Medicine › Gastroenterology

Gastrointestinal motility and disorders

Works Count: 65299

Wikipedia

Description

This cluster of papers explores the complex landscape of functional bowel disorders, with a focus on conditions such as irritable bowel syndrome, constipation, and gastroparesis. It delves into the role of microbiota, enteric nervous system, and intestinal permeability in these disorders, as well as the potential therapeutic impact of probiotics and serotonin signaling. Additionally, the cluster addresses the prevalence, epidemiology, and global burden of functional gastrointestinal disorders.

Keywords

Irritable Bowel Syndrome; Gastrointestinal Disorders; Microbiota; Enteric Nervous System; Constipation; Probiotics; Intestinal Permeability; Gastroparesis; Serotonin Signaling; Inflammation

The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems.

2015-04-02

Marilia Carabotti , Annunziata Scirocco , M.A. Maselli +1 more

The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. Recent advances … The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. Recent advances in research have described the importance of gut microbiota in influencing these interactions. This interaction between microbiota and GBA appears to be bidirectional, namely through signaling from gut-microbiota to brain and from brain to gut-microbiota by means of neural, endocrine, immune, and humoral links. In this review we summarize the available evidence supporting the existence of these interactions, as well as the possible pathophysiological mechanisms involved. Most of the data have been acquired using technical strategies consisting in germ-free animal models, probiotics, antibiotics, and infection studies. In clinical practice, evidence of microbiota-GBA interactions comes from the association of dysbiosis with central nervous disorders (i.e. autism, anxiety-depressive behaviors) and functional gastrointestinal disorders. In particular, irritable bowel syndrome can be considered an example of the disruption of these complex relationships, and a better understanding of these alterations might provide new targeted therapies.

Physiology of the Gastrointestinal Tract.

1982-01-01

F. Avery Jones

Functional Gastroduodenal Disorders

2006-04-01

Jan Tack , Nicholas J. Talley , Michael Camilleri +4 more

View PDF Chat

The Serotonin Signaling System: From Basic Understanding To Drug Development for Functional GI Disorders

2007-01-01

Michael D. Gershon , Jan Tack

View PDF Chat

Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome

2004-02-25

Giovanni Barbara , Vincenzo Stanghellini , Roberto De Giorgio +7 more

View PDF Chat

Dysbiosis of the gut microbiota in disease

2015-02-02

Simon R. Carding , Kristin Verbeke , Daniel T. Vipond +2 more

There is growing evidence that dysbiosis of the gut microbiota is associated with the pathogenesis of both intestinal and extra-intestinal disorders.Intestinal disorders include inflammatory bowel disease, irritable bowel syndrome (IBS), … There is growing evidence that dysbiosis of the gut microbiota is associated with the pathogenesis of both intestinal and extra-intestinal disorders.Intestinal disorders include inflammatory bowel disease, irritable bowel syndrome (IBS), and coeliac disease, while extra-intestinal disorders include allergy, asthma, metabolic syndrome, cardiovascular disease, and obesity.In many of these conditions, the mechanisms leading to disease development involves the pivotal mutualistic relationship between the colonic microbiota, their metabolic products, and the host immune system.The establishment of a 'healthy' relationship early in life appears to be critical to maintaining intestinal homeostasis.Whilst we do not yet have a clear understanding of what constitutes a 'healthy' colonic microbiota, a picture is emerging from many recent studies identifying particular bacterial species associated with a healthy microbiota.In particular, the bacterial species residing within the mucus layer of the colon, either through direct contact with host cells, or through indirect communication via bacterial metabolites, may influence whether host cellular homeostasis is maintained or whether inflammatory mechanisms are triggered.In addition to inflammation, there is some evidence that perturbations in the gut microbiota is involved with the development of colorectal cancer.In this case, dysbiosis may not be the most important factor, rather the products of interaction between diet and the microbiome.High-protein diets are thought to result in the production of carcinogenic metabolites from the colonic microbiota that may result in the induction of neoplasia in the colonic epithelium.Ever more sensitive metabolomics methodologies reveal a suite of small molecules produced in the microbiome which mimic or act as neurosignallers or neurotransmitters.Coupled with evidence that probiotic interventions may alter psychological endpoints in both humans and in rodent models, these data suggest that CNS-related co-morbidities frequently associated with GI disease may originate in the intestine as a result of microbial dysbiosis.This review outlines the current evidence showing the extent to which the gut microbiota contributes to the development of disease.Based on evidence to date, we can assess the potential to positively modulate the composition of the colonic microbiota and ameliorate disease activity through bacterial intervention.

View PDF Chat

Altered rectal perception is a biological marker of patients with irritable bowel syndrome

1995-07-01

Howard Mertz , Bruce D. Naliboff , Julie Munakata +2 more

Mutation of the proto‐oncogene c‐kit blocks development of interstitial cells and electrical rhythmicity in murine intestine.

1994-10-01

Sean M. Ward , Alan J. Burns , Shigeko Torihashi +1 more

1. Interstitial cells of Cajal (ICs) have been proposed as pacemakers in the gastrointestinal tract. We studied the characteristics and distribution of ICs and electrical activity of small intestinal muscles … 1. Interstitial cells of Cajal (ICs) have been proposed as pacemakers in the gastrointestinal tract. We studied the characteristics and distribution of ICs and electrical activity of small intestinal muscles from mice with mutations at the dominant-white spotting/c-kit (W) locus because the tyrosine kinase function of c-kit may be important in the development of the IC network. 2. W/WV mutants (days 3-30 postpartum) had few ICs in the myenteric plexus region compared with wild type (+/+) siblings. The few ICs present were associated with neural elements and lay between myenteric ganglia and the longitudinal muscle layer. 3. Electrical recordings from intestinal muscle strips showed that electrical slow waves were always present in muscles of +/+ siblings, but were absent in W/WV mice. 4. Muscles from W/WV mice responded to stimulation of intrinsic nerves. Neural responses, attributed to the release of acetylcholine, nitric oxide and other unidentified transmitters, were recorded. 5. These findings are consistent with the hypothesis that ICs are a critical element in the generation of electrical rhythmicity in intestinal muscles. The data also show that neural regulation of gastrointestinal muscles can develop independently of the IC network. 6. W locus mutants provide a powerful new model for studies of the physiological role of ICs and the significance of electrical rhythmicity to normal gastrointestinal motility.

Types of neurons in the enteric nervous system

2000-07-01

John B. Furness

Gut microbes promote colonic serotonin production through an effect of short‐chain fatty acids on enterochromaffin cells

2014-12-30

Christopher S. Reigstad , Charles E. Salmonson , John F. Rainey +5 more

Gut microbiota alterations have been described in several diseases with altered gastrointestinal (GI) motility, and awareness is increasing regarding the role of the gut microbiome in modulating GI function. Serotonin … Gut microbiota alterations have been described in several diseases with altered gastrointestinal (GI) motility, and awareness is increasing regarding the role of the gut microbiome in modulating GI function. Serotonin [5-hydroxytryptamine (5-HT)] is a key regulator of GI motility and secretion. To determine the relationship among gut microbes, colonic contractility, and host serotonergic gene expression, we evaluated mice that were germ-free (GF) or humanized (HM; ex-GF colonized with human gut microbiota). 5-HT reduced contractile duration in both GF and HM colons. Microbiota from HM and conventionally raised (CR) mice significantly increased colonic mRNAs Tph1 [(tryptophan hydroxylase) 1, rate limiting for mucosal 5-HT synthesis; P < 0.01] and chromogranin A (neuroendocrine secretion; P < 0.01), with no effect on monoamine oxidase A (serotonin catabolism), serotonin receptor 5-HT4, or mouse serotonin transporter. HM and CR mice also had increased colonic Tph1 protein (P < 0.05) and 5-HT concentrations (GF, 17 ± 3 ng/mg; HM, 25 ± 2 ng/mg; and CR, 35 ± 3 ng/mg; P < 0.05). Enterochromaffin (EC) cell numbers (cells producing 5-HT) were unchanged. Short-chain fatty acids (SCFAs) promoted TPH1 transcription in BON cells (human EC cell model). Thus, gut microbiota acting through SCFAs are important determinants of enteric 5-HT production and homeostasis.

The Interdigestive Motor Complex of Normal Subjects and Patients with Bacterial Overgrowth of the Small Intestine

1977-06-01

G. Vantrappen , Jules Janssens , J. Hellemans +1 more

Intraluminal pressures were measured in the gastric antrum and at different levels of the upper small intestine in 18 normal subjects to investigate whether or not the interdigestive motor complex, … Intraluminal pressures were measured in the gastric antrum and at different levels of the upper small intestine in 18 normal subjects to investigate whether or not the interdigestive motor complex, identified in several animal species, occurs in man and, if so, to determine its characteristics. In all normal subjects, the activity front of the interdigestive motor complex was readily identified as an uninterrupted burst of rhythmic contraction waves that progressed down the intestine and that was followed by a period of quiescence. Quantitative analysis of various parameters of the complex and simultaneous radiological and manometrical observations revealed that it resembled closely the canine interdigestive motor complex. To test the hypothesis that disorders of this motor complex may lead to bacterial overgrowth in the small intestine, similar studies were performed in 18 patients with a positive (14)CO(2) bile acid breath test and in an additional control group of 9 patients with a normal (14)CO(2) breath test. All but five patients had normal interdigestive motor complexes. The five patients in whom the motor complex was absent or greatly disordered had bacterial overgrowth as evidenced by (14)CO(2) bile acid breath tests before and after antibiotics. These studies establish the presence and define the characteristics of the normal interdigestive motor complex in man. They also suggest that bacterial overgrowth may be due to a specific motility disorder i.e., complete or almost complete absence of the interdigestive motor complex.

View PDF Chat

The Fecal Microbiota of Irritable Bowel Syndrome Patients Differs Significantly From That of Healthy Subjects

2007-04-15

Anna Kassinen , Lotta Krogius-Kurikka , Harri Mäkivuokko +6 more

View PDF Chat

American Gastroenterological Association Technical Review on Constipation

2012-12-19

Adil E. Bharucha , John H. Pembérton , G. Richard Locke

A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome

2013-09-25

Emma P. Halmos , Victoria A. Power , Susan Shepherd +2 more

A constipation scoring system to simplify evaluation and management of constipated patients

1996-06-01

Feran Agachan , Teng Chen , Johann Pfeifer +2 more

Constipation is a common complaint; however, clinical presentation varies with each individual. The aim of this study was to assess a standard scoring system for evaluation of constipated patients.All consecutive … Constipation is a common complaint; however, clinical presentation varies with each individual. The aim of this study was to assess a standard scoring system for evaluation of constipated patients.All consecutive patients with idiopathic constipation who were referred for anorectal physiologic testing were assessed. A subjective constipation score was calculated based on a detailed questionnaire that included over 100 constipation-related symptoms. Based on the questionnaire, scores ranged from 0 to 30, with 0 indicating normal and 30 indicating severe constipation. The constipation score was then compared with the objective findings of the physiology tests, which include colonic transit time (CTT), anal manometry (AM), cinedefecography (CD), and electromyography (EMG). Colonic inertia was defined as diffuse marker delay on CTT without evidence of paradoxical contraction on AM, CD, or EMG. Pelvic outlet obstruction was defined as paradoxical puborectalis contraction, rectal prolapse or rectoanal intussusception, rectocele, or sigmoidocele.A total of 232 patients (185 females and 47 males) of a mean age of 64.9 (range, 14-92) years were evaluated. All patients had a score of more than 15; on evaluation of the significance of different symptoms in the constipation score with the Pearson's linear correlation test, 8 of 18 factors were identified as significant (P < 0.05). These factors included frequency of bowel movements, painful evacuation, incomplete evacuation, abdominal pain, length of time per attempt, assistance for evacuation, unsuccessful attempts for evacuation per 24 hours, and duration of constipation. All 232 patients had objective obstruction attributable to one or more of the following causes: paradoxical puborectalis contraction (81), significant rectocele or sigmoidocele (48), rectoanal intussusception (64), and rectal prolapse (9).The proposed constipation scoring system correlated well with objective physiologic findings in constipated patients to allow uniformity in assessment of the severity of constipation.

Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome

1973-02-01

James Ritchie

The effects of inflating a balloon introduced through a sigmoidoscope to 35 cm in the pelvic colon have been observed and compared in 67 patients with the irritable colon syndrome … The effects of inflating a balloon introduced through a sigmoidoscope to 35 cm in the pelvic colon have been observed and compared in 67 patients with the irritable colon syndrome and in 16 normal and constipated subjects acting as controls. Inflation to 60 ml caused pain in 6% of the controls at a mean diameter of 3.8 cm and in 55% of patients with the irritable colon syndrome (diameter 3.4 cm). An estimate of gut wall tension at this volume of inflation showed it to be normal in patients with the irritable colon syndrome; the incidence of pain in relation to wall tension was increased nearly tenfold in the irritable colon group. Inflation of the balloon to different volumes was normally painless to a maximum acceptable diameter which remained constant for each study under constant conditions; continued inflation eventually gave rise to pain without increasing the diameter. The pain was felt in the hypogastrium in 40%, in one or both iliac fossae in 31%, and in the rectum in 21%; the other 8% felt pain in the back or elsewhere and there were no significant differences between clinical groups. Exceptionally, in 6% of the controls, and in 52% of patients with the irritable colon syndrome, pain occurred at balloon diameters that could still be increased by 10% or more with further inflation. This was probably the outcome of a low threshold for visceral pain in the section of bowel in contact with the balloon. Colonic hyperalgesia of this kind, possibly a random occurrence, may be an important contributory factor in the aetiology of the irritable colon syndrome.

View PDF Chat

Stool Form Scale as a Useful Guide to Intestinal Transit Time

1997-01-01

Stephen J. Lewis , K W Heaton

Background: Stool form scales are a simple method of assessing intestinal transit rate but are not widely used in clinical practice or research, possibly because of the lack of evidence … Background: Stool form scales are a simple method of assessing intestinal transit rate but are not widely used in clinical practice or research, possibly because of the lack of evidence that they are responsive to changes in transit time. We set out to assess the responsiveness of the Bristol stool form scale to change in transit time. Methods: Sixty-six volunteers had their whole-gut transit time (WGTT) measured with radiopaque marker pellets and their stools weighed, and they kept a diary of their stool form on a 7-point scale and of their defecatory frequency. WGTT was then altered with senna and loperamide, and the measurements were repeated. Results: The base-line WGTT measurements correlated with defecatory frequency (r = 0.35, P = 0.005) and with stool output (r= -0.41, P = 0.001) but best with stool form O=-0.54, P< 0.001). When the volunteers took senna (n = 44), the WGTT decreased, whereas defecatory frequency, stool form score, and stool output increased (all, P< 0.001). With loperamide (n = 43) all measurements changed in the opposite direction. Change in WGTT from base line correlated with change in defecatory frequency (r= 0.41, P < 0.001) and with change in stool output (r= -0.54, P < 0.001) but best with change in stool form (r= -0.65, P < 0.001). Conclusions: This study has shown that a stool form scale can be used to monitor change in intestinal function. Such scales have utility in both clinical practice and research.

GSRS?A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease

1988-02-01

Jan Svedlund , Ingemar Sj�din , G. Dotevall

Role of impaired gastric accommodation to a meal in functional dyspepsia

1998-12-01

Jan Tack , Hubert Piessevaux , Bernard Coulie +2 more

View PDF Chat

Functional Bowel Disorders

2006-04-01

George F. Longstreth , Wade Thompson , William D. Chey +3 more

Childhood Functional Gastrointestinal Disorders: Child/Adolescent

2006-04-01

Andrée Rasquin , Carlo Di Lorenzo , David Forbes +4 more

View PDF Chat

U. S. Householder survey of functional gastrointestinal disorders

1993-09-01

Douglas A. Drossman , Zhiming Li , Eileen Andruzzi +7 more

Prevalence of, and Risk Factors for, Chronic Idiopathic Constipation in the Community: Systematic Review and Meta-analysis

2011-05-24

Nicole C Suares , Alexander C. Ford

OBJECTIVES: Chronic idiopathic constipation (CIC) is a common functional gastrointestinal disorder in the community, yet no previous systematic review and meta-analysis has estimated the global prevalence, or potential risk factors … OBJECTIVES: Chronic idiopathic constipation (CIC) is a common functional gastrointestinal disorder in the community, yet no previous systematic review and meta-analysis has estimated the global prevalence, or potential risk factors for the condition. METHODS: MEDLINE, EMBASE, and EMBASE Classic were searched (up to December 2010) to identify population-based studies reporting the prevalence of CIC in adults (≥15 years), according to self-report, questionnaire, or specific symptom-based criteria. The prevalence of CIC was extracted for all studies, and according to country, age, gender, socioeconomic status, and presence or absence of irritable bowel syndrome (IBS) where reported. Pooled prevalence overall, and according to study location and certain other characteristics, as well as odds ratios (ORs), with 95% confidence intervals (CIs) were calculated. RESULTS: Of the 100 papers evaluated, 45 reported the prevalence of CIC in 41 separate study populations, containing 261,040 subjects. Pooled prevalence of CIC in all studies was 14% (95% CI: 12–17%). The prevalence of CIC was lower in South East Asian studies, and in studies using the Rome II or III criteria. The prevalence of CIC was higher in women (OR: 2.22; 95% CI: 1.87–2.62), and increased with age and lower socioeconomic status. The prevalence was markedly higher in subjects who also reported IBS (OR: 7.98; 95% CI: 4.58–13.92), suggesting common pathogenic mechanisms. CONCLUSIONS: Pooled prevalence of CIC in the community was 14%, and of similar magnitude in most geographical regions. Rates were higher in women, older individuals, and those of lower socioeconomic status. Presence of IBS was strongly associated with CIC.

Principles and clinical implications of the brain–gut–enteric microbiota axis

2009-04-30

Sang Hoon Rhee , Charalabos Pothoulakis , Emeran A. Mayer

Serotonin signalling in the gut—functions, dysfunctions and therapeutic targets

2013-06-25

Gary M. Mawe , Jill M. Hoffman

View PDF Chat

Epidemiology of Constipation in North America: A Systematic Review

2004-04-01

Peter Higgins , John F. Johanson

OBJECTIVE The aim of this study was to systematically review the published literature regarding prevalence, risk factors, incidence, natural history, and the effect on quality of life of constipation in … OBJECTIVE The aim of this study was to systematically review the published literature regarding prevalence, risk factors, incidence, natural history, and the effect on quality of life of constipation in North America. METHODS A computer-assisted search of MEDLINE, EMBASE, and Current Contents databases was performed independently by two investigators. Study selection criteria included the following: (1) North American population-based sample of adults with constipation; (2) publication in full manuscript form in English; and (3) report on the prevalence, incidence, and natural history of constipation or impact of constipation on quality of life. Eligible articles were reviewed in a duplicate, independent manner. Data extracted were compiled in tables and presented in descriptive form. RESULTS The estimates of the prevalence of constipation in North America ranged from 1.9% to 27.2%, with most estimates from 12% to 19%. Prevalence estimates by gender support a female-to-male ratio of 2.2:1. Constipation appears to increase with increasing age, particularly after age 65. No true population-based incidence studies or natural history studies were identified. In one cohort, 89% of patients with constipation still reported constipation at 14.7 months follow-up. From limited data, quality of life appears to be diminished by constipation, but the clinical significance of this is unclear. CONCLUSIONS Constipation is very common, as approximately 63 million people in North America meet the Rome II criteria for constipation. Minimal data are available regarding incidence, natural history, and quality of life in patients with constipation. Effort should be expended toward the study of these topics, particularly in the elderly, who are disproportionately affected by this condition.

Evaluation and Treatment of Functional Constipation in Infants and Children

2013-12-17

Merit M. Tabbers , Carlo DiLorenzo , Marjolein Y. Berger +6 more

ABSTRACT Background: Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management … ABSTRACT Background: Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence‐based guidelines. Methods: Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence‐Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. Results: This evidence‐based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. Conclusions: This document is intended to be used in daily practice and as a basis for further clinical research. Large well‐designed clinical trials are necessary with regard to diagnostic evaluation and treatment.

Guidelines on the irritable bowel syndrome: mechanisms and practical management

2007-05-09

Robert E. Spiller , Qasim Aziz , Francis Creed +7 more

IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance.

View PDF Chat

Epidemiology of constipation in children and adults: A systematic review

2011-02-01

Suzanne M. Mugie , Marc A. Benninga , Carlo Di Lorenzo

Clinical Guideline: Management of Gastroparesis

2012-11-13

Michael Camilleri , Henry P. Parkman , Mehnaz A. Shafi +2 more

This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed … This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control. Patient nutritional state should be managed by oral dietary modifications. If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered. Parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained. Medical treatment entails use of prokinetic and antiemetic therapies. Current approved treatment options, including metoclopramide and gastric electrical stimulation (GES, approved on a humanitarian device exemption), do not adequately address clinical need. Antiemetics have not been specifically tested in gastroparesis, but they may relieve nausea and vomiting. Other medications aimed at symptom relief include unapproved medications or off-label indications, and include domperidone, erythromycin (primarily over a short term), and centrally acting antidepressants used as symptom modulators. GES may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies. Second-line approaches include venting gastrostomy or feeding jejunostomy; intrapyloric botulinum toxin injection was not effective in randomized controlled trials. Most of these treatments are based on open-label treatment trials and small numbers. Partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients. Attention should be given to the development of new effective therapies for symptomatic control.

View PDF Chat

Global and Deep Molecular Analysis of Microbiota Signatures in Fecal Samples From Patients With Irritable Bowel Syndrome

2011-09-15

Mirjana Rajilić‐Stojanović , Elena Biagi , Hans G. H. J. Heilig +4 more

AGA technical review on irritable bowel syndrome

2002-11-26

Douglas A. Drossman , Michael Camilleri , Emeran A. Mayer +1 more

View PDF Chat

Intestinal microbiota in functional bowel disorders: a Rome foundation report

2012-06-22

Magnus Simrén , Giovanni Barbara , Harry J. Flint +6 more

It is increasingly perceived that gut host–microbial interactions are important elements in the pathogenesis of functional gastrointestinal disorders (FGID). The most convincing evidence to date is the finding that functional … It is increasingly perceived that gut host–microbial interactions are important elements in the pathogenesis of functional gastrointestinal disorders (FGID). The most convincing evidence to date is the finding that functional dyspepsia and irritable bowel syndrome (IBS) may develop in predisposed individuals following a bout of infectious gastroenteritis. There has been a great deal of interest in the potential clinical and therapeutic implications of small intestinal bacterial overgrowth in IBS. However, this theory has generated much debate because the evidence is largely based on breath tests which have not been validated. The introduction of culture-independent molecular techniques provides a major advancement in our understanding of the microbial community in FGID. Results from 16S rRNA-based microbiota profiling approaches demonstrate both quantitative and qualitative changes of mucosal and faecal gut microbiota, particularly in IBS. Investigators are also starting to measure host–microbial interactions in IBS. The current working hypothesis is that abnormal microbiota activate mucosal innate immune responses which increase epithelial permeability, activate nociceptive sensory pathways and dysregulate the enteric nervous system. While we await important insights in this field, the microbiota is already a therapeutic target. Existing controlled trials of dietary manipulation, prebiotics, probiotics, synbiotics and non-absorbable antibiotics are promising, although most are limited by suboptimal design and small sample size. In this article, the authors provide a critical review of current hypotheses regarding the pathogenetic involvement of microbiota in FGID and evaluate the results of microbiota-directed interventions. The authors also provide clinical guidance on modulation of gut microbiota in IBS.

View PDF Chat

Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis

2012-03-16

Rebecca Lovell , Alexander C. Ford

Lactobacillus and bifidobacterium in irritable bowel syndrome: Symptom responses and relationship to cytokine profiles

2005-03-01

Liam O’Mahony , Jane McCarthy , John Ly +7 more

Irritable Bowel Syndrome

2015-03-03

William D. Chey , Jacob E. Kurlander , Shanti Eswaran

Irritable bowel syndrome (IBS) affects 7% to 21% of the general population. It is a chronic condition that can substantially reduce quality of life and work productivity.To summarize the existing … Irritable bowel syndrome (IBS) affects 7% to 21% of the general population. It is a chronic condition that can substantially reduce quality of life and work productivity.To summarize the existing evidence on epidemiology, pathophysiology, and diagnosis of IBS and to provide practical treatment recommendations for generalists and specialists according to the best available evidence.A search of Ovid (MEDLINE) and Cochrane Database of Systematic Reviews was performed for literature from 2000 to December 2014 for the terms pathophysiology, etiology, pathogenesis, diagnosis, irritable bowel syndrome, and IBS. The range was expanded from 1946 to December 2014 for IBS, irritable bowel syndrome, diet, treatment, and therapy.The database search yielded 1303 articles, of which 139 were selected for inclusion. IBS is not a single disease but rather a symptom cluster resulting from diverse pathologies. Factors important to the development of IBS include alterations in the gut microbiome, intestinal permeability, gut immune function, motility, visceral sensation, brain-gut interactions, and psychosocial status. The diagnosis of IBS relies on symptom-based criteria, exclusion of concerning features (symptom onset after age 50 years, unexplained weight loss, family history of selected organic gastrointestinal diseases, evidence of gastrointestinal blood loss, and unexplained iron-deficiency anemia), and the performance of selected tests (complete blood cell count, C-reactive protein or fecal calprotectin, serologic testing for celiac disease, and age-appropriate colorectal cancer screening) to exclude organic diseases that can mimic IBS. Determining the predominant symptom (IBS with diarrhea, IBS with constipation, or mixed IBS) plays an important role in selection of diagnostic tests and treatments. Various dietary, lifestyle, medical, and behavioral interventions have proven effective in randomized clinical trials.The diagnosis of IBS relies on the identification of characteristic symptoms and the exclusion of other organic diseases. Management of patients with IBS is optimized by an individualized, holistic approach that embraces dietary, lifestyle, medical, and behavioral interventions.

