Prevalence and Risk Factors of Functional Constipation According to the Rome Criteria in China: A Systematic Review and Meta-Analysis

Association between tobacco smoke exposure and constipation among American adults: a National Health and Nutrition Examination Survey

Background

Studies have shown that there is a relationship between smoke exposure and constipation. However, there are limited data on the associations between constipation and smoking or serum cotinine levels, a metabolite of nicotine commonly used as a marker of tobacco exposure.

Methods

This study thoroughly examined the cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. We applied multivariate logistic regression models to assess the association between tobacco smoking status, serum cotinine levels, and constipation.

Results

In this cross-sectional study, 11,651 participants were included. The average age of the participants was 48.8 ± 17.9 years. After controlling for covariates, there was no significant relationship between serum cotinine levels, smoking status, and constipation risk. According to the categorical analysis, the incidence of constipation was 36% higher in participants with serum cotinine levels between 0.05 and 2.99 ng/mL (model 1: OR = 1.45 [1.13-1.85]; model 2: OR = 1.44 [1.12-1.83]; and model 3: OR = 1.36 [1.06-1.74]; p < 0.05) after adjusting for covariates by using the lowest levels of serum cotinine (<0.05 ng/mL) as a reference. In the non-smokers, serum cotinine levels were linearly and positively associated with the risk of constipation (p > 0.05), and the relationship between smoke exposure and constipation remained relatively stable in across all subgroups.

Conclusion

The study suggests that serum cotinine levels have a promoting effect on stool frequency-related constipation in non-smokers. Therefore, avoiding passive smoking as much as possible may reduce the effect of smoke exposure on constipation and serve as a preventive measure for treatment.

Electroacupuncture alleviates functional constipation by upregulating host-derived miR-205-5p to modulate gut microbiota and tryptophan metabolism

Electroacupuncture (EA) has shown promise as a treatment for Functional constipation (FC), with growing evidence suggesting it may enhance gut motility. MicroRNAs (miRNAs) serve as key regulatory molecules mediating host-microbiota interactions. However, the specific fecal miRNAs regulating microbiota composition and metabolism in EA-treated constipated mice, along with their key targets, remain unidentified. We examined fecal microbiome composition, metabolism, and colonic miRNA expression in loperamide-induced constipated mice and EA-treated mice to identify differentially expressed miRNAs and assess their relationships with microbial abundance, metabolism, and gut motility. An antibiotic cocktail and adeno-associated virus were employed to interfere with the gut microbiota and target miRNA in vivo, thereby validating the proposed mechanism. Our results indicate that miR-205-5p, significantly upregulated in fecal and colonic tissues of EA-treated constipated mice, promotes intestinal motility in a microbiome-dependent manner. Specifically, EA promoted the growth of Lactobacillus reuteri, enriched in the feces of constipation-recovered mice, through host-derived miR-205-5p regulation. Furthermore, Lactobacillus reuteri and its tryptophan metabolites (indole-3-acetamide, indole-3-acetic acid, and indole-3-carboxaldehyde) alleviated loperamide-induced constipation. These findings underscore the pivotal role of host-derived miR-205-5p in modulating microbial composition and tryptophan metabolites to enhance intestinal motility through EA.

Associations between constipation risk and lifestyle, medication use, and affective symptoms in patients with schizophrenia: a multicenter cross-sectional study

PURPOSE

To investigate the association between lifestyle and atypical antipsychotic drug use in patients with schizophrenia and the risk of constipation and to assess the impact of anxiety and depressive symptoms on constipation risk.

METHODS

Cross-sectional convenience sampling was employed, and 271 participants aged 20-65 were enrolled. Data were collected via a structured questionnaire comprising participants' demographic data, medication information, dietary behavior assessment, and the Baecke Physical Activity Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory. IBM SPSS 24.0 with multivariate logistic regression was used for data analysis. We performed a subgroup analysis of anticholinergic drugs via multivariate logistic regression.

