevalent and recurrent gastrointestinal disorder causing significant discomfort. However, current treatments often prove ineffective. Previous research indicates that the postbiotic derived from a combination of hawthorn and probiotics can alleviate constipation. This study aimed to investigate its mechanisms using loperamide-induced constipation in aged KM mice.

Methods

Constipated mice were divided into groups receiving 10% lactulose (Y), hawthorn extract (S), probiotics (F), and the postbiotic of hawthorn-probiotic (FS). UPLC–MS metabolomics identified constituents of F, S, and FS. Network pharmacological analysis identified targets affected by FS. RT-qPCR assessed target expression in mouse colons, along with IL-6 and IL-17A levels. Molecular docking with AutoDock Tools1.5.6 evaluated interactions between FS components and targets. ex vivo colonic organ culture and RT-qPCR assessed target changes. Molecular dynamics analysis further scrutinized interactions. Targeted metabolomics measured short-chain fatty acid levels in mouse stool.

Results

UPLC–MS metabolomics revealed distinct profiles for F, S, and FS, with FS showing decreased toxic substances and increased beneficial ones compared to S. Network pharmacology identified 20 cross-targets of FS in constipation. RT-qPCR showed decreased NR1I2 and SULT1A1 and increased GLP-2r in FS-treated mice. Inflammatory cytokines IL-6 and IL-17A were also reduced. ex vivo colonic organ culture and molecular docking identified effective combinations such as TNF-Baicalin and AQP3-Quinacridone. RMSD, RMSF, and RG analyses indicated favorable interactions between small molecules and targets. Targeted metabolomics revealed differing short-chain fatty acid contents in feces among groups.

Conclusion

The postbiotic of hawthorn-probiotic alleviates constipation by regulating intestinal water and sodium metabolism, maintaining the intestinal barrier and gut flora, promoting epithelial cell proliferation, reducing inflammatory responses, and improving short-chain fatty acid metabolism.

Useful Bowel Preparation with Ultralow-Volume (500 mL) Polyethylene Glycol for Colonoscopy: A Retrospective Study

INTRODUCTION

Adequate bowel preparation is indispensable for high-quality colonoscopy. We have developed an ultralow-volume (500 mL) polyethylene glycol (PEG) combined with other laxatives (sennoside, sodium picosulfate, and lactulose) and applied this regimen clinically to all patients with colonoscopy for 3 decades. This study aimed to assess the effectiveness of this ultralow-volume bowel preparation regimen.

METHODS

This single-center, retrospective study analyzed data from consecutive outpatients who underwent colonoscopy between January 2022 and December 2022. All the patients took sennoside (24 mg) two nights before, sodium picosulfate (75 mg) one night before, and 500 mL of PEG with lactulose (58.5 g) on the day of examination. Cleaning efficacy was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a total BBPS score ≥6, with all colon segments scoring ≥2.

RESULTS

Out of 862 patients with colonoscopy, 773 were eligible for this study, and the median age was 66 years. The adequate bowel preparation rate was 91.8% (710/773). Notably, the BBPS full score "9" was observed in 50.5% (390/773). The median cecal intubation time and examination time were 8 and 20 min, respectively. Only 3 patients vomited as a side effect. In the multivariate analysis, age ≥70 years, diabetes mellitus, and diverticula were significantly independent risk factors for inadequate bowel preparation.

CONCLUSIONS

Our established ultralow-volume (500 mL) PEG is safe and useful as a bowel preparation method.

Leaky gut in systemic inflammation: exploring the link between gastrointestinal disorders and age-related diseases

Global average life expectancy has steadily increased over the last several decades and is projected to reach ~ 77 years by 2050. As it stands, the number of people > 60 years currently outnumbers children younger than 5 years, and by 2050, it is anticipated that the global population of people aged > 60 years will double, surpassing 2.1 billion. This demographic shift in our population is expected to have substantial consequences on health services globally due to the disease burden associated with aging. Osteoarthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and cognitive decline associated with dementia are among the most common age-related diseases and contribute significantly to morbidity and mortality in the aged population. Many of these age-related diseases have been linked to chronic low-grade systemic inflammation which often accompanies aging. Gastrointestinal barrier dysfunction, also known as "leaky gut," has been shown to contribute to systemic inflammation in several diseases including inflammatory bowel disease and irritable bowel syndrome, but its role in the development and/or progression of chronic low-grade systemic inflammation during aging is unclear. This review outlines current literature on the leaky gut in aging, how leaky gut might contribute to systemic inflammation, and the links between gastrointestinal inflammatory diseases and common age-related diseases to provide insight into a potential relationship between the intestinal barrier and inflammation.

Strategic Considerations in Designing Food Solutions for Seniors

The demographic shift towards an aged population calls for targeted nutrition strategies to support healthy aging and bridge the gap between life expectancy and a healthy life span. Older adults face various nutritional deficiencies, particularly in protein, vitamins (B12, D), minerals (calcium, iron), and dietary fiber. This work delves into the EAT4AGE project efforts that strategically aimed to develop age-oriented food products (European Joint Programming Initiative "A Healthy Diet for a Healthy Life" JPI HDHL). Currently, manufacturing of age-tailored food products presents significant complexities, from challenges of commercialization to the generation of acceptable and palatable food choices. As a first step, a literature-based comprehensive checklist has been developed to facilitate product development. This tool provides an integrated approach, ensuring that all critical aspects of product development are addressed systematically. Secondly, we describe the application of the tool in the development of a series of products, such as plant-based protein-rich cereals, reformulated dairy products, processed meat, and enriched spreads; all combining high nutritional values with adaptations to the physiological and sensory needs of seniors. Overall, this work offers insight into the current needs of seniors and a tool for product development that can be utilized for prospective product development, such as the ones detailed herein. Thus, the EAT4AGE hopes to set an example that will stimulate the fabrication of effective, well-received nutritional solutions, ultimately improving health outcomes for older adults.

Understanding constipation as a geriatric syndrome

Constipation is common among older adults and significantly impacts their quality of life (QoL). Prior studies have extensively detailed constipation, but conceptualization of constipation as a geriatric syndrome is lacking. In this review, we provide an overview of constipation in the geriatric population and conceptualize constipation as a geriatric syndrome given its high prevalence, under-recognized status, and association with poor QoL and adverse outcomes among older adults. The conceptualization of constipation as a geriatric syndrome, as with frailty and delirium, highlights its importance and need for a multi-faceted approach. Future research is needed to 1) better define constipation, 2) explore the multifactorial nature of constipation in older adults and relationship with other geriatric syndromes, 3) include more older adults in pharmacological and non-pharmacological interventions for constipation, and 4) curate multidisciplinary care models. Appreciating constipation as a geriatric syndrome will yield tailored management strategies, ensure timely intervention, and avoid adverse outcomes.

Prevalence, risk factors, and adverse outcomes of diastasis of rectus abdominis in men: a cross-sectional study

PURPOSE

This observational study aimed to investigate the prevalence of DRA, ascertain the possible risk factors and analyse the adverse outcomes of DRA among men. Moreover, the reasonable diagnostic criterion was further explored.

MATERIALS AND METHODS

1575 men aged 18 years or older were recruited from a Grade III A Hospital. Data were obtained by electronic medical record, subsequent unified questionnaire and clinical examinations. Possible risk factors of DRA were confirmed in the univariate analysis and multivariate analysis. Based on two diagnostic criteria, Chi square test and Wilcoxon rank sum test were used to compare the difference of adverse outcomes among men with and without DRA.

RESULTS

The prevalence of DRA in men was 29.78% when IRD > 2 cm was used as a diagnostic criterion, but decreased to 10.16% when IRD > 3 cm as a criterion. Age, BMI, smoking and physical exercise were proved as influencing factors for DRA. No association was found between DRA and abdominal wall muscle function, low back pain, and quality of life. But hernia was significant with DRA, when IRD>3 cm as diagnostic criterion.

