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Wu S, Yuan G, Wu L, Zou L, Wu F. Identifying the association between depression and constipation: An observational study and Mendelian randomization analysis. J Affect Disord 2024; 359:394-402. [PMID: 38806066 DOI: 10.1016/j.jad.2024.05.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Both depression and constipation are universal disorders that seriously affect quality of life. But the phenotypic relationship and causality between depression and constipation are still unclear. METHODS We first assessed phenotypic relationships by logistic regression analysis using large-scale data extracted from the National Health and Nutrition Examination Survey (N = 11,585). We then evaluated causality by bidirectional two-sample mendelian randomization (MR) analysis using Genome-wide association study (GWAS) data (depression: N = 807,553; constipation: N = 377,277). To investigate whether depression severity affects the causal relationship between depression and constipation, we conducted a further MR study on GWAS data of major depression (N = 480,359). RESULTS About 11.31 % of the participants in the constipation group suffered from depression, which was significantly higher than the normal bowel group (6.09 %). The observational study showed a positive correlation between depression and constipation (OR = 1.968, 95%CI = 1.530-2.532). Besides, the risk of constipation was higher in participants with severe depression (OR = 2.294, 95%CI = 1.538-3.422) than in participants with mild depression (OR = 1.549, 95%CI = 1.242-1.932). Bidirectional MR analysis revealed an obviously causal effect of depression on constipation, but no causal effect of constipation on depression. In addition, the MR analysis also revealed a causal relationship between major depression and constipation. LIMITATION The exact mechanism by which depression affects constipation is still unclear. CONCLUSION This study reveals a positive correlation between depression and constipation and the causal effect of depression on constipation. Clinicians should keep the risk of constipation in mind when treating patients with depression.
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Affiliation(s)
- Shasha Wu
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Guojun Yuan
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Linlin Wu
- Department of Psychosomatic diseases, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China
| | - Long Zou
- Department of Gastroenterology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China.
| | - Feixiang Wu
- Department of Urology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, PR China.
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Li Y, Tong WD. Association between dietary protein intake and constipation: Data from the National Health and nutrition examination survey 2005-2010. Neurogastroenterol Motil 2024; 36:e14795. [PMID: 38651659 DOI: 10.1111/nmo.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The association between dietary protein intake and constipation remains inconclusive. The aim of this study was to investigate whether dietary protein intake is associated with constipation. METHODS This cross-sectional study included 13,941 adults from the 2005 to 2010 National Health and Nutrition Examination Survey. A weighted logistic regression analysis was used to control for confounding factors. In addition, weighted interaction and stratified analyses were conducted to ascertain the potential modifying factors. RESULTS The prevalence of constipation was 7.5% when constipation was defined by stool consistency and 3.5% when constipation was defined by stool frequency. After adjusting for covariates, an increase in dietary protein intake of 10 g was not associated with constipation, as defined by stool frequency (OR = 0.94, 95% CI = 0.54, 1.62) or stool consistency (OR = 1.02, 95% CI = 0.75, 1.39). Subgroup analyses revealed that dietary protein intake was associated with an increase in constipation defined by stool consistency risk in participants who consumed a low amount of carbohydrates (OR = 1.08, 95% CI = 1.02-1.14 for every 10-g increase in protein intake), but a decrease in risk in participants in the moderate-carbohydrate group (OR = 0.94, 95% CI = 0.89-0.99 for every 10-g increase in protein intake), suggesting a significant interaction (p = 0.001). CONCLUSION & INFERENCES Dietary protein intake is not associated with stool consistency or frequency-defined constipation. However, the association between dietary protein intake and constipation defined by stool consistency in participants with a low carbohydrate intake differed from that in participants with a moderate carbohydrate intake.
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Affiliation(s)
- Yi Li
- Gastric and Colorectal Division, Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei-Dong Tong
- Gastric and Colorectal Division, Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Yu Z, Guo M, Bai X, Ruan G, Sun Y, Han W, Yang H. Exploring the association between cardiovascular health and bowel health. Sci Rep 2024; 14:11819. [PMID: 38783080 PMCID: PMC11116406 DOI: 10.1038/s41598-024-62715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic constipation, diarrhea, and fecal incontinence have high incidence, potential disability, and socioeconomic impact, imposing a heavy burden on the quality of life. We aim to explore the association between cardiovascular health (CVH) and bowel health from National Health and Nutrition Survey 2005-2010. CVH is assessed using Life's Essential 8 (LE8). Chronic constipation, chronic diarrhea, and fecal incontinence are assessed based on Bristol Stool Form Scale classification, bowel movements, and bowel leakage. Better health behaviors (odds ratio [OR]: 0.71, 95% confidence interval [CI] 0.53-0.94, p = 0.02) and worse health factors (OR: 1.45, CI 1.03-2.04, p = 0.04) were associated with less chronic constipation. Less chronic diarrhea is correlated with better CVH (OR: 0.53, 95% CI 0.35-0.79, p = 0.003) and health factors (OR: 0.61, CI 0.46-0.81, p = 0.001). Meanwhile, the proportion of chronic diarrhea significantly decreases when the health behaviors score exceeds 59.42. Lower fecal incontinence was associated with better health behaviors (OR: 0.63, CI 0.44-0.90, p = 0.01) CVH. Better CVH and health behaviors are both linked to lower all-cause mortality in participants with chronic constipation and chronic diarrhea. A higher health behaviors score is also associated with less all-cause mortality in patients with fecal incontinence. Maintaining CVH at the population level contributes to intestinal health, achieving the dual management of both while saving on healthcare costs. However, further prospective research is needed to confirm these associations.
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Affiliation(s)
- Ziqing Yu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yinghao Sun
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Ding L, Duan J, Yang T, Jin C, Lv S, Ma A, Qin Y. Association between circadian syndrome and chronic diarrhea: a cross-sectional study of NHANES 2005-2010 data. Front Physiol 2024; 15:1301450. [PMID: 38742154 PMCID: PMC11089382 DOI: 10.3389/fphys.2024.1301450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
Background Circadian rhythms are reported to influence physiological processes in the gastrointestinal system, but associations between circadian syndrome (Circs) and chronic diarrhea (CD) remain unclear. Here, we explored such relationships to provide new insights into CD management. Methods We conducted a cross-sectional retrospective analysis using the National Health and Nutrition Examination Survey (NHANES) data between 2005 and 2010. Univariate and multivariable logistic regression analyses were performed on weighted data to explore associations between Circs and CD. Results Results were presented using forest plots, odds ratios (ORs), and 95% confidence intervals (CIs). Data with p-values < 0.05 were considered statistically significant. In total, 5,661 US participants, of which 412 had CD (weighted percentage = 6.20%), were enrolled. In univariate logistic regression analyses, participants with Circs had a significantly higher risk of CD (OR = 1.51, 95% CI: 1.15-1.99). After adjusting for covariates, model 2 (OR = 1.40, 95% CI: 1.03-1.90) and model 3 (OR = 1.42, 95% CI: 1.01-2.00) data were consistent with model 1 data. Additionally, the number of Circs components was positively associated with CD in all three models. Subgroup analyses revealed an association between CD and Circs in participants who had high blood pressure (OR = 2.46, 95% CI: 1.48-4.11, p < 0.001). Conclusion In this cross-sectional study, we found that Circs is positively associated with the risk of CD in US adults, especially in those with high blood pressure. This association may provide new management strategies for CD.
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Affiliation(s)
- Liang Ding
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
| | - Jinnan Duan
- Department of Infectious Diseases, Shaoxing People's Hospital, Shaoxing, China
| | - Tao Yang
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
| | - Chaoqiong Jin
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
| | - Shanmei Lv
- Department of Clinical Laboratory, Shaoxing People's Hospital, Shaoxing, China
| | - Ahuo Ma
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
| | - Yuehua Qin
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
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Zhu JY, Liu MY, Sun C. Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation. World J Clin Cases 2024; 12:1094-1103. [PMID: 38464922 PMCID: PMC10921306 DOI: 10.12998/wjcc.v12.i6.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance (IR). However, the link between two of the most prevalent bowel disorders, chronic diarrhea and constipation, and the triglyceride glucose (TyG) index, a marker of IR, has not yet been investigated. AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation. METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010. TyG was used as an exposure variable, with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables. A demographic investigation based on TyG quartile subgroups was performed. The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG, chronic diarrhea, and constipation. Subgroup analyses were performed to examine the stability of any potential associations. RESULTS In the chosen sample, chronic diarrhea had a prevalence of 8.00%, while chronic constipation had a prevalence of 8.04%. In multiple logistic regression, a more prominent positive association was found between TyG and chronic diarrhea, particularly in model 1 (OR = 1.45; 95%CI: 1.17-1.79, P = 0.0007) and model 2 (OR = 1.40; 95%CI: 1.12-1.76, P = 0.0033). No definite association was observed between the TyG levels and chronic constipation. The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63 (OR = 1.89; 95%CI: 1.05-3.41, P = 0.0344), and another positive association with chronic constipation when it was greater than 8.2 (OR = 1.74; 95%CI: 1.02-2.95, P = 0.0415). The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations. CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.