RESULTS

In total, 180 participants had functional constipation; risk factors included female sex, anxiety symptoms, depressive symptoms, and quetiapine and aripiprazole use. Patients who drank more than 3,000 cc of water daily or used risperidone were less likely to have functional constipation. Depressive and anxiety symptoms were risk factors even after adjusting for sex, use of anticholinergics and laxatives, consuming two servings of fruit, consuming three servings of vegetables, consuming more than 3,000 cc of water daily, physical activity, medical comorbidity, chlorpromazine equivalent dose, and atypical antipsychotic use. Similar associations were found for two affective symptoms and functional constipation in the subgroup analysis of anticholinergic drugs.

CONCLUSION

The prevalence of functional constipation in patients with schizophrenia was 66.4%. The risk factors included female sex, anticholinergics, aripiprazole, quetiapine, and depressive and anxiety symptoms. Risperidone users and those who drank 3000 cc of water daily were less likely to have constipation.

The Effectiveness of Caffeine in Reducing Constipation in Adults: A Systematic Review

INTRODUCTION AND HYPOTHESIS

Constipation is defined as infrequent stools/difficultly passing stools, or the sensation of incomplete emptying. The prevalence of constipation is estimated at 14% worldwide. Caffeine is believed to increase gastric motility in the colon, causing a laxative effect. The results of the studies in the literature are conflicting. The aim of this review is to assess the effectiveness of caffeine in reducing constipation in adults.

METHODS

We searched the Cochrane Library, AMED, MEDLINE, EMBASE, Web of Science and CINAHL. Search terms included "constipation", "faecal impaction" and "caffeine" in different forms. The screening of the titles was carried out by two independent reviewers for trials that assessed the effect of caffeine on constipation. We assessed the quality of the studies included and the data collated. ROBINS-I and risk-of-bias tools were employed to assess for risk of bias in the studies included.

RESULTS

Eight studies were included in the final review. The studies assessed caffeine in the forms of coffee, tea, energy drinks, cocoa and kombucha with different doses. Three studies were at a low risk of bias, 3 were at a moderate risk of bias and the randomised controlled trial (RCT) had some concerns regarding blinding. Four studies concluded that caffeine may be effective in reducing constipation and 4 studies showed no improvement or an increase in constipation. Meta-analysis was not done as the studies were too dissimilar in interventions and outcome assessments.

CONCLUSION

The results of the studies are conflicting. Further rigorously designed and conducted RCTs need to be carried out to substantiate the effectiveness of caffeine on reducing constipation in adults.

Probiotics interventions modulating gut microbiota composition in individuals with intestinal constipation: Protocol of a systemic review and meta-analysis of randomized controlled trials

INTRODUCTION

Intestinal constipation is a substantive global health concern, significantly impairing patient quality of life. An emerging view is that the gut microbiota plays a critical role in intestinal function, and probiotics could offer therapeutic benefits. This study aims to consolidate evidence from randomized controlled trials (RCTs) that assess the effectiveness of probiotics in modulating microbiota and ameliorating symptoms of constipation.

METHODS

We will execute a systematic evidence search across Medline (via PubMed), Embase, Cochrane CENTRAL, Web of Science, Scopus, and CINAHL, employing explicit search terms and further reference exploration. Two independent reviewers will ensure study selection and data integrity while assessing methodological quality via the Cochrane Collaboration's Risk of Bias-2 tool. Our primary goal is to outline changes in microbiota composition, with secondary outcomes addressing symptom relief and stool characteristics. Meta-analyses will adopt a random-effects model to quantify the effects of interventions, supplemented by subgroup analyses and publication bias assessments to fortify the rigor of our findings.

DISCUSSION

This study endeavors to provide a rigorous, synthesized overview of the probiotics interventions evidence for modulating gut microbiota in individuals with intestinal constipation. The insights derived could inform clinical guidelines, nurture the creation of novel constipation management strategies, and direct future research in this field.

ETHICS AND DISSEMINATION

As this study aggregates and analyzes existing data without direct human subject involvement, no ethical approval is required. We will disseminate the study's findings through scientific forums and seek publication in well-regarded, peer-reviewed journals.

TRIAL REGISTRATION

OSF registration number: 10.17605/OSF.IO/MEAHT.

