Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction.

BACKGROUND: The pathophysiology of bloating is partially understood. We investigated in patients with disorders of gut-brain interaction (DGBI) the relationship between severity of bloating, abdominal girth changes and defecation pattern, and the efficacy of pelvic floor biofeedback treatment on bloating. METHODS: Disorders of gut-brain interaction patients with severe bloating as the main complaint were prescribed 2 weeks dietary advice and underwent abdominal girth measurements. At the first visit, all patients underwent a questionnaire on the subjective improvement of bloating, a (0-100) VAS abdominal bloating, and abdominal girth measurement. Patients reporting inadequate bloating relief underwent a standardized balloon expulsion test. Furthermore, they were invited to undergo pelvic floor electromyography and biofeedback treatment previously used for constipation due to dyssynergic defecation. The primary outcome was bloating improvement on a 5-point Likert scale. The secondary outcomes were the effect of diet intervention and pelvic floor biofeedback treatment on bloating severity and quality of life changes as well as the effect of pelvic floor biofeedback treatment on BET and EMG on straining. KEY RESULTS: One hundred and fifty six patients (129 F, 39.3 ± 11.7 mean age) completed the 2-week run-in period. 105 patients were diet non-responder and underwent balloon expulsion test, with the vast majority (64%) failing the test. Patients who scored higher bloating on VAS had a significant association with failed balloon expulsion test (adjusted B 0.4 [95% CI 10.8-25.7], p < 0.0001). 63% agreed to perform pelvic floor biofeedback treatment at Verona center, 54% became responders reporting fair or major improvement/cure (ITT analysis, McNemar test, p < 0.0001), and all of them showed a 50% decrease in bloating severity. CONCLUSIONS AND INFERENCES: Disordered defecation is a prevalent etiology in DGBI patients with bloating unresponsive to conservative measures; pelvic floor biofeedback treatment to improve the defecation effort significantly relieved bloating (http://www.isrctn.com, ISRCTN17004079).

Constipation in older people: A consensus statement.

BACKGROUND AND AIMS: Chronic constipation is a serious medical condition that affects 30%-40% of people over 60 years old. Although not normally life threatening, constipation reduces quality of life by the same extent as diabetes and osteoarthritis. There are currently no Europe-wide guidelines for treating constipation in older people, although there is some country-level guidance for the general population. We have evaluated the existing guidance and best clinical practice to improve the care of older people with constipation. METHOD: European healthcare professionals working in gastroenterology, geriatrics, nursing and pharmacology discussed the treatment of constipation in older people and reviewed existing guidance on the treatment of constipation in the general population. This manuscript represents the consensus of all authors. DISCUSSION: Most general guidance for constipation treatment recommends increased dietary fibre, fluid intake and exercise; however, this is not always possible in older patients. Although a common first-line treatment, bulk-forming laxatives are unsuitable for older people because of an associated need to increase fluid intake, osmotic laxatives are likely to be the most suitable laxative type for older patients. Treatment is often hampered by reluctance to talk about bowel problems so healthcare providers should proactively identify older constipated patients who are self-medicating or not receiving treatment. CONCLUSIONS: With certain modifications, general treatment guidelines can be applied to older people with constipation, although specific guidelines are still required for this age group. Awareness of constipation, its complications and treatment options need to be increased among healthcare providers, patients and carers.

Distortion of iron status indices by acute inflammation in older hospitalized patients.

The relation between acute inflammation and biochemical indices of iron and nutritional status in older in-patients have been investigated. Thirty-nine consecutive patients (25 men and 14 women; median age 79 years) with acute inflammation episode were evaluated. C-reactive protein (CRP) > or = 3 mg/dl was considered to indicate acute inflammation. Iron and nutritional status were explored measuring hemoglobin (Hb), hematocrit (Ht), red blood cell (RBC), white blood cell (WBC), mean erythrocyte volume (MCV), mean corpuscular hemoglobin (MCH), and serum levels of iron (Fe), transferrin (T), percentage transferrin saturation (%TS), ferritin (SF), albumin (Alb) and pre-albumin (pre-Alb), the day after admission (T-basal), the day of onset of inflammation (T0), and successively (T5, T8-15, and T-final). CRP and WBC were significantly higher at T0 than T-basal (CRP: +1014%, P < 0.01; WBC: +30%, P < 0.01) but had reduced on days T8-15 compared to T0 (CRP: -90%, P < 0.01; WBC: -26%, P < 0.01). Fe serum levels fell at the beginning of the acute phase (T0: -24% versus T-basal; P < 0.01), but had recovered at T-final (+36% versus T5; P < 0.01). T levels also varied significantly (P < 0.01) (T0: -16% versus T-basal; T-final: +18% versus T5). SF was slightly higher than normal at T-basal and increased further during inflammation (+41% at T5 versus T-basal) to reduce at T-final (-36% versus T5; P < 0.01). At T-final, pre-Alb and Alb were significantly higher than at T5 (pre-Alb +63%, P < 0.01; Alb +20%, P < 0.05). The indices of iron status are disrupted in elderly patients during acute inflammation, just as they are in chronic inflammation, and cannot therefore be used to diagnose sideropenic anemia. The only variables not influenced by inflammation are MCV and %TS. Low values of these, associated with other symptoms of anemia, suggest sideropenic anemia, irrespective of the values of the other indices of iron status. With the appearance of inflammation, nutritional indices tend to decline as liver activity shifts to the production of acute phase proteins.