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The Journal of Pediatrics Oct 2023To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values.
STUDY DESIGN
Systematic review including cross-sectional, observational, and interventional studies published in English, that reported on defecation frequency and/or stool consistency in healthy children 0-4 years old.
RESULTS
Seventy-five studies were included with 16 393 children and 40 033 measurements of defecation frequency and/or stool consistency. Based on visual inspection of defecation frequency data, a differentiation was made between two age categories: young infants (0-14 weeks old) and young children (15 weeks-4 years old). Young infants had a mean defecation frequency of 21.8 per week (95 % CI, 3.9-35.2) compared with 10.9 (CI, 5.7-16.7) in young children (P < .001). Among young infants, human milk-fed (HMF) infants had the highest mean defecation frequency per week (23.2 [CI, 8.8-38.1]), followed by formula-fed (FF) infants (13.7 [CI 5.4-23.9]), and mixed-fed (MF) infants (20.7 [CI, 7.0-30.2]). Hard stools were infrequently reported in young infants (1.5%) compared with young children (10.5%), and a reduction in the frequency of soft/watery stools was observed with higher age (27.0% in young infants compared with 6.2% in young children). HMF young infants had softer stools compared with FF young infants.
CONCLUSIONS
Young infants (0-14 weeks old) have softer and more frequent stools compared with young children (15 weeks-4 years old).
Topics: Infant; Humans; Child; Child, Preschool; Infant, Newborn; Defecation; Cross-Sectional Studies; Milk, Human; Diarrhea; Food, Formulated; Feces
PubMed: 37331467
DOI: 10.1016/j.jpeds.2023.113559 -
World Journal of Surgical Oncology Mar 2023Anastomosis for gastrointestinal reconstruction has been contentious after low anterior resection of rectal cancer for the past 30 years. Despite the abundance of... (Meta-Analysis)
Meta-Analysis
Comparison of complications and bowel function among different reconstruction techniques after low anterior resection for rectal cancer: a systematic review and network meta-analysis.
BACKGROUND
Anastomosis for gastrointestinal reconstruction has been contentious after low anterior resection of rectal cancer for the past 30 years. Despite the abundance of randomized controlled trials (RCTs) on colon J-pouch (CJP), straight colorectal anastomosis (SCA), transverse coloplast (TCP), and side-to-end anastomosis (SEA), most studies are small and lack reliable clinical evidence. We conducted a systematic review and network meta-analysis to evaluate the effects of the four anastomoses on postoperative complications, bowel function, and quality of life in rectal cancer.
METHODS
We assessed the safety and efficacy of CJP, SCA, TCP, and SEA in adult patients with rectal cancer after surgery by searching the Cochrane Library, Embase, and PubMed databases to collect RCTs from the date of establishment to May 20, 2022. Anastomotic leakage and defecation frequency were the main outcome indicators. We pooled data through a random effects model in a Bayesian framework and assessed model inconsistency using the deviance information criterion (DIC) and node-splitting method and inter-study heterogeneity using the I-squared statistics (I). The interventions were ranked according to the surface under the cumulative ranking curve (SUCRA) to compare each outcome indicator.
RESULTS
Of the 474 studies initially evaluated, 29 were eligible RCTs comprising 2631 patients. Among the four anastomoses, the SEA group had the lowest incidence of anastomotic leakage, ranking first (SUCRA = 0.982), followed by the CJP group (SUCRA = 0.628). The defecation frequency in the SEA group was comparable to those in the CJP and TCP groups at 3, 6, 12, and 24 months postoperatively. In comparison, the defecation frequency in the SCA group 12 months after surgery all ranked fourth. No statistically significant differences were found among the four anastomoses in terms of anastomotic stricture, reoperation, postoperative mortality within 30 days, fecal urgency, incomplete defecation, use of antidiarrheal medication, or quality of life.
CONCLUSIONS
This study demonstrated that SEA had the lowest risk of complications, comparable bowel function, and quality of life compared to the CJP and TCP, but further research is required to determine its long-term consequences. Furthermore, we should be aware that SCA is associated with a high defecation frequency.
