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Journal of Gastrointestinal Surgery :... Aug 2023Postoperative ileus is common after gastrointestinal surgery. This network meta-analysis aimed to compare the effectiveness of gum chewing and coffee and caffeine intake... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative ileus is common after gastrointestinal surgery. This network meta-analysis aimed to compare the effectiveness of gum chewing and coffee and caffeine intake on ileus-related outcomes.
METHODS
A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing noninvasive treatments for ileus after gastrointestinal surgery. The main analyses included random effects network meta-analyses using frequentist methods with simultaneous direct and indirect comparisons of time to first flatus, time to first defecation, and length of stay. Bayesian network meta-analysis using Markov chains was also used.
RESULTS
A total of 32 RCTs comparing 4999 patients were included in this network meta-analysis. Time to flatus was reduced by gum chewing (mean difference compared to control (MD): -11 h, 95% confidence interval (95% CI) - 16 to - 5 h, P < 0.001). Time to defecation was reduced by gum chewing and coffee, with MDs of -18 h (95% CI - 23 to - 13 h, P < 0.001) and -13 h (95% CI - 24 to - 1 h, P < 0.001), respectively. Length of stay was reduced by coffee and gum chewing with MDs of - 1.5 days (95% CI: - 2.5 to - 0.6 days, P < 0.001) and - 0.9 days (95% CI: - 1.3 to - 0.4 days, P < 0.001), respectively.
CONCLUSION
Coffee and gum chewing were proven to be effective noninvasive approaches for shortening the postoperative length of hospital stay and time to first defecation, especially in open gastrointestinal surgery; thus these actions should be recommended after gastrointestinal surgery.
Topics: Humans; Defecation; Coffee; Network Meta-Analysis; Mastication; Flatulence; Ileus; Postoperative Complications; Digestive System Surgical Procedures; Chewing Gum; Length of Stay; Gastrointestinal Motility
PubMed: 37277676
DOI: 10.1007/s11605-023-05702-z -
Neurogastroenterology and Motility Oct 2021Bisacodyl is a member of the diphenylmethane family and is considered to be a stimulant laxative. It has a dual prokinetic and secretory action and needs to be converted... (Review)
Review
BACKGROUND
Bisacodyl is a member of the diphenylmethane family and is considered to be a stimulant laxative. It has a dual prokinetic and secretory action and needs to be converted into the active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) in the gut to achieve the desired laxative effect. Bisacodyl acts locally in the large bowel by directly enhancing the motility, reducing transit time, and increasing the water content of the stool. A recent network meta-analysis concluded that bisacodyl showed similar efficacy to prucalopride, lubiprostone, linaclotide, tegaserod, velusetrag, elobixibat, and sodium picosulfate for the primary endpoint of ≥3 complete spontaneous bowel movements (CSBM)/week and an increase of ≥1 CSBM/week over baseline. The meta-analysis also found that bisacodyl may be superior to the other laxatives for the secondary endpoint of change from baseline in the number of spontaneous bowel movements per week in patients with chronic constipation. This observation stimulated the authors to review the available literature on bisacodyl, which has been available on the market since the 1950 s.
PURPOSE
The aim of the current review was to provide an overview of the historic background, structure, function, and mechanism of action of bisacodyl. Additionally, we discuss the important features and studies for bisacodyl to understand its peculiar characteristics and guide its use in clinical practice, but also stimulate research on open questions.
Topics: Bisacodyl; Constipation; Defecation; Humans; Intestine, Large; Laxatives
PubMed: 33751780
DOI: 10.1111/nmo.14123 -
Digestive Diseases (Basel, Switzerland) 2021Chronic diarrhea is defined as more than 3 bowel movements per day, or loose stools, or stool weight >200 g/day for at least 4 weeks. Accompanying symptoms may include...
BACKGROUND
Chronic diarrhea is defined as more than 3 bowel movements per day, or loose stools, or stool weight >200 g/day for at least 4 weeks. Accompanying symptoms may include urgency, abdominal pain, or cramps.
