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Saikumar P, Sadauskas M, Izhar S, Moshiree B, Patel D. Constipation and DIOS: Diagnosis, differential diagnosis, and management. Pediatr Pulmonol 2024; 59 Suppl 1:S81-S90. [PMID: 39105354 DOI: 10.1002/ppul.27104] [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: 09/11/2023] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 08/07/2024]
Abstract
Cystic Fibrosis (CF) is a complex disorder that requires multidisciplinary expertise for effective management. The GALAXY study estimated the prevalence of constipation to be about 25% among People with Cystic Fibrosis (PwCF), identifying it as one of the common gastrointestinal (GI) symptoms within this patient population. Quality of Life (QoL) assessments uncovered high patient dissatisfaction, highlighting the imperative need for enhanced treatment strategies. Similarly, Distal Intestinal Obstruction Syndrome (DIOS) is a unique condition exclusive to PwCF that, if left undiagnosed, can lead to considerable morbidity and mortality. Given the broad spectrum of differential diagnoses for abdominal pain, including constipation and DIOS, it is paramount for healthcare providers to possess a clear understanding of these conditions. This paper aims to delineate various differentials for abdominal pain while elucidating the pathogenesis, diagnostic criteria, and treatment options for managing constipation and DIOS in PwCF.
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Affiliation(s)
- Pavithra Saikumar
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Marisa Sadauskas
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Sophia Izhar
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Baha Moshiree
- Atrium Health, Division of Gastroenterology, Hepatology and Nutrition, Wake Forest Medical University, Charlotte, North Carolina, USA
| | - Dhiren Patel
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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2
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Montgomery G, Patel A, Pfeil S. Treatment and Management of Gastrointestinal Disorders. Med Clin North Am 2024; 108:777-794. [PMID: 39084834 DOI: 10.1016/j.mcna.2024.03.010] [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] [Indexed: 08/02/2024]
Abstract
This article reviews the evaluation and management of several gastrointestinal disorders that are commonly encountered by gastroenterologists and primary care physicians. With a focus on newer therapies, we discuss the management of chronic constipation, irritable bowel syndrome, Clostridioides difficile infection, gastroparesis, steatotic liver disease, and diverticulitis.
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Affiliation(s)
- Garren Montgomery
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Arsheya Patel
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sheryl Pfeil
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Medical Center, Columbus, OH, USA
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3
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Parekh A. Letter to the editor regarding hypothesis linking primary idiopathic constipation to lack of thirst: is it so simple? J Gastrointest Surg 2024; 28:1570. [PMID: 38964531 DOI: 10.1016/j.gassur.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Alap Parekh
- Department of Surgery, Parekh's Multispeciality Hospital, Bavla, Ahmedabad, Gujarat, India.
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Zhao L, Deng X, Ding N, Liu Y, Ma Y, Li J, Wang S, Ji X, Wang J, Wang D, Li Y, Dou D, Zhu X, Zhu L, Zhang S. Diminished representation of vitamin-B12-producing bacteria in constipated elders with frailty. iScience 2024; 27:110403. [PMID: 39091462 PMCID: PMC11292359 DOI: 10.1016/j.isci.2024.110403] [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: 02/06/2024] [Revised: 04/24/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Constipation and frailty are associated with intestinal dysbiosis. This study aims to identify intestinal microbial signatures that can differentiate between constipated elders accompanied by frailty and those without frailty. We collected stool samples from 61 participants and conducted 16S rRNA gene sequencing. Constipated patients with frailty (Constipation_F) exhibited reduced gut microbial diversities compared to constipated patients without frailty (Constipation_NF) and healthy individuals (C). From differential genera, random forest models identified 14, 8, and 5 biomarkers for distinguishing Constipation_F from Constipation_NF, Constipation_F from C, and Constipation_NF from C, respectively. Functional analysis revealed that pathways (P381-PWY and PWY-5507) related to vitamin B12 synthesis were reduced in Constipation_F, which aligns with the decreased abundances of vitamin-B12-producing Actinomyces and Akkermansia in this group. Our study unveils substantial differences in gut microbiota between constipated elders with frailty and those without, underscoring the diagnostic and therapeutic potential of genera involved in vitamin B12 synthesis.