Daily sodium intake and constipation in US adult males: an uncommon negative association revealed by national health and nutrition examination survey data from the United States (2005-2010)

BACKGROUND

High sodium intake has been linked to various health outcomes; however, its association with constipation remains unclear, particularly in adult males. This population-based study aimed to investigate the association between daily sodium intake and constipation using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010.

METHODS

Using data from the NHANES database spanning from 2005 to 2010, a cross-sectional study including 7116 adult male participants from the United States was performed to assess the relationship between daily sodium intake and constipation. Multivariable logistic regression models were used, adjusting for various potential confounders, to evaluate this association. Restricted cubic spline (RCS) methods were applied to explore potential nonlinear trends in the association, and subgroup analyses were conducted through forest plots to examine interactions among different subgroups (P for interaction).

RESULTS

The study found that an increase in daily sodium intake was significantly associated with a reduced risk of constipation. Trend analysis indicated a statistically significant trend across all models, where increased daily sodium intake was associated with lower constipation risk, with (OR: 0.78, 95% CI: 0.71 ~ 0.85; P < 0.001) in Model 1; (OR: 0.79, 95% CI: 0.73 ~ 0.87; P < 0.001) in Model 2; and (OR: 0.82, 95% CI: 0.69 ~ 0.97; P = 0.023) in Model 3 (P for trend < 0.05 in all models). On the contrary, RCS analysis did not reveal a nonlinear association between daily sodium intake and constipation risk (P = 0.528). Subgroup analysis further supported a consistent negative association between daily sodium intake and constipation risk across different subgroups, with no significant interactions found (all P values > 0.05).

CONCLUSIONS

This study demonstrates a negative association between daily sodium intake and constipation risk among adult males, suggesting that sodium intake might influence intestinal function.

Efficacy of honey suppositories in treating paediatric functional constipation: A comparative study

AIM

This study sought to assess the clinical efficacy of honey suppositories in managing functional constipation in pre-school children, with a focus on those exhibiting Yin deficiency and intestinal dryness according to traditional Chinese medicine principles. The investigation aimed to determine whether honey suppositories could serve as a safer and more efficacious alternative to standard treatments.

METHODS

A randomised controlled trial was conducted involving pre-school children diagnosed with functional constipation. They were allocated to either a control group or a treatment group. While both groups received standard care, the treatment group also received honey suppositories. The efficacy of the treatment was evaluated based on the 'Guiding Principles for Clinical Research of New Chinese Medicines', and statistical analysis was performed using SPSS 25.0.

RESULTS

Following treatment, the treatment group demonstrated significantly lower constipation scoring system scores and higher bowel movement frequencies compared with the control group (P < 0.05). The clinical efficacy of the treatment group was notably superior, with a higher rate of complete recovery and effectiveness observed (P < 0.05). Additionally, no significant differences in baseline characteristics were found between the groups, confirming the comparability of the study cohorts.

CONCLUSIONS

Honey suppositories offer a promising therapeutic intervention for paediatric functional constipation, with significant clinical benefits over standard care.

Risk factors for constipation during pregnancy: a multicentre prospective cohort study

BACKGROUND

Constipation is frequently encountered in the population of pregnant women. Physical activity and nutritional factors are considered common causes of constipation; however, their impact on this population has not yet been evaluated precisely. This study aimed to assess the prevalence of constipation and its risk factors during pregnancy and postpartum.

METHODS

A prospective observational cohort study was conducted in 3 hospitals in Lithuania, including women with early viable pregnancies using questionnaires on demographic, obstetric, nutrition, behaviour, peri-anal disease, and birth data. All women with an early viable pregnancy (<12 weeks' gestation) aged 18 - 45 years who gave written informed consent were included. The Rome III criteria defined constipation. Independent risk factors were identified using multivariate analysis.

