Does prophylactic use of postcesarean section laxatives favor bowel movements?

Introduction: Chronic constipation (CC) is a highly prevalent disease in Western society. Chronic constipation can have a different etiology in patients who underwent a cesarean section and result from postoperative stress and metabolic response to trauma, analgesic agents, immobilization, and dietary restrictions. Chronic constipation may also occur due to puerperium-related psychological changes and to the stretching and weakening of the perineal and abdominal muscles after childbirth. Objectives: The present study analyzes intestinal transit restoration after a cesarean section and the influence of osmotic laxative agents. Methods: The present prospective, nonrandomized sample study used the ROME III questionnaire and the Bristol stool scale in adult women who underwent a cesarean section. We divided the subjects into 2 groups, each with 30 patients, to compare the effect of the prophylactic administration of an osmotic laxative. Results: We evaluated 60 randomly-chosen pregnant women from the Obstetrics ward of Hospital Santa Marcelina, São Paulo, SP, Brazil, from October 2019 to March 2020. Their mean age was 26.8 years old, and the mean gestation time was 37.95 weeks. Ten patients (16.7%) presented with constipation before the cesarean section, and 38 (63.3%) had a bowel movement after the procedure. However, in 84.2% of these patients, the usual stool consistency worsened. After the cesarean section, 46.7% of the women who did not receive laxative agents had a bowel movement, compared with 80% of those who did (p = 0.0074). Conclusion: Some factors, including those related to the procedure, may hamper intestinal transit restoration after a cesarean section. Osmotic laxative agents can facilitate transit restoration with no negative effects in this group of patients. (AU)

Estreñimiento funcional en pediatría, diagnóstico y tratamiento / Functional constipation in pediatrics, diagnosis and treatment

El estreñimiento funcional es un motivo de consulta frecuente en pediatría, con una prevalencia del 3 %. El Grupo de Trabajo de Constipación del Comité de Gastroenterología de la Sociedad Argentina de Pediatría se reunió con el objetivo de actualizar el diagnóstico y tratamiento de la constipación funcional en pediatría.Se realizó una búsqueda de literatura para evaluar la calidad de la evidencia. Ante un paciente constipado, es fundamental una historia y examen clínico completos. Los Criterios de Roma IV establecen pautas que, habitualmente, permiten diagnosticar la constipación funcional y evitar estudios innecesarios. La realización de estudios diagnósticos solo se pondrá en consideración ante la presencia de respuesta refractaria al tratamiento médico o en los casos de signos de alarma (banderas rojas). El primer paso del tratamiento es la desimpactación (por vía oral o enemas), seguida del tratamiento dietético, de hábitos y laxantes (es de primera elección el polietilenglicol).

Functional constipation is a common disease and one of the most frequent reasons of visit in pediatric clinics with a 3 % of prevalence. The Constipation Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría met with the objective of updating the diagnosis and treatment of functional constipation in pediatrics.A literature search was performed to assess the quality of the evidence. In a constipated patient, a complete history and clinical examination is essential. The Rome IV Criteria establish guidelines that usually allow us to diagnose functional constipation, avoiding unnecessary studies. The performance of diagnostic studies will only be considered in the absence of response to medical treatment or in cases of alarm signs (red flags). The first step of treatment is disimpaction (orally or enemas), followed by dietary treatment, habits and laxatives, with polyethylene glycol being the first choice.

Effect of polyethylene glycol versus lactulose on abdominal pain in children occult constipation: a randomized controlled study: un estudio controlado aleatorio / Efecto del polietilenglicol versus lactulosa sobre el dolor abdominal en el estreñimiento oculto en niños

Introduction and aim: Functional abdominal pain (FAP) is one of the major gastrointestinal complaints in childhood. Studies have reported occult constipation (OC) as one of the leading causes of abdominal pain. Recent researches have proposed laxatives as potent therapeutic targets for abdominal pain in patients with OC. However, no study has compared effect of poly ethylene glycol (PEG) and lactulose on occult constipation. Materials and methods: 51 patients aged 4 to 18 years with abdominal pain who had OC (defined as fecal impaction in abdominal X ray) were studied. Demographic and clinical data including age, sex, body weight, height, abdominal pain duration, abdominal pain rate and fecal odor were registered. They were randomly assigned to receive PEG (1gr/kg) or Lactulose (1cc/kg) for at least two weeks. All patients were reevaluated by pain measurement scale after at least two weeks of treatment. Results: It is indicated that the efficacy of PEG for reducing abdominal pain in OC was 48% while it was 37% for Lactulose. This study indicated that this efficacy is not affected significantly by sex and fecal odor, however this efficacy is influenced by age, body weight, abdominal pain duration and abdominal pain rate for both PEG and Lactulose. Conclusion: It could be concluded that PEG is a more efficient drug for treating abdominal pain in occult constipation than Lactulose and its optimum effect can be achieved in elder patients with more severe abdominal pain.