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Affiliation(s)
- Luqing Zhao
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xin Deng
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Ning Ding
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yanzhen Liu
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yun Ma
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Jiake Li
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Shuqing Wang
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Xingyu Ji
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Jinjuan Wang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Dianpeng Wang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Yanhui Li
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Dan Dou
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xihan Zhu
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Lixin Zhu
- Department of General Surgery (Colorectal Surgery), Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Shengsheng Zhang
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
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de Cates AN, Harmer CJ, Harrison PJ, Cowen PJ, Emmanuel A, Travis S, Murphy SE, Taquet M. Association between a selective 5-HT 4 receptor agonist and incidence of major depressive disorder: emulated target trial. Br J Psychiatry 2024:1-8. [PMID: 39109752 DOI: 10.1192/bjp.2024.97] [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] [Indexed: 09/07/2024]
Abstract
BACKGROUND The serotonin 4 receptor (5-HT4R) is a promising target for the treatment of depression. Highly selective 5-HT4R agonists, such as prucalopride, have antidepressant-like and procognitive effects in preclinical models, but their clinical effects are not yet established. AIMS To determine whether prucalopride (a 5-HT4R agonist and licensed treatment for constipation) is associated with reduced incidence of depression in individuals with no past history of mental illness, compared with anti-constipation agents with no effect on the central nervous system. METHOD Using anonymised routinely collected data from a large-scale USA electronic health records network, we conducted an emulated target trial comparing depression incidence over 1 year in individuals without prior diagnoses of major mental illness, who initiated treatment with prucalopride versus two alternative anti-constipation agents that act by different mechanisms (linaclotide and lubiprostone). Cohorts were matched for 121 covariates capturing sociodemographic factors, and historical and/or concurrent comorbidities and medications. The primary outcome was a first diagnosis of major depressive disorder (ICD-10 code F32) within 1 year of the index date. Robustness of the results to changes in model and population specification was tested. Secondary outcomes included a first diagnosis of six other neuropsychiatric disorders. RESULTS Treatment with prucalopride was associated with significantly lower incidence of depression in the following year compared with linaclotide (hazard ratio 0.87, 95% CI 0.76-0.99; P = 0.038; n = 8572 in each matched cohort) and lubiprostone (hazard ratio 0.79, 95% CI 0.69-0.91; P < 0.001; n = 8281). Significantly lower risks of all mood disorders and psychosis were also observed. Results were similar across robustness analyses. CONCLUSIONS These findings support preclinical data and suggest a role for 5-HT4R agonists as novel agents in the prevention of major depression. These findings should stimulate randomised controlled trials to confirm if these agents can serve as a novel class of antidepressant within a clinical setting.
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Affiliation(s)
- Angharad N de Cates
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; and Institute for Mental Health, University of Birmingham, UK
| | - Catherine J Harmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK; and Oxford Centre for Human Brain Activity and Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK; and Oxford Centre for Human Brain Activity and Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, UK
| | - Philip J Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Travis
- Kennedy Institute of Rheumatology, University of Oxford, UK; and Translational Gastroenterology and Liver Unit, University of Oxford, UK
| | - Susannah E Murphy
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Maxime Taquet
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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Gao Q, Cil O. Magnesium for disease treatment and prevention: emerging mechanisms and opportunities. Trends Pharmacol Sci 2024; 45:708-722. [PMID: 39019764 DOI: 10.1016/j.tips.2024.06.004] [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: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/19/2024]
Abstract
Magnesium (Mg2+) is a commonly used dietary supplement for the prevention and treatment of diseases. However, the efficacy and mechanisms of action of Mg2+ in most diseases have been controversial because of conflicting findings in earlier studies. Recent clinical and preclinical studies provide novel insights into the use of Mg2+ for the treatment and prevention of diseases affecting different organ systems. In this review, we provide an overview of recent clinical evidence for, and controversies over, the medical benefits of Mg2+. In addition, we critically discuss recent advances in understanding the mechanisms of action of Mg2+, which could enable the development of novel targeted therapies.
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Affiliation(s)
- Qi Gao
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Onur Cil
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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Taclob JA, Kalas MA, McCallum RW. Examining linaclotide for the treatment of chronic idiopathic constipation. Expert Opin Pharmacother 2024; 25:1281-1290. [PMID: 39058326 DOI: 10.1080/14656566.2024.2386160] [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: 06/05/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is characterized by infrequent bowel movements and hard stools lasting for at least three months or longer. This disease affects 8-12% of the US population and 10-17% of the world population. Treatment and management involve identifying the primary cause, changing dietary habits, and adequate physical activity. Linaclotide is a guanylate cyclase-agonist acting locally in the luminal surface of the intestinal enterocyte leading to a signal transduction cascade, activation of the cystic fibrosis transmembrane conductance regulator (CFTR), thus increasing secretion of chloride and bicarbonate into the intestinal lumen with eventual increased intestinal fluid and faster transit time. AREAS COVERED We reviewed multiple studies and did a thorough literature review on CIC including its pathophysiology. Through this literature review, we were able to discuss and give the context and rationale for drug regimens indicated for CIC. EXPERT OPINION The era we live in right now is akin to nutrient-rich and fertilized soil as knowledge and resources are abundant. The opportunities and potential are endless. Constipation being more extensively studied, our understanding of medications and diseases broadens, leading to novel medications being discovered. Linaclotide is a pioneer in this aspect and can pave the way for future generations.
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Affiliation(s)
- Jeff Angelo Taclob
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - M Ammar Kalas
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Tan S, Zhang W, Zeng P, Yang Y, Chen S, Li Y, Bian Y, Xu C. Clinical effects of chemical drugs, fecal microbiota transplantation, probiotics, dietary fiber, and acupuncture in the treatment of chronic functional constipation: a systematic review and network meta-analysis. Eur J Gastroenterol Hepatol 2024; 36:815-830. [PMID: 38829940 DOI: 10.1097/meg.0000000000002786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Currently, there are increasingly diverse treatment modalities for chronic functional constipation (CFC). This study aims to compare the relative efficacy and safety of chemical drugs, fecal microbiota transplantation (FMT), probiotics, dietary fiber, and acupuncture in the treatment of patients with CFC. We searched relevant randomized controlled trials (RCTs) published in five databases up to November 2023. Network meta-analysis (NMA) was carried out using R Studio 4.2.1. Cumulative ranking probability plots, assessed through the surface under the cumulative ranking (SUCRA), were employed to rank the included drugs for various outcome measures. We included a total of 45 RCT studies with 17 118 patients with CFC. From the SUCRA values and NMA results FMT showed the best utility in terms of clinical efficacy, Bristol stool form scale scores, patient assessment of constipation quality of life scores, and the treatment modality with the lowest ranked incidence of adverse effects was electroacupuncture. Subgroup analysis of the chemotherapy group showed that sodium A subgroup analysis of the chemical group showed that sodium picosulfate 10 mg had the highest clinical efficacy. FMT is more promising in the treatment of CFC and may be more effective in combination with the relatively safe treatment of acupuncture.