RESULTS

In all, 263 (55.9%) women developed constipation. Multivariate analysis identified haemorrhoidal disease during pregnancy (OR 8.25, 95% CI 4.41-15.4, p < 0.001), inadequate physical activity (OR 1.66, 95% CI 1.03-2.69, p=0.038), not participating in sports (OR 1.98, 95% CI 1.24-3.17, p=0.004), and monthly income 300-500 euros (OR 1.97, 95% CI 1.22-3.19, p=0.006) as significant predictors of constipation during pregnancy. Lower education was defined as a protective factor (retrospectively, secondary education by 2.2 times (OR 0.45, 95% CI 0.22-0.89, p=0.022) and unfinished secondary - by 1.84 times (OR 0.20, 95% CI 0.05-0.90, p=0.036) reduced the possibility of constipation development).

CONCLUSIONS

In conclusion, haemorrhoidal disease during pregnancy, low physical activity, and low monthly income are independent risk factors for constipation during pregnancy. Lower education significantly reduces the incidence of this condition.

Passive Smoking Is Associated with the Risk of Functional Bowel Disorders Among College Freshmen

Background: Functional bowel disorders (FBDs) have detrimental effects on young adults, but the risk factors were not fully explored. This study aimed to investigate the prevalence and potential risk factors of FBDs in college freshmen, including, in particular, the association between passive smoking and the risk and symptoms of FBDs. Methods: A cross-sectional study was conducted in September 2019 in freshmen of Huazhong University of Science and Technology with a random cluster sampling method. Validated questionnaires were voluntarily completed by participants. Rome IV criteria were applied for the diagnosis of FBDs. Univariate analysis and multivariate logistic regression analysis (Model 1: unadjusted; Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, intake frequency of coffee and juice, regular exercise, total sedentary time, sleep quality, interpersonal relationship, and SLSI scores) were performed to determine the potential risk factors of FBDs. Results: A total of 3074 participants were included in this study, among whom 236 college freshmen were diagnosed with FBDs. There was a positive relationship between passive smoking and the risk of FBDs (crude odds ratio [OR] = 2.084, 95% confidence interval [CI]: 1.480, 2.936, Model 1; adjusted OR = 1.825, 95%CI: 1.245, 2.675, Model 3). Moreover, the symptoms of hard stool, exertion, and sensation of obstruction in defecation were more frequent in passive smokers than non-passive smokers among FBD patients. Meanwhile, diarrhea was comparable between passive smokers and non-passive smokers among FBD patients. Conclusions: In the present study, around 7.68% of college freshmen were found to have FBDs. Passive smoking was positively associated with the risk of FBDs. Furthermore, passive smoking was significantly associated with constipation-related symptoms rather than diarrhea among FBD patients.

The Relationship Between Depressive Symptoms and Functional Gastrointestinal Disorders (FGIDs): The Chain Mediating Effect of Sleep Disorders and Somatic Symptom

Background: More than two-thirds of patients with functional gastrointestinal disorders (FGIDs) experience various degrees of mental health issues. Although studies indicate that FGIDs are related to depressive symptoms, sleep disorders, and somatic symptoms, the underlying mechanism between these variables remains unknown. Our objective was to establish a model that outlines the interactions between these psychological dimensions in FGIDs and, thus, provide valuable insights into how to enhance the well-being of affected individuals. Methods: This study used the convenient sampling method to enroll patients who visited the digestive internal medicine department. A total of 238 patients were investigated using the Rome IV criteria (irritable bowel syndrome used Rome Ⅲ criteria). A questionnaire including the Hospital Anxiety and Depressive Symptoms Scale, the Pittsburgh Sleep Quality Index, and the Patient Health Questionnaire-12 was used. The chain mediating roles of sleep disorders and somatic symptoms in the relationship between depressive symptoms and FGIDs were examined by the bootstrap method. Results: Correlation analysis revealed that depressive symptoms were positively related to sleep disorders, somatic symptoms, and FGIDs. Sleep disorders were positively related to somatic symptoms and FGIDs. Somatic symptoms were positively related to FGIDs. Chain mediating effect analysis showed that depressive symptoms can not only affect FGIDs but also through three indirect paths, as follows: the mediating role of sleep disorders and somatic symptoms, the chain mediating roles of sleep disorders and somatic symptoms, and the mediating effect size accounted for 7.2%, 7.7%, and 2.5% of the total effect, respectively. Conclusions: This study is conducive to understanding the internal mechanism underlying the relationship between depressive symptoms and FGIDs. It reminds us that when treating FGIDs patients, we should not only provide adequate psychological support to improve but also pay attention to improvements in their sleep quality and somatic symptoms.