Introducción y objetivo: El dolor abdominal funcional (FAP) es una de las principales molestias gastrointestinales en la infancia. Los estudios han informado que el estreñimiento oculto (OC) es una de las principales causas de dolor abdominal. Investigaciones recientes han propuesto laxantes como objetivos terapéuticos potentes para el dolor abdominal en pacientes con OC. Sin embargo, ningún estudio ha comparado el efecto del polietilenglicol (PEG) y la lactulosa sobre el estreñimiento oculto. Materiales y métodos: Se estudiaron 51 pacientes de 4 a 18 años con dolor abdominal que tenían OC (definida como impactación fecal en rayos X abdominales). Se registraron datos demográficos y clínicos que incluyen edad, sexo, peso corporal, altura, duración del dolor abdominal, tasa de dolor abdominal y olor fecal. Fueron asignados aleatoriamente para recibir PEG (1 gr/kg) o lactulosa (1 cc/kg) durante al menos dos semanas. Todos los pacientes fueron reevaluados por la escala de medición del dolor después de al menos dos semanas de tratamiento. Resultados: Se indica que la eficacia de PEG para reducir el dolor abdominal en OC fue del 48% mientras que fue del 37% para la lactulosa. Este estudio indicó que esta eficacia no se ve afectada significativamente por el sexo y el olor fecal, sin embargo, esta eficacia está influenciada por la edad, el peso corporal, la duración del dolor abdominal y la tasa de dolor abdominal tanto para PEG como para lactulosa. Conclusión: Se podría concluir que el PEG es un fármaco más eficaz para tratar el dolor abdominal en el estreñimiento oculto que la lactulosa y que su efecto óptimo se puede lograr en pacientes mayores con dolor abdominal más severo.Palabras clave: dolor abdominal, estreñimiento oculto, polietilenglicol, lactulosa.

Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study / Combinações de laxantes e biomassa de banana verde no tratamento de constipação funcional em crianças e adolescentes: estudo randomizado

Abstract Objectives: Evaluate the effect of combinations of green banana biomass and laxatives in children and adolescents with chronic constipation. Methods: This was a randomized study of 80 children and adolescents with functional constipation according to the Rome IV Criteria, who were divided into five groups: (1) green banana biomass alone; (2) green banana biomass plus PEG 3350 with electrolytes; (3) green banana biomass plus sodium picosulfate; (4) PEG 3350 with electrolytes alone; and (5) sodium picosulfate alone. Primary outcome measure was the reduction of the proportion of patients with Bristol Stool Form Scale ratings 1 or 2. Secondary outcome measures were: increase of the proportion of >3 bowel movements/week and reduction of the proportion of fecal incontinence, straining on defecation, painful defecation, blood in stool, abdominal pain, and decreased laxative doses. Results: On consumption of green banana biomass alone, a statistically significant reduction was observed in the proportion of children with Bristol Stool Form Scale rating 1 or 2, straining on defecation, painful defecation, and abdominal pain. Conversely, no reduction was observed in fecal incontinence episodes/week, blood in stool, and no increase was observed in the proportion of children with >3 bowel movements/week. The percentage of children who required decreased laxative dose was high when green banana biomass was associated with sodium picosulfate (87%), and PEG 3350 with electrolytes (63%). Green banana biomass alone and associated with laxatives was well tolerated, and no adverse effects were reported. Conclusion: Green banana biomass is advantageous as an adjunct therapy on functional constipation, mainly for reducing doses of laxatives.