CONCLUSIONS

Prevalence of DRA in male is high and taking measure on losing weight, giving up smoking and exercising properly may prevent DRA, along with reducing the possibility of DRA-related hernias. To be important, IRD>3 cm as the reasonable diagnostic criterion was proposed.

Effect of KiwiBiotic on functional constipation and related symptoms: A prospective, single-center, randomized, comparative, crossover study

BACKGROUND

Functional constipation (FC) is a common gastrointestinal disorder characterized by abdominal pain and bloating, which can greatly affect the quality of life of patients. Conventional treatments often yield suboptimal results, leading to the exploration of alternative therapeutic approaches.

AIM

To evaluate the efficacy of KiwiBiotic in the management of FC and related symptoms.

METHODS

This prospective, interventional, single-center, crossover study compared the safety and effectiveness of KiwiBiotic® vs psyllium husk in managing FC, abdominal pain, and bloating. Participants diagnosed with FC were randomly assigned to receive KiwiBiotic or psyllium husk during the two treatment periods, with a 14-day washout period between them.

RESULTS

Seventy participants were enrolled, 32 of whom received KiwiBiotic followed by psyllium husk, and 33 received KiwiBiotic. KiwiBiotic showed superiority over psyllium husk in alleviating abdominal pain and bloating, as evidenced by significantly lower mean scores. Furthermore, KiwiBiotic resulted in more than 90.0% of patients experiencing relief from various constipation symptoms, while psyllium husk showed comparatively lower efficacy.

CONCLUSION

KiwiBiotic is an effective treatment option for FC, abdominal pain, and bloating, highlighting its potential as a promising alternative therapy for patients with FC and its associated symptoms.

Epidemiology of constipation and its associated factors in an ageing population of people with an intellectual disability in Ireland: A cross-sectional study

Background: Constipation impacts health-related quality of life with a burden similar to other chronic conditions. This study characterises the prevalence of constipation and its associated factors in older adults with intellectual disability.Methods: Data from the Intellectual Disability Supplement of The Irish Longitudinal Study on Ageing was analysed using bivariate and multivariate approaches.Results: Constipation affected 43.5% of this cohort and was more common in females, those in residential settings, and those with a severe/profound level of intellectual disability. The type of residence, level of intellectual disability, a low fat diet, high cholesterol, multimorbidity and, physical activity predicted constipation status with 67.7% accuracy. Physical activity was associated with lower constipation prevalence, where minimal activity was sufficient to observe this effect.Conclusions: Constipation is a common health concern in older people with intellectual disability. This analysis reveals characteristics that should inform the careful monitoring of bowel health in this population.

The human colon: Evidence for degenerative changes during aging and the physiological consequences

BACKGROUND

The incidence of constipation increases among the elderly (>65 years), while abdominal pain decreases. Causes include changes in lifestyle (e.g., diet and reduced exercise), disease and medications affecting gastrointestinal functions. Degenerative changes may also occur within the colo-rectum. However, most evidence is from rodents, animals with relatively high rates of metabolism and accelerated aging, with considerable variation in time course. In humans, cellular and non-cellular changes in the aging intestine are poorly investigated.

PURPOSE

To examine all available studies which reported the effects of aging on cellular and tissue functions of human isolated colon, noting the region studied, sex and age of tissue donors and study size. The focus on human colon reflects the ability to access full-thickness tissue over a wide age range, compared with other gastrointestinal regions. Details are important because of natural human variability. We found age-related changes within the muscle, in the enteric and nociceptor innervation, and in the submucosa. Some involve all regions of colon, but the ascending colon appears more vulnerable. Changes can be cell- and sublayer-dependent. Mechanisms are unclear but may include development of "senescent-like" and associated inflammaging, perhaps associated with increased mucosal permeability to harmful luminal contents. In summary, reduced nociceptor innervation can explain diminished abdominal pain among the elderly. Degenerative changes within the colon wall may have little impact on symptoms and colonic functions, because of high "functional reserve," but are likely to facilitate the development of constipation during age-related challenges (e.g., lifestyle, disease, and medications), now operating against a reduced functional reserve.

Development and validation of a nomogram to predict the risk of constipation after lumbar interbody fusion surgery

INTRODUCTION

To understand the incidence of postoperative constipation and the risk factors of constipation in patients with lumbar interbody fusion, we constructed and verified the constipation risk prediction model, so as to provide reference for the prevention and treatment of postoperative constipation.

METHODS

The data of patients undergoing lumbar interbody fusion in our hospital were retrospectively analyzed from December 2021 to December 2022. According to postoperative constipation, the patients were divided into constipation group and non-constipation group. Univariate logistic regression analysis and multivariate logistic regression analysis were used to determine independent risk factors for postoperative constipation. Based on independent risk factors, a nomogram was developed to predict the risk of constipation after lumbar interbody fusion. The prediction performance was assessed using receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA). Finally, bootstrapping method for internal validation was further evaluated the nomogram.

RESULTS

A total of 282 patients participated in the study. 176 patients (62.41%) after lumbar interbody occurred constipation, and 106 patients were asymptomatic. Multivariate regression analysis showed independent risk factors, including the use of calcium channel blockers, polypharmacy, postoperative bed time, and constipation history. Multivariate regression analysis was used to establish the model. The C-index of the nomogram was 0.827 (95% CI 0.779-0.875), and the C-index of interval bootstrapping validation was 0.813 (95% CI 0.765-0.861), and the area under the AUC was 0.800. The nomogram showed good discrimination ability.

CONCLUSIONS

The use of calcium channel blockers, polypharmacy, postoperative bed time, and history of constipation are independent risk factors for postoperative constipation in patients undergoing lumbar interbody fusion. The constructed risk prediction model has good discriminative ability.

Efficacy and mechanism of acupuncture for functional constipation in older adults: study protocol for a randomized controlled trial

Introduction

Functional constipation (FC) is a common functional gastrointestinal disorder in clinical practice, with the prevalence of which increasing with age. With the increasing aging of the population worldwide, this problem is bound to become more prominent. Acupuncture is effective and recommended for the treatment of FC. However, little is known about how acupuncture affects the gut microbiota and inflammatory cytokines and thus improves gut function. Meanwhile, there are few high-quality clinical trials specifically focusing on acupuncture in treating FC in older people. The objective of this study is to assess the efficacy and safety of acupuncture in treating FC in older people. Additionally, the research aims to explore the mechanism of action of acupuncture in treating FC in older people by affecting intestinal microbiota and inflammation cytokines.

Methods and analysis

This study is designed as a single-center, randomized, sham-controlled clinical trial. A total of 98 eligible FC patients will be randomized in a 1:1 ratio into an acupuncture group and a sham acupuncture group. Both groups will receive 24 treatments over 8 weeks with a 12-week follow-up. The primary outcome of the study is the treatment response rate, which is the proportion of participants with ≥3 mean weekly Complete Spontaneous Bowel Movements (CSBMs) over weeks 3-8. The secondary outcomes will include the proportion of participants with ≥3 mean weekly CSBMs during other assessment periods; the percentage of patients with ≥1 increase in mean weekly CSBMs from baseline; the average changes in CSBMs; Patient Assessment of Constipation-Symptoms (PAC-SYM), Bristol Stool Scale, Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and weekly usage of emergency bowel medications. Adverse events will be recorded throughout the study. Data for the outcomes will be collected at Week 0 (baseline), Week 4 (the intervention period), Week 8 (the post-treatment), Week 12 (the follow-up period) and Week 20 (the follow-up period). In addition, changes in intestinal microbiota will be analyzed using 16S rRNA high-throughput detection, and the concentration of relevant inflammatory cytokines in serum will be measured by ELISA based on blood samples. The intention-to-treat analysis will be performed in this study.Clinical trial registration: [https://www.chictr.org.cn/], identifier [ChiCTR2300070735].

