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BMC Gastroenterology Jan 2024Functional gastrointestinal disorders (FGIDs) are closely related to disorders of brain-gut interaction. FGIDs are the dominant disease of acupuncture treatment, which...
BACKGROUND
Functional gastrointestinal disorders (FGIDs) are closely related to disorders of brain-gut interaction. FGIDs are the dominant disease of acupuncture treatment, which can improve the symptoms and emotional state.
AIM
To evaluate the results and quality of the available clinical evidence and to summarize the central mechanism and effect of acupuncture on FGIDs.
METHODS
PubMed, EMBASE, Web of science, Cochrane Library, China National Knowledge Infrastructure (CNKI) were searched by computer to collect the randomized controlled trials (RCTs), which contained central mechanisms via fMRI research of acupuncture in the treatment of FGIDs patients. The search time limit was from the establishment of the database to June 22, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality.
RESULTS
Ten RCTs involving fMRI data were included in this study, including 4 Functional dyspepsia (FD) studies, 3 irritable bowel syndrome (IBS) studies, and 3 functional constipation (FC) studies. The score of improvements in both gastrointestinal symptoms and psychological symptoms showed that acupuncture could significantly improve the clinical symptoms of FGIDs patients, including abdominal pain, abdominal distension, frequency of defecation, and stool characteristics, and could relieve anxiety and depression symptoms of patients. Acupuncture could regulate brain functional connections and functional activity in FGIDs patients, mainly including insula, anterior cingulate cortex, prefrontal cortex, thalamus, hippocampus, amygdala and other brain regions.
CONCLUSION
Acupuncture can improve gastrointestinal symptoms and psychological status in FGIDs patients, and regulate functional connectivity and activity of brain regions such as insula, ACC, PFC, thalamus, HIPP, amygdala, etc. These changes in brain activity may related to visceral sensation, pain regulation, emotion, but further studies of high quality are still necessary.
Topics: Humans; Abdominal Pain; Acupuncture Therapy; Anxiety; Gastrointestinal Diseases; Irritable Bowel Syndrome
PubMed: 38267863
DOI: 10.1186/s12876-024-03124-y -
Colorectal Disease : the Official... Mar 2024Sacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by... (Review)
Review
AIM
Sacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by heterogeneous study populations and designs. The aim of this study was to assess the effectiveness, safety and cost-effectiveness of SNM in children and adults with refractory idiopathic slow-transit constipation (STC).
METHOD
OVID Medline, OVID Embase, Cochrane Library, the KSR Evidence Database, the NHS Economic Evaluation Database and the International HTA Database were searched up to 25 May 2023. For effectiveness outcomes, randomized controlled trials (RCTs) were selected. For safety outcomes, all study designs were selected. For cost-effectiveness outcomes, trial- and model-based economic evaluations were selected for review. Study selection, risk of bias and quality assessment, and data extraction were independently performed by two reviewers. For the intervention 'sacral neuromodulation' effectiveness outcomes included defaecation frequency and constipation severity. Safety and cost-effectiveness outcomes were, respectively, adverse events and incremental cost-effectiveness ratios.
RESULTS
Of 1390 records reviewed, 67 studies were selected for full-text screening. For effectiveness, one cross-over and one parallel-group RCT was included, showing contradictory results. Eleven studies on safety were included (four RCTs, three prospective cohort studies and four retrospective cohort studies). Overall infection rates varied between 0% and 22%, whereas reoperation rates varied between 0% and 29%. One trial-based economic evaluation was included, which concluded that SNM was not cost-effective compared with personalized conservative treatment at a time horizon of 6 months. The review findings are limited by the small number of available studies and the heterogeneity in terms of study populations, definitions of refractory idiopathic STC and study designs.
CONCLUSION
Evidence for the (cost-)effectiveness of SNM in children and adults with refractory idiopathic STC is inconclusive. Reoperation rates of up to 29% were reported.
Topics: Adult; Child; Humans; Cost-Benefit Analysis; Constipation; Sacrum; Research Design; Electric Stimulation Therapy
PubMed: 38247282
DOI: 10.1111/codi.16876 -
Medicine Jan 2024This study aimed to evaluate the efficacy and safety of Buzhongyiqi decoction combined with acupoint application in the treatment of functional constipation in elderly... (Meta-Analysis)
Meta-Analysis
PURPOSE
This study aimed to evaluate the efficacy and safety of Buzhongyiqi decoction combined with acupoint application in the treatment of functional constipation in elderly people.
METHODS
(1) Four Chinese databases (China National Knowledge Infrastructure, China Science Periodical Database, Chinese Citation Database, China Biology Medicine) and 4 foreign databases (PubMed, Web of Science, Cochrane Library, Embase) were searched, excluded, and included in randomized controlled trials of Buzhongyiqi decoction combined with acupoint application for the treatment of functional constipation in elderly people. (2) Systematic evaluation and meta-analysis using the RevMan 5.3 software. (3) Harbord linear regression and sensitivity analyses were conducted to evaluate publication bias using Stata 14.0. (4) Reliability of the conclusion assessment by sequential test analysis in TSA0.9 software. (5) Quality of evidence evaluation of outcome indicators was evaluated using Gradepro 3.6 software.
RESULTS
Eight randomized controlled trials including 658 case sample sizes were included. Compared with the control group, the intervention group showed improved clinical cure rate and effective rate of functional constipation in elderly people, reduced recurrence rate, and efficacy regulated the levels of defecation-related indices and indices of gastrointestinal function. In addition, trial sequential analysis indicated that the total clinical efficacy rate was conclusive, which showed that the therapeutic efficacy of the intervention group was superior to that of the control group. However, the incidence of adverse effects in intervention group was comparable to that of control group, and trial sequential analysis suggests that this result needs to be supported by additional research.