The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress

1997-04-01

Carol Y. Francis , J.A. Morris , Peter J. Whorwell

Background: The clinical assessment and investigation of irritable bowel syndrome would be greatly facilitated by the introduction of a simple, easy to use severity scoring system. Such a system, developed … Background: The clinical assessment and investigation of irritable bowel syndrome would be greatly facilitated by the introduction of a simple, easy to use severity scoring system. Such a system, developed in our department over a number of years, has been submitted to validation in a total of 141 patients and 40 healthy controls. Methods: The system, incorporating pain, distension, bowel dysfunction and quality of life/global well‐being, was assessed for its ability to reliably score patients previously classified as mild, moderate or severe. The reproducibility and sensitivity to change of the system was also assessed. Results: The maximum achievable score was 500. Mild, moderate and severe cases were indicated by scores of 75 to 175, 175 to 300 and >300 respectively. Controls scored below 75 and patients scoring in this range can be considered to be in remission. There was a highly significant difference between controls and patients as a whole ( P =0.0001) as well as significant differences ( P <0.01) between all severity categories. Scores repeated within 24 h were very reproducible and sensitivity to change was also extremely good ( P <0.001) with a change of 50 reliably indicating improvement. Conclusion: These results suggest that this scoring system should prove to be a valuable instrument in helping to meet the many challenges offered by irritable bowel syndrome.

View PDF Chat

Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation

2011-01-05

Mark Pimentel , Anthony Lembo , William D. Chey +7 more

Evidence suggests that gut flora may play an important role in the pathophysiology of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed antibiotic, as treatment for IBS.In … Evidence suggests that gut flora may play an important role in the pathophysiology of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed antibiotic, as treatment for IBS.In two identically designed, phase 3, double-blind, placebo-controlled trials (TARGET 1 and TARGET 2), patients who had IBS without constipation were randomly assigned to either rifaximin at a dose of 550 mg or placebo, three times daily for 2 weeks, and were followed for an additional 10 weeks. The primary end point, the proportion of patients who had adequate relief of global IBS symptoms, and the key secondary end point, the proportion of patients who had adequate relief of IBS-related bloating, were assessed weekly. Adequate relief was defined as self-reported relief of symptoms for at least 2 of the first 4 weeks after treatment. Other secondary end points included the percentage of patients who had a response to treatment as assessed by daily self-ratings of global IBS symptoms and individual symptoms of bloating, abdominal pain, and stool consistency during the 4 weeks after treatment and during the entire 3 months of the study.Significantly more patients in the rifaximin group than in the placebo group had adequate relief of global IBS symptoms during the first 4 weeks after treatment (40.8% vs. 31.2%, P=0.01, in TARGET 1; 40.6% vs. 32.2%, P=0.03, in TARGET 2; 40.7% vs. 31.7%, P<0.001, in the two studies combined). Similarly, more patients in the rifaximin group than in the placebo group had adequate relief of bloating (39.5% vs. 28.7%, P=0.005, in TARGET 1; 41.0% vs. 31.9%, P=0.02, in TARGET 2; 40.2% vs. 30.3%, P<0.001, in the two studies combined). In addition, significantly more patients in the rifaximin group had a response to treatment as assessed by daily ratings of IBS symptoms, bloating, abdominal pain, and stool consistency. The incidence of adverse events was similar in the two groups.Among patients who had IBS without constipation, treatment with rifaximin for 2 weeks provided significant relief of IBS symptoms, bloating, abdominal pain, and loose or watery stools. (Funded by Salix Pharmaceuticals; ClinicalTrials.gov numbers, NCT00731679 and NCT00724126.).

View PDF Chat

MICROBIAL ECOLOGY OF THE GASTROINTESTINAL TRACT

1977-10-01

Dwayne C. Savage

CONTENTS INTRODUCTION 107 MICROBIAL ECOLOGY AS APPLIED TO THE GASTROINTESTINAL TRACT 108 MICROBIAL HABITATS IN THE MAMMALIAN GASTROINTESTINAL TRACT ........ 110 COMPOSITION AND LOCALIZATION OF CLIMAX COMMUNITIES IN ADULTS ...... … CONTENTS INTRODUCTION 107 MICROBIAL ECOLOGY AS APPLIED TO THE GASTROINTESTINAL TRACT 108 MICROBIAL HABITATS IN THE MAMMALIAN GASTROINTESTINAL TRACT ........ 110 COMPOSITION AND LOCALIZATION OF CLIMAX COMMUNITIES IN ADULTS ...... 111 Some Comments on Methods 111 The Stomach (Esophagus) 112 The Small Bowel 115 The Large Bowel 116 The Feces 118 SUCCESSION IN BABIES 119 FACTORS INFLUENCING COMPOSITION OF THE MICROBIOTA 121 Forces Exerted by the Host and Its Diet and Environment 121 Forces Resulting from Activities of the Microbes Themselves 126 HOW MICROBES IN THE BIOTA MAKE THEIR LIVING (NICHES) 127 SUMMARY AND CONCLUSIONS 129

The Functional Gastrointestinal Disorders and the Rome III Process

2006-04-01

Douglas A. Drossman

View PDF Chat

Postinfectious Irritable Bowel Syndrome

2009-05-01

Robert E. Spiller , Klara Garsed

Characteristics of the Cholecystokinin-Induced Depolarization of Pacemaking Activity in Cultured Interstitial Cells of Cajal from Murine Small Intestine

2013-01-01

Jae Hwa Lee , Sung-Young Kim , Young Kyu Kwon +2 more

Cholecystokinin (CCK) is a peptide hormone which is found both in the gastrointestinal tract throughout the human small intestine and nerves in the myenteric plexus of the enteric nervous system … Cholecystokinin (CCK) is a peptide hormone which is found both in the gastrointestinal tract throughout the human small intestine and nerves in the myenteric plexus of the enteric nervous system and in the central nervous system. This dual location constitutes the anatomical basis for this in functions as a hormone and a neurotransmitter implicated in the regulation of both systems. CCK regulates not only motor functions in the gastrointestinal tract like lower oesophageal sphincter relaxation, gastric secretion and emptying, gall bladder contractility and bile secretion into the duodenum, intestinal and colonic motility, but also sensory functions and plays a role in the regulation of food intake. These effects are mediated through selective receptors CCK1 and CCK2. Over the last few years, research has focused on understanding the role of CCK, its receptors with antagonists at the biological, pharmacological, clinical and therapeutic level. As far as the CCK1 antagonists is concerned, important inroads have been made in the potential role of these antagonists in the treatment of GERD, IBS and pancreatitis. They have also shown encouraging results in sphincter of Oddi dysfunction and some gastrointestinal cancers. This review focuses on the recent ad vances of the biological role of CCK and their CCK1 antagonists: their current basic and clinical status in gastroenterology, with particular emphasis on the potential therapeutic role of the CCK1 antagonists and future research directions.

View PDF Chat

The microbiome-gut-brain axis: from bowel to behavior

2011-02-08

John F. Cryan , Siobhain M. O’Mahony

The ability of gut microbiota to communicate with the brain and thus modulate behavior is emerging as an exciting concept in health and disease. The enteric microbiota interacts with the … The ability of gut microbiota to communicate with the brain and thus modulate behavior is emerging as an exciting concept in health and disease. The enteric microbiota interacts with the host to form essential relationships that govern homeostasis. Despite the unique enteric bacterial fingerprint of each individual, there appears to be a certain balance that confers health benefits. It is, therefore, reasonable to note that a decrease in the desirable gastrointestinal bacteria will lead to deterioration in gastrointestinal, neuroendocrine or immune relationships and ultimately disease. Therefore, studies focusing on the impact of enteric microbiota on the host and in particular on the central nervous system are essential to our understanding of the influence of this system. Recent studies published in this Journal demonstrate that germ-free mice display alterations in stress-responsivity, central neurochemistry and behavior indicative of a reduction in anxiety in comparison to conventional mice. Such data offer the enticing proposition that specific modulation of the enteric microbiota may be a useful strategy for stress-related disorders and for modulating the co-morbid aspects of gastrointestinal disorders such as irritable bowel syndrome and inflammatory bowel disease.

Irritable bowel syndrome

2016-03-24

Paul Enck , Qasim Aziz , Giovanni Barbara +7 more

View PDF Chat

Functional bowel disorders and functional abdominal pain

1999-09-01

Wade Thompson , George F. Longstreth , Douglas A. Drossman +3 more

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, … The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient’s pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.

View PDF Chat

Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction

2016-05-01

Douglas A. Drossman , William L. Hasler

Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV

2016-05-01

Douglas A. Drossman

View PDF Chat

Childhood Functional Gastrointestinal Disorders: Child/Adolescent

2016-05-01

Jeffrey S. Hyams , Carlo Di Lorenzo , Miguel Saps +3 more

Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study

2020-04-12

Ami D. Sperber , Shrikant I. Bangdiwala , Douglas A. Drossman +7 more

Background & AimsAlthough functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known … Background & AimsAlthough functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents.MethodsData were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately.ResultsAmong the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9–40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2–21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6–1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3–1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%).ConclusionsIn a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews. Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents. Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately. Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9–40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2–21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6–1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3–1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%). In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews.

View PDF Chat

Bowel Disorders

2016-05-01

Brian E. Lacy , Fermín Mearin , Lin Chang +4 more

View PDF Chat

Engrafted nitrergic neurons derived from hPSCs improve gut dysmotility in mice

2025-06-25

Homa Majd , Ryan M. Samuel , Andrius Cesiulis +7 more | Nature

Abstract Gastrointestinal (GI) motility disorders represent a major medical challenge, with few effective therapies available. These disorders often result from dysfunction of inhibitory nitric oxide (NO)-producing motor neurons in the … Abstract Gastrointestinal (GI) motility disorders represent a major medical challenge, with few effective therapies available. These disorders often result from dysfunction of inhibitory nitric oxide (NO)-producing motor neurons in the enteric nervous system, which are essential for regulating gut motility. Loss or dysfunction of NO neurons is linked to severe conditions, including achalasia, gastroparesis, intestinal pseudo-obstruction and chronic constipation 1,2 . Here we introduce a platform based on human pluripotent stem cells (hPSCs) for therapeutic development targeting GI motility disorders. Using an unbiased screen, we identified drug candidates that modulate NO neuron activity and enhance motility in mouse colonic tissue ex vivo. We established a high-throughput strategy to define developmental programs driving the specification of NO neurons and found that inhibition of platelet-derived growth factor receptors (PDGFRs) promotes their differentiation from precursors of the enteric nervous system. Transplantation of these neurons into NO-neuron-deficient mice led to robust engraftment and improved GI motility, offering a promising cell-based therapy for neurodegenerative GI disorders. These studies provide a new framework for understanding and treating enteric neuropathies.

Probiotic bacteria vs. yeast for gastrointestinal diseases treatment: Protocol for a systematic review and meta-analysis

2025-06-24

Wardah Alsalemi , Zamri Chik , Mohammed Abdullah Alshawsh | PLoS ONE

Background Disruption of the gut microbiota, an essential ecosystem of microorganisms inhabiting the gastrointestinal tract (GIT), has been linked to the development and progression of various gastrointestinal disorders. Probiotics have … Background Disruption of the gut microbiota, an essential ecosystem of microorganisms inhabiting the gastrointestinal tract (GIT), has been linked to the development and progression of various gastrointestinal disorders. Probiotics have received considerable attention for their role in gastrointestinal diseases. However, there is a need to synthesise existing evidence to determine the optimal probiotic approach for managing complications of GIT disorders. By conducting a systematic review of randomised controlled trials (RCTs) comparing the effects of probiotic bacteria and yeast in patients with gastrointestinal diseases, we aim to provide a comprehensive and evidence-based analysis of the benefits and limitations of these interventions, which could inform clinical decision-making and improve patient outcomes in this population. Methods Different databases, including PubMed, Web of Science, and Scopus will be searched to identify randomized controlled trials (RCTs). The titles and abstracts will be screened using Rayyan, and data will be extracted from eligible studies using Microsoft Excel. Critical appraisal and quality assessment will be performed using the ROB 2 tool, while GradePro will be used to assess the certainty of outcomes. All steps will be independently performed by two reviewers. This study will assess the effectiveness of yeast and bacterial probiotics in treating GIT disorders by evaluating inflammation markers, diarrhoeal score and disease severity, stool frequency, length of hospital stay, and adverse effects. By comparing the efficacy of probiotic bacteria and yeast, this review will identify the most effective type of probiotics for different gastrointestinal disorders, potentially enhancing treatment outcomes and reducing healthcare costs. Systematic review registration : PROSPERO (CRD42023384070).

