BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on...BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on Western populations,with limited data originating from China.AIM To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.METHODS Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled.FC and IBS-C diagnoses were established using ROME IV criteria,and patients underwent high-resolution anorectal manometry(ARM)and a colonic transmit test using the Sitz marker study.Constipation-related symptoms were obtained through questionnaires.Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21.The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.RESULTS No significant differences in sex,age or abdominal discomfort symptoms were observed between IBS-C and FC patients(all P>0.05).The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC(36.63%vs 15.91%,P<0.05),while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group(50%vs 26.73%,P<0.05).Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM.IBS-C patients were found to have a higher prevalence of depression than FC patients(66.30%vs 42.42%,P<0.05).The scores for feelings of guilt,suicide,psychomotor agitation,diurnal variation,obsessive/compulsive disorder,hopelessness,self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients(P<0.05).For IBS-C(χ^(2)=5.438,P<0.05)but not FC,patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time.For IBS-C patients but not FC patients,the threshold of first constant sensation,desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety(r=0.414,r=0.404,and r=0.418,respectively,P<0.05).The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression(69.6%vs 41.9%,χ2=4.054,P<0.05).CONCLUSION Our findings highlight both overlapping and distinctive patterns of colon transit,dyssynergic patterns,anorectal sensation,psychological distress,and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population,providing valuable insights into the pathophysiological underpinnings of these disorders.展开更多
Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mech...Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mechanism of BZBS in the treatment of functional constipation(FC)has been little studied and remains unclear.In this study,a behavioral investigation,colon tissue morphology,enzyme-linked immunosorbent assay(Elisa)and intestinal microflora analysis have been used to illuminate the potential mechanism of the effects of BZBS on FC in a rat model.Methods:A FC rat model was constructed and BZBS was given as treatment.Observations and recordings were made of the fecal moisture content,the defecation time of the first black stool,and the rate of intestinal propulsion.Elisa was used to detect the expression levels of substance P(SP),vasoactive intestinal peptide(VIP),5-hydroxytryptamine(5-HT)in the colon.To ascertain the composition of the microbial community,a high throughput 16S ribosomal RNA(16S r RNA)gene sequencing technique was employed.Results:Oral administration of BZBS significantly ameliorated several key excretion parameters,including the time to first black stool defecation,stool water content,and the propulsion rate in the small intestine in FC rats.It increased the expression of SP,VIP and 5-HT in the colon.16S r RNA gene sequencing results showed that BZBS changed the microbial community structure,decreased the Bacteroidetes/Firmicutes ratio,increased the relative abundance of Blautia and Fusicatenibacter,and decreased the relative abundance of Ruminococcus and Roseburia.Conclusions:BZBS effectively alleviates FC and improves dysbacteriosis.展开更多
Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irr...Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irritable bowel syndrome syndrome,at least 6 months before diagnosis,and symptoms within the last 3 months.At present,commonly used drugs include enema and suppositories,laxatives,microecological preparations,gastrointestinal motility drugs and other treatments.However,the effect is limited.Traditional Chinese medicine(TCM)treatment of FC has advantages.Methods:In this randomized controlled study,244 eligible patients were randomly assigned in a 1:1 ratio to a treatment group(Zangfu ointment and massage therapy+Lactulose Oral Liquid)and a control group(Lactulose Oral Liquid)for 14 days.Number of spontaneous defecation per week and First defecation time will be used as primary outcomes,and Traditional Chinese Medicine(TCM)syndrome scores and syndrome scores,PAC-QOL form will be used as secondary outcomes.Blood routine,liver function,and renal function will be used as safety outcomes.The primary and secondary outcomes will be performed at 0th,7th,and 14th day,and the safety outcomes will be performed at 0th and 14th day.Ethics and dissemination:Ethical approval has been obtained from the Committee on Health Research Ethics of the Fangshan Hospital,Beijing University of Chinese Medicine,Beijing,People's Republic of China(FZY LK-2020-010)on September 18,2020.All patients will be provided oral and written information about the trial before screening.The study results will be disseminated by peer-review publications and conference presentations.Trial registration number:ChiCTR2000038754(registered on April 14,2021).This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited,appropriate credit is given,any changes made indicated,and the use is non-commercial.STRENGTHS AND LIMITATIONS OF THIS STUDY(1)The efficacy of the Zangfu ointment and massage therapy is evaluated in a randomised,double-blind 2-week clinical trial in FC patients.(2)Form a complete and generalizable regimen for the treatment of FC(Qi stagnation)with the Zangfu ointment and massage therapy.展开更多
Functional constipation(FC)is a chronic discasc that significantly afcts the life quality of patients.Acupuncture has been used for the treatment of FC for many years,but its effectiveness has not been scientifcally a...Functional constipation(FC)is a chronic discasc that significantly afcts the life quality of patients.Acupuncture has been used for the treatment of FC for many years,but its effectiveness has not been scientifcally assessed.The present study aimed to evaluate the efficacy of electro-acupuncture(EA)in relieving the symptoms,mental states and quality of life(QOL)of FC patients.A total of 96 FC patients were randomly allocated into EA,mosapride&sham EA group(MS)and mosapride control group(MC).In the EA group,patients were treated with 16 sessions of needling at Quchi(LI1I)and Shangjuxu(ST37)bilaterally,5 times a week in the first 2 weeks,and 3 times a.week in the last 2 weeks.In the MC group,patients were treated with 5 mg mosapride citrate three times a day for 4 weeks.In the MS group,patients underwent sham EA and the same mosapride citrate treatment as in the MC group.The primary outcome was the number of weekly spontaneous bowel movements(SBMs).The secondary outcomes included stool consistency,intensity of defecating difficulty,36-Item Short-Form Health Survey(SF-36),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),and the validated Patient Assessment of Constipation-Quality of Life(PAC-QOL).The results showed that as compared with the baseline,EA significantly improved the weekly SBMs,stool consistency and intensity of defecating difficulty(P<0.05).It also partly ameliorated the PAC-QOL,SF-36,SDS and SAS scores when compared with MC or MS group(P<0.05).However,no significant difference was observed between MS and MC groups in bowel function outcomes and QOL scores.It was concluded that EA could effectivcly improve bowel function,mental states and QOL of FC patients.展开更多
