El consumo de dos kiwis diarios podría mejorar el hábito intestinal en personas con estreñimiento crónico / Daily consumption of two kiwifruits could improve bowel habits in people with chronic constipation

A partir del caso de una paciente con síndrome de intestino irritable a predominio de estreñimiento cuyos síntomas mejoraron con el consumo regular de kiwi, el médico de familia se planteó la pregunta de si el kiwi podría mejorar los síntomas asociados a constipación crónica en comparación con el tratamiento habitual. Tras realizar una búsqueda de estudios que analizaran los efectos del consumo de kiwi sobre el hábito intestinal, fueron seleccionados tres artículos que permiten concluir que el consumo de esta fruta tiene una eficacia superior al placebo y comparable al psyllium y las pasas de ciruela para mejorar los síntomas de personas con estreñimiento crónico. (AU)

Based on the case of a patient with constipation-predominant irritable bowel syndrome whose symptoms improved with regular consumption of kiwi, the family doctor wondered if kiwi could improve symptoms associated with chronic constipation compared to usual treatment. After conducting a search for studies that analyzed the effects of kiwi consumption on intestinal habit, three articles were selected that allow us to conclude that the consumption of this fruit has an efficacy superior to placebo and comparable to psyllium and plum raisins to improve the symptoms of people with chronic constipation. (AU)

Laparoscopic Roux-en-Y gastric bypass on bowel habits in patients with type 2 diabetes mellitus / 中华内分泌外科杂志

Objective To observe the impact of laparoscopic Roux-en-Y gastric bypass on bowel habits in patients with type 2 diabetes mellitus(T2DM).Methods 70 cases of T2DM undergoing laparoscopic Roux-en-Y gastric bypass were studied.Changes in bowel habits, frequency and odor of flatulence, and social life were estimated at least 6 months after surgery using a self-administered questionnaire.Results 67.1%of the patients had normal bowel habit, 68.6%of patients maintained normal flatus before undergoing surgery, and visual ana-logue scale reveals bowel and flatus habit would cause little trouble on daily life.47.1% of patients maintained their normal bowel habit, and 45.7%of patients had loose stools and diarrhea after surgery.The number of pa-tients with loose stools significantly increased(28/70, 40% after surgery vs 5/70, 7.1% before surgery), with statistical difference( P<0.001) .42.9%patients believed that eating high-fat diet was related with loose stools (P<0.001).Patients with constipation decreased significantly after surgery(5/70, 7.1% vs the preoperative 16/70, 22.9%), with statistical difference(P=0.016).Visual analogue scale showed that 57.1% of patients thought their daily life and social activities were not affected(P=0.05).50%of patients considered an increase flatus, and 55.7%had malodorous flatus, which had statistical significance compared with those before surgery ( P<0.001) .A visual analogue scale showed that 60%of patients thought that this change would not affect their daily life and social activities( P=0.212) .Conclusions After laparoscopic Roux-en-Y gastric bypass surgery, some patients had loose stod, diarrhea, increased flatus and and offensive odor, but after proper treatment these changes do not affect their daily life and social activities.

Evaluación del hábito intestinal en una población de personal hospitalario / Evaluation of bowel habits in a population of hospital staff

Introducción: La función evacuatoria y sus alteraciones constituyen un motivo de consulta muy frecuente. En Venezuela no disponemos de información para definir cuál es el patrón intestinal normal de nuestra población, ni de la frecuencia con que se presentan dichas alteraciones.Objetivo: Evaluar el hábito intestinal en una población de personal hospitalario, entre 18 a 70 años, del Hospital “Dr. Domingo Luciani” entre abril - septiembre del 2008.Método: Es un estudio descriptivo y transversal en el que participaron 507 trabajadores del hospital, a los cuales se les practicó una encuesta personalizada.Resultados: Participaron 380 (75 %) mujeres y 127 (25 %) hombres con una edad 39,2 ±10 años. El 51,1% son universitarios. Menos de la mitad consumen medicamentos o sufren de enfermedades. La mayoría no fuma e ingiere menos de 2 litros de agua/día. El 73,4 % evacúa diariamente, una vez/día y en la mañana, con heces tipo 3. 12 (2,36 %) presentan constipación según ROMA III, edad 39 años, femenino, la mayoría son TSU y enfermeras (p=0,03) e ingieren menos de 2 litros de agua/día, consumen algunas veces frutas y cereales y muy poco realizan ejercicios. Los síntomas predominantes fueron: dispepsia, dolor y distensión abdominal, dolor al evacuar y sensación de evacuación incompleta. Todos evacuan heces tipo 1 y el 41,66 % empleo laxantes. El 50 % manifestó algún grado de alteración de su calidad de vida.Conclusiones: El hábito intestinal de nuestra población se caracterizó por frecuencia evacuatoria diaria, una vez/día; heces tipo 3 y 4, sin sensación de evacuación incompleta, dolor o esfuerzo al evacuar.