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Affiliation(s)
- Jing-Yi Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Mu-Yun Liu
- Department of Gastroenterology, Navy No. 905 Hospital, Naval Medical University, Shanghai 200433, China
| | - Chang Sun
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
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Yang C, Hong Q, Wu T, Fan Y, Shen X, Dong X. Association between Dietary Intake of Live Microbes and Chronic Constipation in Adults. J Nutr 2024; 154:526-534. [PMID: 38072155 DOI: 10.1016/j.tjnut.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Chronic constipation (CC) is a common gut health problem, and the role of live dietary microbes in CC is unclear. OBJECTIVE This study aimed to investigate the relationship between dietary live microbes consumption and CC. METHODS Using the National Health and Nutrition Examination Survey data (2005-2010), 11,170 adults who completed the 24-h face-to-face dietary recall and bowel health questionnaire were identified. CC was defined by the Bristol Stool Form Scale. Dietary live microbes intake was classified as low, medium, and high. Additionally, combined medium and high categories (MedHi) were analyzed. Multivariate regression models were constructed to assess the association between dietary intake of live microbes and CC. RESULTS In the weighted sample, the age-adjusted CC prevalence was 7.06% (95% confidence interval [CI]: 6.45, 7.67). In multivariate regression models, after controlling for potential confounders race/ethnicity, sex, body mass index, education, poverty, depression, caffeine intake, and alcohol intake, a significant inverse association between dietary live microbes consumption and CC was observed (odds ratio [OR]: 0.77, 95% CI: 0.61, 0.97, P-trend = 0.061). CONCLUSIONS Our findings suggest that a high dietary live microbes consumption may be associated with lower odds of CC. However, further prospective studies are essential to confirm its effectiveness in reducing CC occurrence.
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Affiliation(s)
- Chuanli Yang
- Key Laboratory of Environmental Medical Engineering and Education Ministry, School of Public Health, Southeast University, Nanjing, Jiangsu, China; Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing, China; Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Qin Hong
- Key Laboratory of Environmental Medical Engineering and Education Ministry, School of Public Health, Southeast University, Nanjing, Jiangsu, China; Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing, China
| | - Teng Wu
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yunhe Fan
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaobing Shen
- Key Laboratory of Environmental Medical Engineering and Education Ministry, School of Public Health, Southeast University, Nanjing, Jiangsu, China; Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing, China.
| | - Xiushan Dong
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
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Hong Y, Chen X, Liu J. Analysis of Factors Associated with Constipation in the Population with Obesity: Evidence from the National Health and Nutrition Examination Survey. Obes Facts 2024; 17:169-182. [PMID: 38266495 PMCID: PMC10987188 DOI: 10.1159/000536318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Obesity and constipation are both global problems, but the factors associated with constipation in individuals with obesity are currently understudied. The aim of our study was to explore the factors associated with constipation in people with obesity. METHODS From three cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010, data from 14,048 persons aged ≥20 years were collected. Variables included demographics, lifestyle, comorbidities, and dietary data. Multiple logistic regression analysis was used to calculate adjusted prevalence odds ratio (OR) and assess the relationship between different variables and constipation in population with obesity. RESULTS Using stool consistency definition, multivariate analysis revealed that education ≥12th grade (OR: 0.456; 95% CI: 0.300, 0.694; p = 0.00024), hypertension (OR: 0.505; 95% CI: 0.334, 0.763; p = 0.00119), polypharmacy (OR: 1.669; 95% CI: 1.104, 2.521; p = 0.01507), high cholesterol (OR: 0.400; 95% CI: 0.213, 0.750; p = 0.00430), and high dietary fiber (OR: 0.454; 95% CI: 0.245, 0.841; p = 0.01206) were substantially linked with constipation in the population with obesity. For constipation defined using stool frequency, multivariate regression analysis show constipation in people with obesity had a significant association with the female sex (OR: 2.684; 95% CI: 1.379, 5.223; p = 0.00366 multivariate), Mexican American (OR: 0.142; 95% CI, 0.033, 0.616; p = 0.00914 multivariate), hypertension (OR: 0.569; 95% CI: 0.324, 0.998; p = 0.04916), depression (OR: 2.280; 95% CI: 1.240, 4.195; p = 0.00803), occasional/often milk consumption (OR: 0.473; 95% CI: 0.286, 0.782; p = 0.00356), medium energy (OR: 0.318; 95% CI: 0.118, 0.856; p = 0.02338), polypharmacy (OR: 1.939; 95% CI: 1.115, 3.373; p = 0.01907), and medium moisture (OR: 0.534; 95% CI: 0.285, 0.999; p = 0.04959). In nonobese people, constipation was significantly associated with the female sex and high moisture but not with hypertension and polypharmacy. CONCLUSION This study suggests that the population with obesity has many factors that affect constipation such as hypertension, polypharmacy, cholesterol, dietary fiber, depression, and so on, of which hypertension and polypharmacy were significant associated with constipation, regardless of definitions of constipation. Notably, hypertension might be associated with a reduced risk of constipation in people with obesity.
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Affiliation(s)
- Yongping Hong
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Xingxing Chen
- Department of Ultrasound, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Junping Liu
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
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Huang L, Cao B, Geng Y, Zhou X, Yang Y, Ma T, Lin H, Huang Z, Zhuo L, Li J. A randomized double-blind phase Ib clinical trial of SY-009 in patients with type 2 diabetes mellitus. Eur J Pharm Sci 2024; 192:106644. [PMID: 37981049 DOI: 10.1016/j.ejps.2023.106644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 10/18/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION SY-009 produces a hypoglycemic effect via inhibiting sodium/glucose cotransporter 1 (SGLT1) in type 2 diabetes mellitus (T2DM) patients. This randomized, double-blind, placebo-controlled, and multiple-dose escalation clinical trial aimed to evaluate the pharmacokinetic and pharmacodynamical characteristics as well as the safety and tolerability of SY-009 in T2DM patients. METHOD Fifty T2DM patients were randomized into experimental and placebo groups, and hospitalized for 9 days managed with a unified diet and rest management. Subjects were given SY-009 or placebo from day 1 to day 7 at different frequencies and dosages. Single dose cohort was defined as the first dose on day 1 and multiple dose cohort included all the dose from day 1 to 7. Blood samples were collected for pharmacokinetic analysis. Mixed meal tolerance tests were performed. Blood samples were collected to determine glucose, C-peptide, insulin, glucagon-like peptide-1 (GLP-1), and gastric inhibitory polypeptide (GIP). RESULTS PK parameters were not obtained because blood SY-009 concentrations were below the limit of quantitation in all subjects. SY-009 decreased the postprandial glucose. Blood glucose was controlled within 4 hours after taking the drug. Short-term administration of SY-009 (7 days) had no significant effects on fasting glucose but reduced the secretion of C-peptide, insulin, and GIP and increased GLP-1 secretion. The most common adverse event was gastrointestinal disorder manifesting abdominal pain, diarrhea, and bloating. CONCLUSION Plasma exposure of SY-009 and its metabolites was fairly low in T2DM patients at doses of 1.0-4.0 mg. SY-009 reduced postprandial glucose, C-peptide, and insulin levels, showing relative safety and tolerability in the dose range of 1.0-4.0 mg. TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT04345107.
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Affiliation(s)
- Lei Huang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Bei Cao
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Yan Geng
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xiaoli Zhou
- Suzhou Yabao Pharmaceutical R&D Co., Ltd., Suzhou 215000, China
| | - Yuanxun Yang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Tingting Ma
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Hui Lin
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Zhijiang Huang
- Suzhou Yabao Pharmaceutical R&D Co., Ltd., Suzhou 215000, China
| | - Lang Zhuo
- Suzhou Yabao Pharmaceutical R&D Co., Ltd., Suzhou 215000, China.
| | - Juan Li
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
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Duan R, Zheng Y, Kong W, Wang Y, Zhou Y. Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005-2010). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115776-115787. [PMID: 37889412 DOI: 10.1007/s11356-023-30542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Environmental tobacco smoke (ETS) exposure has been proven to induce digestive diseases such as hepatic steatosis, cirrhosis, and gastrointestinal cancer, yet little is known about the link between ETS exposure and constipation. This study aimed to investigate the impact of ETS exposure on the risk of chronic constipation in adults aged 20 years or older. This is a cross-sectional study based on population. A total number of 7705 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were included. Cotinine, an alkaloid found in tobacco, serves as a reliable and precise biomarker for measuring exposure to ETS. Hence, the categorization of exposure to ETS was conducted based on serum cotinine levels, resulting in four distinct categories. The association between ETS exposure and the risk of constipation was assessed using multivariable restricted cubic spline and logistic regression with odds ratio (OR) and 95% confidence interval (CI). The weighted prevalence of constipation in this study was estimated to be 7.51% based on stool consistency, or 3.11% based on stool frequency. The fully adjusted models indicated a positive correlation between exposure to ETS and constipation as measured by stool frequency, among adults with poor dietary quality (OR (95% CI): moderate exposure: 2.49 (1.05, 5.94); high exposure: 2.36(1.13, 4.95), P for trend = 0.03), while no significant difference was observed in the subgroup with a higher healthy eating index. Furthermore, the log10-transformed serum cotinine level exhibited a non-linear inverted U-shaped association with constipation in individuals with poor dietary quality (P overall = 0.0207, P non-linear = 0.0427). Conversely, a J-shaped non-linear relationship was observed in the subgroup with a higher healthy eating index (P overall = 0.0028, P non-linear = 0.0036). Our results show that ETS exposure appears to be positively associated with stool frequency-related chronic constipation in adults with poor dietary quality.
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Affiliation(s)
- Ruixiao Duan
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ya Zheng
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wanru Kong
- Department of Infection Management, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yuping Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yongning Zhou
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China.
- Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou, China.