Prevalence and patterns of laxative use in subjects with self-reported constipation: results from a multinational digestive health survey

Background

Constipation is characterized by symptoms of straining, hard stool, difficult evacuation, and infrequent bowel movements. Online surveys provide valuable information about patients' perspectives, symptoms, management, treatment satisfaction, and risk factors.

Methods

This survey explored subject experiences involving 20 gastrointestinal (GI) conditions. In total, 20,099 respondents in seven countries with varied cultural and socioeconomic backgrounds participated. Post hoc analysis of 'self-reported constipation' and related symptoms experienced within the past 6 months and the last episode of constipation provided data on prevalence, demographics, frequency and duration of episodes and related symptoms, impact on quality of life (QoL), management with or without laxatives, and resulting treatment satisfaction.

Results

In total, 10,425 subjects reported constipation within 6 months and 2637 at the last episode. Prevalence was highest in females and younger adults. Most subjects reported various coexisting GI symptoms. Almost 80% of 6865 episodes reported by 5337 subjects occurred every 2-3 months to every 2-3 weeks. A higher frequency of constipation correlated with a greater impact on QoL. On a 10-point scale, the mean impact was 6.4. More than 90% of respondents had episodes ranging from 1 day to 1 week. More than 90% took action; 16% used laxatives, of whom 80.3% were satisfied.

Conclusion

Constipation, a highly prevalent disorder, spans cultures and socioeconomic classes. Its chronic recurrence has a significant impact on QoL, resulting in symptom self-management in >90% of subjects. Significantly higher satisfaction rates in subjects treated with than without laxatives reflect subjects' reports that self-reported constipation can be treated effectively with laxatives.

Quality of Life of Young Gastric Cancer Survivors: An Interpretation in the Context of Our Society

Background and Objectives: This retrospective case-control study aimed to investigate the quality of life (QoL) of young gastric cancer survivors and determine what should be pursued to obtain the best QoL for them after surgery. Materials and Methods: Patients with stage I gastric cancer who underwent distal subtotal gastrectomy were included. The European Organization for Research and Treatment of Cancer Quality of Life questionnaires were used to assess QoL. The QoL outcomes of younger (age 30-49 years, n = 76) and older (age 50-69 years, n = 232) groups were compared preoperatively, 3 months, and 1 year postoperatively. Results: There was no statistically significant difference in the preoperative QoL except for the physical functioning scale, which favored the younger group (p = 0.020). This difference remained significant throughout the postoperative periods (3 months, p = 0.002; 1 year, p = 0.004). Better QoL was found for the younger group according to the body image scale (p = 0.031). However, it was limited to the 3-month postoperative assessment. Persistent QoL disadvantages for the younger group were revealed by the diarrhea scale at the 3-month (p = 0.007) and 1-year (p = 0.005) postoperative assessments. Conclusions: While young gastric cancer survivors enjoyed better QoL in physical functioning and body image, worse QoL was related to diarrhea after surgery. Despite ever-rising concerns about QoL deterioration in elderly patients in our aged society, young gastric cancer survivors also need QoL support.

The effectiveness of walking exercise on the bowel preparation before colonoscopy: a single blind randomized clinical trial study

BACKGROUND AND AIM

Bowel preparation is a crucial factor affecting the diagnostic accuracy of colonoscopy, and few randomized control trials evaluated enhancement in bowel preparation. In this study, we aimed to evaluate the effectiveness of walking exercises on bowel preparation before a colonoscopy procedure.

METHODS

The present study is a single-blind randomized controlled trial involving 262 patients scheduled for colonoscopy procedures. These patients were randomly assigned to two groups: an intervention group (n = 131) and a control group (n = 131). In the intervention group, participants followed a predetermined plan that included the consumption of specific liquids and foods, bisacodyl pills, polyethylene glycol powder, and a regimen of walking exercises in preparation for their colonoscopy. Conversely, individuals in the control group followed the same regimen but were not instructed to engage in walking exercises. On the day of the colonoscopy, both groups were assessed for their level of physical activity using a foot counter. Additionally, an experienced gastroenterologist evaluated and compared the bowel preparation between the two groups using the Boston Bowel Preparation Scale (BBPS).

RESULTS

The number of footsteps recorded in the two groups exhibited a significant difference (P < 0.001). Although there was no statistically significant difference between the intervention and control groups in terms of mean BBPS scores (6.26 ± 1.9 vs. 6.29 ± 1.9, P = 0.416), individuals who took more than 6900 steps had significantly higher BBPS scores compared to those with fewer than 6900 footsteps (6.62 ± 1.8 vs. 5.92 ± 1.9, P = 0.003).In the univariate analysis, BBPS was found to be significantly associated with individuals under the age of 50 (OR: 2.45, 95% CI: 1.30-4.61, P = 0.006) and smoking status (OR: 0.41, 95% CI: 0.17-0.94, P = 0.043). In the multivariate analysis, the relationship between BBPS and age below 50 and smoking remained significant (OR: 2.50, 95% CI: 1.30-4.70, P = 0.005, and OR: 0.38, 95% CI: 0.16-0.93, P = 0.034, respectively).

CONCLUSION

A higher number of footsteps taken especially more than 6900 can significantly enhance bowel preparation; however, walking exercise as an intervention before colonoscopy is not significantly associated with BBPS. Also, older people and smokers seem to have fewer benefits from walking exercises for bowel preparation.

TRIAL REGISTRATION

ISRCTN32724024 (Registration date:22/08/2018).

Stercoral Ulcer Presenting in a Patient with Cauda Equina Syndrome Secondary to Postoperative Epidural Hematoma

Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. In extensive posterior thoracolumbar surgery, a long operation time, large blood loss, and perioperative narcotic use may aggravate constipation. Moreover, sacral root palsy due to cauda equina syndrome (CES) can lead to the deterioration of fecal impaction. This report describes the case of a 77-year-old woman with CES who presented with saddle anesthesia, neurogenic bladder, bowel incontinence, and paraplegia. Five days prior, she had undergone extended posterior lumbar interbody fusion from L1 to L5. Lumbar magnetic resonance imaging (MRI) showed an extended epidural hematoma. After urgent neural decompression, she gradually recovered from the saddle anesthesia, leg pain, and paraplegia over 3 weeks. Thereafter, the patient suddenly developed massive hematochezia and hemorrhagic shock. Urgent colonoscopy was performed, and a stercoral ulcer in the sigmoid colon was diagnosed. After 4 weeks of intensive care for hemorrhagic shock, pneumonia, and systemic sepsis, the patient was transferred to a general ward for intensive rehabilitation. One year after the operation, she was able to walk with assistance, and her urinary and bowel incontinence completely recovered. Chronic constipation, a common clinical problem, can sometimes cause relatively obscure but potentially life-threatening complications such as stercoral ulceration. Possible factors including advanced age, extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and the presence of spinal cord injury might contribute to the development of this condition. It highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.

Could atmospheric temperature impact on adequate colon cleansing for colonoscopy? An observational, single-institution study

PURPOSE

Several risk factors affecting the adequacy of colon cleansing have been proposed during the last decades. However, less is known about the impact that atmospheric aspects could have on adequacy of the bowel cleansing. The study aimed to investigate if the atmospheric temperature could impact on the bowel cleansing during colonoscopy.