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Affiliation(s)
- Shufa Tan
- Shaanxi University of Traditional Chinese Medicine, Xianyang
| | - Wei Zhang
- Shaanxi University of Traditional Chinese Medicine, Xianyang
| | - Pengfei Zeng
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yunyi Yang
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Shikai Chen
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Yuwei Li
- Department of Colorectal Surgery, Tianjin Union Medical Center
| | - Yuhong Bian
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chen Xu
- Department of Colorectal Surgery, Tianjin Union Medical Center
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Ulsh L, Halawi H, Triadafilopoulos G, Gurland B, Nguyen L, Garcia P, Sonu I, Fernandez-Becker N, Becker L, Sheth V, Neshatian L. Use of a footstool improves rectal balloon expulsion in some patients with defecatory disorders. Neurogastroenterol Motil 2024; 36:e14781. [PMID: 38488172 DOI: 10.1111/nmo.14781] [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: 05/29/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Whether patients with defecatory disorders (DDs) with favorable response to a footstool have distinctive anorectal pressure characteristics is unknown. We aimed to identify the clinical phenotype and anorectal pressure profile of patients with DDs who benefit from a footstool. METHODS This is a retrospective review of patients with high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) from a tertiary referral center. BET was repeated with a 7-inch-high footstool in those who failed it after 120 s. Data were compared among groups with respect to BET results. KEY RESULTS Of the 667 patients with DDs, a total of 251 (38%) had failed BET. A footstool corrected BET in 41 (16%) of those with failed BET. Gender-specific differences were noted in anorectal pressures, among patients with and without normal BET, revealing gender-based nuances in pathophysiology of DDs. Comparing patients who passed BET with footstool with those who did not, the presence of optimal stool consistency, with reduced instances of loose stools and decreased reliance on laxatives were significant. Additionally, in women who benefited from a footstool, lower anal pressures at rest and simulated defecation were observed. Independent factors associated with a successful BET with a footstool in women included age <50, Bristol 3 or 4 stool consistency, lower anal resting pressure and higher rectoanal pressure gradient. CONCLUSION & INFERENCES Identification of distinctive clinical and anorectal phenotype of patients who benefited from a footstool could provide insight into the factors influencing the efficacy of footstool utilization and allow for an individualized treatment approach in patients with DDs.
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Affiliation(s)
- Lauren Ulsh
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Houssam Halawi
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Linda Nguyen
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Patricia Garcia
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Irene Sonu
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Nielsen Fernandez-Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Laren Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Vipul Sheth
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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10
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Tyler KC, Smith JP, Alexander JT. EBM BLS: Kiwifruit may Improve Constipation in Patients with Functional Gastrointestinal Disorders. J Gen Intern Med 2024; 39:1788-1789. [PMID: 38710860 PMCID: PMC11255134 DOI: 10.1007/s11606-024-08725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 05/08/2024]
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11
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Camilleri M, Yang DY. Algorithms or biomarkers in patients with lower DGBI? Neurogastroenterol Motil 2024:e14856. [PMID: 38934414 DOI: 10.1111/nmo.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Several organizations have proposed guidelines or clinical decision tools for the management of patients with disorders of gut-brain interactions (DGBI) affecting the lower digestive tract including irritable bowel syndrome and chronic idiopathic constipation. Such algorithms are based on sequential therapeutic trials and modifying the treatment strategy based on efficacy and adverse events. PURPOSE The aims of this review are to evaluate the evidence for efficacy of second- and third-line pharmacotherapies and to assess the evidence for the alternative option to manage subgroups of patients with symptoms suggestive of lower DGBI based on diagnostic tests or documented dysfunctions. The preeminent tests to identify such subgroups that present with symptoms that overlap with lower DGBI are detailed: digital rectal examination as well as anorectal manometry and balloon expulsion for evacuation disorders, detailed measurements of colonic transit, and diagnosis of bile acid diarrhea or carbohydrate malabsorption based on biochemical measurements. The review also addresses the cost implications of screening to exclude alternative diagnoses and the costs of therapy associated with the therapeutic options following an algorithmic approach to treatment from the perspective of society, insurer, or patient. Finally, the costs of the diagnostic tests to identify actionable biomarkers and the evidence of efficacy of individualized therapy based on formal diagnosis or documentation of abnormal functions are detailed in the review.