Causal relationships between psychological disorders and functional gastrointestinal disorders: a bidirectional two-sample Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have shown bidirectional associations between psychological disorders (e.g. depression and anxiety) and functional gastrointestinal disorders. However, whether the relationships are causal is uncertain. Here, we used a bidirectional two-sample Mendelian randomization method to investigate the association between psychological disorders and functional gastrointestinal disorders (FGIDs).

METHODS

We obtained genome-wide association study summary statistics for two common psychological disorders: depression (170 756 cases) and anxiety (31 977 cases), as well as for three common FGIDs: functional dyspepsia with 6666 cases, constipation with 26 919 cases, and irritable bowel syndrome (IBS) with 7053 cases. These summary statistics were retrieved from several publicly available genome-wide association study databases. The inverse variance weighted method was used as the main Mendelian randomization method.

RESULTS

Inverse variance weighted Mendelian randomization analyses showed statistically significant associations between genetically predicted depression and risk of functional dyspepsia [odds ratio (OR): 1.40, 95% confidence interval (CI): 1.08-1.82], constipation (OR: 1.28, 95% CI: 1.13-1.44), and IBS (OR: 1.51, 95% CI: 1.37-1.67). Genetically predicted anxiety was associated with a higher risk of IBS (OR: 1.13, 95% CI: 1.10-1.17) instead of functional dyspepsia and constipation. In addition, genetically predicted IBS instead of functional dyspepsia and constipation was associated with a higher risk of depression (OR: 1.33, 95% CI: 1.12-1.57) and anxiety (OR: 2.05, 95% CI: 1.05-4.03).

CONCLUSION

Depression is a causal risk factor for three common FGIDs. A bidirectional causal relationship between IBS and anxiety or depression was also identified.

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project

INTRODUCTION

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments.

OBJECTIVES

This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting.

METHODS

This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project.

RESULTS

Compliance for Criterion 1 (patient education) increased from 0% to 60% ( p  < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% ( p  < 0.001).

CONCLUSIONS

The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A284.

Investigation of functional constipation in elderly inpatients and analysis of its influencing factors: A cross-sectional study

To investigate the prevalence of functional constipation (FC) in elderly hospitalized patients and analyze the influencing factors. This was a cross-sectional study in which 506 patients hospitalized in general surgery from February to June 2020 were selected. Information on patients' age, gender, ethnicity, body mass index, intake of vegetables, fruits, meat, and spicy foods, sleep, smoking, alcohol consumption, time of defecation, and mode of defecation was collected through questionnaires, and the factors affecting functional constipation were analyzed using binary logistic regression models; among 506 patients, 254 had FC, with a prevalence of 50.19%. Among the clinical symptoms of FC, the most common ones were straining to defecate (83.85%) and lumpy or hard stools (81.80%). Univariate analysis revealed statistically significant differences in family history of constipation (P = .033), sedentary (P = .004), self-care ability (P = .001), body mass index (P = .013), defecation time (P < .0001), spicy food intake in dietary preference (P = .001), age (P = .004), and education level (P = .016), and binary logistic regression analysis showed that defecation time and spicy food consumption were independent influencing factors of FC. For hospitalized elderly people, regular morning defecation and not eating spicy foods can more helpful to slow the occurrence of functional constipation.

Abnormalities of white matter network properties in middle-aged and elderly patients with functional constipation

Purpose

To explore white matter network topological properties changes in middle-aged and elderly patients with functional constipation (Functional Constipation, FC) by diffusion tensor imaging (DTI), and to evaluate the correlation between the abnormal changes and clinical data.

Methods

29 FC patients and 31 age- and sex-matched healthy controls (HC) were recruited. Magnetic resonance imaging and clinical data were collected. The white matter network changes in FC patients were analyzed using deterministic fiber tracking methods, graph theory algorithms, and partial correlation analysis with clinical data.