METHODS

A prospective maintained database of the colonoscopies performed since 1^st August 2017 to 31^st March 2020 was retrospective reviewed. The primary outcome of the study was to identify if the atmospheric temperature was associated with inadequate colon cleansing during colonoscopy. Secondary outcome was to identify the other factors associated with an inadequate colon cleansing.

RESULTS

One thousand two hundred twenty patients were enrolled. High atmospheric temperature (> 25 °C) significantly influenced the colon cleansing (p < 0.0001). Adequate colon cleansing was negatively influenced by gender (female patients were associated with higher colon cleansing rate, p = 0.013), diabetes (p < 0.0001), previous pelvic surgery (p = 0.001), use of Beta-Blocker (p = 0.001), anti-platelet (p = 0.017), angiotensin converting enzyme inhibitors (p = 0.001), the adoption of 4 L Poly Ethylene Glycol solution (p = 0.009), single-dose regimen (p < 0.0001) low patients' compliance (p < 0.0001), higher age and body mass index (p < 0.0001 and p = 0.025), lower education levels (p < 0.0001). On the contrary, admission to the ward to perform bowel preparation positively impacted on colon cleansing (p = 0.002).

CONCLUSION

Atmospheric temperature could play an important role in the colon cleansing during colonoscopy, being high temperature (> 25 °C) associated with lower rate of adequate bowel cleansing. However, being this relationship never studied before, these results must be confirmed by other studies.

Mediating Roles of Stress, Anxiety, and Depression in the Relationship between Constipation and Sleep Quality among the Elderly: Structural Equation Modeling (SEM)

Introduction  Sleep quality is an important health index in the elderly. As age increases, changes occur in sleep quality leading to sleep disorders and recurrent complaints. Sleep quality management of the elderly requires identification of its determinants. The present study aimed to determine the mediating roles of stress, anxiety, and depression in the relationship between constipation and sleep quality among the elderly using structural equation modeling (SEM). Materials and Methods  A correlational design was used in the present study through structural equation modeling. In this work, 363 elderlies were examined by multi-stage random sampling. Data collection tools included four questionnaires, namely a demographic information questionnaire, the constipation questionnaire (ROME III), the Depression, Anxiety, and Stress Scale-short form, and the Pittsburgh Sleep Quality Index (PSQI), which were completed by interview and the self-report method. The SPSS Statistics for Windows, version 22.0, and SPSS AMOS (IBM Corp., Armonk, NY, USA) were used to analyze the data. Results  The results indicated that the proposed model had an acceptable fit ( p  < 0.000, root mean square error of approximation [RMSEA] = 0.062, comparative fit index [CFI] = 0.83, goodness-of-fit index [GFI] = 0.87, and Χ ² /df = 1.94). The fitted model could explain 60% of the sleep quality variance. According to the proposed model, constipation could significantly predict sleep quality due to the mediation of stress, anxiety, and depression ( p  < 0.05). Conclusion  The constructs of this model (constipation, stress, anxiety, and depression) can be used as a reference framework to design effective interventions and improve sleep quality in old people.

Ageing and the Autonomic Nervous System

The vertebrate nervous system is divided into central (CNS) and peripheral (PNS) components. In turn, the PNS is divided into the autonomic (ANS) and enteric (ENS) nervous systems. Ageing implicates time-related changes to anatomy and physiology in reducing organismal fitness. In the case of the CNS, there exists substantial experimental evidence of the effects of age on individual neuronal and glial function. Although many such changes have yet to be experimentally observed in the PNS, there is considerable evidence of the role of ageing in the decline of ANS function over time. As such, this chapter will argue that the ANS constitutes a paradigm for the physiological consequences of ageing, as well as for their clinical implications.

The effect of abdominal massage on the severity of constipation in elderly patients hospitalized with fractures: A randomized clinical trial

BACKGROUND

There is significant interest in the use of complementary therapies to control or reduce the severity of constipation.

AIM

The aim of this study was to determine the effect of abdominal massage on the severity of constipation in elderly patients with fractures.

METHODS

In this randomized clinical trial, 60 elderly patients admitted to an Iranian orthopedic referral hospital who were suffering from constipation were randomly assigned to intervention and control groups. For the intervention group, abdominal massage was performed for 3 days, twice a day, for 15 minutes. Both groups were assessed using the Constipation Assessment Scale (CAS) and the Bristol Stool Scale (BSS).

RESULTS

A statistically significant difference was observed between the two groups in BSS scores (p < 0.05). The mean CAS scores in the intervention group decreased from 10.74 to 4.51 after intervention and in the control group, it decreased from 10.20 to 7.37. There was a statistically significant difference in CAS scores between the two groups (p < 0.05).

CONCLUSION

The results of the study showed the positive effect of abdominal massage on stool consistency and reduction of severity constipation.

The effect of Cassia fistula L. syrup in geriatrics constipation in comparison with the lactulose: A randomized clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Cassia fistula is widely used in traditional Persian Medicine as a mild laxative. The rate of chronic constipation increases above the age of 60.

AIM OF THE STUDY

This study aimed to investigate the effect of Cassia fistula syrup (CFS) on geriatric constipation.

MATERIALS AND METHODS

This clinical trial study was performed on 70 aged patients who were referred to the clinic of gastroenterology of Rouhani Hospital, Babol, North of Iran. Patients were randomly divided into two groups of CFS or Lactulose with a dose of 30 ccs/day. Patients were visited two weeks after entering the study to evaluate the frequency of defecation, feeling of incomplete emptying after defecation, manual maneuver, consistency of stool, and also the quality of life.

RESULTS

The frequency of defecation per week varied from 1.82 ± 1.16 to 8.36 ± 3.44 in the CFS group after 2 weeks of intervention that was significantly more than the Lactulose that changed from 2.16 ± 1.46 to 5.66 ± 2.96 (P-value = 0.023, partial eta square = 0.079, NNT = 4). The quality of life, the percent of straining, lumpy or hard stool, pain during defecation, and the consistency of stool based on VAS were significantly better in the CFS group. The sensation of incomplete defecation, anorectal obstruction, and manual maneuvering were not different significantly between groups.

CONCLUSION

CFS can be more effective than Lactulose on geriatric constipation.

Targeting the gut to prevent and counteract metabolic disorders and pathologies during aging

Impairment of gut function is one of the explanatory mechanisms of health status decline in elderly population. These impairments involve a decline in gut digestive physiology, metabolism and immune status, and associated to that, changes in composition and function of the microbiota it harbors. Continuous deteriorations are generally associated with the development of systemic dysregulations and ultimately pathologies that can worsen the initial health status of individuals. All these alterations observed at the gut level can then constitute a wide range of potential targets for development of nutritional strategies that can impact gut tissue or associated microbiota pattern. This can be key, in a preventive manner, to limit gut functionality decline, or in a curative way to help maintaining optimum nutrients bioavailability in a context on increased requirements, as frequently observed in pathological situations. The aim of this review is to give an overview on the alterations that can occur in the gut during aging and lead to the development of altered function in other tissues and organs, ultimately leading to the development of pathologies. Subsequently is discussed how nutritional strategies that target gut tissue and gut microbiota can help to avoid or delay the occurrence of aging-related pathologies.

Age-related differences of γ-aminobutyric acid (GABA)ergic transmission in human colonic smooth muscle

BACKGROUND

Enteric neurons undergo to functional changes during aging. We investigated the possible age-associated differences in enteric γ-aminobutyric acid (GABA)ergic transmission evaluating function and distribution of GABAergic receptors in human colon.

METHODS

Mechanical responses to GABA and GABA receptor agonists on slow phasic contractions were examined in vitro as changes in isometric tension in colonic muscle strips from young (<65 years old) and aged patients (>65 years old). GABAergic receptor expression was assessed by quantitative RT-PCR.