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Abdu Seid M, Diress M, Mohammed A, Sinamaw D. Chronic constipation and its associated factors in patients with type-2 diabetes: A multicenter cross-sectional study. Diabetes Res Clin Pract 2023; 204:110905. [PMID: 37757985 DOI: 10.1016/j.diabres.2023.110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Diabetes is one of the global public health concern and constipation is frequently seen among gastrointestinal symptoms in diabetes. Despite the fact that constipation is common, doctors and/or patients disregard it. This study aimed to determine the prevalence and contributing factors of constipation in patients with diabetes. METHODS Multi-center cross-sectional study was carried out and the data was analyzed using STATA 14. Binary and multilevel logistic regressions were also carried out to identify associated to factors. Factors having a p-value of less than 0.05 were deemed statistically significant in the final model. RESULTS 206 diabetics participated in the survey. The mean age of the participants was 52.7 years (SD ± 11.9). The prevalence of constipation was 16% (95% CI: 10.97-21.07). Age (AOR = 13.56; 95% CI: 1.71, 107.21), females (AOR = 4.58; 95% CI: 1.76, 11.87), the duration of the diabetes (AOR = 3.16; 95% CI: 1.21, 8.24), and psychological distress (AOR = 12.49, 95% CI: 1.53, 101.8) were significant factors. CONCLUSION The magnitude of constipation was considerable, and it was linked to psychological distress, longer-lasting diabetes, being a woman, and ageing. Patients with type-2 diabetes need to receive careful treatment in order to reduce the severity of the condition and its additional complications.
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Affiliation(s)
- Mohammed Abdu Seid
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Ethiopia.
| | | | | | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Ethiopia.
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Wu X, Ai RJ, Xu J, Wen Q, Pan HQ, Zhang ZH, Ning W, Fang Y, Ding DF, Wang Q, Han S, Liu X, Wu M, Jia ZY, Jia S, Lin T, Cui BT, Nie YZ, Wang X, Zhang FM. Washed microbiota transplantation for Clostridioides difficile infection: A national multicenter real-world study. J Dig Dis 2023; 24:540-549. [PMID: 37681235 DOI: 10.1111/1751-2980.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Fecal microbiota transplantation (FMT) has been recommended for the treatment of recurrent Clostridioides difficile infection (CDI). We aimed to evaluate the therapeutic efficacy and safety of washed microbiota transplantation (WMT), a new method of FMT, for CDI across various medical settings. METHODS This multicenter real-world cohort study included CDI patients undergoing WMT. The primary outcome was the clinical cure rate of CDI within 8 weeks after WMT. Secondary outcomes included the CDI recurrence rate and reduction in total abdominal symptom score (TASS) during the follow-up period. Adverse events related to WMT were recorded. RESULTS Altogether 90.7% (49/54) of CDI patients achieved clinical cure after treated with WMT. The cure rate was 83.3% for cases with severe and complicated CDI (ScCDI) (n = 30) and 100% for non-ScCDI cases (n = 24) (P = 0.059). No difference was observed in the clinical cure rate between patients with first and recurrent CDI (91.9% vs 88.2%, P = 0.645). One week post-WMT, TASS showed a remarkable decrease compared to that at baseline (P < 0.001). Totally, 8.2% (4/49) of patients suffered CDI recurrence during the follow-up period. A WHO performance score of 4, age ≥65 years, higher TASS score, and higher Charlson comorbidity index score were potential risk factors for efficacy (P = 0.018, 0.03, 0.01, 0.034, respectively). Four (3.8%) transient adverse events related to WMT were observed. CONCLUSIONS This study emphasizes the attractive value of WMT for CDI. Early WMT may be recommended for CDI, especially for those in serious condition or with complex comorbidities. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT03895593 (registered on 27 March 2019).
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Affiliation(s)
- Xia Wu
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ru Jun Ai
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jie Xu
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Quan Wen
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hua Qin Pan
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhi Hua Zhang
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wang Ning
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Ying Fang
- Department of Gastroenterology, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Da Fa Ding
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Quan Wang
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shuang Han
- Department of Gastroenterology, Honghui Hospital, Xi'an, Shaanxi Province, China
| | - Xiao Liu
- Department of Gastroenterology, Xi'an International Medical Center Hospital, Xi'an, Shaanxi Province, China
| | - Mei Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region, China
| | - Zhen Yu Jia
- Department of General Practice, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Song Jia
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tao Lin
- Department of Gastroenterology, Xi'an Daxing Hospital, Xi'an, Shaanxi Province, China
| | - Bo Ta Cui
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yong Zhan Nie
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
- National Clinical Research Center for Digestive Diseases, Xi'an, Shaanxi Province, China
| | - Xin Wang
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
- National Clinical Research Center for Digestive Diseases, Xi'an, Shaanxi Province, China
| | - Fa Ming Zhang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu Province, China
- National Clinical Research Center for Digestive Diseases, Xi'an, Shaanxi Province, China
- Division of Microbiotherapy, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
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Alexander S, Oelfke U, McNair H, Tree A. GI factors, potential to predict prostate motion during radiotherapy; a scoping review. Clin Transl Radiat Oncol 2023; 40:100604. [PMID: 36936470 PMCID: PMC10020110 DOI: 10.1016/j.ctro.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
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.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Xiao AH, Kathavarayan Ramu S, Gautam M, Bharucha AE. Defecatory disorders in patients with type 1 diabetes and chronic constipation. Neurogastroenterol Motil 2023:e14599. [PMID: 37052404 DOI: 10.1111/nmo.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic constipation (CC) may be caused by defecatory disorders (DDs) and associated with reduced rectal sensation. Among patients with type 1 diabetes (T1D) and CC (T1DCC patients), the prevalence of DDs and reduced rectal sensation is unknown. We sought to compare complications of T1D, anorectal dysfunction, and CC symptoms, among T1DCC patients with versus without a DD. METHODS Anorectal pressures at rest and during squeeze and evacuation, as well as rectal sensation and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry in 114 consecutive T1DCC patients. RESULTS Thirty-seven patients (32%) had prolonged BET, suggestive of a DD. Complications of T1D included peripheral neuropathy (n = 67, 59%), retinopathy (n = 42, 37%), and nephropathy (n = 26, 23%). Among these complications, only retinopathy was associated with, that is, more prevalent in patients with normal (45%) than prolonged BET (19%). Compared with patients with normal BET, patients with prolonged BET had a lower rectal pressure (mean [SD], 32 [23] mm Hg vs. 23 [19] mm Hg, p = 0.03), greater anal pressure (91 [23] mm Hg vs. 68 [36] mm Hg, p < 0.001), and lower rectoanal gradient (-67 [30] mm Hg vs. -36 [32] mm Hg, p < 0.0001) during evacuation. Anal resting pressure and anal squeeze increment were below normal in 14 (13%) and 32 (29%) of patients and one or more rectal sensory thresholds were above normal in 34 (30%) patients; these abnormalities affected similar proportions in the normal and prolonged BET cohorts. CONCLUSIONS Among T1DCC patients, 37 (32%) had prolonged BET, which was associated with anorectal pressures indicative of a DD but was not associated with reduced rectal sensation, suggesting that DDs are more likely explained by abdomino-anal dyscoordination than visceral disturbance.
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Affiliation(s)
- Alexander H Xiao
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | | | - Misha Gautam
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
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Zhao X, Wang L, Quan L. Association between dietary phosphorus intake and chronic constipation in adults: evidence from the National Health and Nutrition Examination Survey. BMC Gastroenterol 2023; 23:24. [PMID: 36694113 PMCID: PMC9875444 DOI: 10.1186/s12876-022-02629-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several studies suggest a link between micronutrients and constipation. However, the relationship between constipation and phosphorus has rarely been examined. The main aim of this study was to investigate the association between changes in the prevalence of chronic constipation and dietary phosphorus intake among adult respondents of the National Health and Nutritional Examination Survey (NHANES). METHODS Data were extracted from the NHANES database for the years 2005-2010. A total of 13,948 people were included in the analysis. Dietary information was collected using the respondents' 24-h dietary records. We conducted multiple logistic regression analyses to examine the correlation between phosphorus intake and poor bowel movement. The primary and secondary outcomes was constipation defined by stool consistency and stool frequency, respectively. RESULTS Following multi-variate adjustment in model III, a significant association between chronic constipation and each additional 0.1-g intake of dietary phosphorus (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95, 1.00; P = 0.034 for stool consistency vs. OR, 0.94; 95% CI, 0.90, 0.99; P = 0.027 for stool frequency) was observed. Following multi-variate adjustment in model III, OR values and 95% CI from the second to fourth quartiles compared to the first quartile (reference group) were 0.92 (0.66, 1.27), 0.73 (0.47, 1.13), and 0.39 (0.20, 0.76), respectively, using the stool frequency definition. CONCLUSIONS This study revealed a negative correlation between phosphorus intake and chronic constipation. This may be due to the fact that dietary phosphorus intake is associated with softer stools and increased stool frequency. Further studies in different settings should be considered to verify these findings.