Resumo Objetivos: Avaliar o efeito das combinações da biomassa de banana verde e laxantes em crianças e adolescentes com constipação crônica. Métodos: Estudo randomizado de 80 crianças e adolescentes com constipação funcional de acordo com os Critérios de Roma IV divididos em cinco grupos: 1) Somente biomassa de banana verde; 2) Biomassa de banana verde mais PEG 3350 com eletrólitos; 3) Biomassa de banana verde mais picossulfato de sódio; 4) PEG 3350 somente com eletrólitos e 5) somente picossulfato de sódio. O desfecho primário foi a redução da proporção de pacientes com as classificações 1 ou 2 da Escala de Bristol para Consistência de Fezes. Os desfechos secundários foram: aumento da produção de > 3 evacuações/semana e redução da proporção de incontinência fecal, esforço na defecação, defecação dolorosa, sangue nas fezes, dor abdominal e redução nas dose de laxantes. Resultados: No consumo somente de biomassa de banana verde há uma redução estatisticamente significativa na proporção de crianças com classificação 1 ou 2 da Escala de Bristol para Consistência de Fezes, esforço na defecação, defecação dolorosa e dor abdominal. Por outro lado, não houve redução nos episódios fecais/semana de incontinência, sangue nas fezes e nenhum aumento na proporção de crianças com > 3 evacuações/semana. O percentual de crianças que tiveram sua dose de laxante reduzida foi alto quando a biomassa de banana verde foi associada a picossulfato de sódio (87%) e PEG 3350 com eletrólitos (63%). A biomassa de banana verde sozinha e associada a laxantes foi bem tolerada e não houve efeitos adversos relatados. Conclusão: A biomassa de banana verde é vantajosa como uma terapia adjuvante na constipação funcional, principalmente na redução das doses de laxantes.

Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria / Diagnóstico e tratamento da constipação crônica: atualização baseado nos critérios Roma IV

ABSTRACT The aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors' experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional intestinal constipation, with surgery reserved for cases in which pharmacologic intervention has failed. The information contained in this review article is subject to the critical evaluation of the medical specialist responsible for determining the action plan to be followed within the context of the conditions and clinical status of each individual patient.

RESUMO O objetivo deste trabalho foi avaliar os consensos de sociedade de especialistas e guidelines publicados sobre o diagnóstico e tratamento da constipação intestinal crônica em adultos, e confrontar com a experiência dos autores, a fim de padronizar condutas que auxiliem o raciocínio e a tomada de conduta do médico. Foi realizada busca na literatura científica, mais precisamente nas bases de dados eletrônicos Medline/Pubmed, Scielo, EMBASE and Cochrane, tendo sido utilizado os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Pode-se concluir que constipação crônica é condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. Identificar com precisão a fisiopatologia presente na constipação crônica funcional é complexo, requerendo a realização de testes funcionais nos casos refratários. O entendimento da motilidade intestinal e do mecanismo defecatório é importante para o manejo da constipação intestinal crônica funcional, sendo o tratamento cirúrgico indicado para casos selecionados, onde à abordagem medicamentosa não surtiu efeito. As informações contidas neste artigo de revisão devem ser submetidas à avaliação e à crítica do médico especialista responsável pela conduta a ser tomada, frente à sua realidade e ao estado clínico de cada paciente.

Successful Removal of Hard Sigmoid Fecaloma Using Endoscopic Cola Injection / 대한소화기학회지

Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery.

Avaliação comparativa de eficácia clínica e tolerabilidade para a combinação de Cassia fistula e Senna alexandrina Miller em pacientes com constipação intestinal funcional crônica / Comparative evaluation of clinical efficacy and tolerability for the combination of Cassia fistula and Senna alexandrina Miller in patients with chronic functional constipation