BACKGROUND Functional constipation(FC)is a common and chronic gastrointestinal disease and its treatment remains challenging.AIM To evaluate the efficacy and safety of Chinese herbal medicine(CHM)on efficacy rate,glob...BACKGROUND Functional constipation(FC)is a common and chronic gastrointestinal disease and its treatment remains challenging.AIM To evaluate the efficacy and safety of Chinese herbal medicine(CHM)on efficacy rate,global symptoms,bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials(RCTs).METHODS RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20,2020.Two independent reviewers assessed the quality of the included articles and extracted data.Meta-analyses were performed to odds ratio(OR),mean differences(MD)and 95%confidence interval(CI)using random-effects models.Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity.The funnel plot,Begg’s test and Egger’s test were used to detect publication bias.RESULTS Ninety-seven studies involving 8693 patients were included in this work.CHM was significantly associated with a higher efficacy rate(OR:3.62,95%CI:3.19-4.11,P<0.00001)less severe global symptoms(OR:4.03,95%CI:3.49-4.65,P<0.00001)compared with control treatment,with the low heterogeneity between studies(I2=0%,P=0.76).CHM was also associated with more frequent bowel movements(MD 0.83,95%CI:0.67-0.98,P<0.00001),a lower score on the Bristol Stool Scale(OR:1.63,95%CI:1.15-2.32,P<0.006),and a not significant recurrence rate(OR:0.47,95%CI:0.22-0.99,P=0.05).No serious adverse effects of CHM were reported.CONCLUSION In this meta-analysis,we found that CHM may have potential benefits in increasing the number of bowel movements,improving stool characteristics and alleviating global symptoms in FC patients.However,a firm conclusion could not be reached because of the poor quality of the included trials.Further trials with higher quality are required.展开更多
Background:We aimed to reveal the mechanism of functional constipation in the treatment of Atractylodes macrocephala Koidz.(AMK)and Paeonia lactiflora Pall.(PLP).Methods:The main active ingredients of AMK and PLP were...Background:We aimed to reveal the mechanism of functional constipation in the treatment of Atractylodes macrocephala Koidz.(AMK)and Paeonia lactiflora Pall.(PLP).Methods:The main active ingredients of AMK and PLP were screened by the Traditional Chinese Medicine Systems Pharmacology(TCMSP)platform.A database of functional constipation targets was established by GeneCard and OMIM.An“ingredient-target”network map was constructed with Cytoscape software(version 3.7.1),and molecular docking analysis was performed on the components and genes with the highest scores.The rats in the normal group were given saline,and those in the other groups were given 10 mg/kg diphenoxylate once a day for 14 days.The serum and intestinal tissue levels of adenosine monophosphate(cAMP),protein kinase A(PKA),and adenylyl cyclase(AC)of the rats and aquaporin(AQP)1,AQP3,and AQP8 were measured.Results:AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.After treatment with AMK,PLP,or mosapride,the serum and intestinal tissue levels of AC,cAMP,and PKA were significantly downregulated.Groups receiving AMK and PLP or mosapride exhibited a reduction in the level of AQP1,AQP3,and AQP8 to varying degrees.Conclusion:Molecular docking analysis revealed that AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.Studies have confirmed that AMK and PLP can also affect AC,cAMP,and PKA.AC,cAMP,and PKA in model rats were significantly downregulated.AQP expression is closely related to AC,cAMP,and PKA.AMK and PLP can reduce the expression of AQP1,AQP3,and AQP9 in the colon of constipated rats.展开更多
BACKGROUND Functional constipation(FC)is a common functional gastrointestinal disease with various clinical manifestations.It is a physical and mental disease,which seriously affects patient physical and mental health...BACKGROUND Functional constipation(FC)is a common functional gastrointestinal disease with various clinical manifestations.It is a physical and mental disease,which seriously affects patient physical and mental health and quality of life.Biofeedback therapy is the treatment of choice for FC,especially outlet obstructive constipation caused by pelvic floor dysfunction.High-quality nursing is a new nursing model in modern clinical work and a new concept of modern nursing service.AIM To explore the effect of biofeedback combined with high-quality nursing in the treatment of FC.METHODS A total of 100 patients with FC admitted to our hospital from March 2015 to July 2019 were selected for clinical observation.These patients were randomly divided into two groups of 50:Experimental group(biofeedback combined with highquality nursing treatment group)and control group(biofeedback group).RESULTS The constipation symptom score of the experimental group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).The anal canal resting pressure and initial defecation threshold of the experimental group were significantly lower than those of the control group,and the maximum squeeze systolic pressure of the anal canal of the experimental group was significantly higher than that of the control group(P<0.05).The Self-Rating Anxiety Scale and Zung’s Self-Rating Depression Scale scores of the two groups were significantly lower than before treatment.The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the experimental group were significantly lower than those of the control group(P<0.05).The patient satisfaction score of the experimental group was significantly higher than that of the control group(P<0.05).CONCLUSION The application of biofeedback combined with high-quality nursing in the treatment of FC has significant advantages over pure biofeedback treatment,and it is worthy of promotion in clinical work.展开更多
BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary&specialized care,which needs proper evaluation&management.Presentation of constipation is variable...BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary&specialized care,which needs proper evaluation&management.Presentation of constipation is variable among children.In Bangladesh there has been no published data regarding constipation in community among school aged children.AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division,Bangladesh.All school aged children between 5-16 years of age who attended school were included in this study.Samples were collected randomly.Proper clinical history&physical examinations(without digital rectal examination)&available investigations(if done previously)were recorded.Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation.Children with any red flag sign,known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded.Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20.For all statistical tests,P value of less than 0.05 was considered as statistically significant.RESULTS Total study populations were 707 and male was 443 and female 264.Among them,134(19%)children had constipation.In constipated children,78 children fulfilled the Rome IV criteria for functional constipation and it was 11%of total population.Mean age of children having functional constipation was 11.24±3.54 years and Male female ratio was 1:1.78.Anorexia,nausea,abdominal pain,hard stool,blood with hard stool,alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group.Children of school,where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number(OR=2.493,95%CI:1.214-5.120).Children who feel embarrassed to use toilet at school,had 3.6 times higher risk of constipation(OR=3.552,95%CI:1.435-8.794).Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs(OR=3.977,95%CI:1.884–8.397)and parents/grandparents(OR=2.569,95%CI:1.172-5.629).Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake(OR=1.972,95%CI:1.135-3.426).Children who passed electronic screen time of>2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time<2 h(OR=2.138,95%CI:1.063-4.301).CONCLUSION Constipation is not uncommon in Bangladeshi school aged children.Inadequate toilet number,family history of constipation,inadequate fluid intake,feeling embarrassed to use toilet at school,and electronic screen time for>2 h/d were found as risk factors in the present study for functional constipation.展开更多