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Affiliation(s)
- Xuelian Zhao
- grid.464402.00000 0000 9459 9325The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250013 Shandong Province People’s Republic of China
| | - Lizhu Wang
- grid.479672.9Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014 Shandong Province People’s Republic of China
| | - Longfang Quan
- grid.410318.f0000 0004 0632 3409Department of Anorectal, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, 100091 People’s Republic of China
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Yuan HL, Zhang X, Peng DZ, Lin GB, Li HH, Li FX, Lu JJ, Chu WW. Development and Validation of a Risk Nomogram Model for Predicting Constipation in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1109-1120. [PMID: 37114216 PMCID: PMC10126724 DOI: 10.2147/dmso.s406884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose Constipation is a common complication of diabetic patients, which has a negative impact on their own health. This study aims to establish and internally validate the risk nomogram of constipation in patients with type 2 diabetes mellitus (T2DM) and to test its predictive ability. Patients and Methods This retrospective study included 746 patients with T2DM at two medical centers. Among the 746 patients with T2DM, 382 and 163 patients in the Beilun branch of the First Affiliated Hospital of Zhejiang University were enrolled in the training cohort and the validation cohort, respectively. A total of 201 patients in the First Affiliated Hospital of Nanchang University were enrolled in external validation cohorts. The nomogram was established by optimizing the predictive factors through univariate and multivariable logistic regression analysis. The prediction performance of the nomogram was measured by the area under the receiver operating characteristic curve (AUROC), the calibration curve, and the decision curve analysis (DCA). Furthermore, its applicability was internally and independently validated. Results Among the 16 clinicopathological features, five variables were selected to develop the prediction nomogram, including age, glycated hemoglobin (HbA1c), calcium, anxiety, and regular exercise. The nomogram revealed good discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.908 (95% CI = 0.865-0.950) in the training cohort, and 0.867 (95% CI = 0.790-0.944) and 0.816 (95% CI = 0.751-0.881) in the internal and external validation cohorts, respectively. The calibration curve presented a good agreement between the prediction by the nomogram and the actual observation. The DCA revealed that the nomogram had a high clinical application value. Conclusion In this study, the nomogram for pretreatment risk management of constipation in patients with T2DM was developed which could help in making timely personalized clinical decisions for different risk populations.
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Affiliation(s)
- Hai-Liang Yuan
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Xian Zhang
- Department of Endocrinology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Dong-Zhu Peng
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Guan-Bin Lin
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Hui-Hui Li
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Fang-Xian Li
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Jing-Jing Lu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
| | - Wei-Wei Chu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, People’s Republic of China
- Correspondence: Wei-Wei Chu, Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, No. 1288, Lushan East Road, Beilun District, Ningbo, Zhejiang Province, People’s Republic of China, Tel +86-134 56123811, Fax +86- 574 86100266, Email
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Кузнецов КО, Михеева АЮ, Ишмухаметова АА, Толстых ТА, Галляметдинова АР, Ботирова ЗУ, Забирова АА, Шарипова АШ, Шайхлисламова АБ, Абрахманова ДР. [Diabetic gastroenteropathy: modern methods of diagnosis and treatment]. PROBLEMY ENDOKRINOLOGII 2022; 68:67-78. [PMID: 36337020 PMCID: PMC9762451 DOI: 10.14341/probl13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
Diabetes mellitus is a chronic disease with a growing prevalence worldwide, however, the prevalence of its complications, including gastroenteropathy, is also increasing. The pathophysiology of diabetic gastroenteropathy (DH) combines hyperglycemia, vagus nerve dysfunction, decreased expression of nitric oxide synthase in the myenteric plexus, changes in the interstitial Cajal cell network, as well as oxidative stress. Clinical signs of DH are gastroesophageal reflux, gastroparesis, constipation, abdominal pain and diarrhea. Among the diagnostic methods are manometry with pH measurement (assessment of esophageal motility), gastric emptying scintigraphy, respiratory test (to assess gastroparesis), aspiration and cultivation of the contents of the jejunum (to diagnose bacterial overgrowth syndrome). To date, there is no definitive treatment for DH - an interdisciplinary approach is aimed at slowing the progression of the disease, relieving symptoms and restoring gastrointestinal function. Patients are recommended a diet low in simple sugars and high in fiber; optimization of glycemic control with a target glycemia of less than 180 mg/dl. As for drug therapy, the use of prokinetics and antiemetics is justified, and in case of excessive bacterial growth syndrome, antibacterial therapy (rifaximin) is carried out. Modern approaches to the treatment of DH are also accumulating, including the use of botulinum toxin, pyloroplasty and electrical stimulation of the stomach in individual patients. Despite the constant development of new treatments, they are not yet able to completely cure DH in the near future, which makes it necessary to conduct further research in this area.
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Affiliation(s)
- К. О. Кузнецов
- Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
| | - А. Ю. Михеева
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - А. А. Ишмухаметова
- Первый Московский государственный медицинский университет им. И.М. Сеченова
| | - Т. А. Толстых
- Первый Московский государственный медицинский университет им. И.М. Сеченова
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Tang C, Pu W, Shan Z. Qibin Tongbian Decoction in the Treatment of Diabetic Constipation and Its Influence on the Intestinal Environment and the Incidence of Adverse Reactions: A Randomized Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5373765. [PMID: 35535151 PMCID: PMC9078779 DOI: 10.1155/2022/5373765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to study the clinical efficacy of Qibin Tongbian decoction in the treatment of diabetic constipation and its influence on the intestinal environment and the incidence of adverse reactions. Methods In this prospective study, a total of 62 patients with diabetic constipation admitted to our hospital from June 2020 to March 2021 were recruited and assigned at a ratio of 1 : 1 to receive either traditional treatment (control group) or Qibin Tongbian decoction (experimental group). Outcome measures included clinical efficacy, intestinal environment, and incidence of adverse reactions. Results Qibin Tongbian decoction was associated with significantly higher efficacy and a lower TCM symptom score versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in significantly lower fasting plasma glucose (FPG) levels and 2-hour postprandial plasma glucose (2hPG) levels versus conventional treatment (P < 0.05). Patients receiving Qibin Tongbian decoction showed significantly lower constipation symptom scores and PAC-QOL scores versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in a significantly larger number of bifidobacteria and enterococci and a smaller number of yeasts versus conventional treatment (P < 0.05). Qibin Tongbian decoction was associated with a significantly lower incidence of adverse reactions and recurrence rate versus conventional treatment (P < 0.05). Conclusion Qibin Tongbian decoction combined with conventional TCM therapy yields a promising effect in the treatment of diabetic constipation. It can improve the intestinal environment of patients, mitigate the symptoms of constipation, enhance the quality of life of patients, and reduce the incidence of adverse reactions, so it is worthy of promotion and application.
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Affiliation(s)
- Cunxiang Tang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenyuan Pu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhaowei Shan
- Nanjing University of Chinese Medicine, Nanjing, China
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The Effect of Electroacupuncture Treatment with Different Intensities for Functional Diarrhea: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2564979. [PMID: 35027932 PMCID: PMC8752238 DOI: 10.1155/2022/2564979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/11/2021] [Indexed: 12/15/2022]
Abstract
Background Electroacupuncture (EA) may have a role in the treatment of diarrhea symptoms. However, the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and quality of life (QOL) of functional diarrhea (FD) remain unknown. Objective To investigate the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and QOL for FD patients. Methods 73 FD patients were randomly divided into three groups: low current intensity group (LI) of EA, high current intensity group (HI) of EA, and loperamide control group (LC). Four weeks of treatment were provided in the three groups. The primary outcome was the proportion of normal defecation. Additional outcomes included the change from baseline for the weekly spontaneous bowel movements (SBMs) and the change from baseline for the mean Bristol Stool Form Scale (BSFS). QOL was assessed by the 36-item short-form health survey (SF-36). Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the psychology state. Results Low current intensity of EA significantly improved the proportion of normal defecation during treatment and follow-up period (P < 0.01). EA significantly improves the mean BSFS scores and weekly SBMs, and this efficacy is equivalent to loperamide (P < 0.05). The SF-36 scores of general health in LI and HI groups and vitality and mental health in LI group were significantly increased compared to baseline (P < 0.05). Low current intensity of EA can significantly improve SAS and SDS scores (P < 0.05). Conclusions EA significantly improved stool consistency and weekly SBMs in FD patients. Compared with loperamide, low current intensity of EA may have a better sustainable effect in restoring normal defecation in patients with FD, and it can also effectively improve QOL, anxiety, and depression. However, larger sample sizes are needed to determine safety and efficacy. Trial registration number: NCT01274793.
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Meling S, Bertoli D, Sangnes DA, Brock C, Drewes A, Ejskjaer N, Dimcevski G, Søfteland E. Diabetic Gastroenteropathy: Soothe the Symptoms or Unravel a Cure? Curr Diabetes Rev 2022; 18:e220321192412. [PMID: 34225633 DOI: 10.2174/1573399817666210322154618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
Autonomic neuropathy in patients with diabetes mellitus, and especially complications related to gastrointestinal neuropathy, are often overlooked in the clinic. Diabetic gastroenteropathy affects every segment of the gastrointestinal tract and generates symptoms that may include nausea, early satiety, vomiting, abdominal pain, constipation, and diarrhea. Severe cases can be complicated by weight loss, dehydration, and electrolyte disturbances. The pathophysiology is complex, the diagnostics and treatment options are multidisciplinary, and there is generally a lack of evidence for the treatment options. The aims for this review are first to summarize the pathophysiology and describe possible and expected symptoms and complications.Further, we will try to supply the clinician with a straightforward tool for diagnostics, and then, we shall summarize established treatment options, including diet recommendations, pharmacological and non-pharmacological options. Finally, we will explore the multiple possibilities of novel treatment, looking at medications related to the pathophysiology of neuropathy, other manifestations of autonomic neuropathies, and symptomatic treatment for other gastrointestinal disorders, also including new knowledge of endosurgical and neuromodulatory treatment. The overall goal is to increase awareness and knowledge on this frequent diabetic complication and to provide better tools for diagnosis and treatment. Ultimately, we hope to encourage further research in this field, as there are clear shortcomings in terms of biomarkers, pathophysiology, as well as treatment possibilities. In conclusion, diagnosis and management of diabetic gastroenteropathy are challenging and often require multidisciplinary teams and multimodal therapies. Treatment options are sparse, but new pharmacological, endoscopic, and neuromodulatory techniques have shown promising results in initial studies.