SUMMARY
A number of causes have to be considered, including inflammatory, neoplastic, malabsorptive, infective, vascular, and functional gastrointestinal diseases. Other causes include food intolerances, side effects of drugs, or postsurgical conditions. Diarrhea may also be symptom of a systemic disease, like diabetes or hyperthyroidism. Special patient groups, like the very elderly and immunocompromised patients, pose special challenges. This review follows a question-answer style and addresses questions raised on the intersection of primary and secondary care. What do you mean by diarrhea? Why is it important to distinguish between acute or chronic diarrhea? How shall the patient with chronic diarrhea be approached? How can history and physical exam help? How can routine laboratory tests help in categorizing diarrhea? Which additional laboratory tests may be helpful? How to proceed in undiagnosed or intractable diarrhea? What are the treatment options in patients with chronic diarrhea? Key Messages: Acute diarrhea is usually of infectious origin with the main treatment goal of preventing water and electrolyte disturbances. Chronic diarrhea is usually not of infectious origin and may be the symptom of a large number of gastrointestinal and general diseases or drug side effects. In undiagnosed or intractable diarrhea, the question shall be raised whether the appropriate tests have been performed and interpreted correctly.
Topics: Aged; Chronic Disease; Defecation; Diarrhea; Feces; Gastroenterologists; Humans; Primary Health Care
PubMed: 33588424
DOI: 10.1159/000515219 -
The American Journal of Gastroenterology Oct 2022The aim of this study was to determine the effectiveness of prune juice on chronic constipation. (Randomized Controlled Trial)
Randomized Controlled Trial
Prune Juice Containing Sorbitol, Pectin, and Polyphenol Ameliorates Subjective Complaints and Hard Feces While Normalizing Stool in Chronic Constipation: A Randomized Placebo-Controlled Trial.
INTRODUCTION
The aim of this study was to determine the effectiveness of prune juice on chronic constipation.
METHODS
We conducted a double-blind, randomized, placebo-controlled trial in Japanese subjects with chronic constipation.
RESULTS
Prune intake significantly decreased hard and lumpy stools while increasing normal stool and not increasing loose and watery stools. Prune intake also ameliorated subjective complaints of constipation and hard stools, without alteration of flatulence, diarrhea, loose stools, or urgent need for defecation. There were no adverse events or laboratory abnormalities of liver or renal function after prune intake.
DISCUSSION
Prune juice exerted an effective and safe natural food therapy for chronic constipation.
Topics: Constipation; Defecation; Diarrhea; Dietary Fiber; Double-Blind Method; Feces; Humans; Pectins; Polyphenols; Sorbitol
PubMed: 35971232
DOI: 10.14309/ajg.0000000000001931 -
Alimentary Pharmacology & Therapeutics Jan 2020The pathogenesis of infant colic is poorly defined. Gut microbiota seems to be involved, supporting the potential therapeutic role of probiotics. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The pathogenesis of infant colic is poorly defined. Gut microbiota seems to be involved, supporting the potential therapeutic role of probiotics.
AIMS
To assess the rate of infants with a reduction of ≥50% of mean daily crying duration after 28 days of intervention with the probiotic Bifidobacterium animalis subsp. lactis BB-12 (BB-12). Secondary outcomes were daily number of crying episodes, sleeping time, number of bowel movements and stool consistency.
METHODS
Randomized controlled trial (RCT) on otherwise healthy exclusively breastfed infants with infant colic randomly allocated to receive BB-12 (1 × 10 CFU/day) or placebo for 28 days. Gut microbiota structure and butyrate, beta-defensin-2 (HBD-2), cathelicidin (LL-37), secretory IgA (sIgA) and faecal calprotectin levels were assessed.
RESULTS
Eighty infants were randomised, 40/group. The rate of infants with reduction of ≥50% of mean daily crying duration was higher in infants treated with BB-12, starting from the end of 2nd week. No infant relapsed when treatment was stopped. The mean number of crying episodes decreased in both groups, but with a higher effect in BB-12 group (-4.7 ± 3.4 vs -2.3 ± 2.2, P < 0.05). Mean daily stool frequency decreased in both groups but the effect was significantly higher in the BB-12 group; stool consistency was similar between the two groups. An increase in Bifidobacterium abundance (with significant correlation with crying time reduction), butyrate and HBD-2, LL-37, sIgA levels associated with a decrease in faecal calprotectin level were observed in the BB-12 group.
CONCLUSIONS
Supplementation with BB-12 is effective in managing infant colic. The effect could derive from immune and non-immune mechanisms associated with a modulation of gut microbiota structure and function.