JUSTIFICATIVA E OBJETIVO: A constipação intestinal é um problema crônico, frequente, que afeta a Qualidade de Vida dos indivíduos. O objetivo deste estudo foi avaliar a eficácia clínica e a tolerabilidade da composição Cassia fistula e Senna alexandrina Miller, na apresentação geleia sem açúcar, em pacientes diagnosticados com constipação intestinal funcional crônica. MÉTODOS: Estudo envolvendo 96 voluntários com diagnóstico de constipação intestinal funcional crônica, conforme Critérios de Roma III, randomizados em grupos ativo e placebo. A avaliação da eficácia primária foi realizada por meio da frequência média de evacuações, consistência média das fezes e melhora global da constipação. Foram realizadas ainda avaliações secundárias, como número de dias seguidos sem evacuação, proporção de evacuações com dor, esforço, sensação de evacuação incompleta ou bloqueio, uso de manobras manuais, sujeitos de pesquisa que aderiram às recomendações de hábitos de vida, uso de fármacos de resgate e melhora da constipação segundo avaliação do sujeito de pesquisa. RESULTADOS: A proporção de sujeitos da pesquisa que apresentou melhora global da constipação foi de 65,1% no grupo ativo e de 22,0% grupo placebo (p<0,0001). Para a maioria das avaliações secundárias de eficácia, o grupo ativo apresentou melhor desempenho quando comparado ao grupo pesquisa. De acordo com a avaliação dos sujeitos de pesquisa sobre a melhora da constipação, o grupo ativo apresentou melhor desempenho do que o grupo pesquisa. Quanto à segurança, os dois grupos apresentaram resultados similares. CONCLUSÃO: A geleia sem açúcar composta de Cassia fistula e Senna alexandrina Miller apresentou um comportamento seguro e eficaz, sendo uma alternativa para tratamento da constipação intestinal funcional crônica.

BACKGROUND AND OBJECTIVE: Intestinal constipation is a chronic and frequent problem that affects Quality of Life. The aim of this study was to evaluate the efficacy and tolerability of the composition Cassia fistula and Senna alexandrina Miller, as sugar free jelly, in patients diagnosed with chronic functional constipation. METHODS: We evaluated 96 volunteers diagnosed with functional constipation according to Rome III criteria. Volunteers were randomized into active and placebo groups. Primary efficacy endpoint was evaluated by mean frequency of bowel movements, consistency of stools and global improvement of constipation. Secondary endpoints were evaluated, such as number of days without bowel movements, proportion of bowel movements with pain, with strain, sensation of incomplete or blocked bowel movement, use of, manual maneuvers to facilitate defecation, subjects who adhered to the diet recommendation, use of rescue medication, and level of constipation improvement, according to subject evaluation. RESULTS: Global improvement of constipationwas observed in 65.1% of subjects enrolled in active group versus 22% in placebo group (p<0.0001). For most secondary efficacy evaluations, the active group performed better when compared to placebo group. According to the evaluation of the subjects on the improvement of constipation, the active group performed better than the placebo group. As for security, the two groups showed similar results. CONCLUSION: Cassia fistula and Senna alexandrina Miller sugar free jelly demonstrated to be safe and effective and it can be used as an alternative for the treatment of functional constipation.

Current Issues on the Treatment of Chronic Constipation / 대한소화기학회지

Chronic constipation is a very common clinical problem with its prevalence of up to 14% in the general population. It is not a life-threatening disease, but since patient's satisfaction to the treatment is known to be as low as 50%, chronic constipation still remains a clinically challenging problem. Fortunately, many new treatments have been introduced or are to be introduced in the near future. This article will review the basic concepts and the results of recent studies on the new treatments for chronic constipation.

Constipação intestinal / Constipation

A constipação intestinal acomete cerca de 20% da população mundial e constitui um dos sintomas mais frequentes de procura ao médico. É mais comum em mulheres e idosos e se encontra entre as doenças funcionais do intestino. Pode ser referida pelo paciente como fezes endurecidas, esforço excessivo no ato evacuatório, evacuações infrequentes ou sensação de evacuação incompleta. Subdivide-se em primária e secundária, tendo essa última causa bem definida, como doenças endócrinas e neurológicas ou uso inadvertido de substâncias obstipantes. É importante orientarmos nossos pacientes para a necessidade de uma dieta rica em fibras e de uma hidratação adequada. O manejo farmacológico pode incluir suplementação de fibras, laxativos osmóticos, emolientes e laxativos irritativos

Constipation occurs in about 20% of the world population and it is a common reason for seeking medical attention. It is more common in women and in the elderly and may be part of a generalized gastrointestinal dysmotility syndrome. Patients may define constipation as hard stools, excessive straining, infrequent stools, or a sense of incomplete evacuation. There are two main types of constipation - primary or secondary, the latter caused by systemic disorders such as endocrine disorders, neurologic dysfunction, or as a side effect of medications. Proper dietary fiber and fluid intake should be emphasized. Pharmacologic management of constipation may include fiber laxatives, osmotic laxatives, stool surfactants, or stimulant laxatives

Cuando la constipación no responde a fibra: ¿qué más hacer? / When constipation does not respond to dietary fiber: what else can we do?