Topics: Adult; Humans; Defecation; Anastomotic Leak; Network Meta-Analysis; Rectal Neoplasms; Rectum; Fecal Incontinence; Anastomosis, Surgical; Colon; Treatment Outcome
PubMed: 36899350
DOI: 10.1186/s12957-023-02977-z -
Colorectal Disease : the Official... Apr 2022Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM)... (Meta-Analysis)
Meta-Analysis Review
AIM
Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM) division in the treatment of anismus.
METHOD
PubMed, Scopus, Web of Science and the Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in the Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI).
RESULTS
Ten studies (204 patients, 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomized trials was 97.6% (95% CI 94%-100%) and across nonrandomized studies it was 63.1 (95% CI 39.3%-87%). The weighted mean rate of 12-month improvement across randomized trials was 64.9% (95% CI 53.3%-76.4%) and across nonrandomized studies it was 55.9% (95% CI 30.8%-81%). The weighted mean rate of FI across randomized trials was 12.1% (95% CI 4.2%-20%) and across nonrandomized studies it was 10.4% (95% CI 1.6%-19.3%). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division and concomitant sphincterotomy were significantly associated with FI after PRM division.
CONCLUSIONS
The use of PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to <60% 12 months after PRM division. The mean rate of FI after PRM division, namely 10%-12%, is a limitation of the technique. Further well-designed trials are needed to verify the outcome of PRM division in the treatment of anismus.
Topics: Anus Diseases; Constipation; Female; Humans; Male; Pelvic Floor; Treatment Outcome
PubMed: 34984814
DOI: 10.1111/codi.16040 -
European Spine Journal : Official... May 2013Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little... (Review)
Review
PURPOSE
Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little seems to be known about long-term outcome. Aim of this study is to review current literature on outcome of micturition, defecation and sexual function in CES due to lumbar disk herniation.
METHODS
A literature search was done in Pubmed, Embase and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a Cochrane checklist adjusted for this purpose.
RESULTS
Fifteen studies were included. Risk of bias varied with six studies showing low risk. Mean minimal follow-up time was 17.0 months (range 3-24 months). All studies evaluated micturition and reported dysfunction at follow-up in 42.5% (range 13.3-90.0%). Defecation and sexual function were evaluated in eight and nine studies, respectively, and reported to be 49.6 (range 10.5-90.0%) and 44.3% (range 10.0-76.6%), respectively. Only two studies assessed sexual function in all patients at follow-up.
CONCLUSION
This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.
Topics: Defecation; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Polyradiculopathy; Rectal Diseases; Sexual Dysfunction, Physiological; Urination; Urination Disorders
PubMed: 23238848
DOI: 10.1007/s00586-012-2601-8 -
Techniques in Coloproctology Sep 2020Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes.
METHODS
MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors.
RESULTS
Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10-11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high.
CONCLUSIONS
Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.
Topics: Adult; Biofeedback, Psychology; Constipation; Defecation; Humans; Quality of Life; Treatment Outcome
PubMed: 32372153
DOI: 10.1007/s10151-020-02230-9 -
Journal of Clinical Nursing Jul 2015The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI)... (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery.
BACKGROUND
GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations.
DESIGN
A systematic review and meta-analysis.
METHODS
An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications.
RESULTS
A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta-analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation.
CONCLUSIONS
This meta-analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement.
RELEVANCE TO CLINICAL PRACTICE
Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low-cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.
Topics: Adult; Cesarean Section; Chewing Gum; Constipation; Female; Humans; Postoperative Nausea and Vomiting; Pregnancy
PubMed: 25850885
DOI: 10.1111/jocn.12836 -
Parasites & Vectors Feb 2016Bovine cysticercosis in Europe has been known for centuries but the data showing the occurrence of this zoonosis are scarce. The aim of this paper is to review and... (Review)
Review
BACKGROUND
Bovine cysticercosis in Europe has been known for centuries but the data showing the occurrence of this zoonosis are scarce. The aim of this paper is to review and present the current knowledge on bovine cysticercosis in Europe.
METHODS
We conducted a systematic review of studies published between 1990 and November 2014. Qualitative and quantitative data on prevalence, risk factors, burden and interventions were extracted and analysed.