Results

The nodal clustering coefficient and nodal local efficiency of FC patients in the right orbital inferior frontal gyrus, right medial superior frontal gyrus, right rectus muscle, right hippocampus, left paracentral lobule and left temporal pole, and the nodal clustering coefficient in right orbital superior frontal gyrus, left cuneus lobe and right superior occipital gyrus, the nodal local efficiency in the right medial and paracingulate gyrus, right precuneus and right dorsolateral superior frontal gyrus of FC patients are lower than that of HC. The nodal local efficiency and clustering coefficient of FC patients in left hippocampus, left amygdala, right parietal inferior limbic angular gyrus and right angular gyrus, the nodal local efficiency in the right fusiform gyrus, left supplementary motor cortex and the nodal efficiency in the left lateral temporal gyrus and right orbital middle frontal gyrus (ORBmid.R) of FC patients are higher than that of HC. The nodal efficiency of ORBmid.R in FC was positively correlated with the Patient Assessment of Constipation quality of life questionnaire (PAC-QoL).

Conclusion

Middle-aged and elderly FC patients have differences in the nodal level properties in the limbic system, supplementary motor cortex, and default mode network brain regions, and the nodal efficiency of ORBmid.R was positively correlated with the PAC-QoL score, revealing that FC may be related to the abnormal processing of visceral sensorimotor in ORBmid.R and providing potential imaging diagnostic markers and therapeutic targets for middle-aged and elderly FC patients.

Effect of a probiotic formula on gastrointestinal health, immune responses and metabolic health in adults with functional constipation or functional diarrhea

Objective

Our aim was to determine the efficacy of four-week probiotic supplementation on gastrointestinal health. The secondary objectives were to assess probiotic effects on immune reaction, as well as weight control and metabolic health.

Methods

We conducted two randomized sub-trials, respectively, among subjects who were diagnosed with functional constipation (FC) or functional diarrhea (FDr) according to the Rome IV criteria. In each sub-trial, 70 eligible Chinese adults were randomized to receive a multi-strain probiotic combination or a placebo. Gastrointestinal symptoms, defecation habits, stool characteristics, blood and fecal biochemistry markers, anthropometrics measures, stress-associated responses, and intestinal flora changes were assessed at baseline and after probiotics intervention.

Results

Four weeks of probiotic supplementation reduced overall gastrointestinal symptoms scores in FC participants (p < 0.0001). Their mean weekly stool frequency increased from 3.3 times to 6.2 times; immune response and inflammation markers improved with increases in serum IgA, IFN-γ and fecal sIgA, and decrease in hsCRP; most components of lipid profile were significantly ameliorated, with increases in HDL-C and reductions in TC and TG; body weight, body mass index and basal metabolic rate decreased following probiotics consumption. For FDr participants, probiotics consumption markedly reduced overall gastrointestinal symptom scores (p < 0.0001); decreased stool frequency by 3 times per week; increased IgA, IFN-γ, sIgA concentrations, while lowered hsCRP and IL-4 levels. Both FC and FDr participants had improvement in the scores of defecation habits, anxiety or depression, and perceived stress. Probiotics supplementation promoted the production of all three major short-chain fatty acids. No changes were observed in LDL-C, IgG, IgM, IL-8, IL-10 and motilin.

Conclusion

Supplementation with the probiotic formula over a four-week period could help relieving gastrointestinal symptoms, improving satisfaction with defecation habits, emotional state and immune response, and ameliorating dysbacteriosis in participants with FC or FDr. It also had beneficial effects on lipid metabolism and weight control for FC participants.