BACKGROUND The intestinal mucosal barrier is the first line of defense against numerous harmful substances,and it contributes to the maintenance of intestinal homeostasis.Recent studies reported that structural and fu...BACKGROUND The intestinal mucosal barrier is the first line of defense against numerous harmful substances,and it contributes to the maintenance of intestinal homeostasis.Recent studies reported that structural and functional changes in the intestinal mucosal barrier were involved in the pathogenesis of several intestinal diseases.However,no study thoroughly evaluated this barrier in patients with functional constipation(FC).AIM To investigate the intestinal mucosal barrier in FC,including the mucus barrier,intercellular junctions,mucosal immunity and gut permeability.METHODS Forty FC patients who fulfilled the Rome IV criteria and 24 healthy controls were recruited in the Department of Gastroenterology of China-Japan Friendship Hospital.The colonic mucus barrier,intercellular junctions in the colonic epithelium,mucosal immune state and gut permeability in FC patients were comprehensively examined.Goblet cells were stained with Alcian Blue/Periodic acid Schiff(AB/PAS)and counted.The ultrastructure of intercellular junctional complexes was observed under an electron microscope.Occludin and zonula occludens-1(ZO-1)in the colonic mucosa were located and quantified using immunohistochemistry and quantitative real-time polymerase chain reaction.Colonic CD3+intraepithelial lymphocytes(IELs)and CD3+lymphocytes in the lamina propria were identified and counted using immunofluorescence.The serum levels of D-lactic acid and zonulin were detected using enzyme-linked immunosorbent assay.RESULTS Compared to healthy controls,the staining of mucus secreted by goblet cells was darker in FC patients,and the number of goblet cells per upper crypt in the colonic mucosa was significantly increased in FC patients(control,18.67±2.99;FC,22.42±4.09;P=0.001).The intercellular junctional complexes in the colonic epithelium were integral in FC patients.The distribution of mucosal occludin and ZO-1 was not altered in FC patients.No significant differences were found in occludin(control,5.76E-2±1.62E-2;FC,5.17E-2±1.80E-2;P=0.240)and ZO-1(control,2.29E-2±0.93E-2;FC,2.68E-2±1.60E-2;P=0.333)protein expression between the two groups.The mRNA levels in occludin and ZO-1 were not modified in FC patients compared to healthy controls(P=0.145,P=0.451,respectively).No significant differences were observed in the number of CD3+IELs per 100 epithelial cells(control,5.62±2.06;FC,4.50±2.16;P=0.070)and CD3+lamina propria lymphocytes(control,19.69±6.04/mm^(2);FC,22.70±11.38/mm^(2);P=0.273).There were no significant differences in serum D-lactic acid[control,5.21(4.46,5.49)mmol/L;FC,4.63(4.31,5.42)mmol/L;P=0.112]or zonulin[control,1.36(0.53,2.15)ng/mL;FC,0.94(0.47,1.56)ng/mL;P=0.185]levels between FC patients and healthy controls.CONCLUSION The intestinal mucosal barrier in FC patients exhibits a compensatory increase in goblet cells and integral intercellular junctions without activation of mucosal immunity or increased gut permeability.展开更多
Objective: To analyze the prescription rule of acupuncture for functional constipation (FC), and explore the effective core clinical acupuncture prescriptions. Methods:The randomized controlled trials published in the...Objective: To analyze the prescription rule of acupuncture for functional constipation (FC), and explore the effective core clinical acupuncture prescriptions. Methods:The randomized controlled trials published in the PubMed, CNKI, Wanfang, and VIP databases were retrieved from January 1, 2010 to January 31, 2020. And the key information about acupuncture therapy for FC in these RCTs was collected according to the predetermined inclusion and exclusion criteria. Eventually, the statisticians analyzed the use frequency of single acupoints and meridian acupoints by descriptive statistical method and explored the combination rule between different acupoints by association rules. Results: Twenty six randomized controlled trials were included, with a total of 29 acupoints. Tianshu (ST25), Shangjuxu (ST37) and Zhongwan (RN12) were the top 3 frequency of acupuncture therapy for FC and the top 3 frequency meridian had been chosen were the stomach meridian of Foot-Yangming, the spleen meridian of Foot-Taiyin and Ren channel. The two acupoints with high support and compatibility frequency ranking in the top 3 are Tianshu (ST25) - Shangjuxu (ST37), Tianshu (ST25) - Zhongwan (RN12), Tianshu (ST25) - Zusanli (ST36). The three acupoints with compatibility frequency ranking in the top 2 are Tianshu (ST25) - Shangjuxu (ST37) - Zusanli (ST36), and Tianshu (ST25) - Shangjuxu (ST37) - Zhigou (SJ6). Conclusion: Tianshu (ST25) is the most common acupoint for acupuncture therapy of FC. Tianshu (ST25) and Shangjuxu (ST37) are the core acupoints to provide basis for clinical practice and future clinical research.展开更多
Objective:To explore the molecular mechanism of buzhong yiqi decoction in the treatment of senile functional constipation based on network pharmacology.Methods:Chemical compositions and selected targets related to the...Objective:To explore the molecular mechanism of buzhong yiqi decoction in the treatment of senile functional constipation based on network pharmacology.Methods:Chemical compositions and selected targets related to the eight traditional Chinese medicine herbs were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).Through GeneCards database and OMIM database,disease targets of senile functional constipation were searched.R language was used to screen the common targets between drugs and disease,and then the interaction network diagram of the targets was constructed by String.Cytoscape3.7.0 was applied to construct the traditional Chinese medicines-chemical compositions-disease targets network.GO enrichment analysis and KEGG enrichment analysis of the targets were based on DAVID.Results:Five main chemical compositions including quercetin,kaempferol,nobiletin,naringenin and formononetin were screened,and five key targets including PTGS2,ESR1,AR,NOS2 and PPARG were identified.622 GO functional entries and 125 pathways were yielded by gene enrichment analysis.Conclusion:Buzhong yiqi decoction may play the role of anti-inflammatory and anti-oxidation through multi-component,multi-target and multi-channel,so as to improve senile functional constipation.展开更多
Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In rec...Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In recent years,with the change of diet structure,accelerated pace of life and the influence of socio-psychological factors,the incidence rate has increased year by year,seriously affecting the quality of life of patients.Professor Yao Shukun has remarkable clinical effect and experience in the treatment of intractable functional constipation.Professor Yao believes that,combined with the changes of people's diet structure,life style and physique,the main TCM syndrome type of clinical stubborn functional constipation is dampness-heat and blood stasis,and the main treatment should be clearing heat and resolving dampness,regulating qi and removing blood stasis;and we should pay attention to the application of the idea of"Simultaneous Treatment of Medicine and Food"in the process of diagnosis and treatment,and educate patients to change their diet structure in order to fundamentally dispel the etiology.展开更多
Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve consti...Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve constipation-related symptoms and rebalance the gut microbiota.However,it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs.Therefore,we assessed the effects of EA in FC mice and pseudo-germfree(PGF)mice to address these questions.Methods:Forty female Kunming mice were randomly separated into a normal control group(n=8),an FC group(n=8),an FC+EA group(n=8),a PGF group(n=8)and a PGF+EA group(n=8).The FC group and FC+EA group were treated with diphenoxylate to establish the FC model;the PGF group and PGF+EA group were given an antibiotic cocktail to initiate the PGF model.After maintaining the model for 14 d,mice in the FC+EA and PGF+EA groups received EA stimulation at the ST25 and ST37 acupoints,once a day,5 times per week,for 2 weeks.Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility.Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing,and measure SCFA concentrations using gas chromatography-mass spectrometry.Results:EA significantly shortened the first black stool defecation time(P<0.05)and increased the intestinal transit rate(P<0.01),and fecal pellet number(P<0.05),wet weight(P<0.05)and water content(P<0.01)over 8 h,compared with the FC group,showing that EA promoted gut motility and alleviated constipation.However,EA treatment did not reverse slow-transit colonic motility in PGF mice(P>0.05),demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation.In addition,EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice(P<0.05),most likely due to the upregulation of Staphylococcaceae microorganisms(P<0.01).Conclusion:EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.展开更多
Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines bot...Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches.This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.Methods:A systematic search of the PubMed,Cochrane Library,and China National Knowledge Infrastructure databases was performed from their inception to June 30th,2022,collecting the current evidence about the efficacious integrative management for FC.We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.Results:We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts.This pathway includes a hierarchy of recommendations for every step of the clinical process,including clinical intake,diagnostic examination,recommended labs,diagnostic flowchart,and guidance for selection of therapeutic drugs.Conclusion:This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine;it will help to provide high-quality medical services in Hong Kong for patients with FC.展开更多
Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Num...Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.展开更多
Functional constipation (FC) is a common condition in the clinics.It is often recurrent and frequently has drug resistance and drug addiction.Its therapeutic costs are high as well. Therefore,the quality
To systematically assess the effectiveness and safety of using acupuncture with traditional Chinese medicine for functional constipation so as to provide the evidence-based data for clinical practice.Wanfang databases...To systematically assess the effectiveness and safety of using acupuncture with traditional Chinese medicine for functional constipation so as to provide the evidence-based data for clinical practice.Wanfang databases,CBM,VIP,CNKI,PubMed,Cochrane Library and EMbase were searched for trials based on randomization and control for use of acupuncture in combination with CHM for functional constipation published from the inception of the database to Dec.2019.We used the risk of bias of Cochrane Collaboration for literature quality assessment,extracted trial data in duplicate,and then assessed the risk of bias.The data were discussed by adopting Review Manager 5.3 program.A total of 22 RCTs with 2574 cases were retrieved.Meta-analysis showed that acupuncture with CHM could improve the clinical effectiveness(OR6.10,95%CI 4.72–7.87,P<0.00001);heterogeneity was not identified(Chi^(2)=32.84,P=0.43,I^(2)=2%),and the difference was statistically significant.Second-level outcomes(e.g.,defecation interval time(P<0.00001),Bristol Stool Scale(P=0.002),defecation difficulty(P=0.01)and accompanying symptoms(P<0.00001))in the treatment groups were significantly different after the acupuncture with CHM compared with control groups,whereas defecation symptoms were not significantly different(P=0.06).The use of acupuncture with CHM can significantly improve the clinical efficacy of functional constipation,ameliorate Bristol Stool Scale,defecation difficulty,defecation symptoms,and accompanying symptoms,as well as shorten the defecation interval time,with better safety.展开更多
Background Fecal microbiota transplantation(FMT)has been well described in the treatment of pediatric diseases;however,the latest updates regarding its use in children are unclear and the concepts involved need to be ...Background Fecal microbiota transplantation(FMT)has been well described in the treatment of pediatric diseases;however,the latest updates regarding its use in children are unclear and the concepts involved need to be revisited.Data sources We performed advanced searches in the MEDLINE,EMBASE,and Cochrane databases using the keywords“Fecal microbiota transplantation OR Fecal microbiota transfer”in the[Title/Abstract]to identify relevant articles published in English within the last five years.To identify additional studies,reference lists of review articles and included studies were manually searched.Retrieved manuscripts(case reports,reviews,and abstracts)were assessed by the authors.Results Among the articles,studies were based on the mechanism(n=28),sample preparation(n=9),delivery approaches(n=23),safety(n=26),and indications(n=67),including Clostridium difficile infection(CDI)and recurrent C.difficile infection(rCDI;n=21),non-alcoholic fatty liver disease(NAFLD;n=10),irritable bowel syndrome(IBS;n=5),inflammatory bowel disease(IBD;n=15),diabetes(n=5),functional constipation(FC;n=4),and autism spectrum disorder(ASD;n=7).Conclusions Concepts of FMT in pediatric diseases have been updated with respect to underlying mechanisms,methodology,indications,and safety.Evidence-based clinical trials for the use of FMT in pediatric diseases should be introduced to resolve the challenges of dosage,duration,initiation,and the end point of treatment.展开更多
OBJECTIVE:To analyze the Doppler ultrasound blood flow of Renying(carotid artery)pulse,Cunkou(radial artery)pulse,and Fuyang(anterior tibial artery)pulse in the normal group and the functional constipation with gastro...OBJECTIVE:To analyze the Doppler ultrasound blood flow of Renying(carotid artery)pulse,Cunkou(radial artery)pulse,and Fuyang(anterior tibial artery)pulse in the normal group and the functional constipation with gastrointestinal heat(FCGH)group,and to compare and explore the differences of Renying,Cunkou and Fuyang pulses.METHODS:Sixty normal subjects and 60 patients with gastrointestinal heat constipation were collected in the department of ultrasound,Beijing Anzhen Hospital,Capital Medical University.Doppler ultrasound was used to observe the blood flow indexes including maximum systolic velocity(Vp),maximum diastolic velocity(Vd),mean velocity(Vm),pulse index(PI),resistance index(RI),vascular diameter(D),and circulation blood flow cycle(ET)of Renying pulse,Cunkou pulse and Fuyang pulse in the normal group and patients with gastrointestinal heat constipation.The differences of these three pulses were compared between the normal group and the FCGH group.RESULTS:The PI,Vp,Vm,RI,and D of the three pulses in the normal group were statistically significant different(P<0.01).In the comparison of Doppler flow diagram of three pulses in the FCGH group,there were significant differences in PI,Vd,Vp,Vm,RI,and D(P<0.01).CONCLUSION:Under normal conditions,the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are significantly different.In the FCGH group,most of the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are different.This result verified the necessity of simultaneous examinations of all Renying,Cunkou,and Fuyang pulses in modern Chinese medicine.展开更多
基金the External Science and Technology Cooperation Planning Projects of Anhui Province of China,No.1604b060202.
文摘BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on Western populations,with limited data originating from China.AIM To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.METHODS Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled.FC and IBS-C diagnoses were established using ROME IV criteria,and patients underwent high-resolution anorectal manometry(ARM)and a colonic transmit test using the Sitz marker study.Constipation-related symptoms were obtained through questionnaires.Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21.The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.RESULTS No significant differences in sex,age or abdominal discomfort symptoms were observed between IBS-C and FC patients(all P>0.05).The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC(36.63%vs 15.91%,P<0.05),while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group(50%vs 26.73%,P<0.05).Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM.IBS-C patients were found to have a higher prevalence of depression than FC patients(66.30%vs 42.42%,P<0.05).The scores for feelings of guilt,suicide,psychomotor agitation,diurnal variation,obsessive/compulsive disorder,hopelessness,self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients(P<0.05).For IBS-C(χ^(2)=5.438,P<0.05)but not FC,patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time.For IBS-C patients but not FC patients,the threshold of first constant sensation,desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety(r=0.414,r=0.404,and r=0.418,respectively,P<0.05).The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression(69.6%vs 41.9%,χ2=4.054,P<0.05).CONCLUSION Our findings highlight both overlapping and distinctive patterns of colon transit,dyssynergic patterns,anorectal sensation,psychological distress,and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population,providing valuable insights into the pathophysiological underpinnings of these disorders.
