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Objective:To evaluate the clinical efficacy and safety of fecal microbiota transplantation(FMT)for the treatment of chronic functional constipation in the elderly.Methods:A total of 33 elderly patients with chronic functional constipation were included and given three sessions of FMT.Changes in fecal characteristics, constipation, mood and quality of life in these patients were evaluated using the Bristol stool form scale(BSFS), the constipation assessment scale(CAS), patient assessment of constipation symptoms(PAC-SYM), the Zung self-rating anxiety scale(SAS), the Zung self-rating depression scale(SDS), and the patient assessment of constipation quality of life(PAC-QOL)before and 12 weeks after treatment.The clinical efficacy was based on comparison between pre-and post-treatment results for each patient.Results:Clear improvement was achieved in 33 patients 12 weeks after treatment, compared with before transplantation.Post-treatment scores of the constipation assessment scale and symptom self-assessment questionnaire for patients with constipation were(8.9±1.2)scores and(26.5±2.4)scores, respectively, significantly lower than pre-transplantation scores of(12.2±1.1)scores and(32.4±2.4)scores( t=15.034, 13.904, both P<0.001). Similarly, post-treatment scores were also lower than pre-transplantation levels for the self-rating anxiety scale[(50.4±8.4)scores vs.(57.5±9.0)scores, t=10.333, P<0.001], the self-rating depression scale[(50.6±8.4)% vs.(55.0±10.5)%, t=5.301, P<0.001], and self-assessment questionnaire for quality of life[(88.2±7.3)scores vs.(103.7±7.3)scores, t=23.300, P<0.001]. Conclusions:FMT can improve fecal characteristics and constipation symptoms, relieve anxiety and depression, improve the quality of life, and provide a new option for the treatment for elderly patients with chronic functional constipation.
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ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.
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Humans , Disease Management , Irritable Bowel Syndrome/therapy , Systematic Reviews as Topic , Psychotherapy/methods , Treatment Outcome , Evidence-Based Medicine , Irritable Bowel Syndrome/psychologyABSTRACT
BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P 6 months (63.8%) than 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.
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Child , Humans , Colonic Diseases, Functional , Constipation , Defecation , Diagnosis , Digital Rectal Examination , Enema , Feeding Behavior , Lactulose , Polyethylene Glycols , Prescriptions , ProbioticsABSTRACT
Objective:To observe the clinical effect of deep insertion at Tianshu(ST 25)for colonic slow transit constipation(STC).Methods:120 cases of STC patients were randomly divided,60 cases in a deep insertion group,30 cases in an electroacupuncture group and 30 cases in a medication group by 2:1:1 ratio.The deep insertion group was treated with deep insertion at Tianshu(ST 25).The electroacupuncture group was treated with routine insertion at Tianshu(ST 25).The medication group was treated with oral administration of Lactulose oral liquid.The first voluntary defecation time,and constipation scores before the treatment,four weeks after the treatment and relevant scores of clinical symptoms were assessed in the three groups of the patients.Results:The scores of the clinical symptoms in improvement of constipation were better in the deep insertion group than in the electroacupuncture group and medication group,with differences in statistical significance(P<0.01).The unsuccessful numbers in the improvement of defecation and abdominal pain were also better in the deep insertion group than in the other two groups,and better in instant effect in the deep insertion.Conclusion:The improvement of STC clinical symptoms was better by deep insertion at Tianshu(ST 25)than by medication and routine acupuncture method at Tianshu(ST 25).