Arctiin alleviates functional constipation by enhancing intestinal motility in mice

Functional constipation (FC), a common symptom that is primarily associated with intestinal motility dysfunction, is a common problem worldwide. Arctiin (Arc) is a lignan glycoside isolated from the Chinese herbal medicine Arctium lappa L., which is a health food in China. The present study aimed to evaluate the laxative effects of Arc against FC in mice. A model of FC induced by loperamide (5 mg/kg) was established in male Institute of Cancer Research (ICR) mice. Arc was administered at a dose of 100 mg/kg as a protective agent. The faecal status, intestinal motility and histological analyses were evaluated. Furthermore, the levels of gastrointestinal motility-associated neurotransmitters, such as motilin (MTL), nitric oxide (NO), and brain-derived neurotrophic factor (BDNF) and the protective effect of Arc on interstitial cells of Cajal (ICC) were assessed. Arc treatment reversed the loperamide-induced reduction in faecal number and water content and the intestinal transit ratio in ICR mice. Histological analysis confirmed that Arc administration mitigated colonic injury. Moreover, Arc treatment increased levels of motilin and brain-derived neurotrophic factor while decreasing nitric oxide levels and ICC injury in the colon of FC mice. Arc decreased inflammation induction and aquaporin expression levels. Owing to its pro-intestinal motility property, Arc was shown to have a protective effect against FC and may thus serve as a promising therapeutic strategy for the management of FC.

An empowerment-based, healthy dietary behavioral intervention to ameliorate functional constipation

Objective

To explore the boost effect on ameliorating functional constipation in elderly patients through empowerment-based, healthy dietary behavioral intervention.

Design

In this randomized parallel group study, elderly patients with functional constipation were recruited and assigned to the experimental and control groups at a ratio of 1:1. The control group received routine intervention. The experimental group received 3-month empowerment-based intervention. The results were evaluated based on the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) and Cleveland Clinic Constipation Score (CCS). GraphPad Prism (Version 9) software was used for the statistical analysis.

Setting

As the world's population ages, functional constipation in the elderly has attracted widespread attention. The practical behavioral intervention to ameliorate constipation are worth exploring.

Participants

Sixty elderly patients with functional constipation.

Results

The study results showed no significant difference in the baseline data between the two groups (P &gt; 0.05). After the intervention, the scores of HLPCQ (77.90 ± 14.57 vs. 61.11 ± 13.64) and CCS (7.48 ± 3.73 vs. 9.70 ± 3.07) in the experimental group were significantly higher than those in the control group (P &lt; 0.05).

Conclusion

The results showed that empowerment-based intervention can effectively strengthen the healthy dietary behavior of elderly patients. Through patient empowerment, the subjective initiative and willingness to communicate were boosted in the experimental group. Their symptoms of functional constipation improved considerably better than in the control group.

Luteolin ameliorates loperamide-induced functional constipation in mice

Functional constipation (FC) is one of the most common gastrointestinal disorders characterized by hard stools and infrequent bowel movements, which is associated with dysfunction of the enteric nervous system and intestinal motility. Luteolin, a naturally occurring flavone, was reported to possess potential pharmacological activities on intestinal inflammation and nerve injury. This study aimed to explore the role of luteolin and its functional mechanism in loperamide-induced FC mice. Our results showed that luteolin treatment reversed the reduction in defecation frequency, fecal water content, and intestinal transit ratio, and the elevation in transit time of FC models. Consistently, luteolin increased the thickness of the muscular layer and lessened colonic histopathological injury induced by loperamide. Furthermore, we revealed that luteolin treatment increased the expression of neuronal protein HuC/D and the levels of intestinal motility-related biomarkers, including substance P (SP), vasoactive intestinal polypeptide (VIP), and acetylcholine (ACh), as well as interstitial cells of Cajal (ICC) biomarker KIT proto-oncogene, receptor tyrosine kinase (C-Kit), and anoctamin-1 (ANO1), implying that luteolin mediated enhancement of colonic function and contributed to the anti-intestinal dysmotility against loperamide-induced FC. Additionally, luteolin decreased the upregulation of aquaporin (AQP)-3, AQP-4, and AQP-8 in the colon of FC mice. In summary, our data showed that luteolin might be an attractive option for developing FC-relieving medications.

Factors associated with non-response to naldemedine for opioid-induced constipation in cancer patients: A subgroup analysis

BACKGROUND

Opioid-induced constipation (OIC) is one of the most common adverse events of opioid therapy and can severely reduce quality of life (QOL). Naldemedine is the orally available peripheral-acting μ-opioid receptor antagonist approved for OIC treatment. However in daily clinical practice, some cancer patients show insufficient control of OIC even while receiving naldemedine.