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Affiliation(s)
- Michael Camilleri
- Division of Gastroenterology and Hepatology, Mayo Clinic, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Rochester, Minnesota, USA
| | - David Yi Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Rochester, Minnesota, USA
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Whorwell P, Lange R, Scarpignato C. Review article: do stimulant laxatives damage the gut? A critical analysis of current knowledge. Therap Adv Gastroenterol 2024; 17:17562848241249664. [PMID: 38887508 PMCID: PMC11181897 DOI: 10.1177/17562848241249664] [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: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 06/20/2024] Open
Abstract
Stimulant laxatives are well established as first- or second-line treatments for constipation and although they have a reliable therapeutic effect, alleged safety concerns still exist, particularly with long-term use. The potential harmful effects on the gastrointestinal system (including carcinogenicity) of the long-term use of diphenylmethane [bisacodyl, sodium picosulfate (SPS)] and senna stimulant laxatives were assessed in a comprehensive review of the publications identified in literature searches performed in PubMed and Embase up to and including June 2023. We identified and reviewed 43 publications of interest. While stimulant laxatives at supratherapeutic doses have been shown to cause structural alterations to surface absorptive cells in animals and humans, these effects are reversible and not considered clinically relevant. No formal long-term studies have demonstrated morphological changes in enteric neural elements or intestinal smooth muscle with bisacodyl or SPS in humans. Furthermore, there is no convincing evidence that stimulant laxatives are associated with the development of colon cancer, and in fact, chronic constipation itself has been reported to potentially increase the risk of colon cancer, therefore, the use of stimulant laxatives might reduce this risk. Many studies suggesting a possible harmful effect from laxatives were limited by their failure to consider confounding factors such as concomitant neurological disease, metabolic disorders, and age. These findings highlight the lack of evidence for the harmful effects of laxatives on the colon, and thus, the benefits of treatment with stimulant laxatives, even in the long-term, should be reconsidered for the management of patients with constipation.
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Affiliation(s)
- Peter Whorwell
- Neurogastroenterology Unit, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | | | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta
- Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
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13
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Pinto-Sanchez MI, Blom JJ, Gibson PR, Armstrong D. Nutrition Assessment and Management in Celiac Disease. Gastroenterology 2024; 167:116-131.e1. [PMID: 38593924 DOI: 10.1053/j.gastro.2024.02.049] [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: 11/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.
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Affiliation(s)
- M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jedid-Jah Blom
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter R Gibson
- Central Clinical School, Department of Gastroenterology, Monash University, Clayton, Victoria, Australia
| | - David Armstrong
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Yamamoto S, Ohashi W, Yamaguchi Y, Igari H, Koshino A, Sugiyama T, Nagao K, Tamura Y, Izawa S, Mano M, Ebi M, Usami J, Hamano K, Izumi J, Wakita Y, Funaki Y, Ogasawara N, Sasanabe R, Sasaki M, Maekawa M, Kasugai K. Factors Associated with Defecation Satisfaction among Japanese Adults with Chronic Constipation. J Clin Med 2024; 13:3216. [PMID: 38892926 PMCID: PMC11172833 DOI: 10.3390/jcm13113216] [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: 02/24/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Constipation causes substantial morbidity worldwide. Methods: This survey assessed constipation-related factors in Japan using the Japanese version of the Irritable Bowel Syndrome Quality of Life (IBS-QOL-J) instrument. We also examined the relationship among laxative type, Bristol Stool Form Scale (BSFS) scores, and treatment cost. Finally, we examined differences in satisfaction scores according to laxative type, treatment type, treatment cost, and BSFS score. Results: IBS-QOL-J was higher among those taking salt and/or irritation laxatives. Those paying >JPY 5000 (USD 50.00) had the lowest IBS-QOL-J. IBS-QOL-J was significantly lower among those with a BSFS score of 1 or 2 (severe constipation). Conclusions: This study's findings suggest that a variety of factors, including treatment type and cost, are associated with defecation satisfaction. Those who had hard stools, used multiple laxatives, or spent more on treatment were less satisfied. Future strategies should target therapies that do not require multiple laxatives with lower treatment costs. Adequate defecation with a small number of appropriate laxatives at minimal cost appears to improve defecation satisfaction. It is desirable to identify appropriate laxatives and improve dietary habits and exercise routines. It is also necessary to stop blindly increasing laxative usage and properly diagnose constipation disorders such as anatomical abnormalities other than functional constipation.
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Affiliation(s)
- Sayuri Yamamoto
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yoshiharu Yamaguchi
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroki Igari
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Akira Koshino
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Tomoya Sugiyama
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Kazuhiro Nagao
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yasuhiro Tamura
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Shinya Izawa
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Mamiko Mano
- Division of Sleep Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Masahide Ebi
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Jun Usami
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Koichi Hamano
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Junko Izumi
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yoshinori Wakita
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yasushi Funaki
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Naotaka Ogasawara
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ryujiro Sasanabe
- Division of Sleep Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Makoto Sasaki
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Masato Maekawa
- Division of General Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Japan
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Marasco M, Dell'Unto E, Laviano A, Campana D, Panzuto F. Gastrointestinal side effects of somatostatin analogs in neuroendocrine tumors: a focused review. J Gastroenterol Hepatol 2024. [PMID: 38783558 DOI: 10.1111/jgh.16638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/06/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Neuroendocrine tumors (NETs) are a group of well-differentiated heterogeneous neoplasms characterized by slow progression and distinct clinical and biological behavior. In the majority of patients with NET, first-line treatment is represented by somatostatin analogs (SSAs) that, despite being drugs with high tolerability (even at high doses) and providing to carcinoid symptoms control and anti-proliferative effects, may present some side effects, with potential impact on quality of life and nutritional status. The most frequent side effects are represented by gastrointestinal events in particular alterations in bowel habits (diarrhea and constipation), abdominal pain, exocrine pancreatic insufficiency, and cholelithiasis. Considering the relative rarity of NETs, literature about frequency and standard clinical management of adverse events SSA-related is still lacking and heterogeneous. The aim of this review is to arm gastroenterologists and other physicians treating NET patients with essential knowledge on the side effects of SSAs. By identifying and managing these adverse events early, healthcare professionals can offer optimal care, avert foreseeable complications, and ensure the best outcomes for patients. Without such early recognition, there is a risk of diminishing the patient's quality of life and their ability to sustain treatment over time.