基金Natural Science Foundation of Zhejiang Province,Grant/Award Number:Y19H280022。
文摘Background:In China,Rhizoma atractylodis macrocephalae-Paeonia lactiflora Pall(Biazhu-Baishao,BZBS)is a classic herb pair used to treat intestinal stress syndrome,ulcerative colitis and other diseases.However,the mechanism of BZBS in the treatment of functional constipation(FC)has been little studied and remains unclear.In this study,a behavioral investigation,colon tissue morphology,enzyme-linked immunosorbent assay(Elisa)and intestinal microflora analysis have been used to illuminate the potential mechanism of the effects of BZBS on FC in a rat model.Methods:A FC rat model was constructed and BZBS was given as treatment.Observations and recordings were made of the fecal moisture content,the defecation time of the first black stool,and the rate of intestinal propulsion.Elisa was used to detect the expression levels of substance P(SP),vasoactive intestinal peptide(VIP),5-hydroxytryptamine(5-HT)in the colon.To ascertain the composition of the microbial community,a high throughput 16S ribosomal RNA(16S r RNA)gene sequencing technique was employed.Results:Oral administration of BZBS significantly ameliorated several key excretion parameters,including the time to first black stool defecation,stool water content,and the propulsion rate in the small intestine in FC rats.It increased the expression of SP,VIP and 5-HT in the colon.16S r RNA gene sequencing results showed that BZBS changed the microbial community structure,decreased the Bacteroidetes/Firmicutes ratio,increased the relative abundance of Blautia and Fusicatenibacter,and decreased the relative abundance of Ruminococcus and Roseburia.Conclusions:BZBS effectively alleviates FC and improves dysbacteriosis.
基金This work was supported by Beijing TCM science and Technology Development Fund Project(No.JJ-2020-43)The sixth batch of Beijing TCM master-apprentice work project+2 种基金Cheng Hongjie famous doctor inheritance studio,Fangshan hospital,Beijing University of Chinese Medicine1234 talent project of Fangshan Hospital,Beijing University of Chinese MedicineNew Teachers Launch Fund Project,Fangshan hospital,Beijing University of Chinese Medicine.(No.2021-BUCMXJKY044).
文摘Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irritable bowel syndrome syndrome,at least 6 months before diagnosis,and symptoms within the last 3 months.At present,commonly used drugs include enema and suppositories,laxatives,microecological preparations,gastrointestinal motility drugs and other treatments.However,the effect is limited.Traditional Chinese medicine(TCM)treatment of FC has advantages.Methods:In this randomized controlled study,244 eligible patients were randomly assigned in a 1:1 ratio to a treatment group(Zangfu ointment and massage therapy+Lactulose Oral Liquid)and a control group(Lactulose Oral Liquid)for 14 days.Number of spontaneous defecation per week and First defecation time will be used as primary outcomes,and Traditional Chinese Medicine(TCM)syndrome scores and syndrome scores,PAC-QOL form will be used as secondary outcomes.Blood routine,liver function,and renal function will be used as safety outcomes.The primary and secondary outcomes will be performed at 0th,7th,and 14th day,and the safety outcomes will be performed at 0th and 14th day.Ethics and dissemination:Ethical approval has been obtained from the Committee on Health Research Ethics of the Fangshan Hospital,Beijing University of Chinese Medicine,Beijing,People's Republic of China(FZY LK-2020-010)on September 18,2020.All patients will be provided oral and written information about the trial before screening.The study results will be disseminated by peer-review publications and conference presentations.Trial registration number:ChiCTR2000038754(registered on April 14,2021).This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited,appropriate credit is given,any changes made indicated,and the use is non-commercial.STRENGTHS AND LIMITATIONS OF THIS STUDY(1)The efficacy of the Zangfu ointment and massage therapy is evaluated in a randomised,double-blind 2-week clinical trial in FC patients.(2)Form a complete and generalizable regimen for the treatment of FC(Qi stagnation)with the Zangfu ointment and massage therapy.
基金This study was supported by grants from the National Basic Research Program(No.2011CB505203)the National Natural Science Foundation of China(No.81603652,No.81874388).
文摘Functional constipation(FC)is a chronic discasc that significantly afcts the life quality of patients.Acupuncture has been used for the treatment of FC for many years,but its effectiveness has not been scientifcally assessed.The present study aimed to evaluate the efficacy of electro-acupuncture(EA)in relieving the symptoms,mental states and quality of life(QOL)of FC patients.A total of 96 FC patients were randomly allocated into EA,mosapride&sham EA group(MS)and mosapride control group(MC).In the EA group,patients were treated with 16 sessions of needling at Quchi(LI1I)and Shangjuxu(ST37)bilaterally,5 times a week in the first 2 weeks,and 3 times a.week in the last 2 weeks.In the MC group,patients were treated with 5 mg mosapride citrate three times a day for 4 weeks.In the MS group,patients underwent sham EA and the same mosapride citrate treatment as in the MC group.The primary outcome was the number of weekly spontaneous bowel movements(SBMs).The secondary outcomes included stool consistency,intensity of defecating difficulty,36-Item Short-Form Health Survey(SF-36),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),and the validated Patient Assessment of Constipation-Quality of Life(PAC-QOL).The results showed that as compared with the baseline,EA significantly improved the weekly SBMs,stool consistency and intensity of defecating difficulty(P<0.05).It also partly ameliorated the PAC-QOL,SF-36,SDS and SAS scores when compared with MC or MS group(P<0.05).However,no significant difference was observed between MS and MC groups in bowel function outcomes and QOL scores.It was concluded that EA could effectivcly improve bowel function,mental states and QOL of FC patients.
基金Supported by the Hong Kong Chinese Medicine Development Fund(19B2/057A).
文摘BACKGROUND Functional constipation(FC)is a common and chronic gastrointestinal disease and its treatment remains challenging.AIM To evaluate the efficacy and safety of Chinese herbal medicine(CHM)on efficacy rate,global symptoms,bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials(RCTs).METHODS RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20,2020.Two independent reviewers assessed the quality of the included articles and extracted data.Meta-analyses were performed to odds ratio(OR),mean differences(MD)and 95%confidence interval(CI)using random-effects models.Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity.The funnel plot,Begg’s test and Egger’s test were used to detect publication bias.RESULTS Ninety-seven studies involving 8693 patients were included in this work.CHM was significantly associated with a higher efficacy rate(OR:3.62,95%CI:3.19-4.11,P<0.00001)less severe global symptoms(OR:4.03,95%CI:3.49-4.65,P<0.00001)compared with control treatment,with the low heterogeneity between studies(I2=0%,P=0.76).CHM was also associated with more frequent bowel movements(MD 0.83,95%CI:0.67-0.98,P<0.00001),a lower score on the Bristol Stool Scale(OR:1.63,95%CI:1.15-2.32,P<0.006),and a not significant recurrence rate(OR:0.47,95%CI:0.22-0.99,P=0.05).No serious adverse effects of CHM were reported.CONCLUSION In this meta-analysis,we found that CHM may have potential benefits in increasing the number of bowel movements,improving stool characteristics and alleviating global symptoms in FC patients.However,a firm conclusion could not be reached because of the poor quality of the included trials.Further trials with higher quality are required.