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Affiliation(s)
- Sondre Meling
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Davide Bertoli
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Dag A Sangnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christina Brock
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Asbjørn Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Jutland, Aalborg, Denmark
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Georg Dimcevski
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Huang Y, Ma Q, He J, Liang X, Mai Q, Luo H, Hu J, Song Y. Abdominal massage alleviates functional diarrhea in immature rats via modulation of intestinal microbiota and tight junction protein. Front Pediatr 2022; 10:922799. [PMID: 35935373 PMCID: PMC9354804 DOI: 10.3389/fped.2022.922799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Functional diarrhea (FD) is a common type of chronic diarrhea in children. Recurrent diarrhea can negatively impact children's quality of life and raise healthcare costs significantly. However, conventional treatments are ineffective and limited. Moreover, children with chronic conditions have poor medication compliance. Therefore, non-pharmacological and complementary treatments are urgently needed. In China, abdominal massage is widely used to treat diarrhea in children. Numerous clinical studies have verified its usefulness in treating gastrointestinal disorders as well. Nevertheless, its intrinsic mechanisms are still unclear, and the impact of massage direction on treatment effects has received less attention. In our study, we found that FD was not associated with pathogen infection. A dysbiosis of the intestinal microbiota and disruption of the intestinal barrier are most likely to cause FD. Moreover, this study also substantiates that abdominal massage can mitigate functional diarrhea by altering the intestinal microbiota structure and decreasing the number of bacteria that damage intestinal mucosal barriers. The reduction of Ruminococcus_torques_group and Clostridium_innocuum_group at the genus level potentially mediated the beneficial effects of abdominal massage on alleviating diarrhea. Furthermore, massaging from two different directions, clockwise (CW) and counter-clockwise (CCW) massage, would not significantly influence the effect of the massage on intestinal microbiota or tight junction proteins. In summary, abdominal massage is an effective complementary therapy for children suffering from functional diarrhea.
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Affiliation(s)
- Yanyi Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing Ma
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingxin He
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingshan Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qingxin Mai
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huifang Luo
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingyi Hu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Song
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
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21
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Sangnes DA, Lundervold K, Bekkelund M, von Volkmann HL, Berentsen B, Gilja OH, Dimcevski G, Søfteland E. Gastrointestinal transit and contractility in diabetic constipation: A wireless motility capsule study on diabetes patients and healthy controls. United European Gastroenterol J 2021; 9:1168-1177. [PMID: 34687494 PMCID: PMC8672085 DOI: 10.1002/ueg2.12169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic constipation is traditionally attributed to slow colonic transit, despite limited evidence. More than half of patients find treatment unsatisfactory. To improve treatment, there is a need for better diagnostic understanding of the condition. OBJECTIVE In this wireless motility capsule study, we aimed to investigate gastrointestinal transit and contractility in diabetes patients with and without constipation, and in healthy controls. METHODS We prospectively included type 1 or type 2 diabetes patients with gastrointestinal symptoms. Based on the Gastrointestinal Symptom Rating Scale we distinguished into two groups: with constipation and without constipation. Non-diabetic controls were asymptomatic. All were examined with wireless motility capsule, determining transit times and contractility parameters. RESULTS 57 patients (42 women, 46 with type 1 diabetes) and 26 healthy controls (14 women) were included. We found no difference in transit times between diabetes patients with and without constipation. Compared to healthy controls (35:55, h:min), whole-gut transit was slower in both diabetes patients with constipation (66:15, p = 0.03) and without constipation (71:16, p < 0.001). Small bowel motility index correlated rs = -0.32 (p = 0.01) with constipation symptoms. CONCLUSIONS Diabetes patients with constipation had similar transit times as those without constipation. Both groups had slower whole-gut transit than healthy controls. Constipation was associated with reduced small bowel, but not colonic contractility. Our results imply that other mechanisms than slow colonic transit may be more important in the pathogenesis of diabetic constipation.
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Affiliation(s)
- Dag A. Sangnes
- Department of MedicineHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Katarina Lundervold
- The National Centre for Functional Gastrointestinal DisordersHaukeland University HospitalBergenNorway
- National Centre for Ultrasound in GastroenterologyHaukeland University HospitalBergenNorway
- Department of NeurologyHaukeland University HospitalBergenNorway
| | - Mattis Bekkelund
- The National Centre for Functional Gastrointestinal DisordersHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Birgitte Berentsen
- Department of MedicineHaukeland University HospitalBergenNorway
- The National Centre for Functional Gastrointestinal DisordersHaukeland University HospitalBergenNorway
| | - Odd Helge Gilja
- Department of MedicineHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- National Centre for Ultrasound in GastroenterologyHaukeland University HospitalBergenNorway
| | - Georg Dimcevski
- Department of Clinical MedicineUniversity of BergenBergenNorway
- National Centre for Ultrasound in GastroenterologyHaukeland University HospitalBergenNorway
| | - Eirik Søfteland
- Department of MedicineHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Hormone LaboratoryHaukeland University HospitalBergenNorway
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22
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Sangnes DA, Dimcevski G, Frey J, Søfteland E. Diabetic diarrhoea: A study on gastrointestinal motility, pH levels and autonomic function. J Intern Med 2021; 290:1206-1218. [PMID: 34089624 DOI: 10.1111/joim.13340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic diarrhoea is a common, but poorly investigated diabetes complication. Autonomic neuropathy is a leading pathophysiological theory founded on old, small studies. Studies of gastrointestinal motility and pH levels are lacking. OBJECTIVES Using new diagnostic methods, we aimed to find out if diabetic diarrhoea was associated with alterations in gastrointestinal motility, pH levels and autonomic function. METHODS Fifty-seven patients (42 women, 46 with type 1 diabetes) were prospectively included. Symptoms were evaluated with the gastrointestinal symptom rating scale, defining ≥4 points as cases with diarrhoea. Patients scoring <4 were used as controls. We used the wireless motility capsule to measure gastrointestinal transit times, pH levels and contractility parameters. Autonomic function was assessed by measuring heart rate variability, baroreflex sensitivity and orthostatic hypotension. RESULTS Seventeen patients (30%) had diarrhoea. Compared with controls, cases had slower gastric emptying (21:46 vs. 4:14, h:min, p = 0.03) and faster colonic transit (18:37 vs. 54:25, p < 0.001). Cases had increased intraluminal pH in the antrum (2.4 vs. 1.2, p = 0.009), caecum (7.3 vs. 6.4, p = 0.008) and entire colon (7.1 vs. 6.7, p = 0.05). They also had a decreased pH difference across the pylorus (3.3 vs. 4.9, p = 0.004) and ileocaecal junction (0.6 vs 1.0, p = 0.009). The groups did not differ in autonomic function, but diastolic blood pressure drop correlated rs = -0.34 (p = 0.04) with colonic transit time. CONCLUSIONS Patients with diabetic diarrhoea had altered gastrointestinal transit and intraluminal pH levels, but minimal changes in autonomic function. Our results suggest that tests of gastrointestinal function are clinically useful in diabetic diarrhoea.
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Affiliation(s)
- Dag A Sangnes
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Georg Dimcevski
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Jakub Frey
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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23
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Yang J, Lei Y. Comparison of the Efficacy and Safety of Different Doses of Linaclotide for Patients with Chronic Constipation: A Meta-Analysis and Bayesian Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:9923879. [PMID: 34691232 PMCID: PMC8531776 DOI: 10.1155/2021/9923879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/04/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is ambiguous whether a higher dose of linaclotide provides higher efficacy for chronic constipation (CC) patients. The meta-analysis aimed to assess the efficacy and safety of linaclotide doses ranging from 62.5 μg to 600 μg for CC patients. METHODS A comprehensive search was conducted, and STATA16 software was used for data analysis. RESULTS Seven studies with 4,107 patients were eligible. A significantly enhanced number of completely spontaneous bowel movement (CSBM) responders were found in the extremely low-dose group (OR: 2.94; 95% CI: 1.98-4.34; p < 0.001), the low-dose group (OR: 3.24; 95% CI: 2.44-4.31; p < 0.001), the medium-dose group (OR: 3.08; 95% CI: 1.46-6.50; p=0.003), and high-dose group (OR: 4.79; 95% CI: 3.04-7.54; p < 0.001). Bayesian analysis showed the high-dose group obtained the maximum CSBM responder rate (OR: 4.94; 95% credible interval (CrI): 3.22-7.79; probability rank = 0.87) indirectly compared with extremely low-dose, low-dose, and medium-dose groups. However, no significant difference presented in the CSBM responder rate by pairwise comparisons of the different dose groups. Additionally, no more any adverse events occurred in the higher linaclotide dose group (RR: 0.91; 95% CrI: 0.60-1.38) indirectly compared with other dose groups. CONCLUSIONS High dose of linaclotide could be more effective and safer for CC patients, which need more trials to confirm in the future.