RESULTS
Reports on prevalence were available for 23 European countries, mostly from western and central Europe; for a few of these only data before 1990 were available. Prevalence based on meat inspection was generally low (below 6.2% in 95% of the records) and varied between and within countries. Serology and detailed meat inspection provided a higher prevalence range (0.41-14%). Only few studies analysing risk factors were identified. Reported factors related to access to pastures and risky waters, dairy production and uncontrolled human defecation in the proximity of the farm among others. Only one estimate of the economic impact of the disease could be identified. Recommended interventions were focused on increasing diagnostic tests sensitivity or the application of risk based surveillance strategies.
CONCLUSIONS
There is a lack of complete and updated data on most countries, especially in eastern Europe. Further risk factor studies might be needed together with estimates on the burden of the disease in all European countries. Risk-based interventions are being encouraged but current data are limited to guide this approach.
Topics: Animals; Cattle; Cattle Diseases; Communicable Disease Control; Cysticercosis; Europe; Prevalence; Risk Factors
PubMed: 26860313
DOI: 10.1186/s13071-016-1362-3 -
Life (Basel, Switzerland) Feb 2023Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of... (Review)
Review
INTRODUCTION
Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of retentive fecal incontinence. Neuromodulation has been used to treat many health problems, with promising results.
OBJECTIVE
To conduct a systematic review of randomized clinical trials based on the effects of transcutaneous neuromodulation in treating constipation and retentive fecal incontinence in children and adolescents.
METHODS
A systematic review of randomized clinical trials was performed. Medline (PubMed), PEDro, SciELO, Cochrane (CENTRAL), Embase, and Scopus databases were searched from March 2000 to August 2022. We included clinical trials evaluating transcutaneous neuromodulation in children with constipation and fecal incontinence compared or associated with other types of treatment. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted the data.
RESULTS
Three studies with 164 participants were included in this review. Two meta-analyses were generated based on these studies. These analyses revealed that transcutaneous neuromodulation is an effective adjuvant treatment modality that improves children's constipation and retentive fecal incontinence. The methodological quality of the included studies was classified as high based on the assessment of the quality of evidence, with a high degree of confidence based on the GRADE system.
CONCLUSIONS
Transcutaneous neuromodulation is an effective adjuvant treatment modality for children with constipation and retentive fecal incontinence.
PubMed: 36836787
DOI: 10.3390/life13020430 -
BMJ Clinical Evidence Apr 2010Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious aetiological factors. One... (Review)
Review
INTRODUCTION
Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious aetiological factors. One third of children with chronic constipation continue to have problems beyond puberty. Half of children with chronic faecal impaction and faecal incontinence have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for children with chronic constipation? What are the effects of treatments for clearing the bowel in children with faecal impaction? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 14 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: anal dilatation, behavioural treatments (biofeedback, diaries, or toilet training), bulk-forming laxatives, enemas, faecal softeners, fibre, macrogols, oral fluids, osmotic laxatives, prebiotics, probiotics, stimulant laxatives, and surgical disimpaction.
Topics: Administration, Oral; Child; Constipation; Fecal Incontinence; Humans; Laxatives; Polyethylene Glycols; Sexual Maturation
PubMed: 21718570
DOI: No ID Found -
World Journal of Gastroenterology Apr 2012Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at...
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at which health care is sought for this condition. The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation. The commission presents its results in a "Question-Answer" format, including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine. This section represents the consensus for the diagnosis. The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation. The presence of alarm symptoms and risk factors requires investigation. The physical examination should assess the presence of lesions in the anal and perianal region. The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation. Various scoring systems are available to quantify the severity of constipation; the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable. The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life. No single test provides a pathophysiological basis for constipation. Colonic transit and anorectal manometry define the pathophysiologic subtypes. Balloon expulsion is a simple screening test for defecatory disorders, but it does not define the mechanisms. Defecography detects structural abnormalities and assesses functional parameters. Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports. All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
Topics: Chronic Disease; Constipation; Defecography; Evidence-Based Medicine; Gastrointestinal Transit; Humans; Manometry; Quality of Life; Severity of Illness Index
PubMed: 22529683
DOI: 10.3748/wjg.v18.i14.1555