The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trials.

BACKGROUND: & Objectives: Constipation-predominant irritable bowel syndrome (IBS-C) is functional bowel disorders that may involve disturbance of the gastrointestinal microbiota. We performed a systematic review and meta-analysis of the efficacy and safety of probiotics in patients with IBS-C. METHODS: We searched the Cochrane Library, PubMed, EMBASE and Web of Science databases up to 1 May 2019. Randomized controlled trials (RCTs) involving adults with IBS-C that compared probiotics to placebo or no therapy were eligible for the analysis. Dichotomous symptom data were pooled to calculate the relative risk (RR) with a 95% confidence interval (CI) of remaining symptoms after therapy. Continuous data were pooled using a standardized or weighted mean difference (MD) with the 95% CI. Two reviewers assessed trial quality and extracted data independently. The analysis was performed using Review Manager version 5.2. RESULTS: Seventeen RCTs involving 1469 patients were included in the analysis. Overall, probiotics significantly increased stool frequency by 1.29 bowel movements (BM)/wk (95% CI: 0.69 to 1.89 BM/wk; P < 0.0001), and improved stool consistency (SMD: 0.55; 95% CI: 0.27 to 0.82; P = 0.0001). Compared with placebo, patients using probiotics experienced a shorter gut transit time by 12.36 h (95% CI: -20.74 to -3.98 h; P = 0.004). No serious adverse events were reported. CONCLUSIONS: Generally, probiotics may be safe and may improve whole gut transit time, stool frequency, and stool consistency. However, adequately powered RCTs are required to better determine the species or strains, doses, and duration of use of probiotics that are most efficacious. Further research and evidence is required before probiotics is adopted as one of treatments of IBS-C.

[Effect of electroacupuncture preconditioning combined with induced urination on urinary retention after milligan-morgan hemorrhoidectomy].

OBJECTIVE: To investigate the effect of electroacupuncture preconditioning combined with induced urination on urinary retention after milligan-morgan hemorrhoidectomy. METHODS: Eighty patients with mixed hemorrhoids were randomly divided into an electroacupuncture group and a routine group, 40 cases in each group. Anesthesia at Yaoshu (GV 2) was given in the two groups. In the electroacupuncture group, electroacupuncture at Zhongji (CV 3)，Guanyuan (CV 4)，Pangguangshu (BL 28) and Sanyinjiao (SP 6) was applied with tolerant intensity for 30 min before operation, 2 Hz/100 Hz in frequency. After operation, induced urination was given, namely hot compress of bladder area and sound of hearing water. In the routine group，induced urination was given after operation. The score of the first urination waiting time, the distension of lower abdomen on the evening of the postoperative, the first time urinary volume and incidence of urinary retention were compared between the two groups. RESULTS: The scores of the first urination waiting time after operation and distension of lower abdomen in the evening of the postoperative in the electroacupuncture group were lower than those in the routine group, the first time urinary volume was more than that in the routine group, and the incidence of urinary retention was lower than that in the routine group (5.0% (2/40) vs 22.5% (9/40), all P<0.05). CONCLUSION: Electroacupuncture preconditioning combined with induced urination can effectively prevent the incidence of urinary retention after milligan-morgan hemorrhoidectomy.

[Effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy].

OBJECTIVE: To compare the effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy. METHODS: A total of 120 patients with mixed hemorrhoids were randomly divided into an electroacupuncture group A (dilatational wave, 2 Hz/100 Hz in frequency), an electroacupuncture group B (continuous wave, 2 Hz in frequency) and an electroacupuncture group C (continuous wave, 100 Hz in frequency), 40 cases in each group. Electroacupuncture at Xialiao (BL 34) and Chengshan (BL 57) was applied with tolerant intensity for 30 min before operation in all groups. The number of additional anesthetic drugs in the 3 groups, the visual anal pain score (VAS) and limb activity score at 4, 12, and 24 h after operation, the maximum VAS score within 24 h after surgery and oral dose of aminophenol dihydrocodeine were compared. RESULTS: The number of additional anesthetic drugs in the electroacupuncture group A, the electroacupuncture group B and the electroacupuncture group C were 4, 5, 4 respectively, and there was not statistically significant (P>0.05). There was no significant difference in the anal pain VAS score and limb activity score at 4 h after operation among the 3 groups (P>0.05), at the 12 h after operation, the VAS scores and limb activity scores in the electroacupunctures group A and B were lower than those in the electroacupuncture group C (P<0.05), at 24 h after operation, the VAS score and limb activity score in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (P<0.05), the maximum VAS score within 24 h and oral dose of aminophenol dihydrocodeine within 24 h after operation in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (P<0.05). CONCLUSION: Different frequency electroacupuncture preconditioning has the effect of alleviating anal pain after milligan-morgan hemorrhoidectomy. The analgesic effect of electroacupuncture with different frequencies is different. The electroacupuncture analgesic effect of 2 Hz /100 Hz dilatational wave is better than 2 Hz and 100 Hz continuous waves.

[Effect of preconditioning of thermopaste application at Shenque (CV 8) on stretch reflex induced by procedure for prolapse and hemorrhoids in patients with hemorrhoids].

OBJECTIVE: To observe clinical effect, feasibility and security of preconditioning of thermopaste application at Shenque (CV 8) for relieving stretch reflex induced by procedure for prolapse and hemorrhoids (PPH). METHODS: A total of 100 cases of mixed hemorrhoids (stage III and IV) patients were randomized into 1.0 h, 0.5 h, 0 h and control (no application) groups (n = 25 in each group) according to a random number table. Thermopaste was applied to Shenque (CV 8) 1.0 h and 0.5 h before PPH or conducted simultaneously with PPH. The mean arterial pressure, heart rate, blood oxygen saturation of patients before and after anastomose operation, and the incidence of adverse reactions within 24 hours after the procedure were monitored and recorded. The patient's pain degree was assessed by using visual analogue scale. RESULTS: After the preconditioning, of the 25 patients in the 0.5 h group (0.5 h G), 14 experienced marked improvement (in the stretch reflex during PPH), 10 had an improvement, and 1 was invalid, respectively. The markedly effective rate and the total effective rate were 56% and 96%, respectively. The therapeutic effects for inhibiting stretch reflect being from the better to the poorer were 0.5 h G > 1.0 h G > 0 h G >NG. The heart rate and blood pressure from more stable to lesser stable were 0.5 h G> 1.0 h G > 0 h G > NG. The patients' pain reaction during operation and their adverse effects of nausea, vomiting, abdominal distention and abdominal pain, etc. occurred during operation also presented the same tendency in the 4 groups. CONCLUSION: Thermopaste application to Shenque (CV 8) can effectively prevent and control visceral reflex in patients undergoing PPH, which effect is significantly better when conducted 0.5 hour before the operation.