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Affiliation(s)
- Jiao Yang
- Department of Gastroenterology, WenChang Road 8, Liuzhou People's Hospital, Liuzhou 545000, Guangxi, China
| | - YanChang Lei
- Department of Gastroenterology, WenChang Road 8, Liuzhou People's Hospital, Liuzhou 545000, Guangxi, China
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24
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Wang C, Zhang L, Li L. Association Between Selenium Intake with Chronic Constipation and Chronic Diarrhea in Adults: Findings from the National Health and Nutrition Examination Survey. Biol Trace Elem Res 2021; 199:3205-3212. [PMID: 33095434 DOI: 10.1007/s12011-020-02451-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022]
Abstract
The effects of dietary selenium intake on specific bowel habits (i.e., constipation or diarrhea) in the general population are not well understood. This study aims to evaluate the associations of selenium intake with the risk of chronic constipation and chronic diarrhea in adults aged ≥ 20 years using data from the 2007-2008 and 2009-2010 continuous National Health and Nutritional Examination Surveys (NHANES) (N = 9585). Chronic constipation and chronic diarrhea were defined by Bristol Stool Form Scale (BSFS) types 1 and 2 and BSFS types 6 and 7 as the "usual or most common stool type," respectively, and frequent laxative users were also defined as having chronic constipation. Dietary selenium intake was obtained from 24-h dietary recall. Multivariable logistic regression models were performed controlling for confounding factors (dietary, lifestyle, psychological, and health conditions). No significant associations between selenium intake and chronic diarrhea were found. However, selenium intake was inversely associated with the risk of chronic constipation. Compared with quartile 1, the multivariate-adjusted ORs (95% CI) of chronic constipation across quartiles 2 to 4 of selenium intake were 0.81 (0.64-1.03), 0.74 (0.58-0.95), and 0.54 (0.33-0.89), respectively. This association was significant among men, but not significant among women in subgroup analyses. Generally, there was an inverse association between selenium intake and chronic constipation in adults that modified by sex.
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Affiliation(s)
- Chaoqian Wang
- Department of Anorectal Surgery, Dongyang People's Hospital, 60 West Wuning Road, Jinhua, 322100, Zhejiang, China
| | - Lei Zhang
- Department of Anorectal Surgery, Dongyang People's Hospital, 60 West Wuning Road, Jinhua, 322100, Zhejiang, China
| | - Lijun Li
- Department of Anorectal Surgery, Dongyang People's Hospital, 60 West Wuning Road, Jinhua, 322100, Zhejiang, China.
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25
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Choi YI, Kim KO, Chung JW, Kwon KA, Kim YJ, Kim JH, Park DK. Effects of Automatic Abdominal Massage Device in Treatment of Chronic Constipation Patients: A Prospective Study. Dig Dis Sci 2021; 66:3105-3112. [PMID: 33001346 DOI: 10.1007/s10620-020-06626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Manual abdominal massage has been shown to effectively treat slow-transit constipation, but it is labor-intensive. To offer an alternative treatment option for constipation, the Bamk-001 automatic abdominal massage device was developed. The aim of this study was to assess the effect of the Bamk-001 device on symptom profiles and colon transit time (CTT) in patients with chronic constipation. METHODS Thirty-seven patients with chronic functional constipation diagnosed using the Rome IV criteria were enrolled prospectively from December 2018 to February 2019. All patients received device-assisted automatic abdominal massage for 15 min twice daily, once in the morning before breakfast and once at night, for 14 days. CTT was measured before and at the end of the study period. Slow-transit constipation and very-slow-transit constipation were defined as CTT ≥ 48 h and ≥ 72 h, respectively. Patients' symptom profiles regarding overall defecation satisfaction and device-related adverse events were analyzed. RESULTS Among the 37 patients, the mean age was 40.1 ± 11.8, and 5.4% (n = 2) were men. The Bamk-001 device significantly improved CTT from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.001) in patients with chronic constipation. In subgroup analysis, CTT improved significantly from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.003) and from 88.2 (74.4-124.8) to 45.6 (27.3-74.1) h (p = 0.005) in the slow-transit and very-slow-transit constipation groups, respectively (p = 0.001). Moreover, all patient symptoms were alleviated after treatment. No serious adverse events were reported. CONCLUSION The Bamk-001 automatic abdominal massage device showed significant care efficacy, including the improvement in CTT and symptom profiles in patients with slow-transit constipation. The use of an automatic abdominal massage device as an adjunct in the management of constipation is a potentially beneficial intervention for patients with slow-transit constipation.
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Affiliation(s)
- Youn I Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
| | - Jun-Won Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kwang An Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Jung Ho Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Dong Kyun Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
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26
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Kim JY, Lim MH. Psychological factors to predict chronic diarrhea and constipation in Korean high school students. Medicine (Baltimore) 2021; 100:e26442. [PMID: 34232176 PMCID: PMC8270581 DOI: 10.1097/md.0000000000026442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Chronic diarrhea and constipation are common in adolescents and are associated with depression and anxiety. However, the association was not reported in adolescents adjusted for other psychological factors (resilience, personality traits, perceived stress, and suicidal ideation). Therefore, we investigated the significant psychological factors predicting chronic diarrhea and constipation in adjusted individuals for co-variables.A total of 819 Korean high school students who completed bowel health and psychological questionnaires were enrolled in this study. Depression and anxiety were assessed using validated questionnaires. We used multivariate analyses, controlling for demographic, dietary, lifestyle, and psychological variables to predict chronic diarrhea and constipation.Chronic diarrhea and constipation were more common in individuals with depression (22.3% and 18.6%, respectively) than in individuals with no depression (7.0% and 10.9%, respectively). In addition, they were more prevalent in individuals with anxiety (24.5% and 18.6%, respectively) than in individuals with no anxiety (9.1% and 12.7%, respectively). Multivariate analyses showed that resilience (adjusted risk ratio [aRR] = 0.98, adjusted 95% confidence interval [CI] = 0.97-0.99), moderate (aRR = 6.77, adjusted 95% CI = 3.55-12.91), and severe depression (aRR = 7.42, adjusted 95% CI = 3.61-15.27) were associated with chronic diarrhea. Only mild depression was associated with chronic constipation (aRR = 2.14, adjusted 95% CI = 1.36-3.38). However, anxiety was not significantly associated with chronic diarrhea or constipation.Among the psychological factors predicting disordered bowel habits, resilience and moderate and severe depression were significant predictors of chronic diarrhea, but not anxiety. Furthermore, only mild depression was an independent predictor of chronic constipation.
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Affiliation(s)
- Ji Young Kim
- Department of Psychology, Graduate School of Dankook University
| | - Myung Ho Lim
- Department of Psychology and Psychotherapy, College of Health Science
- Environmental Health Center, Dankook Medical Hospital, Dankook University, Cheonan, Korea
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27
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Concepción Zavaleta MJ, Gonzáles Yovera JG, Moreno Marreros DM, Rafael Robles LDP, Palomino Taype KR, Soto Gálvez KN, Arriola Torres LF, Coronado Arroyo JC, Concepción Urteaga LA. Diabetic gastroenteropathy: An underdiagnosed complication. World J Diabetes 2021; 12:794-809. [PMID: 34168729 PMCID: PMC8192258 DOI: 10.4239/wjd.v12.i6.794] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
This article is an extensive review that provides an update on the pathophysiology, symptoms, diagnosis, and treatment of diabetic gastroenteropathy. There is no reported prevalence, but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%, and type 2 patients, 1%. Also, in the group of type 1 diabetes, it has been observed that women are more likely to present this condition (5.8% vs 3.5%). Many factors are associate with its development (e.g., hyperglycemia, vagal dysfunction, loss of expression of neural nitric oxide synthase in the myenteric plexus, alterations in the Cajal interstitial cell network, and oxidative stress). Gastrointestinal discomfort could be perceived 70% higher in diabetic patients, describing that 25% of diabetic patients experience gastrointestinal symptoms. Diabetic enteropathy could affect any portion of the gastrointestinal tract, but esophageal alterations were described in more than 60% of diabetic patients, also 60% of them present constipation, and 20%, diarrhea. Gastric emptying scintigraphy is useful to evaluate gastroparesis, therefore, gastric retention of more than 60% at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis; however, other studies such as breath tests, with a sensitivity of 89% and a specificity of 80%, or the endoscopic capsule contribute to the diagnosis. There is no cure; however, management must be multidisciplinary, focused on slowing the progression of diabetic gastroenteropathy, reducing symptoms, and restoring function; that includes nutritional recommendation, maintain glucose levels kept below 180 mg/dL, use of prokinetics, anti-emetics; nowadays, it has been special interest in surgical treatment, such as pyloroplasty, also gastric electrical stimulation appears to be another alternative.
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Li Y, Tong WD, Qian Y. Effect of Physical Activity on the Association Between Dietary Fiber and Constipation: Evidence From the National Health and Nutrition Examination Survey 2005-2010. J Neurogastroenterol Motil 2021; 27:97-107. [PMID: 33380555 PMCID: PMC7786093 DOI: 10.5056/jnm20051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The effect of physical activity on the relationship between dietary fiber intake and constipation has not been comprehensively studied. This study aims to explore the impact of physical activity. Methods Data were obtained from 3 cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and included a total of 13 941 participants aged ≥ 20 years. Multiple logistic regression analysis was used to investigate the independent association between dietary fiber and constipation. Interaction analysis was also performed to analyze the relationship between dietary fiber and constipation in different physical activity groups. Results Among non-active participants, dietary fiber intake did not associate with stool consistency (OR, 1.02; 95% CI, 0.98-1.05; P = 0.407). For physically active participants, 1-gram unit increase in dietary fiber intake reduced the risk of stool consistency by 3% (OR, 0.97; 95% CI, 0.94-0.99; P = 0.020). Moreover, the relationship between dietary fiber intake and stool consistency was significantly different for groups with different levels of physical activity (P interaction = 0.044). However, dietary fiber intake was not related to stool frequency among non-active participants (OR, 0.99; 95% CI, 0.94-1.05; P = 0.767) nor physically active participants (OR, 1.01; 95% CI, 0.97-1.04; P = 0.751). Conclusions Increasing dietary fiber intake was associated with stool consistency-related constipation among physically active participants, but not among non-active participants. However, increasing dietary fiber intake is not significantly associated with stool frequency in different physical activity groups.