Comparison of the Effectiveness of Magnesium Oxide and Elobixibat on Improving Rectal Sensitivity and Colonic Transit Time in Patients With Chronic Constipation: An Observational Study

2025-06-24

Takaomi Kessoku , Yo Ishihara , Kota Takahashi +7 more | Neurogastroenterology & Motility

ABSTRACT Background We compared the effectiveness of magnesium oxide (MgO) and elobixibat (EXB) in improving defecation desire (DD), rectal sensation, and colonic transit time (CTT) in patients with chronic constipation … ABSTRACT Background We compared the effectiveness of magnesium oxide (MgO) and elobixibat (EXB) in improving defecation desire (DD), rectal sensation, and colonic transit time (CTT) in patients with chronic constipation (CC). Methods This was a prospective, observational study conducted in real‐world clinical practice. We included patients with CC who met the Rome IV criteria and underwent colon transit study and rectal sensory tests ( RSTs ). Loss of defecation desire (LODD) was subjectively assessed using a questionnaire, and the rectal sensation was objectively assessed using the balloon air volume, which was measured using the first defecation desire volume (FDDV). CTT was measured using radiopaque markers, and slow transit constipation (STC) and normal transit constipation (NTC) were diagnosed using marker residual rate. The shift rate from STC at baseline to NTC after each drug administration was calculated. Drugs were selected at the discretion of the attending physician. Key Results Patients in the MgO ( n = 30) and EXB ( n = 43) groups had comparable demographic characteristics, an average prescription duration of 27 days, and average daily dosages of 1413 and 13 mg, respectively. Patients in the MgO and EXB groups showed different improvement rate of LODD (33% vs. 65%, p < 0.001), absolute changes in FDDV (−0.1 vs. 35 mL, p < 0.0001), and shift rate from STC to NTC (37% vs. 87%, p = 0.003, respectively). Conclusions and Inferences EXB demonstrated significantly greater improvements of LODD, rectal sensation, and CTT compared to MgO.

Swedish abdominal massage against warm water therapy on postoperative orthopaedic surgery constipation: a comparison quasi-experimental study

2025-06-23

Enny Selawaty Boangmanalu , Masfuri Masfuri , Muhamad Adam +3 more | F1000Research

<ns3:p>Background Postoperative immobilizatiton for patients with lower extremity fractures causes constipation, which usually affects 50–70% of patients. When it comes to nursing interventions for postoperative constipation, Swedish abdominal massage and … <ns3:p>Background Postoperative immobilizatiton for patients with lower extremity fractures causes constipation, which usually affects 50–70% of patients. When it comes to nursing interventions for postoperative constipation, Swedish abdominal massage and warm water drinking therapy are two possible options. Aim The objective of this study is to compare the effectiveness of drinking warm water and Swedish abdominal massage on constipation scores on post-operative lower extremity fractures. Methods A quasi-experimental pre-posttest design without control group design was applied. 30 respondents used simple random sampling technique. The Constipation Assessment Scale (CAS) questionnaire was used to assess the patient’s constipation levels before and after the intervention. The data analysis used independent t-test. Results The mean score of constipation of drinking water group after the intervention was 4.60 while abdominal Swedish massage was 3.56. Although both significantly reduced the constipation score, the p-value was 0.00. Conclusion The protocol of drinking warm water and Swedish abdominal massage immediately after waking up effectively reduced constipation scores on postoperative lower extremity fracture patients and can be use to adjuvant therapy. Further studies are needed to investigate postoperative constipation patients with immobility and the use of strong analgetics.</ns3:p>

Probiotics and gastrointestinal disorders: an umbrella meta-analysis of therapeutic efficacy

2025-06-23

Qingfang Zeng , Pingdong Li , Henry H. L. Wu +6 more | European journal of medical research

Probiotic interventions are increasingly considered for alleviating gastrointestinal disorders such as diarrhea, nausea, bloating, and epigastric discomfort. This umbrella meta-analysis aims to resolve inconsistencies in existing research and offers a … Probiotic interventions are increasingly considered for alleviating gastrointestinal disorders such as diarrhea, nausea, bloating, and epigastric discomfort. This umbrella meta-analysis aims to resolve inconsistencies in existing research and offers a comprehensive assessment of probiotics' impact on these gastrointestinal symptoms. We conducted an extensive literature search across PubMed, Scopus, Web of Science, and Google Scholar (up to June 2024), including meta-analyses of interventional studies investigating probiotics' effects on gastrointestinal disorders. Pooled effect sizes with 95% confidence intervals were derived using a random-effects model, accompanied by subgroup and sensitivity analyses. The certainty of evidence and study quality were evaluated using AMSTAR 2 tools. Probiotic supplementation was associated with a significant reduction in the risk of diarrhea (RR 0.44; 95% CI 0.37-0.52), nausea (RR 0.59; 95% CI 0.49-0.60), epigastric pain (RR 0.71; 95% CI 0.56-0.87), bloating (RR 0.74; 95% CI 0.64-0.84), and taste disturbance (RR 0.55; 95% CI 0.36-0.75), all with p-values < 0.001. Subgroup analyses revealed more pronounced effects in studies with shorter intervention durations (≤ 2-4 weeks), and multi-strain formulations, particularly for diarrhea and epigastric pain. However, moderate to high heterogeneity and generally low methodological quality among several included meta-analyses limit the robustness of the findings. This umbrella meta-analysis demonstrates the potential effectiveness of probiotics in alleviating gastrointestinal symptoms. However, the findings should be interpreted with caution due to moderate to high heterogeneity and the generally low methodological quality of many included studies.

Feasibility Study for the Quantification of Fullness and Discomfort in the Chest and Hypochondrium

2025-06-23

Keun Ho Kim , Jeong Hwan Park , Seok‐Jae Ko +1 more | Journal of Clinical Medicine

Background/Objective: Abdominal examination by medical doctors is undertaken to observe abdominal shape and tenderness, but it is not typically quantified. Our goal was to explore the potential of physical metrics … Background/Objective: Abdominal examination by medical doctors is undertaken to observe abdominal shape and tenderness, but it is not typically quantified. Our goal was to explore the potential of physical metrics for identifying significant differences between individuals with fullness and discomfort in the chest and hypochondrium (FDCH) and those without FDCH. We utilized a 3D camera and a digital algometer to obtain these metrics. Methods: We screened sixty participants with functional dyspepsia and complaints of epigastric discomfort or pain and sixty healthy participants without any digestive problems as a case-control study. We assessed the degree of agreement with FDCH of the abdominal signs diagnosed by traditional East Asian medicine doctors by performing clinical studies that involved assessing abdomens with the aforementioned devices. Results: Algometric features such as pressure, depth, and stiffness (defined as the pressure-to-depth ratio) were significantly lower in the FDCH group than in the non-FDCH group, with mean differences across locations ranging from −1.47 to −0.86, −8.75 to −4.46, and −0.31 to −0.12, respectively. Therefore, the physical algometric features decreased, the skin stiffness decreased, and the sensitivity increased. The point estimates for the mean differences in the geometric factor of depth between FDCH and non-FDCH across the locations ranged from −2.09 to −1.66, with generally smaller depth values in the FDCH group, indicating a flat or drooping abdominal shape. Conclusions: The algometric and geometric metrics showed differences between the FDCH and non-FDCH groups, and various physical metrics will be expanded to identify other diseases through the collection of more clinical data in future. Trial registration/Protocol registration: CRIS and KCT0003369.

Cultural translation of the constipation assessment a study on the reliability and validity of the Chinese version of the constipation severity index

2025-06-23

Wei Hu , Madhulika G. Varma , Xiaoli Huang +4 more | Frontiers in Medicine

Background Assessing the severity of constipation in patients is important for tailoring treatment plans and monitoring outcomes. However, validated assessment tools for constipation severity are limited in China. Objective This … Background Assessing the severity of constipation in patients is important for tailoring treatment plans and monitoring outcomes. However, validated assessment tools for constipation severity are limited in China. Objective This study aimed to evaluate the psychometric properties of the Chinese version of the Constipation Severity Index (CSI). Methods A cross-sectional survey was conducted in two tertiary hospitals in China. A total of 621 patients meeting the diagnostic criteria for constipation were enrolled. The scale’s reliability and validity were assessed using Content Validity Index (CVI), Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), internal consistency, and test–retest reliability. Results The expert-rated Item-level Content Validity Index (I-CVI) was 0.90. EFA revealed a three-factor structure comprising 16 items, accounting for 71.81% of the total variance. CFA results suggested acceptable model fit (χ2 = 257.711, df = 96, p &lt; 0.001; CFI = 0.965; TLI = 0.956; RMSEA = 0.074, 90% CI: 0.063–0.085; SRMR = 0.047). The scale demonstrated good internal consistency (Cronbach’s alpha = 0.936, McDonald’s Omega = 0.937). Conclusion This study provides preliminary evidence for the reliability and validity of the Chinese version of the CSI. While the initial results are promising, further research is needed to validate its applicability in various clinical settings and patient populations. The CSI may potentially serve as a useful tool for assessing constipation severity in Chinese patients, but additional validation studies are necessary before its widespread clinical application.

Biomarkers in Patients with IBS: Continue the Grail Quest or Give It a Rest?

2025-06-23

Mauricio F. Jin , Xiao Jing Wang | Digestive Diseases and Sciences

Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database

2025-06-23

Shuo Li , Xingxing Liu , Taiyu Chen +5 more | Research Square (Research Square)

<title>Abstract</title> Background: Oral health and gut health are closely related. Gut flora changes can be modulated via the mouth-gut axis, impacting bowel health. This study aimed to explore the relationship … <title>Abstract</title> Background: Oral health and gut health are closely related. Gut flora changes can be modulated via the mouth-gut axis, impacting bowel health. This study aimed to explore the relationship between oral health and the incidence of chronic diarrhea and constipation, as well as its impact on all-cause mortality. Methods: This cross-sectional study used data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES) database. Multivariable logistic regression and subgroup analyses assessed the associations between oral health status, dental pain frequency, and chronic diarrhea/constipation. Multivariable Cox regression evaluated the link between oral health and all-cause mortality in patients with chronic constipation or diarrhea. Results: Chronic constipation was present in 10.37% (957/9231) of participants, and chronic diarrhea in 12.06% (1113/9231). Adjusted multivariable logistic regression models showed that poor oral health and high frequency of dental pain were significantly associated with an increased risk of chronic constipation [odds ratio (OR) = 1.65, 95% confidence interval (CI) 1.28–2.12, <italic>P</italic> < 0.001; OR = 1.43, 95% CI 1.01–2.02, <italic>P</italic> = 0.044] and chronic diarrhea (OR = 1.31, 95% CI 1.07–1.71, <italic>P</italic> = 0.044; OR = 1.69, 95% CI 1.35–2.11, <italic>P</italic> < 0.001), particularly in smokers, drinkers, and those with a history of neoplasia. Adjusted multivariable Cox regression indicated that poor dental health was linked to all-cause mortality in diarrhea patients (HR = 1.66, 95% CI 1.08–2.54, P = 0.033). Conclusion: Oral health conditions are significantly correlated with chronic intestinal diseases. This discovery highlights the significance of oral factors in the treatment strategies for chronic intestinal diseases.