Topics: Bifidobacterium animalis; Breast Feeding; Colic; Crying; Defecation; Double-Blind Method; Feces; Female; Gastrointestinal Microbiome; Humans; Infant; Infant Care; Male; Placebos; Probiotics; Treatment Outcome
PubMed: 31797399
DOI: 10.1111/apt.15561 -
Nutrients Sep 2019Partially hydrolyzed guar gum (PHGG) is a water-soluble dietary fiber and is used in solid and liquid food to regulate gut function. The aim of this study was to... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Repeated Consumption of Partially Hydrolyzed Guar Gum on Fecal Characteristics and Gut Microbiota: A Randomized, Double-Blind, Placebo-Controlled, and Parallel-Group Clinical Trial.
Partially hydrolyzed guar gum (PHGG) is a water-soluble dietary fiber and is used in solid and liquid food to regulate gut function. The aim of this study was to investigate effects of PHGG on bowel movements (stool form and frequency), plasma bile acids, quality of life, and gut microbiota of healthy volunteers with a tendency toward diarrhea, i.e., irritable bowel syndrome diarrhea (IBS-D)-like symptoms. A randomized, double-blind, placebo-controlled, and parallel trial was performed on 44 healthy volunteers (22 males, 22 females, 41.9 ± 6.3 years old (average ± SD)) with minimum 7 bowel movements every week, wherein above 50% of their stool was between the Bristol stool scale (BSS) value of 5 and 6. Intake of the PHGG for 3 months significantly improved stool form, evaluated using BSS, and had no effects on stool frequency. BSS was significantly normalized in the group consuming the PHGG compared with the placebo. Comprehensive fecal microbiome analysis by the 16S rRNA-sequence method detected significant changes in the ratio of some bacteria, such as an increase of ( < 0.05) in the PHGG group. Our results suggest that intake of PHGG improves human stool form via regulating intestinal microbiota.
Topics: Adult; Bacteria; Bile Acids and Salts; Defecation; Diarrhea; Dietary Fiber; Double-Blind Method; Feces; Female; Galactans; Gastrointestinal Microbiome; Humans; Hydrolysis; Male; Mannans; Middle Aged; Plant Gums; Prebiotics; Quality of Life; Time Factors; Tokyo; Treatment Outcome; Young Adult
PubMed: 31509971
DOI: 10.3390/nu11092170 -
Journal of Feline Medicine and Surgery Oct 2020The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation.
OBJECTIVES
The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation.
METHODS
Medical records and radiographs were reviewed for cats with sacrocaudal luxation. Information obtained from the clinical records included signalment, clinical presentation, concurrent traumatic injuries, treatment details, outcome and survival time. Severity of neurological signs was graded from 1 to 5, based on previous grading systems for cats with sacrocaudal luxation. Degree of vertebral displacement was calculated on survey radiographs. Outcomes were collected from serial neurological examinations and telephone interviews. Cats had to be given a minimum of 30 days to regain urinary function to be included in the study.
RESULTS
Seventy cats were included. Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood ( = 0.01) and longer duration ( = 0.0003) of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function ( = 0.03). Defecatory outcome was not significantly associated with any other variables.
CONCLUSIONS AND RELEVANCE
In agreement with previous studies, neurological grade is the most important prognostic indicator for cats with sacrocaudal luxation. Determination of the severity of neurological signs can also aid in advising owners the time frame in which urinary function is expected to return. Faecal incontinence may be a more important prognostic factor than previously suspected.
Topics: Animals; Cat Diseases; Cats; Defecation; Female; Joint Dislocations; Male; Prognosis; Recovery of Function; Retrospective Studies; Sacroiliac Joint; Urination
PubMed: 31904316
DOI: 10.1177/1098612X19895053 -
The American Journal of Gastroenterology Mar 2023Few reports exist regarding the therapeutic effects of probiotics on chronic constipation in elderly individuals. This study evaluated the effects of Bifidobacterium... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Few reports exist regarding the therapeutic effects of probiotics on chronic constipation in elderly individuals. This study evaluated the effects of Bifidobacterium longum BB536 in elderly individuals with chronic constipation.