Introduction: Bowel function and related disorders are common consulting problems. Because in Venezuela we lack of adequate information to define both bowel normal habit and the frequency of its alterations in our population we decided to perform this study. Objective: To assess bowel function of the “Dr. Domingo Luciani” hospital staff between April and September of 2008.Method: In a descriptive and transversal study, we apply a personalized survey to all the hospital staff who participated.Results: 507 hospital staff members were studied. 380 females (75 %) /127 males (25 %). The average age was 39,2 ±10 years. The 51,1% have an universitary degree, and less than half used medications or suffer diseases. Most of them were no smokers and drink less than 2 liters of water per day. The 73,4 % of the subjects passed a stool on a daily basis, in the morning with feces type 3. 12 patients (2,36 %) had constipation according to Roma III criteria. In those subjects predominant symptoms were: dyspepsia, abdominal pain and bloating, pain during evacuation and incomplete evacuation sensation. All had a type I stool pattern and the 41,66 % used laxatives regularly. The 50 % exhibit some degree of quality of life impairment. Average age in this group was 39 years, female sex, nurses and Higher University Technicians (p=0, 03). They drink less than 2 liters of water/day, sometimes consume fruits and cereals and do very little exercise

Avaliação da potencialidade da farinha de banana verde como ingrediente funcional: estudo in vivo e in vitro / Evaluation of the unripe banana flour potential as a functional ingredient: In vivo and in vitro studies

A cada dia cresce o interesse por alimentos ricos em carboidratos não disponíveis em virtude da relação inversa entre seu consumo e o risco de doenças crônicas não transmissíveis (DCNT). No presente trabalho, foi avaliado o potencial fisiológico da farinha de banana verde (FBV) como ingrediente funcional. Em ratos adultos, foi realizado ensaio de média duração (28 dias) para avaliação do efeito trófico da FBV sobre o intestino grosso e de parâmetros relacionados à tolerância à glicose. Em humanos, foram realizados ensaios clínicos de curta e média duração para avaliação dos efeitos sobre resposta glicêmica; liberação de hormônios gastrintestinais relacionados à saciedade; status antioxidante; fome e saciedade; e funcionamento intestinal. A FBV foi produzida com banana verde, Musa acuminata, de acordo com patente depositada pelo grupo (Patente (RPI - 1941), 2008). A FBV é uma fonte concentrada de carboidratos não disponíveis, com 56% de AR e 8% de FAT na base integral. A adição de FBV nas rações provocou efeito trófico no ceco dos animais, evidenciado por aumento no índice metafásico, número de células da cripta e profundidade das criptas. Além disso, a ração com FBV proporcionou melhora nos parâmetros relacionados à tolerância à glicose. Em voluntários saudáveis, a ingestão de uma única refeição adicionada de 8 g de FBV proporcionou aumento na saciedade e boa correlação entre os parâmetros fome/saciedade e níveis plasmáticos de grelina e insulina, melhorou o funcionamento intestinal, além de resultar em alta fermentabilidade in vitro em relação à lactulose. Após ingestão diária da FBV por 14 dias, os resultados da ingestão de RC0 (refeição controle antes do tratamento) e de RC14 (RC0 após 14 dias de tratamento) mostraram que ocorre melhora na tolerância à glicose, evidenciada pela menor liberação de insulina durante o GTT. O efeito positivo sobre funcionamento intestinal, sobre saciedade e sobre liberação de hormônios gastrintestinais no plasma permaneceu...