Response to ‘Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimize Adherence With Therapy’ by Emmanuel et al. <i>Neurogastroenterol Motil</i>. 2025

2025-06-22

Michelle N. Bloem , Ilan J.N. Koppen , Marc A. Benninga | Neurogastroenterology & Motility

Gastric Accommodation and Impact on Emptying of Solids in Gastroparesis

2025-06-22

David Yi Yang , Nada Abdelnaem , Ayah Matar +1 more | Neurogastroenterology & Motility

ABSTRACT Background In healthy controls, higher gastric accommodation (GA) was associated with slower gastric emptying (GE) of solids. Aims In patients with gastroparesis: (1) To investigate the association between GA … ABSTRACT Background In healthy controls, higher gastric accommodation (GA) was associated with slower gastric emptying (GE) of solids. Aims In patients with gastroparesis: (1) To investigate the association between GA and GE of solids. (2) To assess the prevalence of abnormally high GA. Methods An electronic medical records (EMR) review (2010–2024) was conducted on 745 adult patients with measured GA following 300 kcal Ensure using SPECT, and scintigraphy‐based GE of solids (320 kcal, 30% fat, egg meal). Among these patients, 284 had gastroparesis (GE < 25% emptied at 2 h or < 75% emptied at 4 h). Spearman correlation analysis examined associations between GA volume or ratio and GE at 1, 2, and 4 h, and GE T 1/2 . Results Weak positive correlations were observed between GA volume and GE of solids % at 1 and 2 h (respectively R s = 0.148, p = 0.0234, and R s = 0.121, p = 0.042). In addition, there was a correlation between GA ratio and GE of solids % at 2 h ( R s = 0.143, p = 0.0160). However, there were no significant correlations of GA with GE % at 4 h or GE T 1/2 . Among the 284 patients with gastroparesis, we had documented increased GA, assessed by postprandial minus preprandial gastric volume (> 640 mL), in 7.75%, and increased GA by GA ratio > 3.85 in 22.9%. Conclusions Among patients with gastroparesis, higher GA is associated with accelerated GE of solids in the first 2 h, though the effect size is small. There is no significant effect on delayed GE at 4 h or GE T 1/2 .

Decreased Excitability and Voltage‐Gated Sodium Currents in Myenteric Neurons Contribute to the Impairment of Gut Contraction in Type 2 Diabetes Mice

2025-06-22

Guillermo A. Cabral‐García , Estefanía G. Contreras‐Vázquez , Andrómeda Liñán‐Rico +4 more | Neurogastroenterology & Motility

ABSTRACT Background Diabetic gastrointestinal dysfunction is a common complication of long‐standing diabetes and poorly controlled hyperglycemia, often associated with considerable morbidity. However, the cellular mechanisms that underlie the diabetic impairment … ABSTRACT Background Diabetic gastrointestinal dysfunction is a common complication of long‐standing diabetes and poorly controlled hyperglycemia, often associated with considerable morbidity. However, the cellular mechanisms that underlie the diabetic impairment of the intestine remain poorly understood. In the present study, we examined whether alterations in myenteric neuron excitability contribute to diabetic intestinal dysfunction. Methods Type 2 diabetic mice were generated by administering a cafeteria diet for 21 weeks and an intraperitoneal injection of streptozotocin. Fasting blood glucose assessment and glucose and insulin tolerance tests confirmed the development of diabetes. The effect of diabetes on gut contractility was tested in an isolated organ bath, and patch‐clamp recordings were conducted to measure neuronal biophysical properties. Key Results Type 2 diabetic mouse colons had a decreased twitch force amplitude and a decrease in the frequency of rhythmic spontaneous contractions. Moreover, S‐myenteric neurons of type 2 diabetic mice exhibited reduced excitability with a significant increase of 41% in rheobase. Incubation of naïve myenteric neurons with colonic supernatants from type 2 diabetic mice recapitulated the effects on rheobase. Finally, the total voltage‐gated sodium currents were significantly decreased in myenteric neurons incubated with diabetic colonic supernatants. Conclusion and Inferences The decreased excitability and downregulation of total voltage‐gated sodium currents in the myenteric neurons of type 2 diabetic mice could partially explain the cellular mechanisms underlying the colonic dysmotility observed in patients with diabetes. Targeting voltage‐gated sodium channels may represent a novel therapeutic approach for modulating diabetic intestinal dysfunction.

Abnormal Homeostasis in the Redox State and Related Signaling Pathways, in Irritable Bowel Syndrome

2025-06-22

Alizon Sujey Morales‐Guzmán , Adriana Alarcón‐Aguilar , Armando Luna‐López +5 more | Neurogastroenterology & Motility

ABSTRACT Background IBS is multifactorial; however, elucidating its underlying mechanisms is crucial for advancing in its diagnosis and management. Aims Evaluate molecular processes related to oxidative stress (OS) and inflammation … ABSTRACT Background IBS is multifactorial; however, elucidating its underlying mechanisms is crucial for advancing in its diagnosis and management. Aims Evaluate molecular processes related to oxidative stress (OS) and inflammation in IBS and its subtypes. Methods Thirty Rome III‐IBS outpatients and 30 controls were studied for OS biomarkers, including malondialdehyde (MDA), protein carbonyls (PC), reduced glutathione (GSH), and oxidized glutathione (GSSG). Also, serum interleukins (IL‐10, IL‐4, TNF‐α, IL‐6), and the nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB), nuclear factor erythroid 2‐related factor 2 (Nrf2), and nicotinamide‐adenine‐dinucleotide phosphate (NADPH) catalytic subunit gp91 phox . Results In IBS vs. controls there were higher MDA: 4.44 ± 1.76 vs. 2.42 ± 0.5 nmol/mg/protein ( p < 0.01); GSSG: 57.17 ± 17.49 vs. 42.73 ± 14.26 μM ( p < 0.01); and lower GSH: 26.17 ± 12.36 vs. 38.47 ± 16.71 μM ( p < 0.01). Also, an imbalance in pro‐ and anti‐inflammatory interleukins ( p < 0.01); and higher NF‐κB: 5.33 ± 3.39 vs. 3.08 ± 1.19 ( p = 0.01); gp91 phox : 4.28 ± 1.81 vs. 3.29 ± 1.03 ( p < 0.05); and lower Nrf2: 3.87 ± 2.9 vs. 7.56 ± 2.59 ( p < 0.05). Additionally, there were no significant differences between the IBS subtypes, nor according to severity. Finally, in IBS‐C, MDA correlated with IL‐4, TNF‐α with IL‐10; and in IBS‐D, GSH correlated with IL‐4 and no differences in transcription factors. Conclusions The data demonstrate an alteration in the homeostasis of the cellular redox state in IBS. Also, in IBS‐D, the antioxidant effect counteracts the low‐grade inflammation, whereas in IBS‐C, it is mainly driven by interleukins.

Shugan Decoction Ameliorated WAS‐Induced Abnormal Colonic Motility in Rats by Inhibiting Colonic <scp>TRPV4</scp>‐<scp>PGE<sub>2</sub></scp> Signaling

2025-06-22

Ya Feng , Chunyu Zhou , Youcheng He +5 more | Neurogastroenterology & Motility

ABSTRACT Aim To clarify the function of transient receptor potential vanilloid 4 (TRPV4)‐prostaglandin E2 (PGE 2 ) signaling in the colon of rats with irritable bowel syndrome (IBS) induced by … ABSTRACT Aim To clarify the function of transient receptor potential vanilloid 4 (TRPV4)‐prostaglandin E2 (PGE 2 ) signaling in the colon of rats with irritable bowel syndrome (IBS) induced by water‐avoidance stress (WAS). On this basis, to explore whether colonic TRPV4‐PGE 2 signaling is involved in the mechanism of action of Chinese herbal formula Shugan Decoction (SGD) on IBS. Methods The rat model of IBS was induced by chronic WAS, and the number of fecal pellets was counted. Meanwhile, the visceral pain pressure threshold was measured using colorectal distension. Western blot or immunofluorescence was used to measure the protein expressions of TRPV4, EP1, and EP3 in the colon. ELISA was used to determine the contents of PGE 2 in colonic tissue. The contractile activities of the colonic longitudinal muscle strips were observed via an organ bath experiment. Results Compared with the control group, the content of PGE 2 , the expressions of TRPV4, EP1, and EP3 receptors in the colon of the rats in the WAS group increased, accompanied by enhanced fecal pellet output and reduced visceral pain pressure threshold; meanwhile, the tension and the amplitude of the spontaneous contraction of the colonic longitudinal muscle were significantly enhanced. These parameter values in the SGD group were significantly restored compared with those in the WAS group. The suppression of contractile tension and amplitude by the TRPV4 inhibitor HC‐067047 in the WAS group was greater than that in the control and SGD groups. The enhancement of contractile amplitude by PGE 2 in the WAS group was weaker than that in the control group but was stronger than that in the SGD group. Interestingly, the suppression of contractile tension by the EP1 antagonist ONO‐8711 in the SGD group was less than that in the WAS group. Conclusion SGD can ameliorate dysmotility of colonic longitudinal muscle and visceral hypersensitivity caused by WAS maybe by reducing the release of PGE 2 and decreasing the expression of TRPV4 and EP1.

Opioid analgesic-related severe constipation

2025-06-21

| Reactions Weekly

IBS treatment-related AEs

2025-06-21

| Reactions Weekly

The outcomes of a structured bowel management programme on childhood functional constipation: a retrospective pre – post intervention study

2025-06-20

Gunilla Flankegård , Peter Wide , Evalotte Mörelius | Journal of Pediatric Nursing

The purpose of this study was to describe and evaluate the effectiveness of a six-month structured bowel management programme (SBMP) for children with therapy-resistant functional constipation (FC). A retrospective review … The purpose of this study was to describe and evaluate the effectiveness of a six-month structured bowel management programme (SBMP) for children with therapy-resistant functional constipation (FC). A retrospective review of medical records with a pre-post design was conducted at an outpatient paediatric clinic in Sweden. Bowel frequency, stool form, faecal incontinence, and abdominal pain were compared before and after the intervention. Predictive factors for successful discharge and duration of care through long-term follow-up were calculated. Of the 142 children enrolled in the SBMP, 132 completed the programme. Despite previous FC therapy resistance, the SBMP achieved a treatment success rate of 44 % within 6 months, and 58 % after 12 months. The need for additional contacts beyond those scheduled and persistent faecal leakage were significant predictors of non-recovery. Long-term follow-ups indicate that after 2 years of care, approximately 80 % of the children achieved recovery. This study highlights the effectiveness of the SBMP in managing therapy-resistant FC in children at a general outpatient paediatric clinic, while also emphasising the necessity of long-term follow-up for sustainable results. The results suggest that a structured care programme like the SBMP helps set realistic expectations and ensures consistent quality of care for children with FC, despite the severity and complexities involved.

The Impact of Oral- vs. Nasogastric Tube-Administered Osmotic Laxative on Pediatric Patients with Fecal Impaction Complicating Functional Constipation

2025-06-20

Thomas Aviles , Neha R. Santucci | Digestive Diseases and Sciences

Overlapping inflammatory bowel and irritable bowel: Time to screen for parental catastrophizing

2025-06-19

Miranda A.L. van Tilburg , Rasmita Budhathoki , Amber Langshaw +1 more | Journal of Pediatric Gastroenterology and Nutrition

Efficacy of a Low-FODMAP Diet on the Severity of Gastrointestinal Symptoms and Quality of Life in the Treatment of Gastrointestinal Disorders—A Systematic Review of Randomized Controlled Trials

2025-06-19

Laura Kuźmin , Katarzyna Kubiak , Ewa Lange | Nutrients

Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled … Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled trials assessing the efficacy of the low-FODMAP diet on the severity of gastrointestinal symptoms and quality of life in patients with gastrointestinal disorders. Methods: This review was conducted in accordance with CASP tool and PRISMA guidelines. A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of fourteen randomized controlled trials. Results: Ten studies examined the effect of the low-FODMAP diet in patients with irritable bowel syndrome (IBS), three with inflammatory bowel disease (IBD), and one with symptomatic proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD). All interventions compared the low-FODMAP diet with another diet and lasted from 3 to 12 weeks. Most studies on IBS showed significant improvements in abdominal pain, bloating, and quality of life compared to control diets. In IBD, improvements were mainly observed in functional gastrointestinal symptoms, while no clear benefit was demonstrated in GERD. Heterogeneity in study designs, intervention durations, comparator diets, and outcome measures limited the ability to conduct a meta-analysis. Conclusions: Although a low-FODMAP diet may reduce symptoms in selected individuals, it is not universally necessary. Importantly, the diet's restrictive nature and potential long-term effects-such as nutritional deficiencies and alterations in gut microbiota-highlight the need for clinical supervision by dietitians with expertise in gastrointestinal disorders. Furthermore, in some cases, symptom improvement may be achievable through less restrictive changes, such as improving food hygiene and reducing intake of processed or high-sugar foods. Further high-quality randomized controlled trials with standardized endpoints and longer follow-up are needed to clarify the efficacy and safety of the low-FODMAP diet across various gastrointestinal conditions.

Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review

2025-06-19

Akshaya Srikanth Bhagavathula , Ahmed Mourtada Al Qady , Wafa Ali Aldhaleei | World Journal of Gastroenterology

Irritable bowel syndrome (IBS) affects approximately 9%-12% of the global population, presenting substantial diagnostic challenges due to symptom subjectivity and lack of definitive biomarkers. To systematically examine the diagnostic accuracy … Irritable bowel syndrome (IBS) affects approximately 9%-12% of the global population, presenting substantial diagnostic challenges due to symptom subjectivity and lack of definitive biomarkers. To systematically examine the diagnostic accuracy of artificial intelligence (AI) models applied to various biomarkers in IBS diagnosis. A comprehensive search of six databases identified 18053 articles published up to May 31, 2024. Following screening and eligibility criteria, six observational studies involving 1366 participants from the United Kingdom, China, and Japan were included. Risk of bias and reporting quality were assessed using quality assessment of diagnostic accuracy studies-2, prediction model risk of bias assessment tool-AI, and transparent reporting of a multivariable prediction model for individual prognosis or diagnosis-AI tools. Key metrics included sensitivity, specificity, accuracy, and area under the curve (AUC). The included studies applied AI models such as random forests, support vector machines, and neural networks to biomarkers like fecal microbiome composition, gas chromatography data, neuroimaging features, and protease activity. Diagnostic accuracy ranged from 54% to 98% (AUC: 0.61-0.99). Models using fecal microbiome data achieved the highest performance, with one study reporting 98% sensitivity and specificity (AUC = 0.99). While most studies demonstrated high methodological quality, significant variability in datasets, biomarkers, and validation methods limited meta-analysis feasibility and generalizability. AI models show potential to improve IBS diagnostic accuracy by integrating complex biomarkers which will aid the development of algorithms to direct treatment strategies. However, methodological inconsistencies and limited population diversity underscore the need for standardized protocols and external validation to ensure clinical applicability.

Digital health intervention in an innovative and personalized approach to the management of irritable bowel syndrome in Indian patients: A case series

2025-06-19

Ramesh Kumar Garg , Sujeet Narayan Charugulla , Surbhi Agarwal +3 more | Indian Journal of Case Reports

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder marked by abdominal discomfort and altered bowel habits. Despite its prevalence, managing IBS remains challenging due to its complex nature. Digital … Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder marked by abdominal discomfort and altered bowel habits. Despite its prevalence, managing IBS remains challenging due to its complex nature. Digital health interventions have emerged as innovative solutions, combining dietary changes, psychological support, and wellness strategies. This case series of seven IBS patients explores the effectiveness of the DailyBloom IBS App in managing IBS through a 14-week program incorporating a low-FODMAP diet, cognitive behavioral therapy, and physical wellness. Patients experienced reduced abdominal pain, bloating, and diarrhea frequency, alongside the improved quality of life, including less anxiety and stress. This case series highlights the potential of digital therapeutics as a complement to conventional care in India. The DailyBloom™ IBS App adopts a structured four-phase approach: discovery (weeks 1–2), elimination (weeks 3–5), reintroduction (weeks 6–11), and sustenance (weeks 12–14). Patients, categorized into IBS subtypes (IBS-constipation, IBS-diarrhea, IBS-mixed, IBS-undefined), were evaluated for symptom progression, management, and outcomes. Findings emphasize the role of digital therapeutics in providing personalized, evidence-based care, marking a significant advancement in IBS management within the digital health landscape promising both symptom relief and lifestyle improvements for patients.

Case Report: Traditional Korean Medical Treatment for Slow Transit Constipation Diagnosed as Colonic Inertia in a Laxative-Dependent Patient

2025-06-19

Yoohyun Sim , Nahyun Jeong , Da‐Hee Jeong +5 more | The Journal of Internal Korean Medicine

Objective: This case study reports on the effectiveness of traditional Korean medicine in treating slow transit constipation (STC) and colonic inertia.Methods: A 68-year-old male patient diagnosed with STC and colonic … Objective: This case study reports on the effectiveness of traditional Korean medicine in treating slow transit constipation (STC) and colonic inertia.Methods: A 68-year-old male patient diagnosed with STC and colonic inertia received inpatient Korean medical treatments, including acupuncture, electroacupuncture, herbal medicine, and moxibustion, for approximately seven weeks. Changes in symptoms were evaluated using the Numeric Rating Scale (NRS) and the Gastrointestinal Symptom Rating Scale (GSRS), while quality of life was evaluated using the EuroQol-5 Dimension-5 Level (EQ-5D-5L) and the EuroQol Visual Analog Scale (EQ-VAS).Results: After treatment, the patient showed significant improvement in constipation-related symptoms and quality of life. The NRS score for constipation-related discomfort decreased from 8 to 1, and the score for dyspepsia decreased from 5 to 0. The GSRS score improved from 23 to 16, indicating a reduction in gastrointestinal symptoms. The EQ-VAS score increased from 50 to 90 and the EQ-5D-5L index improved from 0.722 to 0.886, reflecting an improved quality of life. In addition, bowel movement frequency and stool consistency normalized without the need for laxatives.Conclusion: This study suggests that Korean medical treatment, including acupuncture, electroacupuncture, herbal medicine, and moxibustion, may be an effective therapeutic approach for patients with slow transit constipation and colonic inertia.

Accuracy and outcomes of endoscopic ultrasound guided anal botulinum toxin injections for pediatric constipation: A pilot study

2025-06-18

Brianne Shuler , Alexandra Kilgore , Paul Tran +4 more | Journal of Pediatric Gastroenterology and Nutrition

Abstract Objectives Injection of Onabotulinumtoxina (BT) into the internal anal sphincter (IAS) is commonly used for pediatric constipation. Typically, BT injections are guided by anatomic landmarks (standard technique [ST]). This … Abstract Objectives Injection of Onabotulinumtoxina (BT) into the internal anal sphincter (IAS) is commonly used for pediatric constipation. Typically, BT injections are guided by anatomic landmarks (standard technique [ST]). This pilot study assessed the accuracy of BT injection placement with ST versus endoscopic ultrasound (EUS) guidance and compared clinical outcomes. Methods Children aged 2–18 with chronic functional constipation undergoing BT injections without anorectal anatomic or neurologic abnormalities were eligible. Fifteen children were enrolled in the intervention arm with ST placement and needle location assessment using EUS. Subsequently, EUS‐guided injection was specifically placed into the IAS. Additionally, 30 children (controls) received BT by ST without EUS‐guidance. A constipation severity questionnaire was administered at 2 weeks, 3 months, and 6 months postprocedure. Results The initial needle tip location was the IAS for 30 placements (50.1%, 95% confidence interval [CI]: 38.1%–63.5%) and the external anal sphincter in 15 placements (20.3%, 95% CI: 11.8%–32.8%) of a total 59 injections assessed by EUS. Patients reported improvement at 2 weeks, 3 months, and 6 months in both study groups. Constipation scores obtained only after injections were worse in EUS versus control (22.21 vs. 13.83, p < 0.0001) at 2 weeks, with no significant difference at 3 (15.8 vs. 13.57, p = 0.127) or 6 months (13.10 vs. 13.27, p = 0.9322). Conclusions This study shows the IAS is injected with BT only 50% of the time with standard technique based on anatomical landmarks.

Research on functional constipation with anxiety or depression: a bibliometric analysis

2025-06-18

Xiaoqin Li , Qiang Lei , Xie Jiao +4 more | Frontiers in Psychiatry

Background Although the phenomenon of functional constipation (FC) that accompanies anxiety or depression has been extensively investigated worldwide, no bibliometric studies are available in this regard. This study therefore aimed … Background Although the phenomenon of functional constipation (FC) that accompanies anxiety or depression has been extensively investigated worldwide, no bibliometric studies are available in this regard. This study therefore aimed to analyze the current status and extent of research and areas of interest in the study of FC with anxiety or depression. Methods Data from studies on FC with anxiety or depression, that were performed between 2003 and 2024, were retrieved from the Web of Science Core Collection database. Data regarding the annual number of publications, authors, countries, and references were assessed using CiteSpace v6.3.R1 (64-bit) and Microsoft Excel, and those pertaining to keywords and cited authors were evaluated using VOSviewer 1.6.20. The co-occurrence and clustering functions were then used to generate visual knowledge maps. Results The overall annual publication volume demonstrated an upward trend between 2003 and 2024; this was indicative of promising research prospects. The 427 publications identified included 6 types of papers, among which original research articles represented the highest proportion (357 [83.61%] articles published across 200 journals). Neurogastroenterology and Motility had the highest publication volume (30 articles, 7.02%). The United States of America had published most of the papers (135 articles, 31.61%) on the topic. Harvard University was the research institution with the most published papers (21 articles, 4.92%), and Michel Bouchoucha had authored the highest number of articles (13 articles, 3.04%). Conclusion Future studies in the field of basic medicine need to determine the etiology and pathogenesis of FC with anxiety or depression; in particular, they need to evaluate the role of opioid drugs as a key etiological factor. The role played by the brain-gut axis also warrants investigation. From the clinical perspective, studies need to focus on evidence-based medicine; particular emphasis needs to be placed on randomized double-blind controlled trials with stringent quality control, high-quality meta-analyses, and evaluation of questionnaires and scales. Treatment techniques need to be explored in greater detail; in this context, it is recommended that fecal microbiota transplantation and biofeedback therapy are adopted in the clinic. Furthermore, Patients with FC, especially those with a history of anxiety or depression, tend to have overlapping dyspepsia symptoms.

Laxative effect of Zengye granule by modulating the SCF/c-Kit pathway and gut microbiota in constipated mice

2025-06-18

Fengxia Lv , Pan Li , Bin Wang +3 more | Frontiers in Veterinary Science

Introduction Zengye granule (ZYG), a traditional Chinese medicine, is listed in the Chinese Pharmacopoeia as a prescription medicine for treating various yin-deficiency diseases including inner heat, dry mouth and pharynx, … Introduction Zengye granule (ZYG), a traditional Chinese medicine, is listed in the Chinese Pharmacopoeia as a prescription medicine for treating various yin-deficiency diseases including inner heat, dry mouth and pharynx, and dry bound stool. However, the underlying mechanisms of its action remain unclear. This study aimed to assess the laxative effects of ZYG on diphenoxylate-induced constipation in Kunming mice and clarify the underlying mechanism of action of ZYG in treating constipation. Methods A model of constipation induced by diphenoxylate was developed. The laxative effect was evaluated based on the discharge time of the first black stool, fecal number, fecal weight, intestinal propulsion rate, and intestinal moisture content. Enzyme-linked immunosorbent assay was used to analyze the expression of inflammatory cytokines and neurotransmitters in serum. Histopathological analysis of colon tissues was performed using hematoxylin–eosin staining. Real-time quantitative polymerase chain reaction, immunohistochemistry, and western blotting were used to analyze the mRNA and protein expression of the stem cell factor (SCF)/c-Kit tyrosine kinase (c-Kit) signaling pathway. The composition of the mouse intestinal microbiota was determined by 16S rDNA sequencing. Results ZYG improved intestinal peristalsis, defecation frequency, and intestinal moisture content. ZYG decreased the abundance of Firmicutes at the phylum and genus levels and increased the abundance of Bacteroidetes at the genus level. ZYG exerted a laxative effect by modulating the SCF/c-Kit signaling pathway. Discussion This study provides valuable insights into laxative mechanism of ZYG and its potential veterinary application.

Clinical efficacy of probiotics in improving intestinal mucosal permeability for functional dyspepsia patients with anxiety

2025-06-18

Kangming Huang , H. Qiu , D. Liao +3 more | Frontiers in Microbiology

Background The aim of this study was to investigate whether probiotics are effective in improving symptoms of functional dyspepsia (FD) accompanied by anxiety. Methods There were 116 patients with FD … Background The aim of this study was to investigate whether probiotics are effective in improving symptoms of functional dyspepsia (FD) accompanied by anxiety. Methods There were 116 patients with FD accompanied by anxiety and 114 patients without anxiety. Each group was randomly divided into an intervention group and a control group. The intervention group received probiotics in addition to conventional acid suppression and gastric protection, as well as prokinetic treatments. The control group received conventional treatment plus a placebo. Results Before treatment, significant differences were observed in IL-1, IL-6, TNF- α , LPS, Zonulin, DAO, and I-FABP between patients with FD accompanied by anxiety and those without anxiety ( p &lt; 0.05). Following the intervention with probiotics, the group with FD and anxiety experienced significant decreases in IL-1, IL-6, TNF- α , LPS, Zonulin, and DAO ( p &lt; 0.001), as well as significant reductions in the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and the Hamilton Anxiety Scale (HAMA) scores ( p &lt; 0.001). In contrast, the intervention group with FD but without anxiety had significant reductions in IL-6 and TNF- α ( p &lt; 0.05), along with a significant decrease in the PAGI-SYM score ( p &lt; 0.001). Binary logistic regression analysis further revealed that lower I-FABP values (OR = 0.999, p = 0.036), lower LPS values (OR = 0.998, p = 0.013), and probiotic intervention (OR = 5.138, p = 0.000) were significantly associated with symptom relief. Conclusion The intervention significantly improved the symptoms and anxiety scores of patients with FD and anxiety, and the changes in intestinal mucosal permeability indexes were closely related to symptom relief and anxiety improvement, Probiotic interventions may be an effective means of improving symptoms in patients with FD. Clinical trial registration identifier ChiCTR2300077847 https://www.chictr.org.cn/ .