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Affiliation(s)
- Matteo Marasco
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
- PhD in Translational Medicine and Oncology, Sapienza University of Rome, Rome, Italy
| | - Elisabetta Dell'Unto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Clinical Nutrition Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
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Ramu SK, Oblizajek NR, Savica R, Chunawala ZS, Deb B, Bharucha AE. Defecatory disorders are a common cause of chronic constipation in Parkinson disease. Neurogastroenterol Motil 2024; 36:e14767. [PMID: 38376243 PMCID: PMC11061800 DOI: 10.1111/nmo.14767] [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: 10/20/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS Up to 50% of patients with Parkinson disease have constipation (PD-C), but the prevalence of defecatory disorders caused by rectoanal dyscoordination in PD-C is unknown. We aimed to compare anorectal function of patients with PD-C versus idiopathic chronic constipation (CC). METHODS Anorectal pressures, rectal sensation, and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry (HR-ARM) in patients with PD-C and control patients with CC, matched for age and sex. RESULTS We identified 97 patients with PD-C and 173 control patients. Eighty-six patients with PD-C (89%) had early PD, and 39 (40%) had a defecatory disorder, manifest by a prolonged rectal balloon expulsion time (37 patients) or a lower rectoanal pressure difference during evacuation (2 patients). PD-C patients with a prolonged BET had a greater anal resting pressure (p = 0.02), a lower rectal pressure increment (p = 0.005), greater anal pressure (p = 0.047), and a lower rectoanal pressure difference during evacuation (p < 0.001). Rectal sensory thresholds were greater in patients with abnormal BET. In the multivariate model comparing CC and PD-C (AUROC = 0.76), PD-C was associated with a lower anal squeeze increment (odds ratio [OR] for PD-C, 0.93 [95% CI, 0.91-0.95]), longer squeeze duration (OR, 1.05 [95% CI, 1.03-1.08]), lower rectal pressure increment (OR per 10 mm Hg, 0.72 [95% CI, 0.66-0.79]), and negative rectoanal gradient during evacuation (OR per 10 mm Hg, 1.16 [95% CI, 1.08-1.26]). CONCLUSIONS Compared with CC, PD-C was characterized by impaired squeeze pressure, longer squeeze duration, lower increase in rectal pressure, and a more negative rectoanal gradient during evacuation.
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Affiliation(s)
| | - Nicholas R Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Division of Movement Disorders, Mayo Clinic, Rochester, Minnesota, USA
| | - Zainali S Chunawala
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Brototo Deb
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Lembo A, Cash BD, Lu M, Terasawa E, Terreri B, Du S, Ayyagari R, Feuerstadt P, Moshiree B, Westermeyer B, Pi S, Boules M. Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States. Clin Transl Gastroenterol 2024; 15:e00687. [PMID: 38357940 PMCID: PMC11124638 DOI: 10.14309/ctg.0000000000000687] [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: 07/14/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This real-world US-based claims study compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC). METHODS This observational, retrospective cohort analysis used the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental Database (January 2015-June 2020). Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code during the baseline or study period were included. The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding) were examined. Constipation-related symptoms and complications were identified using ICD-10-CM , ICD-10 - Procedure Coding System , or Current Procedural Terminology codes. Data were stratified by age (overall, 18-64 years, and ≥65 years). RESULTS This study included 690 patients: The mean (SD) patient age was 48.0 (14.7) years, and 87.5% were women. The proportions of patients overall with constipation-related symptoms decreased 6 months after prucalopride initiation (abdominal pain [50.4% vs 33.3%, P < 0.001]; abdominal distension [gaseous] [23.9% vs 13.3%, P < 0.001]; and nausea [22.6% vs 17.7%, P < 0.01]; no improvements observed for incomplete defecation). Similarly, the proportions of patients overall with constipation-related complications decreased 6 months after prucalopride initiation (intestinal obstruction [4.9% vs 2.0%, P < 0.001]; hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]). DISCUSSION This study suggests that prucalopride may be associated with improved constipation-related symptoms and complications 6 months after treatment initiation.