基金supported by the Project of Zhejiang Natural Science Foundation(LY19H280004)the Exploration Project of Zhejiang Natural Science Foundation(LQ21H270002)。
文摘Background:We aimed to reveal the mechanism of functional constipation in the treatment of Atractylodes macrocephala Koidz.(AMK)and Paeonia lactiflora Pall.(PLP).Methods:The main active ingredients of AMK and PLP were screened by the Traditional Chinese Medicine Systems Pharmacology(TCMSP)platform.A database of functional constipation targets was established by GeneCard and OMIM.An“ingredient-target”network map was constructed with Cytoscape software(version 3.7.1),and molecular docking analysis was performed on the components and genes with the highest scores.The rats in the normal group were given saline,and those in the other groups were given 10 mg/kg diphenoxylate once a day for 14 days.The serum and intestinal tissue levels of adenosine monophosphate(cAMP),protein kinase A(PKA),and adenylyl cyclase(AC)of the rats and aquaporin(AQP)1,AQP3,and AQP8 were measured.Results:AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.After treatment with AMK,PLP,or mosapride,the serum and intestinal tissue levels of AC,cAMP,and PKA were significantly downregulated.Groups receiving AMK and PLP or mosapride exhibited a reduction in the level of AQP1,AQP3,and AQP8 to varying degrees.Conclusion:Molecular docking analysis revealed that AMK and PLP had a significant role in the regulation of targets in the treatment of functional constipation.Studies have confirmed that AMK and PLP can also affect AC,cAMP,and PKA.AC,cAMP,and PKA in model rats were significantly downregulated.AQP expression is closely related to AC,cAMP,and PKA.AMK and PLP can reduce the expression of AQP1,AQP3,and AQP9 in the colon of constipated rats.
文摘BACKGROUND Functional constipation(FC)is a common functional gastrointestinal disease with various clinical manifestations.It is a physical and mental disease,which seriously affects patient physical and mental health and quality of life.Biofeedback therapy is the treatment of choice for FC,especially outlet obstructive constipation caused by pelvic floor dysfunction.High-quality nursing is a new nursing model in modern clinical work and a new concept of modern nursing service.AIM To explore the effect of biofeedback combined with high-quality nursing in the treatment of FC.METHODS A total of 100 patients with FC admitted to our hospital from March 2015 to July 2019 were selected for clinical observation.These patients were randomly divided into two groups of 50:Experimental group(biofeedback combined with highquality nursing treatment group)and control group(biofeedback group).RESULTS The constipation symptom score of the experimental group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).The anal canal resting pressure and initial defecation threshold of the experimental group were significantly lower than those of the control group,and the maximum squeeze systolic pressure of the anal canal of the experimental group was significantly higher than that of the control group(P<0.05).The Self-Rating Anxiety Scale and Zung’s Self-Rating Depression Scale scores of the two groups were significantly lower than before treatment.The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the experimental group were significantly lower than those of the control group(P<0.05).The patient satisfaction score of the experimental group was significantly higher than that of the control group(P<0.05).CONCLUSION The application of biofeedback combined with high-quality nursing in the treatment of FC has significant advantages over pure biofeedback treatment,and it is worthy of promotion in clinical work.
文摘BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary&specialized care,which needs proper evaluation&management.Presentation of constipation is variable among children.In Bangladesh there has been no published data regarding constipation in community among school aged children.AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division,Bangladesh.All school aged children between 5-16 years of age who attended school were included in this study.Samples were collected randomly.Proper clinical history&physical examinations(without digital rectal examination)&available investigations(if done previously)were recorded.Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation.Children with any red flag sign,known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded.Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20.For all statistical tests,P value of less than 0.05 was considered as statistically significant.RESULTS Total study populations were 707 and male was 443 and female 264.Among them,134(19%)children had constipation.In constipated children,78 children fulfilled the Rome IV criteria for functional constipation and it was 11%of total population.Mean age of children having functional constipation was 11.24±3.54 years and Male female ratio was 1:1.78.Anorexia,nausea,abdominal pain,hard stool,blood with hard stool,alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group.Children of school,where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number(OR=2.493,95%CI:1.214-5.120).Children who feel embarrassed to use toilet at school,had 3.6 times higher risk of constipation(OR=3.552,95%CI:1.435-8.794).Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs(OR=3.977,95%CI:1.884–8.397)and parents/grandparents(OR=2.569,95%CI:1.172-5.629).Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake(OR=1.972,95%CI:1.135-3.426).Children who passed electronic screen time of>2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time<2 h(OR=2.138,95%CI:1.063-4.301).CONCLUSION Constipation is not uncommon in Bangladeshi school aged children.Inadequate toilet number,family history of constipation,inadequate fluid intake,feeling embarrassed to use toilet at school,and electronic screen time for>2 h/d were found as risk factors in the present study for functional constipation.
基金the National Key Technology Support Program during“12th Five-Year Plan”Period of China,No.2014BAI08B00the Project“The role of the gut microbiota and metabolites in the pathogenesis of diarrheapredominant irritable bowel syndrome”of China-Japan Friendship Hospital,No.2019-64-K44.
文摘BACKGROUND The intestinal mucosal barrier is the first line of defense against numerous harmful substances,and it contributes to the maintenance of intestinal homeostasis.Recent studies reported that structural and functional changes in the intestinal mucosal barrier were involved in the pathogenesis of several intestinal diseases.However,no study thoroughly evaluated this barrier in patients with functional constipation(FC).AIM To investigate the intestinal mucosal barrier in FC,including the mucus barrier,intercellular junctions,mucosal immunity and gut permeability.METHODS Forty FC patients who fulfilled the Rome IV criteria and 24 healthy controls were recruited in the Department of Gastroenterology of China-Japan Friendship Hospital.The colonic mucus barrier,intercellular junctions in the colonic epithelium,mucosal immune state and gut permeability in FC patients were comprehensively examined.Goblet cells were stained with Alcian Blue/Periodic acid Schiff(AB/PAS)and counted.The ultrastructure of intercellular junctional complexes was observed under an electron microscope.Occludin and zonula occludens-1(ZO-1)in the colonic mucosa were located and quantified using immunohistochemistry and quantitative real-time polymerase chain reaction.Colonic CD3+intraepithelial lymphocytes(IELs)and CD3+lymphocytes in the lamina propria were identified and counted using immunofluorescence.The serum levels of D-lactic acid and zonulin were detected using enzyme-linked immunosorbent assay.RESULTS Compared to healthy controls,the staining of mucus secreted by goblet cells was darker in FC patients,and the number of goblet cells per upper crypt in the colonic mucosa was significantly increased in FC patients(control,18.67±2.99;FC,22.42±4.09;P=0.001).The intercellular junctional complexes in the colonic epithelium were integral in FC patients.The distribution of mucosal occludin and ZO-1 was not altered in FC patients.No significant differences were found in occludin(control,5.76E-2±1.62E-2;FC,5.17E-2±1.80E-2;P=0.240)and ZO-1(control,2.29E-2±0.93E-2;FC,2.68E-2±1.60E-2;P=0.333)protein expression between the two groups.The mRNA levels in occludin and ZO-1 were not modified in FC patients compared to healthy controls(P=0.145,P=0.451,respectively).No significant differences were observed in the number of CD3+IELs per 100 epithelial cells(control,5.62±2.06;FC,4.50±2.16;P=0.070)and CD3+lamina propria lymphocytes(control,19.69±6.04/mm^(2);FC,22.70±11.38/mm^(2);P=0.273).There were no significant differences in serum D-lactic acid[control,5.21(4.46,5.49)mmol/L;FC,4.63(4.31,5.42)mmol/L;P=0.112]or zonulin[control,1.36(0.53,2.15)ng/mL;FC,0.94(0.47,1.56)ng/mL;P=0.185]levels between FC patients and healthy controls.CONCLUSION The intestinal mucosal barrier in FC patients exhibits a compensatory increase in goblet cells and integral intercellular junctions without activation of mucosal immunity or increased gut permeability.