Constipation should be defined by symptoms, and is refractory to fiber in about 40 percent of the cases. About 50 percent of these cases caused by a defecatory disorder, usually dyssynergic defecation, which is defined as inadequate relaxation of the pelvic floor during straining. In this cases, biofeedback therapy produces an adequate relief in about 80 percent. It is suggested that ano-rectal manometry with balloon expulsion test should be the first approach in cases of fiber-refractory constipation. In cases of normal ano-rectal test, an evaluation of colonic transit time is suggested. In cases of slow transit constipation, treatment responses are much lower. Osmotic laxatives, especially polyethilenglicol, are recommended in all types of constipation. There are new laxatives, like lubiprostone and linaclotide, and new prokinetics, like prucalopride, that are already available in different countries, that show a reasonable good response profile.

La constipación debe ser definida por síntomas, y es refractaria al uso de fibra en alrededor de 4 por ciento de los casos. En alrededor de 50 por ciento existe un defecto expulsivo, casi siempre defecación disinérgica, la que es definida por una relajación inadecuada del piso pelviano al momento de pujar. Se recomienda un estudio de manometría ano-rectal con test de expulsión del balón como primera opción en estos casos. En los casos de disinergia, la terapia con biofeedback tiene una eficacia del alrededor de 80 por ciento, beneficio que se mantiene a largo plazo. En casos de manometría ano-rectal normal, se sugiere evaluar un tiempo de transito colónico, pues la respuesta de los casos con tránsito lento es bastante menor. En todos los casos de constipación se recomienda el uso de laxantes osmóticos tipo polietilenglicol. Existen nuevos laxantes, como lubiprostona y linaclotide, y nuevos procinéticos como prucalopride, que ya están disponibles en diversos países del mundo, que tienen una eficacia razonable en estos casos.

Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.

Impactación fecal / Fecal impactation

Introducción: La Impactación fecal (I.F.) es la acumulación de materia fecal dura fundamentalmente en el recto, que no puede evacuarse voluntariamente. Es más común en el anciano y en personas debilitadas, inactivas, o que usan drogas por enfermedades psiquiátricas. Objetivo: Evaluar una serie consecutiva de pacientes con I.F., discutir su etiopatogenia y los resultados del tratamiento. Pacientes y método: Entre Enero 2006 y Diciembre 2008, de 26862 internaciones en el Sanatorio Trinidad Dupuytren de la Ciudad de Buenos Aires, 87 (0.32%) fueron por I.F. Mujeres 54 (62%), edad promedio 75 (rango 95-32) años. La I.F. fue baja (en el recto ó el rectosigma) en 50 (57.47%) pacientes y alta en 37 (42.53%). El diagnóstico se hizo con: examen semiológico y proctológico con instrumental rígido, Videocolonoscopía (VCC), radiología directa del abdomen, radiología contrastada del colon y tomografía abdominal computada (TC) según el caso. Resultados: Todos tenían factores condicionantes, más frecuentemente senectud (42.52%), trastornos neurológicos (20.69%), dolicocolon (9.19%) y megacolon chagásico (5.74%). Más del 90% se diagnosticaron con tacto rectal y endoscopía rígida. Las altas con VCC y ocasionalmente TC. Todos recibieron tratamiento médico (enemas tipo Murphy, laxantes y dieta), excepto 3 (3.45%) que fueron operados de emergencia por úlceras estercoráceas con peritonitis localizadas (operaciones tipo Hartmann). En 7 (8.3%) pacientes el tratamiento con enemas fue inefectivo, requiriendo extracción manual con anestesia: 4 y cirugía electiva: 3 (2 colostomías transversas y una cecostomía). Hubieron 9 (10.2%) complicaciones en los pacientes no operados (2 neumopatías, 5 fl ebitis y 2 infecciones urinarias) y 2 en los operados (absceso de pared y eventración). Estadía hospitalaria promedio: 11 (rango 5-45) días. Conclusión: El tratamiento con enemas por goteo, dieta y laxantes es de alta respuesta en la mayoría...