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Affiliation(s)
- Anthony Lembo
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brooks D. Cash
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mei Lu
- Takeda Pharmaceuticals USA, Inc., Lexington, Massachusetts, USA
| | | | - Brian Terreri
- Takeda Pharmaceuticals USA, Inc., Lexington, Massachusetts, USA
| | - Shawn Du
- Analysis Group, Inc., New York, New York, USA
| | | | - Paul Feuerstadt
- PACT Gastroenterology Center, Hamden, Connecticut, USA
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Baharak Moshiree
- Atrium Health Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | | | - Selina Pi
- Analysis Group, Inc., New York, New York, USA
| | - Mena Boules
- Takeda Pharmaceuticals USA, Inc., Lexington, Massachusetts, USA
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18
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Triadafilopoulos G, Gardner JD. Relationship of Age and Gender to Motility Test Results and Symptoms in Patients with Chronic Constipation. Dig Dis Sci 2024; 69:1302-1317. [PMID: 38430328 DOI: 10.1007/s10620-024-08314-y] [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: 10/22/2023] [Accepted: 01/23/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND/AIMS Patients with chronic constipation (CC) exhibit symptoms and functional abnormalities upon testing, but their relationship to age and gender is unclear. We assessed age- and gender-related differences in symptoms, colon transit time, and anorectal motility, sensation, and expulsion. PATIENTS AND METHODS Retrospective, post hoc data analysis of patients with CC, who underwent Wireless Motility Capsule (WMC), High-Resolution Anorectal Manometry (HR-ARM), Balloon Expulsion Test (BET) and Rectal Sensory Testing (RST). Clinical assessment was made by questionnaires. Standard WMC criteria for colonic transit time (CTT) and the London classification was used for HR-ARM analyses, and regression plots between age, gender, CTT, HR-HRM, RST and BET were calculated. RESULTS We studied 75 women and 91 men. Abdominal pain, infrequent defecation, incomplete evacuation, defecatory straining, and multiple motility and anorectal function abnormalities were common. Abdominal pain was least frequently, and straining was most frequently associated with a motility abnormality. For each symptom, the highest prevalence was associated with failed BET. There was a significant increase in CTT with age only in men (p = 0.0006). In men, for each year of age there was a CTT increase of 1.02 h. The prevalence of abdominal pain and incomplete evacuation for females was significantly higher than that for males (both P < 0.05). The prevalence of low anal squeeze pressure for females was significantly higher than that for males, and the prevalence of poor rectal sensation for males was significantly higher than that for females (both P < 0.05). A significant decrease in basal anal and squeeze pressures with age occurred in women (p < 0.0001); an increase in age of one year was associated with a decrease in anal base pressure of 1.2 mmHg. Abnormal CTT and HR-ARM tests were associated with increased symptom frequency, but not severity. CONCLUSIONS There are significant age- and gender-related differences in symptoms, CTT, and HR-HRM parameters, rectal sensation, and expulsion, that may influence the multifaceted management of constipation.
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Affiliation(s)
- George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 420 Broadway Street, Pavilion D, 2nd Floor, Redwood City, CA, 94063, USA.
- Silicon Valley Neuro-Gastroenterology and Motility Center, 2490 Hospital Drive, Suite 211, Mountain View, CA, 94040, USA.
| | - Jerry D Gardner
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 420 Broadway Street, Pavilion D, 2nd Floor, Redwood City, CA, 94063, USA
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Lee A, Kim SY, Kang S, Kang SH, Kim DW, Choe JW, Hyun JJ, Jung SW, Jung YK, Koo JS, Yim HJ, Kim S. Effect of Probiotics in Stress-Associated Constipation Model in Zebrafish ( Danio rerio) Larvae. Int J Mol Sci 2024; 25:3669. [PMID: 38612481 PMCID: PMC11012156 DOI: 10.3390/ijms25073669] [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: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The pathophysiology of functional bowel disorders is complex, involving disruptions in gut motility, visceral hypersensitivity, gut-brain-microbiota interactions, and psychosocial factors. Light pollution, as an environmental stressor, has been associated with disruptions in circadian rhythms and the aggravation of stress-related conditions. In this study, we investigated the effects of environmental stress, particularly continuous light exposure, on intestinal motility and inflammation using zebrafish larvae as a model system. We also evaluated the efficacy of probiotics, specifically Bifidobacterium longum (B. longum), at alleviating stress-induced constipation. Our results showed that continuous light exposure in zebrafish larvae increased the cortisol levels and reduced the intestinal motility, establishing a stress-induced-constipation model. We observed increased inflammatory markers and decreased intestinal neural activity in response to stress. Furthermore, the expressions of aquaporins and vasoactive intestinal peptide, crucial for regulating water transport and intestinal motility, were altered in the light-induced constipation model. Administration of probiotics, specifically B. longum, ameliorated the stress-induced constipation by reducing the cortisol levels, modulating the intestinal inflammation, and restoring the intestinal motility and neural activity. These findings highlight the potential of probiotics to modulate the gut-brain axis and alleviate stress-induced constipation. Therefore, this study provides a valuable understanding of the complex interplay among environmental stressors, gut function, and potential therapeutic strategies.
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Affiliation(s)
- Ayoung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Seung Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
- Zebrafish Translational Medical Research Center, Korea University, Ansan 15355, Republic of Korea;
| | - Seyoung Kang
- Zebrafish Translational Medical Research Center, Korea University, Ansan 15355, Republic of Korea;
| | - Seong Hee Kang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Dong Woo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Jung Wan Choe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Jong Jin Hyun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Sung Woo Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Young Kul Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Ja Seol Koo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Hyung Joon Yim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Korea University, Ansan 15355, Republic of Korea; (A.L.); (S.Y.K.); (S.H.K.); (D.W.K.); (J.W.C.); (J.J.H.); (S.W.J.); (Y.K.J.); (J.S.K.); (H.J.Y.)