Research on the Development of an Abdominal Massage Robot: Diversified Manipulation Strategies and Improved Force Interaction Performance

2025-06-18

Xinyi Tang , Ping Shi , Hongliu Yu +4 more | Actuators

Abdominal massage for constipation has problems such as high labor costs, insufficient standardization, and large differences in efficacy. This study aims to develop a new type of abdominal massage robot … Abdominal massage for constipation has problems such as high labor costs, insufficient standardization, and large differences in efficacy. This study aims to develop a new type of abdominal massage robot to break through the bottlenecks of manual abdominal massage. This paper constructs a new six-degree-of-freedom multi-functional abdominal massage robot system, improves and designs a new series-parallel hybrid mechanical structure, and based on this, establishes an abdominal interaction force control strategy that uses a variable-stiffness physical model to represent the biomechanical properties of the abdomen. Verified by simulation and human experiments, this robot can accurately reproduce a variety of massage techniques, and demonstrate stable force control performance in prosthesis experiments and human abdominal tests, with the interaction force error controlled within 0.8 N, providing an innovative path for the intelligentization and standardization of clinical abdominal massage.

Gastroparesis needs to be detected and treated

2025-06-18

E. Yu. Plotnikova , Andrey Sukhikh | Meditsinskiy sovet = Medical Council

Gastroparesis is a symptomatic chronic stomach disease characterized by objective sings of delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis is rarely documented in routine clinical practice. This … Gastroparesis is a symptomatic chronic stomach disease characterized by objective sings of delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis is rarely documented in routine clinical practice. This disease is usually suspected, examined and diagnosed in patients with a syndrome of intense and prolonged nausea, vomiting, early satiety, epigastric pain, which occur as a result of muscular, nervous or rhythmic abnormalities of gastric functioning. Although delayed gastric emptying is a determining feature of gastroparesis, other aspects of gastric neuromuscular dysfunction, such as maladaptation and visceral hypersensitivity, may also contribute to the symptoms of gastroparesis. The symptoms of gastroparesis often overlap with those of other functional gastrointestinal disorders, including chronic unexplained nausea and vomiting syndrome, cyclic vomiting syndrome, various impaired "gut-brain" interactions, and, first of all, functional dyspepsia. This article presents a review of different examinations in gastroparesis from a gastric motility perspective. In clinical gastroenterological practice, gastroparesis is considered one of the most complex conditions due to the disagreements regarding the definition, range of symptoms, diagnosis and optimal therapeutic strategy, particularly due to the lack of treatment methods with proven efficacy. The article reviews current data on epidemiology, etiologic factors, pathophysiological concepts, and substantiates the need for proper diagnosis of gastroparesis. The methods for treating functional gastroparesis such as diet therapy, prokinetics, antiemetics and symptom relief drugs are described in detail. In addition, the rationale for the use of itopride prokinetic and rebamipide gastroprotector is presented.

Irritable bowel syndrome after acute intestinal infection: Aspects of therapy on a clinical example

2025-06-18

И. Г. Пахомова | Meditsinskiy sovet = Medical Council

Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is common among young and working-age individuals and can significantly impact quality of life. Among the etiopathogenetic aspects of … Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is common among young and working-age individuals and can significantly impact quality of life. Among the etiopathogenetic aspects of IBS development, the most important are intestinal motility disorders, visceral hypersensitivity, and intestinal microbiome disorders. A previous acute intestinal infection can have a significant impact on the latter, subsequently forming a post-infectious variant of IBS (PI-IBS), the frequency of which depends on what etiological factor led to the development of acute infectious gastroenteritis (bacteria, viruses, protozoa). Risk factors for the development of PI-IBS have been studied and described, among which are the severity of intestinal infection, duration of diarrhea for more than 7 days, female gender, level of anxiety and depression. Approaches to the treatment of PI-IBS have not been developed. It is proposed to use treatment options that are consistent with approaches to non-infectious IBS in accordance with the Rome Consensus IV. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine, effectively coping with abdominal pain. The drug of choice for patients with PI-IBS are calcium channel blockers, namely Otilonium bromide, which is widely used worldwide, is effective and safe, has additional antibacterial and antimycotic properties, is well tolerated and is superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. In the therapy of PI-IBS, the use of rifaximin and probiotic preparations for at least 12 weeks is of great importance. This article provides a review of the literature on the prevalence and etiopathogenetic aspects of PI-IBS, as well as possible approaches to the treatment of such patients. A clinical case is presented.

Chronic constipation: From syndrome to diagnosis and effective therapy

2025-06-18

О. В. Гаус , М. А. Ливзан , D. A. Gavrilenko | Meditsinskiy sovet = Medical Council

Chronic constipation is a generally recognized medical and social problem and occupies a leading place in the number of requests for outpatient medical care among patients with a gastroenterological profile … Chronic constipation is a generally recognized medical and social problem and occupies a leading place in the number of requests for outpatient medical care among patients with a gastroenterological profile in many countries of the world. The persistent trend in recent years towards an increase in global prevalence regardless of gender, age and socioeconomic status emphasizes the relevance of studying and systematizing data on the causes of chronic constipation and optimal approaches to diagnosis in order to improve the effectiveness of treatment of patients. A particular difficulty in managing patients with chronic constipation is identifying the etiological factor due to the presence of a wide range of possible causes. This often increases the time of diagnosis and complicates the timely initiation of rational therapy. According to etiology, chronic constipation is classified as primary (functional) – an independent disease in the absence of organic or metabolic disorders and secondary – as a symptom of another pathology or associated with a known factor. In clinical practice, the majority of cases are patients with primary chronic constipation, namely, with functional constipation and irritable bowel syndrome with a predominance of constipation. The diagnostic algorithm for chronic constipation should be aimed at assessing “alarm symptoms”, excluding organic pathology and other secondary causes. This involves a thorough collection of complaints, anamnesis of the disease and life, physical examination and the appointment of the necessary laboratory and instrumental examination methods, the scope of which is determined individually. The basis of therapy for a patient with primary chronic constipation is lifestyle modification. In the absence of a positive effect from non-drug methods, it is advisable to prescribe laxatives – osmotic action as first-line therapy, stimulating or agonists of 5HT4 receptors in case of insufficient response to the former. One of the stimulant laxatives that has shown its effectiveness and a reliable safety profile in the treatment of patients with primary chronic constipation is sodium picosulfate.

Efficacy of conventional treatments combined with biofeedback therapy in patients with constipation-predominant irritable bowel syndrome

2025-06-18

A. V. Gilyuk , Д. Н. Андреев , G. L. Yurenev +2 more | Meditsinskiy sovet = Medical Council

Introduction. The mainstay of treatment of constipation-predominant irritable bowel syndrome (IBS-C) are antispasmodic and laxative drugs. The use of biofeedback therapy is effective in patients with IBS-C, when dyssynergic defecation … Introduction. The mainstay of treatment of constipation-predominant irritable bowel syndrome (IBS-C) are antispasmodic and laxative drugs. The use of biofeedback therapy is effective in patients with IBS-C, when dyssynergic defecation (DD) is detected. Aim. To evaluate the efficacy of additional biofeedback therapy in patients with IBS-C and dyssynergic defecation versus conventional pharmacotherapy. Materials and methods. A total of 28 patients aged 30 to 40 years with IBS-C and concomitant DD were included in the study. The subjects were divided into two groups: standard pharmacotherapy (Group 1) and standard pharmacotherapy combined with biofeedback therapy (Group 2). The subjects underwent assessment of the clinical picture, and findings of the evacuation test (ET) and anorectal manometry (AM). Results. After treatment the frequency of defecations per week in Group 1 increased to 3.13 (95% CI 2.67–3.59), and in Group 2 to 4.3 (95% CI 3.68–4.93). AM data showed a decrease in average resting pressure in the anal canal to 80.33 (95% CI 72.97– 87.69) (Group 1), and to 77.15 (95% CI 72.07–82.23) mm Hg (Group 2), an increase in intrarectal pressure to 78.06 (95% CI 69.30–86.82) (group 1) and to 70.76 (95% CI 63.08–78.44) mm Hg (Group 2). In Group 2, the defecation index increased to 2.61 (95% CI 2.0-3.22) versus 1.19 (95% CI 0.92-1.44) in Group 1, positive ET was reported in 5 of 15 subjects (33.33%) in Group 1, and in 10 of 13 subjects (76.92%) in Group 2. Conclusions. This study shows that conventional pharmacotherapy combined with biofeedback therapy demonstrated greater efficacy than standard pharmacotherapy in patients with IBS-C and DD.

Exploring the Correlation between GCSI Score and GES in Type 2 Diabetic Patients—Proposing a GCSI Cut-off Score for Guiding GES Utilization: A Record-centric Research Approach

2025-06-18

Manisha Naithani , Mukesh Bairwa , Ashwin Parchani +5 more | Bengal Physician Journal

Bottom‐Up Design of Prebiotics and Probiotics: An Intestinal Microbiota‐Centered Approach to Chronic and Functional Constipation Management

2025-06-17

Penglin He , Shang Chen , Chenang Lyu +2 more | Molecular Nutrition & Food Research

ABSTRACT Chronic constipation (CC) and functional constipation (FC) are common gastrointestinal disorders that significantly affect quality of life. This study investigates the intestinal microbiota characteristics in CC and FC patients, … ABSTRACT Chronic constipation (CC) and functional constipation (FC) are common gastrointestinal disorders that significantly affect quality of life. This study investigates the intestinal microbiota characteristics in CC and FC patients, revealing microbial imbalances characterized by reduced beneficial taxa, such as Acinetobacter, Blautia, Dorea formicigenerans, Eubacterium ramulus , and Halomonas , alongside increased levels of Alistipes, Holdemanella, Parabacteroides, Pseudomonas, Streptococcus , and so on. These findings highlight dysbiosis as a critical factor in constipation pathogenesis and provide a foundation for the bottom‐up design of targeted probiotics and prebiotics. Potential therapeutic strategies include tailored probiotic formulations to replenish deficient taxa and the application of prebiotics to restore microbial balance. Additionally, the role of microbial metabolites, particularly short‐chain fatty acids, and the microbiota–gut–brain axis offers further insight into mechanisms underlying symptom modulation. The integration of artificial intelligence enhances precision in probiotic design, enabling the prediction of strain‐specific combinations optimized for therapeutic efficacy. This microbiota‐centered approach underscores the potential for personalized interventions in addressing dysbiosis and advancing innovative management for CC and FC.

Association of Constipation and Geriatric Depressive Symptoms: Cross-Sectional Analysis Using Baseline Data from the JUSTICE-TOKYO Prospective Cohort Study

2025-06-17

Hiroyuki Kiko , Daisuke Asaoka , Osamu Nomura +7 more | Diagnostics

Objective: To clarify the relationship between constipation and depressive symptoms among the elderly. Methods: This single-center, cross-sectional study was performed using baseline data obtained at the time of enrollment in … Objective: To clarify the relationship between constipation and depressive symptoms among the elderly. Methods: This single-center, cross-sectional study was performed using baseline data obtained at the time of enrollment in the prospective cohort of the JUSTICE-TOKYO study. Participants underwent assessments including patient profiling, drug use history, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale 15 (GDS-15), gastrointestinal-related quality of life (QOL), and the constipation scoring system (CSS). Geriatric depressive symptoms were evaluated based on GDS-15. We investigated correlations between GDS-15 scores and various abdominal symptoms and assessed risk factors for geriatric depressive symptoms using multiple regression analysis. Results: A total of 984 elderly participants (57% female, mean age 78.1 ± 6.1 year) were included. The GDS-15 scores were significantly correlated with body mass index (BMI) (r = -0.056) and MMSE (r = -0.092), reflex-related QOL (r = 0.253), pain-related QOL (r = 0.229), fullness-related QOL (r = 0.269), constipation-related QOL (r = 0.329), diarrhea-related QOL (r = 0.264), and CSS (r = 0.285) scores. Multiple regression analysis indicated that BMI (β = -0.069, p = 0.020) and MMSE (β = -0.074, p = 0.013), constipation-related QOL (β = 0.136, p = 0.002), reflex-related QOL (β = 0.126, p < 0.001), diarrhea-related QOL (β = 0.095, p = 0.006), and CSS (β = 0.098, p = 0.016) scores were significantly correlated with GDS-15 scores. Conclusions: Depressive symptoms among older individuals are associated with various abdominal symptoms, particularly constipation. However, the causality between depressive symptoms and constipation cannot be inferred due to the study's cross-sectional design.