KEY RESULTS

In both preparations GABA induced an excitatory effect, consisting in an increase in the basal tone, antagonized by the GABAA receptor antagonist, bicuculline, and potentiated by phaclofen, GABAB receptor antagonist.Tetrodotoxin (TTX) and atropine-sensitive contractile responses to GABA and GABAA receptor agonist, muscimol, were more pronounced in old compared to young subjects. Baclofen, GABAB receptor agonist, induced a TTX-sensitive reduction of the amplitude of the spontaneous. Nω-nitro-l-arginine methyl ester (L-NAME), nitric oxide (NO) synthase inhibitor abolished the inhibitory responses in old preparations, but a residual responses persisted in young preparations, which in turn was abolished by suramin, purinergic receptor antagonist. α3-GABAA receptor subunit expression tends to change in an age-dependent manner.

CONCLUSIONS AND INFERENCES

Our results reveal age-related differences in GABAergic transmission in human colon. At all the age tested GABA regulates muscular contractility modulating the activity of the intrinsic neurons. Activation of GABAA receptor, through acetylcholine release, induces contraction, which increases in amplitude with age. GABAB receptor activation leads to neural release of NO and purines, being a loss of purinergic-component in aged group.

Efficacy of Natural Formulation Containing Activated Charcoal, Calcium Sennosides, Peppermint Oil, Fennel Oil, Rhubarb Extract, and Purified Sulfur (Nucarb®) in Relieving Constipation

Introduction Long-term use of laxatives may have side effects such as bloating, allergic reaction, abdominal pain, metabolic disturbances, and hepatotoxicity. In this study, we have compared the efficacy of herbal medicine Nucarb, a combination of activated charcoal, calcium sennosides, peppermint oil, fennel oil, rhubarb extract, and purified sulfur, in relieving constipation. Methods This longitudinal study was conducted in multiple cities of Pakistan from April 2021 to June 2021. A total of 1000 patients, of either gender between age group 18 and 75 years, with complete spontaneous bowel movement of less than or equal to two times per week, were enrolled in the study. Participants were prescribed two tablets of Nucarb once daily (OD) at bedtime for the first seven days, followed by one tablet of Nucarb OD at bedtime for the following seven days. They were asked to return for follow-up after 14 days. Results There was a statistically significant improvement in all six components of constipation. After 14 days, the severity of constipation reduced by 80.70%, the sensation of straining was reduced by 72.69%, and the feeling of incomplete evacuation was reduced by 71.87%. There was no adverse event reported. Conclusion Nucarb is efficacious in reducing the severity of constipation, sensation of straining, bloating and abdominal pain, feeling of incomplete evacuation, and difficulty in passing gas. Since it is a herbal product, it can be safely used in all populations.

Herbal Medicine for the Management of Laxative Activity

Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation were discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role, because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in-vivo/ in-vitro models.

Risk Factors for Inadequate Bowel Preparation During Colonoscopy in Nigerian Patients

Background The past few decades have witnessed the introduction of various innovative technologies into colon study by colonoscopy. A well-prepared bowel is crucial to their effective utilization. An inadequate bowel preparation during colonoscopy is associated with increased technical difficulties, enhanced risks of perforation, longer examination durations, reduced adenoma detection rates, and additional costs related to repeated colonoscopies. There is a paucity of literature from Africa on the multiple patient factors that affect the quality of bowel preparation; hence, the need to identify patients at risk for inadequate bowel preparation to allow for more diligence in this special group. Aim To study the risk factors of inadequate bowel preparation for colonoscopy and identify the group of patients who need intensified preparation in a Nigerian population. Methods A case-control study of consecutive patients undergoing colonoscopy in an open access/referral-based multi-disciplinary endoscopy facility in Port Harcourt metropolis, Nigeria from March 2014 to November 2020. Consecutive adult patients who underwent colonoscopy with inadequate bowel preparation irrespective of the indication were retrospectively identified. Each case of inadequate bowel preparation while using a particular bowel preparation agent was matched with the next colon study with adequate bowel preparation (control) for the same agent in a 1:1 ratio. The variables collated were age, gender, literacy level, colonoscopy indication, medical history, bowel preparation agent, timing of endoscopy, and outcome. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY). Results There were 143 cases of inadequate bowel preparation during colonoscopy included in the study with an equal number of control (cases of adequate bowel preparation). The age of patients ranged from 24 years to 92 years. Bleeding per rectum - 122(42.7%), and screening for colorectal cancer - 67(23.4%), were the leading indications for colonoscopy in study patients. Bivariate analysis of cases and controls revealed significant difference in educational status, comorbidity of hypertension, and constipation (p < 0.01, p = 0.082, p = 0.143, respectively). In the multivariate analysis of risk factors, the odds ratio (OR) for secondary level of education and below was 2.54 (95% confidence interval CI 1.50-4.30; p = 0.001); hypertension - OR 1.64 (95% CI 0.98-2.73; p = 0.058); constipation - OR 1.27 (95% CI 0.52-3.10; p = 0.598). Conclusion The educational status of patients is a strong risk factor associated with inadequate bowel preparation for colonoscopy in this Nigerian population. There is a need for effective patient education especially for patients with a low literacy level.

Functional Constipation in Older Adults: Prevalence, Clinical Symptoms and Subtypes, Association with Frailty, and Impact on Quality of Life

INTRODUCTION

Functional constipation (FC) is very prevalent in older adults, especially in women, but its relationship with frailty is not fully understood. The aims were to assess FC prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life (QoL) in older people.

METHODS

This epidemiological study included 384 individuals aged over 70 years recruited from the community, a hospital, and a nursing home and stratified into robust, pre-frail, and frail groups (Fried criteria). The following criteria were evaluated: frailty, FC (Rome III criteria), stool consistency (Bristol Stool Chart), comorbidities (Charlson), dependency (Barthel), QoL (EQ5D), and clinical and sociodemographic data. Defined by symptom aggregation were 2 main clinical subtypes as follows: slow colonic transit time (CTT) and functional defecation disorder (FDD).

RESULTS

Mean age was 79.11 ± 6.43 years. Overall FC prevalence was 26.8%, higher in women (32.4% women vs. 21.8% men; p = 0.019) and highest in frail patients (41.7% frail vs. 33.9% pre-frail vs. 24.2% robust; p < 0.001). Straining and hard stools (Bristol 1-2) were the most prevalent symptoms (89.3 and 75.7%, respectively). Frailty and benzodiazepine intake were independently associated with FC. Patients with FC obtained poorer QoL scores in the EQ5D (perceived health 66.09 ± 17.8 FC patients vs. 56.4 ± 19.03 non-FC patients; p < 0.05). The FDD subtype became significantly more prevalent as frailty increased (6.5, 25.8, and 67.7% for robust, pre-frail, and frail patients, respectively); the slow CTT subtype was significantly more frequent in robust patients (38.5% robust vs. 30.5% pre-frail vs. 23.1% frail), p = 0.002.

DISCUSSION/CONCLUSION

FC prevalence in older adults was high, especially in women, and was associated with frailty and poor QoL. Clinical subtypes as related to frailty phenotypes reflect specific pathophysiological aspects and should lead to more specific diagnoses and improved treatment.

Potential risk factors for constipation in the community

Constipation is a common community health problem. There are many factors that are widely thought to be associated with constipation but real-world evidence of these associations is difficult to locate. These potential risk factors may be categorised as demographic, lifestyle and health-related factors. This review presents the available evidence for each factor by an assessment of quantitative data from cross-sectional studies of community-dwelling adults published over the last 30 years. It appears that there is evidence of an association between constipation and female gender, residential location, physical activity and some health-related factors such as self-rated health, some surgery, certain medical conditions and certain medications. The available evidence for most other factors is either conflicting or insufficient. Therefore, further research is necessary to determine if each factor is truly associated with constipation and whether it can be regarded as a potential risk factor. It is recommended that studies investigating a broad range of factors are conducted in populations in community settings. Multivariate analyses should be performed to account for all possible confounding factors. In this way, valuable evidence can be accumulated for a better understanding of potential risk factors for constipation in the community.