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Objective To explore the effect of corticotropin releasing factor (CRF) and its receptor on visceral sensitivity and colon motility of irritable bowel syndrome (IBS) rats. Methods sixty SD rats were divided randomly and equally into control group (without treatment),model group (sensitized in turn with camphor odor as conditional stimulation and physical restraint in combination with rectal distention pressure as non-conditional stimulation),treatment control group (injected physiological saline into lateral ventricles before treatment),treatment group 1 (injected CRF-R1antagonist into lateral ventricles before treatment),treatment group 2 (injected CRF-R2 agonist into lateral ventricles before treatment). Then the rats' visceral sensitivity were assessed by AWR,and colonic electricity activities such as volatility,maximum amplitude of fast wave and slow wave,interdigestive number of contraction wave and index of contraction were recorded. The data was analyzed with SPSS 16. 0 software. Results By the amount of ractal water injection to reach AWR=3 as the evaluation index,model group [(0. 90±0. 11) ml] showed higher visceral sensitivity than that of control group [(1. 23±0. 07) ml,F=82. 586,P＜0. 01],and colonic electricity activity increased (P＜0. 05),model was successfully set up. There was no significant difference of the amount of ractal water injection between model group [(0. 90±0. 11) ml] and treatment control group [(0. 81±0. 11) ml,F=3. 734,P＞0. 05]. Compared with treatment control group,the visceral sensitivity decreased in treatment group 1 [(1. 28±0. 07) ml,F=161. 878,P＜0. 01] and treatment group 2 [(1. 22±0.05) ml,F=121. 564,P＜0. 01]. There was no significant difference between treatment control group and model group in electricity activities such as volatility,maximum amplitude of fast wave and slow wave,interdigestive number of contraction wave and index of contraction (all P＞0. 05). While the electricity activities was weakened in treatment group 1 and 2 compared with the treatment control group (all P＜0. 05). Conclusions CRF plays an important role in the pathogenesis of IBS. Inhibition of CRF-R1 or activation of CRF-R2 may lower visceral hypersensitivity and decrease colon motility of rats.
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Objoctive:To investigate the expression of transforming growth factor-β(TGF-β)isoforms in colonic mucosa of ulcerative colitis(UC),and its role in the incidence of UC thereof.Methods:The expression of TGF-β isoforms was detected in colonic mucosa by immunohistochemical Envision method in UC patients,and the patients with irritable bowel syndrome (IBS)were used as controls.The relationship was analyzed between the expression of TGF-β isoforms and the degree of severity and extent of the disease.Results:There were statistical differences in the expression of TGF-β1 and TGF-β2 between the active stage UC,remission stage UC and IBS groups(P ＜ 0.01).The expression was significantly higher in active stage UC group than that in remission stage UC and 1BS groups(P＜ 0.01).The expression was significantly higher in remission stage UC group than that in IBS group(P ＜ 0.01).However,there was no statistical difference in the expression of TGF-β3 between active stage UC,remission stage UC and IBS groups(P＞ 0.05).The expression of TGF-β1 and TGF-β2 had positive correlation with the degree of sevefity(P ＜ 0.05).However,the expression of TGF-β3 had no linear correlation with the degree of severity(P ＞ 0.05).There was no linear correlation on the expressions of TGF-β1,TGF-β2 and TGF-β3 with extent of the disease(P ＞ 0.05).The degree of severity had positive correlation with extent of the disease(P ＜ 0.05).Conclusion:The expressions of TGF-β1 and TGF-β2 were enhanced in colonic mucosa of UC,and were correlated with the pathogenesis of UC.The expressions of TGFβ1 and TGF-β2 may serve as markers for assessing disease activity of UC.
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Objective To screen and identify the anomously expressed proteins at protein level in colon mucosa of diarrhea-predominant irritable bowel syndrome(D-IBS)patients and healthy individuals.Methods Four D-IBS patients and four healthy individuals were included in the study.Biopsies of mucosa at the ileocecal junction and sigmoid colon were performed via colonoscopy.The specimens were cleaned with ice cold saline which contained 0.1% PMSF,and were snap frozen in liquid nitrogen.The two-dimensional gel electrophoresis(2-DE)was used to screen the anomously expressed proteins,and the two proteins which presented the greatest changes in each group were identified by mass spectrometry method.Results Proteomics maps of human colon mucosa were obtained successfully with 2-DE.Average protein spots were 336 in normal control group,and the matching rate among them was 92%,while in D-IBS group,the average protein spots were 426,and the matching rate was 95%.The average matching rate between the test group and the control group was 74%.It was found that the volume value of 24 proteins spots changed more than two folds.The protein expression was found to decrease in 3 spots and increase in 21 spots.Four proteins were chosen for analysis with mass spectrometry analysis.The two up-regulated proteins were identified as Immunoglobulin J chain and heat shock protein 27,while the other two down-regulated proteins were identified as hemoglobin beta subunit and fructose-bisphosphate aldolase A.Conclusion With 2-DE,proteomics maps of human colon mucosa have been obtained successfully.The proteome expressions of colon mucosa in D-IBS patients are remarkably different from that of the healthy individuals.The four identified proteins may play a certain role in the pathogenesis of D-IBS.