The study of unavailable carbohydrates has been of great concern due to their inverse relation with the risk for non-transmissible chronic diseases (NTCD). In the present study, the functional potential of unripe banana flour (UBF) was evaluated. In rats, a medium-term assay was carried in order to evaluate parameters related to glucose tolerance and the trophic effect of UBF on the large bowel. In healthy volunteers, short and medium-term clinical assays were carried to evaluate the effects of UBF on glycemic response; release of gastrointestinal hormones related to satiety (ghrelin, leptin and insulin); antioxidant status; hunger and satiety; and intestinal health. UBF was produced with unripe banana, Musa acuminata, subgroup Cavendish, maturation stage I, in industrial scale and according to a patent deposited by the group (Patent (RPI - 1941), 2008). UBF is a concentrated source of unavailable carbohydrates, with 56% RS and 8% DF (wet weight). Adding UBF in rat rations resulted in a trophic effect in the animals' cecum, which was evidenced by increase in the metaphasic index, number of crypt cells and crypt depth. Moreover, the ration with UBF resulted in better glucose tolerance parameters. In healthy volunteers, adding UBF (8 g) to an only meal provided significant satiety and good correlation between the parameters hunger/ satiety and plasmatic levels of ghrelin and insulin, improved bowel habit, as well as resulted in high in vitro fermentability in relation to lactulose. After daily intake of UBF for 14 days, the results of the intake of RC0 (control meal before treatment) and RC14 (RC0 after 14 days treatment) showed that there is a positive post-prandial variation in the plasmatic concentrations of gastrointestinal hormones, as well as improvement in glucose tolerance, evidenced by lower insulin release during GTT. The positive effect on bowel habit, satiety and release of gastrointestinal hormones in plasma was kept after prolonged intake of UBF...

A Study on the Defecation Pattern and Lifestyle Factors of Female High School and College Students in Gyeonggi Province / 대한지역사회영양학회지

The aim of this study was to investigate the dietary and lifestyle factors related to bowel pattern of female high school and college students in Gyeonggi Province. The total of 202 self-administered questionnaires (high school students 77;college students 125) were analyzed. All respondents were devided into four groups based on their self-reported pattern of defecation:18 subjects (9.0%) comprised the normal group, 73 (36.1%) the constipation group, 73 (36.1%) the constipation/diarrhea group, and 38 (18.8%) the diarrhea group. Regularity of exercise was significantly higher in the college students than high school students, and times spending on a chair were longer in the high school students than college students. Most students (72.7%) reported that they had stress. Fourty point six percent of the subjects reported that they had 3 meals per day, which tended to be higher in the normal and diarrhea group than constipation and constipation/diarrhea group. Most students (69.7) skipped breakfast which was lower in the normal group than the other groups. The most preferred dietary fiber food was korean cabbage kimchi. Fifty-eight point four percent of the subjects reported that they had irregular bowel movement. Bowel movement was more irregular in the high school students than college students, and in the constipation group than the other groups. Of the subjects, 77.7% had defecation frequency between three per week and three per day. Those who spent within 10 minutes for defecation were 79.6%, and those had difficulty in evacuating were 76.0%. High school students and those with constipation and constipation/diarrhea had a significantly lower defecation frequency, longer time spent at the toilet, and greater difficulty in evacuating than college students and normal and diarrhea group. The percentage of those who had feelings of residue in the intestine after defecation was 92.5%, and it was greater in the constipation or diarrhea group than in the normal group. Most students (93.5%) reported that they had abdominal pain or discomfort. These results suggest that decreasing times spending on a chair, decreasing stress, keeping 3 meal per day at regular hours, and increasing dietary fiber intake are associated with desirable bowel pattern.

Outcome and Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Non- relaxing Puborectalis Syndrome