Profiles of polypharmacy in older adults and medication associations with signs of aspiration

BACKGROUND

Polypharmacy and specific medication classes are prevalent in older adults. Their relationships with swallowing disorders are not well explored, which would best be managed holistically, with consideration of medication profiles. This study aimed to establish profiles of polypharmacy in older adults and investigate the associations of polypharmacy and medication class with signs of aspiration during swallowing.

METHODS

This was a secondary retrospective analysis of data from 291 adults aged 60 years and older. Polypharmacy was profiled numerically and described. Multivariate logistic regression was used to identify associations between medication classes with signs of aspiration, while controlling for independent variables of demographics, functional status, and medical history.

RESULTS

Three distinct profiles of polypharmacy were described. Higher numbers of medications were associated with higher age, lower functional status, nursing home residency, multimorbidity, and showing signs of aspiration. Thirty-four classes of medications were found in this study, benzodiazepines were the only class independently associated with signs of aspiration.

CONCLUSIONS

Different profiles of polypharmacy can be observed in older adults, but none were independently associated with signs of aspiration. In addition to known demographic and functional status variables, benzodiazepine-use was found to be independently associated with signs of aspiration (p = .005, B = 7.94).

Rhubarb extract relieves constipation by stimulating mucus production in the colon and altering the intestinal flora

BACKGROUND

Constipation, mainly characterized by the difficulty in defecation, is a clinical symptom caused by a variety of factors. It can be manifested as normal or slow colonic transport abnormalities, which can occur alone or concurrently with defecation disorders. As there is not uniform definition and assessment standard, no clear plan could be used for the treatment of constipation. Although rhubarb, a traditional Chinese medicine, plays a therapeutic role in diseases involving constipation symptoms, the detailed mechanism of it in treating constipation remains unclear.

METHODS

A model of constipation-induced by diphenoxylate was prepared. Immunofluorescent staining was used to detect the expression of mucin 2 (MUC2), calnexin and chymase in colon. Western blotting was used to detect changes of tryptase and calnexin in the colon. And real-time polymerase chain reaction (PCR) was utilized to detect the changes of immunoglobulin-binding protein (Bip), X-box binding protein 1 (Xbp1) and C/EBP homologous protein (CHOP) of colonic goblet cells in mRNA levels. ELISA and biochemical kits were utilized to detect the changes of MUC2, Trefoil factor 3 (TFF3), acetylcholine, histamine and C-C motif chemokine ligand 5 (CCL5) in the colon. And the changes of colonic mucosa and intestinal flora of constipation model mice caused by rhubarb extract (RE) were analyzed to identify the mechanism of RE on the treatment of constipation.

RESULTS

RE promotes the secretion of colonic mucus by recruiting mast cells and enhancing the content of histamine and Ach in the mice colon. In the process, RE causes up-regulation of Bip and CHOP mRNA expression and down-regulation of Xbp1 and Xbp1s mRNA expression that induces ER stress of colonic epithelium associated with changes in the intestinal flora diversity and short-chain fatty acids content.

CONCLUSION

RE could relieve constipation by promoting the secretion of colonic mucus via mast cells activation and improving the intestinal microenvironment.

Higher frailty burden in older adults with chronic constipation

Background

Despite constipation being a common clinical condition in older adults, the clinical relevance of constipation related to frailty is less studied. Hence, we aimed to investigate the association between chronic constipation (CC) and frailty in older adults.

Methods

This is a cross-sectional analysis of a population-based, prospective cohort study of 1278 community-dwelling older adults in South Korea. We used the Rome criteria to identify patients with irritable bowel syndrome with predominant constipation (IBS-C) and functional constipation (FC). We investigated whether participants consistent with the criteria for IBS-C and FC had CC. Frailty was assessed using the Cardiovascular Health Study (CHS) frailty phenotype.

Results

In the study population with a mean age of 75.3 ± 6.3 years, 136 (10.7%) had CC. The participants with CC were older, had higher medication burdens, and had worse physical performances compared to those without CC (All P < .05). By association analysis, the prevalence of CC was associated with frailty by the CHS criteria (P < .001). The CHS frailty score was associated with the presence of CC by the univariate logistic regression analysis and the multivariate analysis adjusted for age, sex, and multimorbidity.

Conclusions

Frailty was associated with CC in community-dwelling older people, suggesting that constipation should be considered as an important geriatric syndrome in clinical practice concerning frail older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01684-x.

Efficacy and Safety of Traditional Chinese Herbal Medicine for Antipsychotic-Related Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Constipation is a common but often ignored side effect of antipsychotic treatment, although it is associated with adverse outcomes. The results of the efficacy and safety of traditional Chinese herbal medicine (TCM) in treating constipation are mixed across studies. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) of the efficacy and safety of TCM compared to Western medicine (WM) in treating antipsychotic-related constipation. Methods: Major international electronic (PubMed, EMBASE, Cochrane Library, and Web of Science) and Chinese (Wanfang, WeiPu VIP, SinoMed, and CNKI) databases were searched from their inception to November 29, 2020. Meta-analysis was performed using the random-effects model. Results: Thirty RCTs with 52 arms covering 2,570 patients in the TCM group and 2,511 patients in the WM group were included. Compared with WM, TCM alone was superior regarding the moderate response rate [risk ratio (RR) = 1.165; 95% confidence interval (CI): 1.096-1.238; P < 0.001], marked response rate (RR = 1.437; 95% CI: 1.267-1.692; P < 0.001), and remission rate (RR = 1.376; 95% CI: 1.180-1.606; P < 0.001) for constipation, while it was significantly associated with lower risk of rash (RR = 0.081; 95% CI: 0.019-0.342; P = 0.001). For the moderate response rate, meta-regression analyses revealed that publication year (β = -0.007, P = 0.0007) and Jadad score (β = 0.067, P < 0.001) significantly moderated the results. For the remission rate, subgroup and meta-regression analyses revealed that the geographical region (P = 0.003), inpatient status (P = 0.035), and trial duration (β = 0.009, P = 0.013) significantly moderated the results. Conclusions: The efficacy of TCM for antipsychotic-related constipation appeared to be greater compared to WM, while certain side effects of TCM, such as rash, were less frequent.

Managing Nocturia in Frail Older Adults

This review discusses the available evidence in the current evaluation and treatment of nocturia in frail older adults. No evidence specifically evaluates the use of behavioral interventions in the treatment of the frail older adult with nocturia, but their use is supported in other cohorts. Behavioral modifications and optimal management of comorbidities remain the first-line treatment for all age groups and should be emphasized in the frail due to their favorable safety profile. No studies specific to the frail older adult support the use of pharmacotherapy. Some evidence exists for the efficacy of several agents in the older adult; however, this is difficult to extrapolate to the frail, and safety concerns abound. Desmopressin may be effective in the older adult, but a high risk of hyponatremia raises concerns for its safety, and therefore it is not recommended in the frail. α-Antagonists may have limited efficacy in men with known benign prostatic hyperplasia (BPH); they are relatively well tolerated, although the risk of orthostatic hypotension in the frail should be considered. β3-agonist trials suggest limited clinical utility. Antimuscarinics are not found to be useful in this cohort and are contraindicated in the frail older adult given the ability of antimuscarinics to cause cognitive impairment, delirium, and falls. No data examine the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the frail older adult. Additionally, the American Geriatrics Society Beers Criteria recommends against the use of muscarinics in those over the age of 75 years and therefore their use is not supported.