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Affiliation(s)
- Yi Li
- Medical College of Yan'an University, Yan'an, Shaanxi, China
| | - Wei-Dong Tong
- Gastric and Colorectal Division, Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Qian
- Operating Room, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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29
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Marathe CS, Jones KL, Wu T, Rayner CK, Horowitz M. Gastrointestinal autonomic neuropathy in diabetes. Auton Neurosci 2020; 229:102718. [PMID: 32916479 DOI: 10.1016/j.autneu.2020.102718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/22/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Gastrointestinal autonomic neuropathy represents an important and diverse, but poorly appreciated, manifestation of diabetic autonomic neuropathy that impacts negatively on quality of life. There is no test to assess gastrointestinal autonomic nerve damage directly in humans; cardiovascular autonomic reflex tests are often used as a surrogate, but are suboptimal. Gastrointestinal symptoms are common in diabetes, but usually correlate only weakly with disordered motility. Diabetic gastroparesis, or abnormally delayed gastric emptying, occurs frequently and is the best characterized manifestation of gastrointestinal autonomic neuropathy. There is a bi-directional relationship between postprandial glycaemia and the rate of gastric emptying. However, autonomic neuropathy can affect the function of any gut segment from the esophagus to the anus. Current management options for gastrointestinal autonomic neuropathy are, for the main part, empirical and sub-optimal.
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Affiliation(s)
- Chinmay S Marathe
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia.
| | - Karen L Jones
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia.
| | - Tongzhi Wu
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
| | - Christopher K Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia.
| | - Michael Horowitz
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia.
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30
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Johnson LM, White SK, Schmidt RL. Are calprotectin and lactoferrin equivalent screening tests for inflammatory bowel disease? Clin Chim Acta 2020; 510:191-195. [PMID: 32673669 DOI: 10.1016/j.cca.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lactoferrin and calprotectin are frequently ordered stool tests used to screen patients for inflammatory bowel disease versus functional bowel disease. Current guidelines recommend using either one to screen for inflammation in the GI tract; however, little information is available on how these 2 assays compare and their use in different clinical specialties. METHODS We compared order patterns for lactoferrin and calprotectin using data from a large reference laboratory over a 10-y period (2009-2019). We also studied the concordance of lactoferrin and calprotectin in cases where both tests were ordered concurrently. Finally, we reviewed the records at a university hospital to determine which clinicians ordered each test and the indications associated with orders. RESULTS Orders for calprotectin are increasing relative to lactoferrin. The relative proportion of calprotectin orders have increased from 60% to nearly 90% over the past decade. Results for lactoferrin and calprotectin show concordance (90%). Calprotectin and lactoferrin are ordered by different clinical specialties for different indications. Calprotectin is most often ordered by gastroenterologists in the context of abdominal pain. Lactoferrin is most often ordered by primary care providers in the context of acute diarrhea. CONCLUSION Lactoferrin and calprotectin are not treated as equivalent tests by clinicians.
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Affiliation(s)
- Lisa M Johnson
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States
| | - Sandra K White
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States.
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Dantas AAG, Barbosa IR, Castro SSD, Ferreira CWS, Camara SMAD, Dantas DDS. PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:188-192. [PMID: 32609161 DOI: 10.1590/s0004-2803.202000000-36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.
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Affiliation(s)
- Amanda Almeida Gomes Dantas
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde de Trairi (FACISA), Santa Cruz, RN, Brasil
| | - Isabelle Ribeiro Barbosa
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde de Trairi (FACISA), Santa Cruz, RN, Brasil
| | | | | | | | - Diego de Sousa Dantas
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde de Trairi (FACISA), Santa Cruz, RN, Brasil.,Universidade Federal de Pernambuco, Recife, PE, Brasil
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32
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Ikee R, Yano K, Tsuru T. Constipation in chronic kidney disease: it is time to reconsider. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0246-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AbstractConstipation is highly prevalent in patients with chronic kidney disease (CKD) and is primarily characterized by decreased intestinal motility. This chronic disorder affects the quality of life of patients. However, nephrologist and dialysis clinicians have long had a disproportionately limited understanding of constipation. Accumulating evidence has revealed a relationship between constipation and cardiovascular disease and CKD. The pathogenesis of constipation in CKD patients is multifactorial: decreased physical activity, comorbidities affecting bowel movement, such as diabetes mellitus, cerebrovascular disease, and hyperparathyroidism, a restricted dietary intake of plant-based fiber-rich foods, and multiple medications, including phosphate binders and potassium-binding resins, have all been implicated. CKD is associated with alterations in the composition and function of the gut microbiota, so-called gut dysbiosis. Recent studies showed that CKD-related gut dysbiosis decreased intestinal motility via intestinal inflammation or the increased generation of gut-derived uremic toxins, such as indoxyl sulfate and p-cresyl sulfate. Furthermore, the gastrointestinal secretion of mucin was found to be decreased in CKD animal models, which may delay colonic transit by diminished lubrication in the alimentary tract. Thus, CKD-related gut dysbiosis may play a role in constipation, but limited information is currently available. Since constipation is often intractable, particularly in CKD patients, every available means needs to be employed in its treatment. The effects of probiotics, prebiotics, and synbiotics on the composition of the gut microbiota and gut-derived uremic toxins have been increasingly reported. However, their effects on stool consistency or frequency in CKD patients remain unclear. Some laxatives may be beneficial for improving not only bowel habits but also gut dysbiosis. Further studies are required to elucidate the CKD-specific pathogenesis of constipation and develop novel effective treatment options.
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Ballou S, Katon J, Singh P, Rangan V, Lee HN, McMahon C, Iturrino J, Lembo A, Nee J. Chronic Diarrhea and Constipation Are More Common in Depressed Individuals. Clin Gastroenterol Hepatol 2019; 17:2696-2703. [PMID: 30954714 PMCID: PMC6776710 DOI: 10.1016/j.cgh.2019.03.046] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/11/2019] [Accepted: 03/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Depression is a major health issue in the United States and is highly comorbid with gastrointestinal conditions. We collected data from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the US population, to study the relationship between depression and bowel habits. METHODS Using data from the NHANES (2009-2010), we identified 495 depressed and 4709 non-depressed adults who filled out the Bowel Health Questionnaire. Depression was defined according to a validated questionnaire. We used multivariable analysis, controlling for clinical and demographic variables, to evaluate the relationship between mood and bowel habits. RESULTS In our weighed sample, 24.6% of depressed individuals and 12.6% of non-depressed individuals reported disordered bowel habits. Chronic diarrhea was significantly more prevalent in depressed individuals (15.53%; 95% CI, 11.34%-20.90%) than non-depressed individuals (6.05%; 95% CI, 5.24%-6.98%; P = .0001). Chronic constipation was also more common in depressed individuals (9.10%; 95% CI, 7.02%-11.69%) than non-depressed individuals (6.55%; 95% CI, 5.55%-7.70% CI; P = .003). Mean depression scores in patients with chronic diarrhea (4.9 ± 5.8) and with chronic constipation (4.4 ± 4.93) were significantly higher than mean depression scores for individuals with normal bowel habits (3.2 ± 4.6) (P < .001). Moderate and severe depression were significantly associated with chronic diarrhea but not chronic constipation. Only mild depression was significantly associated with chronic constipation. CONCLUSIONS In an analysis of the NHANES database, we found a higher proportion of depressed individuals to have chronic diarrhea and constipation than non-depressed individuals; chronic diarrhea was more strongly associated with depression. Our findings provide support for the relationship between mood and specific bowel habits, accounting for multiple co-variables in a large sample of the general US population.
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Affiliation(s)
- Sarah Ballou
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Jesse Katon
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Prashant Singh
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Vikram Rangan
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Ha Neul Lee
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Courtney McMahon
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Johanna Iturrino
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anthony Lembo
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Judy Nee
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
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Zhao H, Wang C, Pan Y, Guo Y, Yao N, Wang H, Jin L, Li B. Niacin, lutein and zeaxanthin and physical activity have an impact on Charlson comorbidity index using zero-inflated negative binomial regression model: National Health and Nutrition Examination Survey 2013-2014. BMC Public Health 2019; 19:1589. [PMID: 31779602 PMCID: PMC6883694 DOI: 10.1186/s12889-019-7906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Combined with the increasing life expectancy, chronic medical conditions have gradually become the dominant cause of death and disability, and multimorbidity became an increasingly serious public health challenge. However, most existing studies have focused on the coexistence of specific diseases or relatively few diseases. Given one person may have multiple diseases at the same time, we applied Charlson Comorbidity Index (CCI) to systematically evaluate one’s 10-year mortality. In this study, we explored the effects of nutrients and physical activity on CCI using National Health and Nutrition Examination Survey (NHANES) 2013–2014 data. Methods The study sample consists of one continuous cycle (2013–2014) of NHANES, and 4386 subjects were included in the study. Nutrients intake was measured by dietary recall, and physical activity was evaluated by the Global Physical Activity Questionnaire respectively. Besides, CCI was the sum of the scores assigned for each medical condition. We utilized zero-inflated negative binomial (ZINB) model to investigate the effects in nutrients intake and physical activity on CCI by adjusting for seven sociodemographic characteristics, smoking and drinking. Results Among the 4386 participants, 2018 (68.7%) are Non-Hispanic White, over half participants (78.6%) drink. In count part (CCI ≥ 0), holding other variables constant, the expected change in CCI for a one-unit increase in niacin is 1.621(RR = 1.621, p = 0.016), in lutein + zeaxanthin is 0.974 (RR = 0.974, p = 0.031), and in sedentary time is 1.035 (RR = 1.035, p = 0.005). Moreover, those who do not have vigorous work activity would be more likely to have higher CCI than those who have (RR = 1.275, P = 0.045). In logit part (CCI = 0), the log odds of having CCI equals zero would increase by 0.541 and 0.708 for every additional vigorous recreational activity (OR = 0.541, p = 0.004) and moderate recreational activity (OR = 0.708, p = 0.017) respectively. Conclusions Lutein and zeaxanthin intake, vigorous work activity, vigorous recreational activity and moderate recreational activity may be good for one’s health. Rather, increasing niacin intake and sedentary activity may be likely to raise 10-year mortality. Our findings may be significant for preventing diseases and improving health, furthermore, reducing people’s financial burden on healthcare.