基金This study was supported by Beijing Municipal Science&Technology Commission(No.BZ0374)Beijing Administration of Traditional Chinese Medicine(No.JJ2018-70)
文摘Objective: To analyze the prescription rule of acupuncture for functional constipation (FC), and explore the effective core clinical acupuncture prescriptions. Methods:The randomized controlled trials published in the PubMed, CNKI, Wanfang, and VIP databases were retrieved from January 1, 2010 to January 31, 2020. And the key information about acupuncture therapy for FC in these RCTs was collected according to the predetermined inclusion and exclusion criteria. Eventually, the statisticians analyzed the use frequency of single acupoints and meridian acupoints by descriptive statistical method and explored the combination rule between different acupoints by association rules. Results: Twenty six randomized controlled trials were included, with a total of 29 acupoints. Tianshu (ST25), Shangjuxu (ST37) and Zhongwan (RN12) were the top 3 frequency of acupuncture therapy for FC and the top 3 frequency meridian had been chosen were the stomach meridian of Foot-Yangming, the spleen meridian of Foot-Taiyin and Ren channel. The two acupoints with high support and compatibility frequency ranking in the top 3 are Tianshu (ST25) - Shangjuxu (ST37), Tianshu (ST25) - Zhongwan (RN12), Tianshu (ST25) - Zusanli (ST36). The three acupoints with compatibility frequency ranking in the top 2 are Tianshu (ST25) - Shangjuxu (ST37) - Zusanli (ST36), and Tianshu (ST25) - Shangjuxu (ST37) - Zhigou (SJ6). Conclusion: Tianshu (ST25) is the most common acupoint for acupuncture therapy of FC. Tianshu (ST25) and Shangjuxu (ST37) are the core acupoints to provide basis for clinical practice and future clinical research.
基金Construction project of studio for reputed physicians of TCM of 13th Five-years planning in Nanjing(No.ZXP-2019-NJ)Scientific research project of health care for cadres of Jiangsu province in 2018(No.BJ18001)
文摘Objective:To explore the molecular mechanism of buzhong yiqi decoction in the treatment of senile functional constipation based on network pharmacology.Methods:Chemical compositions and selected targets related to the eight traditional Chinese medicine herbs were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).Through GeneCards database and OMIM database,disease targets of senile functional constipation were searched.R language was used to screen the common targets between drugs and disease,and then the interaction network diagram of the targets was constructed by String.Cytoscape3.7.0 was applied to construct the traditional Chinese medicines-chemical compositions-disease targets network.GO enrichment analysis and KEGG enrichment analysis of the targets were based on DAVID.Results:Five main chemical compositions including quercetin,kaempferol,nobiletin,naringenin and formononetin were screened,and five key targets including PTGS2,ESR1,AR,NOS2 and PPARG were identified.622 GO functional entries and 125 pathways were yielded by gene enrichment analysis.Conclusion:Buzhong yiqi decoction may play the role of anti-inflammatory and anti-oxidation through multi-component,multi-target and multi-channel,so as to improve senile functional constipation.
基金Evaluation and promotion of appropriate technology for the prevention and treatment of common frequently occurring diseases at grassroots level(No.2014BA108B00)。
文摘Intractable functional constipation is a type of constipation which is difficult to cure,which is usually characterized by persistent constipation,dependence on laxative and/or ineffective treatment of laxative.In recent years,with the change of diet structure,accelerated pace of life and the influence of socio-psychological factors,the incidence rate has increased year by year,seriously affecting the quality of life of patients.Professor Yao Shukun has remarkable clinical effect and experience in the treatment of intractable functional constipation.Professor Yao believes that,combined with the changes of people's diet structure,life style and physique,the main TCM syndrome type of clinical stubborn functional constipation is dampness-heat and blood stasis,and the main treatment should be clearing heat and resolving dampness,regulating qi and removing blood stasis;and we should pay attention to the application of the idea of"Simultaneous Treatment of Medicine and Food"in the process of diagnosis and treatment,and educate patients to change their diet structure in order to fundamentally dispel the etiology.
基金National Natural Science Foundationof China(grant number:82074554,82205270 and 81774430)Chengdu University of Traditional Chinese Medicine Xinglin Scholars Program(grant number:YXRC2018007).
文摘Objective:Abnormalities in the gut microbiota and intestinal short-chain fatty acid(SCFA)levels are implicated in the pathogenesis of functional constipation(FC).Electro-acupuncture(EA)has been shown to improve constipation-related symptoms and rebalance the gut microbiota.However,it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs.Therefore,we assessed the effects of EA in FC mice and pseudo-germfree(PGF)mice to address these questions.Methods:Forty female Kunming mice were randomly separated into a normal control group(n=8),an FC group(n=8),an FC+EA group(n=8),a PGF group(n=8)and a PGF+EA group(n=8).The FC group and FC+EA group were treated with diphenoxylate to establish the FC model;the PGF group and PGF+EA group were given an antibiotic cocktail to initiate the PGF model.After maintaining the model for 14 d,mice in the FC+EA and PGF+EA groups received EA stimulation at the ST25 and ST37 acupoints,once a day,5 times per week,for 2 weeks.Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility.Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing,and measure SCFA concentrations using gas chromatography-mass spectrometry.Results:EA significantly shortened the first black stool defecation time(P<0.05)and increased the intestinal transit rate(P<0.01),and fecal pellet number(P<0.05),wet weight(P<0.05)and water content(P<0.01)over 8 h,compared with the FC group,showing that EA promoted gut motility and alleviated constipation.However,EA treatment did not reverse slow-transit colonic motility in PGF mice(P>0.05),demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation.In addition,EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice(P<0.05),most likely due to the upregulation of Staphylococcaceae microorganisms(P<0.01).Conclusion:EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.