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Skill in the diagnosis and management of functional disorders is essential for anyone concerned with human disease. The main principie is to distinguish between organic clinical entities and functional disorders. The pathophysiologic mechanisms that generate the symptoms of the functional disorders are imper- fectly understood. The most important etiologic factors are rela- ted to stress such as mental, emotional, or physical tension, strain, or distress. The importance of the functional disorders in gastroenterology is due to their high prevalence in almost all peoples at some time of their lives. The treatment of the func- tional disorders try to be specific but is very difficult because the pathophysiologic mechanisms involved are unclear. On the other hand, nonpharmacologic strategies by the physician can be efficients, mainly establishing a therapeutic relationship with your patient.
Habilidade em diagnosticar e lidar com desordens funcionais é essencial a qualquer um que cuide de doenças humanas. É fundamental distinguir entre entidades clínicas orgânias e distúrbios funcionais. A fisiopatologia dos distúrbios funcionais nâo é bem compreendida. Os fatores etiológicos mais importantes relacionam-se ao estresse, tais como estados de tensâo mental, emocional ou física. O tratamento farmacológico tem limitações como inespecificidade e os altos índices de efeito placebo. Por outro lado, a adoção de estratégias não farmacológicas pelo médico pode ser eficiente, principalmente esta- belecendo um relacionamento terapêutico com seu paciente.
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Humans , Dyspepsia/psychology , Colonic Diseases, Functional/diagnosis , Stress, Psychological , Gastrointestinal Diseases/psychologyABSTRACT
[A Review] The irritable bowel syndrome (IBS) is a chronic functional bowel disorder,and its pathogenesis remains unclear. Serotonin is thought to be an important brain-gut axis neurotransmitter,which plays an important role in the gastrointestinal motility,sensation and secretion. Serotonin is closely associatied with IBS and regarded as one of the therapeutic targets. This article reviews the related investigations in the recent years.
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To evaluate the clinical application of defecography in irritable bowel syndrome, 14 cases of diarrhoea predominant IBS, 12 cases of constipation predominant IBS and 10 cases of mixed patterns underwent defecography. Thirteen cases showed abnormal IBS (36 11%). The abnormal X ray features of anorectal angle and pelvic floor descent included rectocele, rectal mucosal prolapse, splanchnoptosis, perineum descent and spastic pelvic floor syndrome. Defecography is valuable in the diagnosis and treatment of irritable bowel syndrome
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To investigate fecal continence in patients with irritable bowel syndrome (IBS), studies were performed in 43 patients with IBS and 20 healthy subjects. Anorectal pressure was measured with BioLAB monitor of digestive tract and anorectal catheter with solid state manometric transducers. The results were analyzed by computation programs of American Sandhill Company. The sensation of defecation volume (DSV),sensation of defecation urgent volume (DUSV) and maximal tolerable volume (MTV) in the patients with diarrhea predominant type IBS (Dp-IBS) were significantly lower than healthy subjects (P
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Objective To study the effects of intragastric ice water stimulation on bowel sensitivity, mast cells (MCs), the serum contents of serotonin (5-HT), leukotriene B 4 (LTB 4 ), histamine(HA)and bradykinin (BK) in rats, and explore the possible pathogenesis of cold drinks-induced irritable bowel syndrome (IBS). Methods 40 Wistar rats aged 4 weeks were randomly divided into two groups. Twenty rats of group A as experimental group were gavaged 0-4℃ ice water for 14 days, and the rats of group C as control group were not treated. On day 28, the group A and group C were again divided into two subgroups, respectively, i.e. A1, A2, C1, and C2. In the rats of subgroups A1 and C1, a balloon was introduced into the rectum of each animal, and number of abdominal withdrawal reflexes (AWR) was recorded after the balloon was distended for 3 minutes to assess bowel sensitivity. One hour after rectal distention, blood sample of each rat was collected from the heart for the measurement of the contents of 5-HT, LTB 4 , HA and BK in serum by enzyme linked immunoadsorbent assay (ELISA). Tissues harvested from the ileocecal junction and colon were sectioned and stained with haematoxylin-eosin (HE) for routine pathological examination, and with the improved toluidine blue method for the identification of MCs. Results The number of AWR to 1.0ml balloon distention in subgroup A 1 was significantly lower than that in subgroup C 1 (P0.05). Routine pathological examination did not show abnormality in both subgroups. In group A 1 , the numbers of MCs in the ileocecal junction and colon were significantly higher than those of group C 1 (P0.05). Conclusion The stimulation of the stomach with ice water results in lowering of bowel sensitivity, increase of MCs and elevation of serum contents of 5-HT, LTB 4 and HA, and the results might imply that cold stimulation of the stomach might play a role in the pathogenesis of IBS.