Introduction: Fecal impaction (F.I.) is the accumulation of hard feces, mainly in the rectum, that cannot be voluntarily expelled. It is more common in the elderly and in debilitated, or inactive persons, and those who use drugs for mental diseases. Objective: To assess a consecutive series of patients with con F.I., and discuss the etiopathology, and results of treatment. Patients and Methods: Between January 2006 and December 2008, from 26862 admissions in the Sanatorio Trinidad Dupuytren of Buenos Aires, 87 (0.32%) were for (F.I.) Women 54 (62%), mean age 75 (range 95-32) years. F.I. was low (in rectum or rectosigmoid) in 50 (57.47%) patients, and high in 37 (42.53%). Diagnosis was done with: physical exam, rigid sigmoidoscopy, videocolonoscopy (VC), plain abdominal X-ray, contrast colon radiology, and abdominal computed tomography (CT), case dependent. Results: All patients had conditioning factors, more frequently old age (42.52%), neurological conditions (20.69%), dolicocolon (9.19%) and Chagasic megacolon (5.74%). More than 90% were diagnosed with rectal digital exam and rigid sigmoidoscopy. For those with high impaction VC and occasionally CT were used. All patients had medical treatment (Murphy enemas, laxatives, and diet), except for 3 (3.45%) who underwent emergency surgery for estercoracic ulcers with localized peritonitis (Hartmann type operations). Enemas were ineffective in 7 (8.3%) patients, requiring manual extraction under anesthesia: 4, and elective surgery: 3 (2 transverse colostomies and 1 cecostomy). There were 9 (10.2%) complications in non-operated patients (2 pneumonias, 5 phlebitis, and 2 urinary infections), and 2 in operated patients (abdominal wall abscess, and incisional hernia). Length of stay: 11 (range 5-45) days. Conclusion: Treatment with enemas, diet and laxatives is highly effective in most patients...

Doença celíaca é super-representada em pacientes com constipação / Celiac disease is overrepresented in patients with constipation

OBJETIVO: Tem sido sugerido que pacientes com constipação sejam triados para doença celíaca. Da mesma forma, recomenda-se a investigação desses pacientes para hipotiroidismo e hipercalcemia. Contudo, nenhuma evidência para essas recomendações está disponível até o momento. Assim, propusemos-nos determinar a prevalência de doença celíaca, hipotiroidismo e hipercalcemia em crianças com constipação. MÉTODOS: Estudo de coorte prospectivo com 370 pacientes consecutivos que preencheram os critérios de Roma III para constipação. Esses pacientes foram encaminhados por um clínico geral a um pediatra devido ao fracasso no tratamento com laxantes. RESULTADOS: A biópsia comprovou doença celíaca em sete desses pacientes. Isso é significativamente mais alto (p < 0,001) do que a prevalência de 1:198 de doença celíaca nos Países Baixos. Dois pacientes tinham tiroidite autoimune. Nenhum paciente tinha hipercalcemia. CONCLUSÕES: Conclui-se que a doença celíaca é significativamente super-representada em pacientes com constipação encaminhados por um clínico geral a um pediatra devido ao fracasso no tratamento com laxantes. Todos esses pacientes devem, portanto, ser triados para doença celíaca.

OBJECTIVE: It is suggested that patients with constipation should be screened for celiac disease. Similarly, it is recommended to investigate these patients for hypothyroidism and hypercalcemia. However, no evidence for these recommendations is available so far. We therefore set out to determine the prevalence of celiac disease, hypothyroidism, and hypercalcemia in children with constipation. METHODS: Prospective cohort study of 370 consecutive patients who met the Rome III criteria for constipation. These patients were referred by a general practitioner to a pediatrician because of failure of laxative treatment. RESULTS: Seven of these patients had biopsy-proven celiac disease. This is significantly higher (p < 0.001) than the 1:198 prevalence of celiac disease in the Netherlands. Two patients had auto-immune thyroiditis. No patient had hypercalcemia. CONCLUSIONS: We conclude that celiac disease is significantly overrepresented in patients with constipation who are referred by a general practitioner to a pediatrician because of failure of laxative treatment. All such patients should, therefore, be screened for celiac disease.

Practical Treatments for Constipation in Korea

Constipation is a digestive symptom that is frequently seen in clinical practice. Its prevalence has been reported to be 2% to 20%, depending on geographical region. Despite the rapid development of medical science, systematic studies on constipation have been rarely conducted in Korea. Recently, guidelines on the diagnosis and treatment of functional gastrointestinal disorders, including constipation, were proposed by The Korean Society of Neurogastroenterology and Motility. These guidelines are expected to reflect the current situation regarding treatment of constipation in Korea. In this paper, practical constipation treatment methods that are in current use will be reviewed with reference to these recent guidelines.