Healthcare Professionals' Experiences of Assessing, Treating and Preventing Constipation Among Older Patients During Hospitalization: An Interview Study

PURPOSE

Constipation is a common and troublesome condition among older patients and can result in a variety of negative health consequences. It is often undiagnosed or undertreated. Healthcare professionals have a responsibility to understand and address patients' overall healthcare needs; so exploring their experiences is, therefore, highly relevant. The purpose of the study was to explore healthcare professionals' experiences of assessing, treating and preventing constipation among older patients.

METHODS

A qualitative design with an exploratory approach was used. The participants (registered nurses and physicians) were purposively sampled from three wards in a geriatric department in a medium-sized hospital in Sweden. Data were collected through focus group discussions and individual interviews, and analyzed using content analysis.

RESULTS

Three categories were generated: Reasons for suboptimal management of constipation, Strategies for management, and Approaching the patients' needs. In the care of older patients at risk of or with constipation, decisions were made based on personal knowledge, personal experience and clinical reasoning. A person-centered approach was highlighted but was not always possible to incorporate.

CONCLUSION

Different strategies for preventing and treating constipation were believed to be important, as was person-centered care, but were found to be challenging in the complexity of the care situation. It is important that healthcare professionals reflect on their own knowledge and clinical practice. There is a need for more support, information and specific guidance for healthcare professionals caring for older patients during hospitalization. Overall, this study underscores the importance of adequate access to resources and education in constipation management and that clinical guidelines, such as the Swedish Handbook for Healthcare, could be used as a guide for delivering high-quality care in hospitals.

Chronic constipation and abdominal pain: Independent or closely interrelated symptoms?

Constipation is both a symptom and a disorder, seen in both functional constipation and irritable bowel syndrome with constipation predominance (IBS-C). Despite the Rome IV criteria distinguishing between these conditions, they share many therapeutic approaches. This review aims to explore the relationship between constipation and abdominal pain and assess the evidence surrounding whether laxation improves abdominal pain and whether such a response to laxation differs between IBS-C and functional constipation. In patients with functional constipation, increasing frequency of bowel motions by laxatives regardless of mechanism of action is associated with reductions in the severity of abdominal pain, supporting the role of constipation as a contributor to abdominal discomfort. In patients with IBS-C, evidence from systematic reviews indicates that abdominal pain is driven by factors additional to constipation alone and that visceral analgesic modulation is also needed to optimize pain. Changing definitions of IBS-C and heterogeneity in clinical trial design including endpoints have raised uncertainty about the comparative ability of older laxatives without known neuromodulatory effects to improve chronic abdominal pain compared with new secretagogues and prokinetics for the management of IBS-C. While it is known that abdominal pain is associated with constipation and laxation contributes to relief of that pain, it remains unproven whether proposed visceral analgesic properties of new laxatives provide greater pain relief than laxation alone. However, it is likely that the response to laxation in IBS-C is only part of the puzzle.

Bowel Preparation for Colonoscopy in 2020: A Look at the Past, Present, and Future

PURPOSE OF THIS REVIEW

Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future.

RECENT FINDINGS

Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations.

CONCLUSIONS

Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.

Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%-30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

Risk Factors for Constipation in Adults: A Cross-Sectional Study

Aim: The objective of this study was to determine associations between physical activity, dietary fiber intake, water and fluid intake, and constipation as well as other possible risk factors for constipation in adults.Method: A cross-sectional study was conducted in 4561 (1812 male and 2749 female) adults, aged between 18-65 years, living in Ankara, Turkey. Participants having three or fewer bowel movements per week were considered constipated. Dietary fiber and fluid intake data were ascertained from a 62-item food frequency questionnaire (FFQ). The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to evaluate participant physical activity.Results: Of the total cohort, 16.6% were diagnosed with constipation (13.6% males, 18.5% females). Logistic regression analysis showed a significantly greater risk of constipation in participants with female gender, advancing age, being obese. Participants who were moderately active (OR: 0.77, 95% CI: 0.62-0.91) and active (OR: 0.74, 95% CI: 0.59-0.90) had a decreased likelihood of constipation, when compared with inactive participants (p < 0.05). Participants in the middle upper quartile for water intake (OR: 0.71, 95% CI: 0.57-0.88), had a decreased likelihood of constipation, when compared with participants in the lowest quartile. Participants in the middle upper quartile (OR: 0.74, 95% CI: 0.58-0.92) and the highest quartile for dietary fiber intake (OR: 0.66, 95% CI: 0.52-0.84), had a decreased likelihood of constipation, when compared with participants in the lowest quartile (p < 0.05).Conclusion: Constipation is common in the Turkish adult population. Insufficient physical activity, decreasing fiber and water intake, obesity, advancing age and female gender were associated with increased constipation risks. Combining regular physical activity and increasing fiber and water intake may protect from constipation, and relieve constipation symptoms.

Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota

Inulin is a soluble dietary fibre, also classified as a prebiotic, extracted from chicory roots. The present study aimed to determine the effect of consumption of native chicory inulin on the stool frequency of middle-aged to older adults (40-75 years old) with uncomfortably but not clinically relevant low stool frequency, specified as two to four days without bowel movements per week. Two randomised, double blind, placebo-controlled crossover trials were conducted using similar protocols in differing populations. Trial A was conducted in Amsterdam, The Netherlands and subsequently Trial B was conducted in Newcastle, United Kingdom. Both trials involved supplementation for 5 weeks with 10 g per day of inulin or placebo, a washout period of 2 weeks, and then crossed over to receive the other treatment. In Trial B, faecal gut microbiota composition was assessed using 16S rRNA gene sequencing. In Trial A, which 10 volunteers completed, the stool frequency was significantly increased to an average 4.9 ± 0.23 (SEM) times per week during inulin periods versus 3.6 ± 0.25 in the periods with placebo (p = 0.01). In contrast, in Trial B which 20 volunteers completed, there was no significant effect of the inulin on stool frequency (7.5 ± 2.1 times per week with inulin, 8.1 ± 3.0 with placebo, p = 0.35). However, many subjects in Trial B had a stool frequency >5 per week also for the placebo period, in breach of the inclusion criteria. Combining the data of 16 low stool frequency subjects from Trials A and B showed a significant effect of inulin to increase stool frequency from 4.1 to 5.0 per week (p = 0.032). Regarding secondary outcomes, stool consistency was significantly softer with inulin treatment compared to placebo periods, it increased 0.29 on the Bristol stool scale (p = 0.008) when data from all subjects of Trials A and B were combined. No other differences in bowel habit parameters due to inulin consumption were significant. None of the differences in specific bacterial abundance, alpha or beta diversity were significant, however the trends were in directions consistent with published studies on other types of inulin. We conclude that 10 g per day of native chicory inulin can increase stool frequency in subjects with low stool frequency.

COMPARISON OF TWO TURNING REGIMENS (1 VERSUS EVERY 2 HOURS) IN THE PREVENTION OF CONSTIPATION IN PATIENTS WITH STROKE

Background: Constipation is one of the most common problems in stroke due to inactivity and immobility. Objective: To compare one hour and every two-hour turning regimens in the prevention of constipation in patients with stroke. Methods: This was a quasi-experimental research with pretest posttest with control group design. There were 39 participants assigned in intervention group (n=17) and control group (n=22). The intervention group turned every one hour, while control group turned every two hours. The turning regimen was implemented for five days. A bowel score was used to measure constipation. McNemar Test and Fisher Test were used to measure and compare the bowel score between the two groups. Results: There was no significant difference in the effect of two turning regiments on constipation (p > .05). However, based on a descriptive result, there was a slight decrease in the number of constipation from 47% to 29.4% in the intervention group, and from 32% to 27% in the control group. Conclusion: Turning might still become an effective way to prevent constipation in patients with stroke either every one hour or two hours without diet modification.