| | - Suhyun Kim
- Zebrafish Translational Medical Research Center, Korea University, Ansan 15355, Republic of Korea;
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 04763, Republic of Korea
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Song H, Guo R, Sun X, Kou Y, Ma X, Chen Y, Song L, Wu Y. Integrated metabolomics and transcriptomics revealed the anti-constipation mechanisms of xylooligosaccharides from corn cobs. Food Funct 2024; 15:894-905. [PMID: 38168976 DOI: 10.1039/d3fo04366e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Xylooligosaccharides (XOSs) have recently garnered interest for their potential as an anti-constipation agent. In this study, we investigated the effects of XOSs derived from corn cobs on constipation in mice through a comprehensive analysis of both the metabolome and transcriptome. Our multi-omics approach revealed that XOSs primarily modulated butanoate metabolism and steroid hormone biosynthesis pathways, as well as key signaling pathways such as PPAR and NF-kappa B. Notably, we observed a decrease in inflammatory biomarker expression and an elevation of butyric acid metabolite levels with XOSs treatment. A deeper analysis of gene expression and metabolite alterations highlighted significant changes in genes encoding critical enzymes and metabolites involved in these pathways. Overall, these findings underscore the considerable potential of XOSs derived from corn cobs as a dietary supplement for effectively alleviating constipation.
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Affiliation(s)
- Hong Song
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Rui Guo
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xianbao Sun
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yuxing Kou
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xuan Ma
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yinan Chen
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Lihua Song
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yan Wu
- Department of Food Science and Engineering, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China.
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Vlismas LJ, Wu W, Ho V. Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:108. [PMID: 38256369 PMCID: PMC10819559 DOI: 10.3390/medicina60010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Slow transit constipation (STC) has an estimated prevalence of 2-4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others.
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Affiliation(s)
- Luke J. Vlismas
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - William Wu
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Vincent Ho
- Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia; (W.W.); (V.H.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
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Staursky D, Shimoga D, Sharma A. Step on the accelerator: modern treatment of constipation. Curr Opin Gastroenterol 2024; 40:43-49. [PMID: 37678175 DOI: 10.1097/mog.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore effective management of constipation, examine challenges in making a positive diagnosis, and highlights the significance of a positive patient-provider relationship and emerging treatments. RECENT FINDINGS Less than one-fifth of patients feel satisfied with treatment of their constipation. Sixty percent of patients with functional dyspepsia and gastroparesis have severe to very severe constipation that correlates with their upper gastrointestinal symptom severity. Two gold kiwifruits are noninferior to 10 g of psyllium in the treatment of constipation. More than 40% of patients undergoing lumbar fusion continue to fill opioid prescriptions 90 days after surgery, contributing to 80 000 chronic opioid users annually. Most patients are using over-the-counter (OTC) treatments for constipation with greater than 60% dissatisfied. Pharmacologic management involves the use of GCC agonists and emerging drug classes such as bile acid transport inhibitors and sodium hydrogen exchanger isoform 3 (NHE3) inhibitors. Nonpharmacologic treatments, including neuromodulation and FDA-approved vibrating capsule, show promise in improving symptoms and quality of life. SUMMARY Constipation significantly impacts patients' quality of life and well being and the majority of patients are refractory to conservative measures and OTC treatments. Both pharmacologic and nonpharmacologic treatments hold promise for improving constipation and quality of life.
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Affiliation(s)
- Daniel Staursky
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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富田 寿, 谷藤 信, 福井 広, 三輪 洋, 新崎 信. [Fecal impaction is one of risk factors for severe hypermagnesemia in oral magnesium preparations: a review of the literature in Japan]. Nihon Ronen Igakkai Zasshi 2024; 61:103-113. [PMID: 38839306 DOI: 10.3143/geriatrics.61.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
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Liang J, Almario CV, Chey WD, Higgins CS, Spiegel BMR. Prevalence and Burden of Illness of Rome IV Chronic Idiopathic Constipation, Opioid-Induced Constipation, and Opioid-Exacerbated Constipation in the United States. Am J Gastroenterol 2023; 118:2033-2040. [PMID: 37335135 DOI: 10.14309/ajg.0000000000002376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) and opioid-induced constipation (OIC) are disorders that negatively affect quality of life. We sought to assess the prevalence, symptom severity, and medication use among people with Rome IV CIC, OIC, and opioid-exacerbated constipation (OEC) using a nationally representative data set with nearly 89,000 people in the United States. METHODS From May 3, 2020, to June 24, 2020, we recruited a representative sample of people in the United States ≥ 18 years to complete an online national health survey. The survey guided participants through the Rome IV CIC and OIC questionnaires, Patient-Reported Outcome Measurement Information System gastrointestinal scales (percentile 0-100; higher = more severe), and medication questions. Individuals with OEC were identified by asking those with OIC whether they experienced constipation before starting an opioid and whether their symptoms worsened afterward. RESULTS Among the 88,607 participants, 5,334 (6.0%) had Rome IV CIC, and 1,548 (1.7%) and 335 (0.4%) had Rome IV OIC and OEC, respectively. When compared with people with CIC (Patient-Reported Outcome Measurement Information System score, 53.9 ± 26.5; reference), those with OIC (62.7 ± 28.0; adjusted P < 0.001) and OEC (61.1 ± 25.8, adjusted P = 0.048) had more severe constipation symptoms. People with OIC (odds ratio 2.72, 95% confidence interval 2.04-3.62) and OEC (odds ratio 3.52, 95% confidence interval 2.22-5.59) were also more likely to be taking a prescription medication for their constipation vs those with CIC. DISCUSSION In this nationwide US survey, we found that Rome IV CIC is common (6.0%) while Rome IV OIC (1.7%) and OEC (0.4%) are less prevalent. Individuals with OIC and OEC have a higher burden of illness with respect to symptom severity and prescription constipation medication use.