OBJECTIVE

To identify factors associated with non-response to naldemedine in cancer patients.

METHODS

This study retrospectively analyzed 127 cancer patients prescribed naldemedine at Seirei Hamamatsu General Hospital in Japan between November 2016 and June 2021. For the regression analysis of factors associated with OIC, variables were extracted manually from electronic medical records. Naldemedine had been prescribed by the attending physician after the presence of OIC had been defined with reference to Rome IV diagnostic criteria. Naldemedine was evaluated as "effective" in cases where the number of defecations increased at least once in the first 3 days after starting naldemedine. Multivariate logistic regression analysis was performed to identify factors associated with non-response to naldemedine. The data used were from the group of patients who received naldemedine in our previous study.

RESULTS

Factors significantly associated with non-response to naldemedine included chemotherapy with taxanes within 1 month of evaluation of naldemedine effect (odds ratio [OR] = 0.063; 95% confidence interval [CI] = 0.007-0.568), and addition of or switching to naldemedine due to insufficient efficacy of prior laxatives (OR = 0.352, 95% CI = 0.129-0.966).

CONCLUSION

The identification of factors associated with non-response to naldemedine prescribed for OIC may help improve QOL among cancer patients.

Probiotics, prebiotics, and synbiotics in chronic constipation: Outstanding aspects to be considered for the current evidence

This integrative aimed to evaluate the effects and the potential mechanism of action of prebiotics, probiotics, and synbiotics on constipation-associated gastrointestinal symptoms and to identify issues that still need to be answered. A literature search was performed in the PubMed database. Animal models (n = 23) and clinical trials (n = 39) were included. In animal studies, prebiotic, probiotic, and synbiotic supplementation showed a decreased colonic transit time (CTT) and an increase in the number and water content of feces. In humans, inulin is shown to be the most promising prebiotic, while B. lactis and L. casei Shirota probiotics were shown to increase defecation frequency, the latter strain being more effective in improving stool consistency and constipation symptoms. Overall, synbiotics seem to reduce CTT, increase defecation frequency, and improve stool consistency with a controversial effect on the improvement of constipation symptoms. Moreover, some aspects of probiotic use in constipation-related outcomes remain unanswered, such as the best dose, duration, time of consumption (before, during, or after meals), and matrices, as well as their effect and mechanisms on the regulation of inflammation in patients with constipation, on polymorphisms associated with constipation, and on the management of constipation via 5-HT. Thus, more high-quality randomized control trials (RCTs) evaluating these lacking aspects are necessary to provide safe conclusions about their effectiveness in managing intestinal constipation.

The effect of multistrain probiotics on functional constipation in the elderly: a randomized controlled trial

BACKGROUND AND OBJECTIVES

Constipation is one of the most common gastrointestinal conditions, particularly among older individuals. This study aimed to evaluate the efficacy and safety of selected multistrain probiotics on functional constipation and laboratory blood parameters in the elderly living in a nursing home.

SUBJECTS AND METHODS

Sixty participants (42 females and 18 males) aged 77.9 ± 8.84 years with functional constipation, who met the eligibility criteria, completed the study. In a double-blind, placebo-controlled, parallel design, each participant was randomized to receive either the selected probiotic mixture (N = 28) or placebo (N = 32) for 12 weeks as an adjunct to their usual diet and medications. The liquid probiotic formulation containing Bifidobacterium animalis subsp. lactis BLC1, Lactobacillus acidophilus LA3 and Lactobacillus casei BGP93 was tested for the first time.

RESULTS

Supplementation of selected probiotics resulted in a slight but nonsignificant increase in cumulative stool frequency compared with placebo. However, after the 71st day of the treatment, the cumulative number of stools was significantly higher in the probiotic group (P < 0.05) when the influence of laxative was excluded. The trend towards an increase in the difference between the two groups, which began 1 week after the probiotic intervention, pointed out to their prolonged effect. There were no significant dependent or independent effects of treatment and time on most of the 27 laboratory blood parameters tested.

CONCLUSIONS

Multistrain probiotic supplementation was found to be efficacious, safe and well tolerated in the elderly with functional constipation.