Effect of induction of meconium evacuation using per rectal laxatives on neonatal hyperbilirubinemia in term infants: A systematic review of randomized controlled trials.

Objective: To study the efficacy of early meconium evacuation using per rectal laxatives on the level of serum bilirubin and the need for phototherapy in healthy term infants. Materials and Methods: Systematic review of randomized controlled trials comparing per rectal laxatives versus no intervention was conducted using English language articles identified from the Cochrane Central Register of Controlled Trials, Medline, Ovid, and CINAHL databases and bibliographies of selected articles. Eligible studies were assessed for the risk of bias in conduct and reporting. Results: A total of three trials (n = 469) mostly with "unclear risk" were eligible for inclusion. Two trials used glycerin suppository whereas one used glycerin enema for meconium evacuation. Meta-analysis was not possible due to clinical heterogeneity in the choice of laxatives and frequency of intervention. In all the three studies, serum bilirubin levels at 48 h and the need for phototherapy was not significantly different between the two groups. Passage of first meconium and the transitional stools occurred significantly early in the intervention group compared to controls. Conclusion: Early evacuation of meconium using per rectal laxatives does not offer any significant clinical advantage for neonatal jaundice.

Comparação da efetividade entre polietilenoglicol 4000 sem eletrólitos e hidróxido de magnésio no tratamento da constipação intestinal crônica funcional em crianças / Comparison of the effectiveness of polyethylene glycol 4000 without electrolytes and magnesium hydroxide in the treatment of chronic functional constipation in children

OBJETIVO: Comparar a efetividade de dois medicamentos: hidróxido de magnésio e polietilenoglicol 4000 sem eletrólitos no tratamento da constipação intestinal crônica funcional em crianças. MÉTODOS: Trinta e oito crianças foram divididas, por processo randômico, em dois grupos para uso de polietilenoglicol 4000 sem eletrólitos ou de hidróxido de magnésio. As crianças foram acompanhadas em consultas periódicas até completarem 6 meses de tratamento. Em todas as consultas, foram investigados: consistência das fezes, frequência evacuatória, presença de escape fecal, dor abdominal, esforço evacuatório e aceitação desses fármacos. RESULTADOS: Dezessete crianças fizeram uso de polietilenoglicol, e 21 utilizaram o hidróxido de magnésio. Houve melhora clínica de todas as variáveis nos dois grupos, sem diferenças com significância estatística. Todas as crianças aceitaram o polietilenoglicol, enquanto 42,9 por cento recusaram o hidróxido de magnésio. CONCLUSÃO: Não houve diferença de efetividade no tratamento da constipação intestinal entre esses dois laxantes. Entretanto, a melhor aceitação do polietilenoglicol, por ser inodoro e insípido, torna-o melhor opção no tratamento da constipação intestinal crônica funcional.

OBJECTIVE: To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS: Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS: Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9 percent refused magnesium hydroxide. CONCLUSION: The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Guidelines for the Treatment of Irritable Bowel Syndrome / 대한소화기학회지

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT4 receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.

Guidelines for the Treatment of Constipation / 대한소화기학회지

While constipation is a common symptom in Korea, there are no existing treatment guidelines. Although constipation may occur as a result of organic cause, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. The present paper deals with only the management of functional constipation: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, and stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents that affect peristalsis through selective interaction with 5-hydroxytryptamine-4 receptors can be effective in patients with constipation who cannot get adequate relief from current laxatives. Biofeedback can relieve symptoms in selected patients with pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation.

Effects of Carbonated Water Intake on Constipation in Elderly Patients Following a Cerebrovascular Accident

PURPOSE: This study was done to identify effects of carbonated water intake on constipation in elders who have experienced a cerebrovascular accident (CVA) and are bed-ridden. METHODS: Forty elderly patients with CVA were randomly assigned to one of two groups in a double-blind study. Patients in the experimental group drank carbonated water and those in the control group drank tap water for two weeks. Six patients dropped out during the study period. Data were analyzed by repeated measured ANCOVA and the covariance was the dose of laxatives used for the two weeks. RESULTS: Frequency of defecation increased significantly and symptoms of constipation decreased significantly for patients in the experimental group. CONCLUSION: The study results suggest that the intake of carbonated water is an effective method for the intervention of constipation in elderly patients with CVA.