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Affiliation(s)
- Jeff Liang
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
| | - Christopher V Almario
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
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Sun T, Wang K, Li L, Yan M, Zou L, Zhang M, Yang S, Wu J, Liu J. Efficacy and safety of acupuncture in post-stroke constipation: a systematic review and meta-analysis. Front Neurosci 2023; 17:1275452. [PMID: 37822350 PMCID: PMC10562632 DOI: 10.3389/fnins.2023.1275452] [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: 08/10/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
Background and objective Post-stroke constipation (PSC) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are needed. Acupuncture is a viable treatment option, but current evidence is insufficient to support its efficacy and safety. This study aims to evaluate the efficacy and safety of acupuncture in the treatment of PSC. Methods A systematic search of eight databases was conducted to identify PSC-related randomized clinical trials from the inception of each database through May 2023. Methodological quality assessment was conducted by RoB 2.0, meta-analysis was conducted by RevMan 5.3 and Stata 15.1, and evidence quality was evaluated by GRADE. Moreover, reporting quality of acupuncture interventions was assessed using the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Results Thirty RCTs involving 2,220 patients were identified. We found that acupuncture was superior to conventional treatment (CT) in improving total responder rate [risk ratio (RR): 1.16, 95% confidence interval (CI): 1.09 to 1.25, p < 0.0001], decreasing constipation symptom scores [standardized mean difference (SMD): -0.65, 95% CI: -0.83 to -0.46, p < 0.00001], increasing serum P substance (SP) levels (SMD: 1.92, 95% CI: 0.47 to 3.36, p = 0.009), reducing the time to first bowel movement (BM) (SMD: -1.19, 95% CI: -2.13 to -0.25, p = 0.01), and lowing serum vasoactive intestinal peptide (VIP) levels (SMD: -2.11, 95% CI: -3.83 to -0.38, p = 0.02). Furthermore, acupuncture plus CT was superior regarding total responder rate (RR: 1.26, 95% CI: 1.17 to 1.35, p < 0.00001), serum SP levels (SMD: 2.00, 95% CI: 1.65-2.35, p < 0.00001), time to first BM (SMD: -2.08, 95% CI: -2.44 to -1.71, p < 0.00001), and serum VIP levels (SMD: -1.71, 95% CI: -2.24 to -1.18, p < 0.00001). However, regarding Bristol Stool Scale (BSS) score, acupuncture plus CT was superior to CT (SMD: -2.48, 95% CI: -3.22 to -1.73, p < 0.00001), while there was no statistically significant difference between acupuncture and CT (SMD: 0.28, 95% CI: -0.02 to 0.58, p = 0.07). Acupuncture causes fewer AEs than CT (RR: 0.13, 95% CI: 0.06 to 0.26, p < 0.00001), though there was no statistically significant difference between acupuncture plus CT vs. CT (RR: 1.30, 95% CI: 0.60 to 2.84, p = 0.51). Conclusion Acupuncture may be an effective and safe therapy for PSC. However, given the inferior quality of clinical data, additional well-designed RCTs are required to confirm these findings.
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Affiliation(s)
- Tianye Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Kaiyue Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Lili Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Mingyuan Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Lin Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Mi Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Songyi Yang
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jinmin Liu
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Iancu MA, Profir M, Roşu OA, Ionescu RF, Cretoiu SM, Gaspar BS. Revisiting the Intestinal Microbiome and Its Role in Diarrhea and Constipation. Microorganisms 2023; 11:2177. [PMID: 37764021 PMCID: PMC10538221 DOI: 10.3390/microorganisms11092177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The gut microbiota represents a community of microorganisms (bacteria, fungi, archaea, viruses, and protozoa) that colonize the gut and are responsible for gut mucosal structural integrity and immune and metabolic homeostasis. The relationship between the gut microbiome and human health has been intensively researched in the past years. It is now widely recognized that gut microbial composition is highly responsible for the general health of the host. Among the diseases that have been linked to an altered gut microbial population are diarrheal illnesses and functional constipation. The capacity of probiotics to modulate the gut microbiome population, strengthen the intestinal barrier, and modulate the immune system together with their antioxidant properties have encouraged the research of probiotic therapy in many gastrointestinal afflictions. Dietary and lifestyle changes and the use of probiotics seem to play an important role in easing constipation and effectively alleviating diarrhea by suppressing the germs involved. This review aims to describe how probiotic bacteria and the use of specific strains could interfere and bring benefits as an associated treatment for diarrhea and constipation.
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Affiliation(s)
- Mihaela Adela Iancu
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Monica Profir
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania; (M.P.); (O.A.R.)
| | - Oana Alexandra Roşu
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania; (M.P.); (O.A.R.)
| | - Ruxandra Florentina Ionescu
- Department of Morphological Sciences, Cell and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Cardiology I, “Dr. Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
| | - Sanda Maria Cretoiu
- Department of Morphological Sciences, Cell and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Bogdan Severus Gaspar
- Surgery Clinic, Emergency Clinical Hospital, 014461 Bucharest, Romania;
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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