METHODS
This was a randomized, double-blind placebo-controlled, parallel-group superiority trial in Japan (UMIN 000033031). Eighty older adults diagnosed with chronic constipation were randomly assigned (1:1) to receive either probiotics ( B. longum BB536, 5 × 10 10 colony-forming unit, n = 39) or placebo (n = 41) once daily for up to 4 weeks. The severity of constipation was evaluated using the Constipation Scoring System. The primary end point was the difference in the changes from baseline in the constipation scoring system total score between the 2 groups at week 4.
RESULTS
A total of 79 patients (mean age of 77.9 years), including 38 patients in the BB536 group and 41 in the placebo group, completed the study. The primary end point was not significant ( P = 0.074), although there was significant improvement ( P < 0.01) in the BB536 group from baseline to week 4, but there were no significant changes in the placebo group. There was a significant difference and a tendency toward a difference in the changes from baseline on the stool frequency ( P = 0.008) and failure of evacuation ( P = 0.051) subscales, respectively, at week 4 between the 2 groups. Few adverse events related to the probiotics were observed.
DISCUSSION
The primary end points were not significant. However, probiotic supplementation significantly improved bowel movements. These results suggest that B. longum BB536 supplementation is safe and partially effective for improving chronic constipation in elderly individuals.
Topics: Aged; Humans; Bifidobacterium; Bifidobacterium longum; Constipation; Defecation; Double-Blind Method; Probiotics; Treatment Outcome; Chronic Disease
PubMed: 36216361
DOI: 10.14309/ajg.0000000000002028 -
Nature Reviews. Gastroenterology &... Nov 2021We need to talk about poo. Everybody does it, and research into defaecation and associated disorders deserves more attention.
We need to talk about poo. Everybody does it, and research into defaecation and associated disorders deserves more attention.
Topics: Humans; Taboo
PubMed: 34580479
DOI: 10.1038/s41575-021-00528-z -
Nutrients Jul 2020The purpose of the randomized double-blind placebo-controlled trial was to assess the effectiveness of synbiotic preparation containing probiotic FloraActive™... (Randomized Controlled Trial)
Randomized Controlled Trial
The Effectiveness of Synbiotic Preparation Containing and Probiotic Strains and Short Chain Fructooligosaccharides in Patients with Diarrhea Predominant Irritable Bowel Syndrome-A Randomized Double-Blind, Placebo-Controlled Study.
The purpose of the randomized double-blind placebo-controlled trial was to assess the effectiveness of synbiotic preparation containing probiotic FloraActive™ 19070-2, DSMZ 32418, DSMZ 32269, DSMZ 32946, DSMZ 32403 and fructooligosaccharides in adult patients with diarrhea-dominant IBS (IBS-D). The study included eighty patients with moderate and severe IBS-D who were randomized to receive synbiotics or placebo for eight weeks. Finally, a total of sixty-eight patients finished the study. The primary endpoints included the assessment of the symptoms' severity with IBS symptom severity scale (IBS-SSS), an improvement of IBS global symptoms with Global Improvement Scale (IBS-GIS) and adequate relief of symptoms after four and eight weeks of therapy. Secondary endpoints, which were collected by telephone interviewers three times a week included the assessment of individual IBS symptoms and adverse events. Synbiotic treatment in comparison to placebo significantly improved IBS-GIS ( = 0.043), and IBS-SSS score inducing a decrease in the total IBS-SSS ( = 0.042) and in domain-specific scores related to flatulence ( = 0.028) and bowel habit ( = 0.028) after four and eight weeks. Patients treated with synbiotics reported in weekly observations a significant amelioration in a feeling of incomplete bowel movements, flatulence, pain, stool pressure and diarrheal stools compared to those receiving placebo. There were no differences in adverse events between both groups. Concluding, the multi-strain synbiotic preparation was associated with a significant improvement in symptoms in IBS-D patients and was well-tolerated. These results suggest that the use of synbiotics offers a benefit for IBS-D patients. [Clinicaltrials.gov NCT04206410 registered 20 December 2019].
Topics: Adolescent; Adult; Bifidobacterium animalis; Bifidobacterium bifidum; Bifidobacterium longum; Defecation; Diarrhea; Double-Blind Method; Feces; Female; Flatulence; Humans; Irritable Bowel Syndrome; Lactobacillus acidophilus; Lacticaseibacillus rhamnosus; Male; Middle Aged; Oligosaccharides; Severity of Illness Index; Synbiotics; Treatment Outcome; Young Adult
PubMed: 32635661
DOI: 10.3390/nu12071999