基金supported by the Strategic Development Fund of Hong Kong Baptist University (Ref No.20–0318-P01)Chinese Medicine Development Fund (No.19B2/057A)
文摘Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches.This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.Methods:A systematic search of the PubMed,Cochrane Library,and China National Knowledge Infrastructure databases was performed from their inception to June 30th,2022,collecting the current evidence about the efficacious integrative management for FC.We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.Results:We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts.This pathway includes a hierarchy of recommendations for every step of the clinical process,including clinical intake,diagnostic examination,recommended labs,diagnostic flowchart,and guidance for selection of therapeutic drugs.Conclusion:This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine;it will help to provide high-quality medical services in Hong Kong for patients with FC.
基金supported by grants from the National Natural Science Foundation of China(No.8207455481774430)the Foundation of the Science and Technology Department of Sichuan Province,China(No.2021YJ0197)。
文摘Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.
文摘Functional constipation (FC) is a common condition in the clinics.It is often recurrent and frequently has drug resistance and drug addiction.Its therapeutic costs are high as well. Therefore,the quality
基金the National Natural Science Foundation of CN(81673795,81503536)the Natural Science Foundation of Jiangsu Province(grant no.BK20181235)+4 种基金The Medical Research Project of Jiangsu Provincial Health Commission(M2022024)Natural Science Foundation of Nanjing University of Traditional Chinese Medicine(grant no.XZR2020084)Open Project of Jiangsu Key Laboratory of Major Neuropsychiatric Diseases Research(grant no.KL20211211)the project of Jiangsu Provincial Administration of TCM(grant no.YB2017066)A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)。
文摘To systematically assess the effectiveness and safety of using acupuncture with traditional Chinese medicine for functional constipation so as to provide the evidence-based data for clinical practice.Wanfang databases,CBM,VIP,CNKI,PubMed,Cochrane Library and EMbase were searched for trials based on randomization and control for use of acupuncture in combination with CHM for functional constipation published from the inception of the database to Dec.2019.We used the risk of bias of Cochrane Collaboration for literature quality assessment,extracted trial data in duplicate,and then assessed the risk of bias.The data were discussed by adopting Review Manager 5.3 program.A total of 22 RCTs with 2574 cases were retrieved.Meta-analysis showed that acupuncture with CHM could improve the clinical effectiveness(OR6.10,95%CI 4.72–7.87,P<0.00001);heterogeneity was not identified(Chi^(2)=32.84,P=0.43,I^(2)=2%),and the difference was statistically significant.Second-level outcomes(e.g.,defecation interval time(P<0.00001),Bristol Stool Scale(P=0.002),defecation difficulty(P=0.01)and accompanying symptoms(P<0.00001))in the treatment groups were significantly different after the acupuncture with CHM compared with control groups,whereas defecation symptoms were not significantly different(P=0.06).The use of acupuncture with CHM can significantly improve the clinical efficacy of functional constipation,ameliorate Bristol Stool Scale,defecation difficulty,defecation symptoms,and accompanying symptoms,as well as shorten the defecation interval time,with better safety.
基金This project was funded by the National Natural Science Foundation of China(30700917,81570465)Minsheng Foundation of Joint Research Project of Liaoning Province(2021JH2/10300129).
文摘Background Fecal microbiota transplantation(FMT)has been well described in the treatment of pediatric diseases;however,the latest updates regarding its use in children are unclear and the concepts involved need to be revisited.Data sources We performed advanced searches in the MEDLINE,EMBASE,and Cochrane databases using the keywords“Fecal microbiota transplantation OR Fecal microbiota transfer”in the[Title/Abstract]to identify relevant articles published in English within the last five years.To identify additional studies,reference lists of review articles and included studies were manually searched.Retrieved manuscripts(case reports,reviews,and abstracts)were assessed by the authors.Results Among the articles,studies were based on the mechanism(n=28),sample preparation(n=9),delivery approaches(n=23),safety(n=26),and indications(n=67),including Clostridium difficile infection(CDI)and recurrent C.difficile infection(rCDI;n=21),non-alcoholic fatty liver disease(NAFLD;n=10),irritable bowel syndrome(IBS;n=5),inflammatory bowel disease(IBD;n=15),diabetes(n=5),functional constipation(FC;n=4),and autism spectrum disorder(ASD;n=7).Conclusions Concepts of FMT in pediatric diseases have been updated with respect to underlying mechanisms,methodology,indications,and safety.Evidence-based clinical trials for the use of FMT in pediatric diseases should be introduced to resolve the challenges of dosage,duration,initiation,and the end point of treatment.
基金Supported by the Fundamental Research Funds for the Central Public Welfare Research Institutes:Theoretical Study of Combination of of Facial Color and Pulses Mode in Traditional Chinese Medicine(No.KJ-202013),Objective Study of“Wei Qi”in Pulse Based on Color Doppler Flow Imaging(CDFI)Technology(No.YZ-202124)。
文摘OBJECTIVE:To analyze the Doppler ultrasound blood flow of Renying(carotid artery)pulse,Cunkou(radial artery)pulse,and Fuyang(anterior tibial artery)pulse in the normal group and the functional constipation with gastrointestinal heat(FCGH)group,and to compare and explore the differences of Renying,Cunkou and Fuyang pulses.METHODS:Sixty normal subjects and 60 patients with gastrointestinal heat constipation were collected in the department of ultrasound,Beijing Anzhen Hospital,Capital Medical University.Doppler ultrasound was used to observe the blood flow indexes including maximum systolic velocity(Vp),maximum diastolic velocity(Vd),mean velocity(Vm),pulse index(PI),resistance index(RI),vascular diameter(D),and circulation blood flow cycle(ET)of Renying pulse,Cunkou pulse and Fuyang pulse in the normal group and patients with gastrointestinal heat constipation.The differences of these three pulses were compared between the normal group and the FCGH group.RESULTS:The PI,Vp,Vm,RI,and D of the three pulses in the normal group were statistically significant different(P<0.01).In the comparison of Doppler flow diagram of three pulses in the FCGH group,there were significant differences in PI,Vd,Vp,Vm,RI,and D(P<0.01).CONCLUSION:Under normal conditions,the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are significantly different.In the FCGH group,most of the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are different.This result verified the necessity of simultaneous examinations of all Renying,Cunkou,and Fuyang pulses in modern Chinese medicine.
基金supported by the Clinical Medicine Development Project of Beijing Municipal Administration of Hospitals[ZYLX201411]the Beijing Nova Program[Z201100006820119]from Beijing Municipal Science&Technology Commission,the Beijing Science and technology project[z181100001718218]+2 种基金National Natural Science Foundation of China[81770571]the Guangdong Province‘Pearl River Talent Plan’Innovation and Entrepreneurship Team Project[2019ZT08Y464]the National Key Clinical Discipline of China.