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Affiliation(s)
- Hantong Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Changcong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Yingan Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Yinpei Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Han Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China.
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China.
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Ballou S, Singh P, Rangan V, Iturrino J, Nee J, Lembo A. Obesity is associated with significantly increased risk for diarrhoea after controlling for demographic, dietary and medical factors: a cross-sectional analysis of the 2009-2010 National Health and Nutrition Examination Survey. Aliment Pharmacol Ther 2019; 50:1019-1024. [PMID: 31532005 PMCID: PMC6800600 DOI: 10.1111/apt.15500] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is associated with increased risk for various gastrointestinal and liver diseases. However, the relationship between obesity and abnormal bowel habits is poorly understood. AIM To investigate the relationship between body mass index (BMI) and bowel habit, controlling for clinical, demographic and dietary factors, in a representative sample of the United States adult population METHODS: Data were extracted from the 2009-2010 National Health and Nutrition Examination Survey. Survey responses were included in this study if respondents completed the bowel health questionnaire (BHQ), were ≥20 years of age, and did not report history of IBD, celiac disease or colon cancer. BMI was divided into the following categories: underweight, normal weight, overweight, obese and severely obese. Stepwise logistic regression provided risk ratios of constipation and diarrhoea controlling for confounding factors (dietary, life-style, psychological and medical). RESULTS A total of 5126 respondents completed the BHQ, had BMI data available, and met eligibility criteria. Of these, 70 (1.40%) were underweight, 1350 (26.34%) were normal weight, 1731 (33.77%) were overweight, 1097 (21.40%) were obese and 878 (17.13%) were severely obese. Up to 8.5% of obese and 11.5% of severely obese individuals had chronic diarrhoea, compared to 4.5% of normal weight individuals. Stepwise regression revealed that severe obesity was independently associated with increased risk of diarrhoea. CONCLUSION Obesity is positively associated with chronic diarrhoea in a nationally representative US adult population after adjusting for several known confounding factors.
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Affiliation(s)
- Sarah Ballou
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA,Corresponding Author: Sarah Ballou, PhD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA 02215,
| | - Prashant Singh
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA,Corresponding Author: Sarah Ballou, PhD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA 02215,
| | - Vikram Rangan
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Johanna Iturrino
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Judy Nee
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anthony Lembo
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
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36
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Chronic constipation: new insights, better outcomes? Lancet Gastroenterol Hepatol 2019; 4:873-882. [DOI: 10.1016/s2468-1253(19)30199-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
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37
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Shin A, Xu H, Imperiale TF. Associations of chronic diarrhoea with non-alcoholic fatty liver disease and obesity-related disorders among US adults. BMJ Open Gastroenterol 2019; 6:e000322. [PMID: 31523443 PMCID: PMC6711435 DOI: 10.1136/bmjgast-2019-000322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Mechanisms explaining observed associations between diarrhoea and obesity or increased body mass index (BMI) are unclear.
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Affiliation(s)
- Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Center of Innovation, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, United States
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Abstract
PURPOSE OF REVIEW Chronic diarrhea is a common problem in all age groups but is a particularly challenging diagnostic problem in the elderly, since many different conditions need to be considered. The purpose of this review is to discuss the evaluation of chronic diarrhea in older individuals. It highlights those conditions that seem to occur with increased frequency in the elderly, discusses the diagnostic tests that are of greatest value in sorting out these problems, and presents an approach to evaluation that is both practical and affordable. RECENT FINDINGS There appears to be little value in distinguishing irritable bowel syndrome with diarrhea (IBS-D) from functional diarrhea in most patients, including older individuals. Both conditions need a thoughtful analysis of potential causes that may lead to more focused treatment. Older individuals may be more at risk of having certain structural disorders, and these need to be considered when constructing a differential diagnosis. In addition, elderly patients may have atypical presentations of specific disorders that require an increased index of suspicion. Diagnostic tests generally seem to perform well in older patients but have not been validated in this cohort of patients. Although the pretest probabilities of certain diseases are different in the elderly, the conventional algorithm for assessment of chronic diarrhea should lead to a diagnosis in most cases. Better studies are needed to adequately quantitate the likelihood of different diagnoses and the operating characteristics of diagnostic tests in older patients with chronic diarrhea. Lacking that information, physicians can still do a good job of making a diagnosis in these patients by adopting a stepwise approach.
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Meldgaard T, Keller J, Olesen AE, Olesen SS, Krogh K, Borre M, Farmer A, Brock B, Brock C, Drewes AM. Pathophysiology and management of diabetic gastroenteropathy. Therap Adv Gastroenterol 2019; 12:1756284819852047. [PMID: 31244895 PMCID: PMC6580709 DOI: 10.1177/1756284819852047] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/26/2019] [Indexed: 02/04/2023] Open
Abstract
Polyneuropathy is a common complication to diabetes. Neuropathies within the enteric nervous system are associated with gastroenteropathy and marked symptoms that severely reduce quality of life. Symptoms are pleomorphic but include nausea, vomiting, dysphagia, dyspepsia, pain, bloating, diarrhoea, constipation and faecal incontinence. The aims of this review are fourfold. First, to provide a summary of the pathophysiology underlying diabetic gastroenteropathy. Secondly to give an overview of the diagnostic methods. Thirdly, to provide clinicians with a focussed overview of current and future methods for pharmacological and nonpharmacological treatment modalities. Pharmacological management is categorised according to symptoms arising from the upper or lower gut as well as sensory dysfunctions. Dietary management is central to improvement of symptoms and is discussed in detail, and neuromodulatory treatment modalities and other emerging management strategies for diabetic gastroenteropathy are discussed. Finally, we propose a diagnostic/investigation algorithm that can be used to support multidisciplinary management.
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Affiliation(s)
| | - Jutta Keller
- Israelitic Hospital in Hamburg, Academic
Hospital University of Hamburg, Germany
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology and
Hepatology and Department of Clinical Medicine, Aalborg University Hospital,
Denmark,Department of Clinical Medicine, Aalborg
University, Denmark
| | - Søren Schou Olesen
- Mech-Sense, Department of Gastroenterology and
Hepatology and Department of Clinical Medicine, Aalborg University Hospital,
Denmark,Department of Clinical Medicine, Aalborg
University, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology,
Aarhus University Hospital, Denmark
| | - Mette Borre
- Department of Hepatology and Gastroenterology,
Aarhus University Hospital, Denmark
| | - Adam Farmer
- Department of Gastroenterology, University
Hospitals of North Midlands, Stoke on Trent, Staffordshire, UK,Centre for Digestive Diseases, Blizard
Institute of Cell and Molecular Science, Wingate Institute of
Neurogastroenterology, Barts and the London School of Medicine and
Dentistry, Queen Mary University of London, UK
| | - Birgitte Brock
- Department of Clinical Research, Steno Diabetes
Center Copenhagen (SDCC), Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and
Hepatology and Department of Clinical Medicine, Aalborg University Hospital,
Denmark,Department of Clinical Medicine, Aalborg
University, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and
Hepatology and Department of Clinical Medicine, Aalborg University Hospital,
Denmark,Department of Clinical Medicine, Aalborg
University, Denmark
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40
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Azmi S, Ferdousi M, Kalteniece A, Al-Muhannadi H, Al-Mohamedi A, Hadid NH, Mahmoud S, Bhat HA, Gad HYA, Khan A, Ponirakis G, Petropoulos IN, Alam U, Malik RA. Diagnosing and managing diabetic somatic and autonomic neuropathy. Ther Adv Endocrinol Metab 2019; 10:2042018819826890. [PMID: 30783521 PMCID: PMC6365998 DOI: 10.1177/2042018819826890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022] Open
Abstract
The diagnosis and management of diabetic neuropathy can be a major challenge. Late diagnosis contributes to significant morbidity in the form of painful diabetic neuropathy, foot ulceration, amputation, and increased mortality. Both hyperglycaemia and cardiovascular risk factors are implicated in the development of somatic and autonomic neuropathy and an improvement in these risk factors can reduce their rate of development and progression. There are currently no US Food and Drug Administration (FDA)-approved disease-modifying treatments for either somatic or autonomic neuropathy, as a consequence of multiple failed phase III clinical trials. While this may be partly attributed to premature translation, there are major shortcomings in trial design and outcome measures. There are a limited number of partially effective FDA-approved treatments for the symptomatic relief of painful diabetic neuropathy and autonomic neuropathy.
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Affiliation(s)
- Shazli Azmi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | - Alise Kalteniece
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | | | | | | | - Salah Mahmoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Harun A. Bhat
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hoda Y. A. Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | | | - Uazman Alam
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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