Changes in neuromuscular structure and functions of human colon during ageing are region-dependent

OBJECTIVE

To determine if human colonic neuromuscular functions decline with increasing age.

DESIGN

Looking for non-specific changes in neuromuscular function, a standard burst of electrical field stimulation (EFS) was used to evoke neuronally mediated (cholinergic/nitrergic) contractions/relaxations in ex vivomuscle strips of human ascending and descending colon, aged 35-91 years (macroscopically normal tissue; 239 patients undergoing cancer resection). Then, to understand mechanisms of change, numbers and phenotype of myenteric neurons (30 306 neurons stained with different markers), densities of intramuscular nerve fibres (51 patients in total) and pathways involved in functional changes were systematically investigated (by immunohistochemistry and use of pharmacological tools) in elderly (≥70 years) and adult (35-60 years) groups.

RESULTS

With increasing age, EFS was more likely to evoke muscle relaxation in ascending colon instead of contraction (linear regression: n=109, slope 0.49%±0.21%/year, 95% CI), generally uninfluenced by comorbidity or use of medications. Similar changes were absent in descending colon. In the elderly, overall numbers of myenteric and neuronal nitric oxide synthase-immunoreactive neurons and intramuscular nerve densities were unchanged in ascending and descending colon, compared with adults. In elderly ascending, not descending, colon numbers of cell bodies exhibiting choline acetyltransferase immunoreactivity increased compared with adults (5.0±0.6 vs 2.4±0.3 neurons/mm myenteric plexus, p=0.04). Cholinergically mediated contractions were smaller in elderly ascending colon compared with adults (2.1±0.4 and 4.1±1.1 g-tension/g-tissue during EFS; n=25/14; p=0.04); there were no changes in nitrergic function or in ability of the muscle to contract/relax. Similar changes were absent in descending colon.

CONCLUSION

In ascending not descending colon, ageing impairs cholinergic function.

[Determining the Prevalence of Constipation and Relating Factors in Elderly People: A Nursing Home Study]

Amaç

Bu çalışma, huzurevinde kalan yaşlılarda Roma II konstipasyon tanılama kriterlerine göre konstipasyon görülme sıklığını ve ilişkili faktörleri belirlemek amacıyla yapılmıştır.

Yöntem

Kesitsel tipteki bu çalışma Ankara’da bir huzurevinde yaşayan ve araştırmaya dahil edilme kriterlerine uyan 160 yaşlı birey ile gerçekleştirilmiştir. Veriler tanıtıcı özellikler bilgi formu ve Roma II Konstipasyon Tanılama Kriterleri formu ile yüz yüze görüşülerek toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler ile Ki-Kare testi kullanılmıştır.

Bulgular

Yaşlı bireylerin yaş ortalaması 78±8.1 (min: 65, max: 95) olup, %53.1’i erkektir. Yaşlı bireylerin %51.9’u Roma II konstipasyon tanılama kriterlerine göre konstipasyon sorunu yaşamaktadır. Roma II konstipasyon tanılama kriterleri incelendiğinde yaşlı bireylerin, %44.4’ünün defekasyon yaparken zorlanma/yoğun ıkınma yaşadığı, %29.4’ünün dışkı kıvamının sert olduğu, %53.8’inin yetersiz dışkılama hissi/tam boşalamama problemi olduğu, %30.2’sinin bağırsak hareketinin haftada 2 kez ve daha az olduğu belirlenmiştir. Düzenli fiziksel aktivite yapmayan, günlük 2 litreden az su tüketen ve huzurevinde kalma süresi 11 yılın üzerinde olan yaşlı bireylerde konstipasyon sorununun daha fazla olduğu belirlenmiştir (p<0.05).

Sonuç

Huzurevinde yaşayan yaşlı bireylerin yarısından biraz fazlasının konstipasyon sorunu yaşadığı belirlenmiştir. Yaşlı bireylerde konstipasyon ve risk faktörlerinin erken dönemde belirlenmesi, düzenli olarak egzersiz yapmalarının desteklenmesi önem taşımaktadır.

A review on squat-assist devices to aid elderly with lower limb difficulties in toileting to tackle constipation

Constipation is an important issue that has impact on quality of life and health expenses of the elderly. It may lead to many other gastrointestinal disorders like colon cancer, haemorrhoids, anal fissures and so on. Squatting is considered to be the natural, traditional and most widely followed posture for defecation and hence, it is one of the practical solutions for avoiding constipation. Musculoskeletal issues due to ageing and changes in lifestyle make it difficult for the elder population to follow squatting or semi-squatting posture for defecation. Developing assistive devices to overcome older people's difficulty to attain squatting or semi-squatting posture is one of the research areas which need to be explored further. This review covers various designs of such devices which will enable a user to attain 'semi-squatting' posture to defecate and also addresses various challenges and limitations to overcome.

Gastrointestinal Tract Disorders in Older Age

Considering an increase in the life expectancy leading to a rise in the elderly population, it is important to recognize the changes that occur along the process of aging. Gastrointestinal (GI) changes in the elderly are common, and despite some GI disorders being more prevalent in the elderly, there is no GI disease that is limited to this age group. While some changes associated with aging GI system are physiologic, others are pathological and particularly more prevalent among those above age 65 years. This article reviews the most important GI disorders in the elderly that clinicians encounter on a daily basis. We highlight age-related changes of the oral cavity, esophagus, stomach, small and large bowels, and the clinical implications of these changes. We review epidemiology and pathophysiology of common diseases, especially as they relate to clinical manifestation in elderly. Details regarding management of specific disease are discussed in detail if they significantly differ from the management for younger groups or if they are associated with significant challenges due to side effects or polypharmacy. Cancers of GI tract are not included in the scope of this article.

Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender

OBJECTIVES

Constipation is a common complaint in older adults. The rise in life expectancy may amplify the problem and increase social expenditure. We investigated the major risk factors associated with constipation in a large sample of elderly.

METHODS

Outpatients from Northern Sardinia attending a Geriatric Unit between 2001 and 2014 were enrolled. Demographic and anthropometric data, income, education and self-reported bowel function were collected. The presence of constipation was adjusted for cognitive status, assessed by the Mini-Mental State Examination (MMSE) test; single and cumulative illness rating scale (CIRS); current or past symptomatic depression and anxiety measured by the Geriatric Depression Scale (GDS); nutritional status, evaluated using the Mini-Nutritional Assessment (MNA); type and number of different medications used.

RESULTS

1328 elderly patients (mean age 77.7 ± 7.2 years) were enrolled. Constipation was present in 32.1%, more commonly in women (35.4% vs 28.3%) and increased with age. The multivariate analysis showed a significantly greater risk of constipation in patients with a risk of malnutrition (OR = 1.745, 95% CI: 1.043-2.022; p = .034), female gender (OR = 1.735, 95% CI: 1.068-2.820; p = .026) and depression (OR = 1.079, 95% CI: 1.022-1.140; p = .006). Other potential predisposing factors assessed such as MMSE, CIRS, body mass index, marital status, smoking habit, education, income and number of taken drugs did not show a statistically significant association. Aging was a risk for constipation also in patients free of medications.

CONCLUSIONS

Knowledge of risk factors associated with bowel alterations in elderly individuals may provide important clues for caregivers to prevent or reduce constipation.

Expert consensus on the assessment and treatment of chronic constipation in the elderly

It is of significant importance to scientifically assess and efficiently address chronic constipation in the elderly population. Therefore, organizing some domestic experts of geriatrics and gastroenterology, we have formulated this consensus to reference for clinical staff.