Naringenin attenuates slow-transit constipation by regulating the AMPK/mTOR/ULK1 signalling pathway: in vivo and in vitro studies

2025-06-17

Yahui Wang , Xiaopeng Wang , Yifei Qian +4 more | Frontiers in Pharmacology

Background Slow-transit constipation (STC) is a widespread functional gastrointestinal condition distinguished by decreased colonic motility as an essential clinical characteristic. The excessive autophagy of interstitial cells of Cajal (ICCs) causes … Background Slow-transit constipation (STC) is a widespread functional gastrointestinal condition distinguished by decreased colonic motility as an essential clinical characteristic. The excessive autophagy of interstitial cells of Cajal (ICCs) causes phenotypic changes and functional abnormalities, which are important in colonic dysmotility. Naringenin (NAR) has been shown to regulate gastrointestinal motility disorders. The present study aimed to elucidate the regulatory role of naringenin in autophagy in STC and its underlying mechanism. Methods In vitro , ICCs were stimulated with L-glutamic acid (GA) to induce autophagy and treated with NAR. A CCK8 assay was performed to evaluate the cytotoxic effect of NAR. Annexin V-FITC/PI staining was used to examine NAR apoptosis. The expression of the autophagy markers Beclin1 and LC3B, as well as proteins related to the AMPK/mTOR/ULK1 pathway was investigated through quantitative PCR, Western blot analysis and immunofluorescence staining. The small interfering RNA (siRNA) technique was used to knockdown selective autophagy receptors (NDP52, OPTN, NBR1, and p62) in ICCs. Coimmunoprecipitation (co-IP) was used to evaluate the binding of pS757-ULK1 to the autophagy receptors NDP52 and OPTN in ICCs. Immunofluorescence (IF) staining was performed to observe the colocalization of pS757-ULK1 with exogenous NDP52 and OPTN in ICCs. In vivo , male C57BL/6 mice were administered loperamide (10 mg/kg) to establish a constipation model and then treated with NAR (75/150/300 mg/kg) for 2 weeks. Finally, colonic tissues were collected for a histological analysis and immunohistochemical for cell growth factor receptor kit (c-Kit) and anoctamin-1 (ANO1). Results Our results indicated that NAR improved the survival and apoptosis of ICCs after GA by inhibiting autophagy through the partial suppression of the AMPK/mTOR/ULK1 signalling pathway. Moreover, NAR inhibited the autophagic degradation of pS757-ULK1 by weakening the interactions between pS757-ULK1 and the selective autophagy receptor genes NDP52 and OPTN. Further research revealed that NAR could increase the moisture content of faeces; increase the rate of small intestinal propulsion in mice; increase the serum concentrations of excitatory neurotransmitters such as GAS, 5-HT, MTL, and SP; and increase the expression levels of ANO1 and c-Kit in the colon, and the molecular mechanism was consistent with the in vitro results. Conclusion NAR attenuates the AMPK/mTOR/ULK1 pathway in ICCs, thereby improving STC colonic dysmotility and underscoring its promise as a therapeutic option for STC.

Association between insufficient sleep and constipation among elementary school children in Japan

2025-06-17

Ritsuko Furuya , Hiroo Wada , Keisuke Onuki +7 more | Sleep and Biological Rhythms

Best Practice to Prevent Constipation in People Living With Dementia: A Scoping Review

2025-06-17

Linda Schnitker , Safa Alrababah , Anne Young +3 more | International Journal of Older People Nursing

ABSTRACT Introduction This scoping review explores available evidence on strategies to guide the prevention of constipation in people with dementia. Methods A systematic literature search was conducted across eight electronic … ABSTRACT Introduction This scoping review explores available evidence on strategies to guide the prevention of constipation in people with dementia. Methods A systematic literature search was conducted across eight electronic databases. Two researchers independently conducted data screening, extraction, analysis and charting using a standardised data extraction tool for obtaining information about studies. Results We identified seven studies, including three randomised controlled trials, carried out between 1997 and 2019. A range of nonpharmacological strategies was utilised to reduce the risk of developing constipation in people who live with dementia. Implications for Practice Strategies identified through this review could guide the care of people with dementia in preventing constipation by emphasising the importance of lifestyle and environmental changes to support regular, soft‐formed bowel movements.

Gender-Related Differences in the Hospitalization Outcomes for Gastroparesis

2025-06-17

Ahmed Ali Aziz , Rehan Shah , Muhammad Aziz +2 more | Cureus

Background Gastroparesis (GP) is a chronic condition in which the stomach takes too long to empty its contents into the small intestine, despite the absence of any physical blockage. Females … Background Gastroparesis (GP) is a chronic condition in which the stomach takes too long to empty its contents into the small intestine, despite the absence of any physical blockage. Females are generally more susceptible to developing GP than males. The objective of this study was to compare clinical outcomes between male and female patients hospitalized with GP using the Nationwide Inpatient Sample (NIS) database. Methods Using the NIS databases from 2020 to 2022 and the International Classification of Diseases, Tenth Edition Revision (ICD-10) codes, we performed a retrospective study of adult patients admitted with GP. We compared inpatient outcomes of GP between males and females. All-cause in-hospital mortality was the primary outcome. Secondary outcomes were total hospitalization cost adjusted to the year 2022, length of stay (LOS), incidence of sepsis, acute renal failure (ARF), shock, and need for intensive care unit (ICU) admission. We used STATA, version 16.1 (StataCorp LLC, College Station, TX), to perform the statistical analyses. Multivariate logistic regression analysis was conducted to assess whether gender was an independent predictor for these outcomes and to adjust for any confounders. Results It was noted that 31,114 adult patients were admitted for GP from 2020 to 2022; 23,886 (76.77%) were females, and 7,228 (23.23%) were males. The mean age of both males and females was 47.2 years. Males had a higher prevalence of diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), congestive heart failure (CHF), chronic kidney disease (CKD), and smoking/tobacco use. Females had a higher prevalence of prior cerebrovascular accident (CVA) and obesity. We found that female patients with GP had significantly longer LOS (+0.88 days, 95% CI: 0.53 - 1.29, P <0.01), higher total hospitalization costs (+$9,129.4, 95% CI: 4,946.0-13,312.7, P <0.01), and higher likelihood of venous thromboembolism (VTE) (adjusted odds ratio (aOR) 1.69, 95% CI: 0.83-3.44, P=0.147) as compared to males. Female patients had lower odds of developing sepsis (aOR: 0.60, 95% CI: 0.43-0.85, P <0.01), ARF (aOR 0.48, 95% CI: 0.41-0.56, P <0.01), shock (aOR: 0.54, 95% CI: 0.24-1.22, P=0.143), ICU admission (aOR 0.73, 95% CI: 0.57-0.92, P <0.01), and in-hospital mortality (aOR: 0.15, 95% CI: 0.05-0.45, P <0.01) as compared to males. Conclusions We found that female patients had longer hospital LOS, total hospitalization charges, and a higher risk of VTE, while males had a higher risk of ARF, sepsis, shock, ICU admission, and all-cause in-hospital mortality. Although females are more frequently hospitalized for GP, males had significantly poorer clinical outcomes as compared to females. Our findings indicate that male patients with GP experience worse inpatient outcomes and require more aggressive treatment to reduce the risk of mortality and morbidity.

Editorial: Shooting in the Dark—The Problem With Empiric Antispasmodics for Abdominal Pain in Inflammatory Bowel Disease

2025-06-16

Jane Lim , Ali Rezaie | Alimentary Pharmacology & Therapeutics

Anorectal manometric data depend on the direction of pressure measurements in healthy individuals and in patients with functional constipation

2025-06-16

Haijiang Yao , Song Ming Bao , Daming Sun +3 more | Annals of Coloproctology

Exploring small intestinal bacterial overgrowth in functional upper gastrointestinal disorder: A comprehensive case-control study

2025-06-16

Bhaswati C Acharyya , Meghdeep Mukhopadhyay | World Journal of Clinical Pediatrics

BACKGROUND Small intestinal bacterial overgrowth (SIBO) is suspected and excluded frequently in functional gastrointestinal (GI) disorders. Children presenting with various esophago-gastro-duodenal (upper GI) symptoms are rarely subjected to investigations for … BACKGROUND Small intestinal bacterial overgrowth (SIBO) is suspected and excluded frequently in functional gastrointestinal (GI) disorders. Children presenting with various esophago-gastro-duodenal (upper GI) symptoms are rarely subjected to investigations for SIBO. AIM To estimate the frequency of SIBO in children having functional upper GI symptoms (as cases) and to compare the result of the SIBO status to that of the controls. METHODS Children aged 6 to 18 who presented with upper GI symptoms were selected for the study. All children were subjected to upper GI endoscopy before being advised of any proton pump inhibitors (PPIs). Children with normal endoscopy were assigned as cases, and children having any endoscopic lesion were designated as controls. Both groups were subjected to a glucose-hydrogen breath test by Bedfont Gastrolyser. RESULTS A total of 129 consecutive children who were naive to PPIs and had normal baseline investigations were included in the study. Among them, 67 patients had endoscopic lesions and served as the control group, with six cases being excluded due to the presence of Helicobacter pylori in gastric biopsies. Sixty-two children with normal endoscopy results formed the case group. In the case group, 35 children (59%) tested positive for hydrogen breath tests, compared to 13 children (21%) in the control group. The calculated odds ratio was 5.38 (95% confidence interval: 2.41-12.0), which was statistically significant. Further analysis of symptoms revealed that nausea, halitosis, foul-smelling eructation, and epigastric fullness were positive predictors of SIBO. CONCLUSION It is worthwhile to investigate and treat SIBO in all children presenting with upper GI symptoms that are not explained by endoscopy findings.

Effects of body mass index on gastric motility: Comparing children with functional abdominal pain disorders and healthy controls

2025-06-16

A. Karunanayake , Shaman Rajindrajith , Manori Vijaya Kumari +1 more | World Journal of Clinical Pediatrics

BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers, yet the underlying reasons remain unclear. Gastrointestinal motility, a key pathophysiological factor in functional … BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers, yet the underlying reasons remain unclear. Gastrointestinal motility, a key pathophysiological factor in functional gastrointestinal disorders, may be influenced by body mass index (BMI). AIM To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders (FAPDs). METHODS We assessed gastric motility in 176 children with FAPDs (61.4% females, mean age 7.94 years, SD 1.96 years) and 63 healthy controls (57.1% females, mean age 9.17 years, SD 1.90 years) at the Gastroenterology Research Laboratory, University of Kelaniya, Sri Lanka. FAPDs were diagnosed and subtyped using the Rome IV criteria: Functional abdominal pain 97 patients; irritable bowel syndrome 39 patients, functional dyspepsia (FD) 25 patients; and abdominal migraine 15 patients. Gastric motility was measured using a validated ultrasound method. Weight and height were measured using sensitive standard scales. RESULTS The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m², respectively (P = 0.33). Fasting antral area (FAA) and antral area at 1 min (AA1) and 15 min (AA15) were significantly greater in patients with FAPD with a higher BMI (2.71 cm², 12.57 cm², and 7.19 cm², respectively) compared with those with a lower BMI (2.12 cm², 10.68 cm², and 6.13 cm², respectively) (P < 0.01). BMI positively correlated with FAA and AA15 (r = 0.18 and r = 0.19, respectively) (P < 0.01) in those with FAPDs. In controls, only AA1 was greater in the higher BMI group (12.51 cm² vs 9.93 cm²) and had a positive correlation (r = 0.33) (P ≤ 0.01). Subgroup analysis revealed that in patients with FD, BMI negatively correlated with gastric emptying rate (GER) (r = -0.59) and antral motility index (MI) (r = -0.49), while in functional abdominal pain, MI positively correlated (r = 0.25) with BMI (P ≤ 0.01). CONCLUSION In children with FAPDs, higher BMI was associated with increased gastric antral distention during fasting and postprandial periods (as indicated by FAA, AA1, and AA15) but not with contractility and transit (MI, GER). However, in the FD subgroup, high BMI correlated with reduced GER and MI. This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD. These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs, particularly FD.