PURPOSE: Biofeedback is a major treatment method for constipated patients with non-relaxing puborectalis syndrome. However a significant percent of patients still showed poor outcome, and little has been known about the predictors associated with outcome of biofeedback. The aim of this study was to determine the outcome and identify predictors associated with poor outcome of biofeedback therapy for constipated patients with non- relaxing puborectalis syndrome. METHODS: Fifty-two constipated patients with non-relaxing puborectalis syndrome (median age, 47 years) who had more than one biofeedback session after defecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were analyzed. Any differences in demographics, clinical symptoms, and parameters of anorectal physiological study were evaluated between success group (patients felt improvement in symptoms at follow-up) and failure group (patients felt no improvement). RESULTS: Follow up (mean follow-up; 17 months) results were evaluated by an independent observer in 45 patients. At post-biofeedback, 42 (81 percents) patients felt improvement in symptoms, including 7 (13 percents) with complete symptom relief. At follow-up, 25 (56 percents) patients felt improvement in symptoms, including 1 (2 percents) with complete symptom relief. There was a significant reduction in difficult defecation (from 81 to 44, 53 percent, from pre-biofeedback to post-biofeedback, and at follow up respectively; P<0.005, P<0.01), sensation of incomplete defecation (from 90 to 50, 40 percent; P< 0.00001, P<0.000005), laxative use (from 25 to 10, 11 percent; P<0.05), and enema use (from 13 to 0, 2 percent; P<0.01, P<0.05). Normal spontaneous bowel movement was increased from 42 percent pre-biofeedback to 81 percent post-biofeedback (P<0.0001), 80 percent at follow up (P<0.0005). Pre-biofeedback presence of symptoms of bowel habit change predict poor outcome (15 vs. 0 percent; failure vs. success, P<0.05). High pressure zone in prebiofeedback manometry was longer in failure group than in success group (2.80 vs 2.01 cm, P<0.05). In the success group, 11 (44 percent) had a rectocele, 1 (4 percent) had a rectal intussussception, 18 (72 percent) had a descending perineal syndrome, and 3 (12 percent) had a sigmoidocele. In the failure group, 4 (20 percent) had a rectocele, and 1 (5 percent) had a rectal intussusception, 14 (70 percent) had a descending perineal syndrome, and a sigmoidocele was not accompanied (P<0.05). Accompanied rectocele, rectal intussusception, descending perineal syndrome, and sigmoidocele did not influence outcome. CONCLUSIONS: Biofeedback is an effective option and should be considered as the first line therapy. Bowel habit change and long high pressure zone in pre-biofeedback manometry were predictors associated with poor outcome of biofeedback therapy for constipated patients with non-relaxing puborectalis syndrome.

The Prevalence of Defecation Difficulty and Bowel Habits in University Students / 간호학회지

To determine bowel patterns and the prevalence of defecation difficulty in young university students, we administered a self-reported questionnaire to 1,617 college students about their bowel habits and eating patterns and obtained the following: 83.7% showed defecation frequency between 2 times per day and 3 times per week, and 33.4% reported difficulty in defecation. Among the subjects with defecation difficulty, 69% complained of constipation and 31% of diarrhea. It was also shown that the prevalence of self-reported defecation difficulty varied by sex. Women were more likely to have defecation difficulty than men (OR=2.5; 95% CI: 2.005-3.149). There were also differences between men and women in respect to the bowel habits (frequency, regularity, thickness, volume, form and time required) and food preferences. Men reported a higher frequency of defecation than women (p<.001). The dietary fiber intake volume of the subjects with defecation difficulty was smaller than subjects without the problem (OR=0.83, CI; 0.706-0.978). Moreover, those whose favorite food was meat were more likely to have defecation difficulty than those preferred vegetables (OR=1.39; 95% CI: 1.058-1.820). Irregular defecation was reported in 44.5% of the students, especially non-residents of Cheolla province (OR=1.2; 95% CI: 1.007-1.480). Non-residents ate dietary fiber significantly less than residents and there were some differences in diet habits and also in bowel habits.

Association between Poor Bowel Habit and Non-Relaxing Puborectalis Syndrome

PURPOSE: Constipation in children usually is due to poor bowel habit. Ignoring the urge to have a bowel movements initiates a viscious cycle of constipation. After a period of time children may stop feeling the urge, leading to fecal impaction. This leads to loss of anorectal reflex. What is the outcome of the children with long-standing poor bowel habit? METHODS: Forty-two patients with obstructed defecation (non-relaxing puborectalis syndrome) diagnosed by defecogram and anorectal manometry were investigated with rectal sensation and elasticity studies (threshold of sense: TS, defecation sensation volume: DS, maximal tolerable volume: MTV, rectal compliance: RC), and colon transit time (CTT). All detailed questionnaires on the subject were completed. Eighteen patients (11F: 7M, mean age 39 years, range 16~75) with history of poor bowel habits since childhood were compared with 24 (16F: 8M, mean age 40 years, range 16~31) with no history of poor bowel habit. RESULTS: Studies of colonic transit time demonstrated no significant difference in the right and left colon between two groups, but the rectosigmoid transit time in the poor bowel habits group was more increased than in the normal bowel habit group (P<0.05). The rectal wall compliance was increased in the poor bowel habit group as compared to the normal bowel habits group (P<0.01). Maximal tolerable volume and defecation sensation volume were greater in the poor bowel habits group than in the control group (P<0.01), but there was no significant difference in the threshold of sense between two groups. CONCLUSIONS: Prolonged poor bowel habit in childhood period leads to loss of rectal sensation, and provide an explanation for one of the pathophysiologic mechanism of non-relaxing puborectalis syndrome.