CONCLUSION
Buzhongyiqi decoction combined with acupoint application has potential value in the treatment of functional constipation in elderly people. Currently, there is insufficient clinical evidence to objectively evaluate safety grades for this combination therapy.
Topics: Humans; Aged; Acupuncture Points; Reproducibility of Results; Constipation; Medicine, Chinese Traditional; Treatment Outcome
PubMed: 38241527
DOI: 10.1097/MD.0000000000036579 -
BMJ Open Jan 2024This study aimed to pool the efficacy in bowel movement and explore the change of gut microbiota on adult functional constipated patients after probiotics-containing... (Meta-Analysis)
Meta-Analysis
Efficacy in bowel movement and change of gut microbiota on adult functional constipation patients treated with probiotics-containing products: a systematic review and meta-analysis.
OBJECTIVES
This study aimed to pool the efficacy in bowel movement and explore the change of gut microbiota on adult functional constipated patients after probiotics-containing products treatment.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Cochrane Library for published studies and ClinicalTrials.gov for 'grey' researches were independently investigated for randomised controlled trials up to November 2022.
ELIGIBILITY CRITERIA, DATA EXTRACTION AND SYNTHESIS
The intervention was probiotics-containing product, either probiotics or synbiotics, while the control was placebo. The risk of bias was conducted. The efficacy in bowel movement was indicated by stool frequency, stool consistency and Patient Assessment of Constipation Symptom (PAC-SYM), while the change of gut microbiota was reviewed through α diversity, β diversity, change/difference in relative abundance and so on. The subgroup analysis, sensitivity analysis and random-effect meta-regression were conducted to explore the heterogeneity. The Grading of Recommendations Assessment Development and Evaluation was conducted to grade the quality of evidence.
RESULTS
17 studies, comprising 1256 participants, were included with perfect agreements between two researchers (kappa statistic=0.797). Compared with placebo, probiotics-containing products significantly increased the stool frequency (weighted mean difference, WMD 0.93, 95% CI 0.47 to 1.40, p=0.000, I=84.5%, 'low'), improved the stool consistency (WMD 0.38, 95% CI 0.05 to 0.70, p=0.023, I²=81.6%, 'very low') and reduced the PAC-SYM (WMD -0.28, 95% CI: -0.45 to -0.11, p=0.001, I²=55.7%, 'very low'). In subgroup analysis, synbiotics was superior to probiotics to increase stool frequency. Probiotics-containing products might not affect α or β diversity, but would increase the relative abundance of specific strain.
CONCLUSIONS
Probiotics-containing products, significantly increased stool frequency, improved stool consistency, and alleviated functional constipation symptoms. They increased the relative abundance of specific strain. More high-quality head-to-head randomised controlled trials are needed.
Topics: Adult; Humans; Constipation; Defecation; Gastrointestinal Microbiome; Probiotics; Synbiotics
PubMed: 38238054
DOI: 10.1136/bmjopen-2023-074557 -
Journal of Gastrointestinal Cancer Jun 2024This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a... (Meta-Analysis)
Meta-Analysis
Perioperative or Postoperative Probiotics Reduce Treatment-Related Complications in Adult Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-analysis.
PURPOSE
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications in patients undergoing surgery, with or without adjuvant therapy.
METHODS
MEDLINE, Embase, and Scopus databases were searched.
RESULTS
Ten RCTs with 1276 patients were included. There was a significant decrease in the incidence of diarrhea (odds ratio (OR) 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p = 0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p < 0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p = 0.004), length of ATB therapy (mean difference (MD) - 1.66 days; 95% CI - 2.13 to - 1.19 days; p < 0.001), and duration of postoperative pyrexia (MD - 0.80 days; 95% CI - 1.38 to - 0.22 days; p = 0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet were not different between groups.
CONCLUSION
Our findings suggest that perioperative or postoperative probiotics is effective for reducing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.
Topics: Humans; Probiotics; Colorectal Neoplasms; Postoperative Complications; Perioperative Care; Randomized Controlled Trials as Topic; Adult
PubMed: 38231290
DOI: 10.1007/s12029-024-01016-8 -
Food and Waterborne Parasitology Mar 2024Understanding the ecological factors that drive the spatial patterns of parasites transmission is essential to predict their distribution under global change and to...
Understanding the ecological factors that drive the spatial patterns of parasites transmission is essential to predict their distribution under global change and to direct proactive surveillance efforts. Here, we systematically reviewed the literature to assess the main ecological drivers responsible for the spatial distribution and transmission of the zoonotic cestode , the aetiological agent of alveolar echinococcosis, focusing on wild hosts. The 23 retrieved studies suggested that the dispersal of definitive hosts, climatic and biotic factors (distribution of intermediate hosts, composition of host communities) shape continental-scale distribution patterns of , whereas the relative importance of climate and land cover in driving distribution at a smaller (country/regional) scale varies with the geographic area considered. At a local scale, two additional factors contribute to determine the distribution of micro-foci of transmission: the trophic relationships between carnivores definitive hosts and small mammals intermediate hosts, and the defecation and marking behaviour of definitive hosts.
PubMed: 38152424
DOI: 10.1016/j.fawpar.2023.e00216 -
Techniques in Coloproctology Dec 2023A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly...
BACKGROUND
A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques.
METHODS
A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed.
RESULTS
Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically.
CONCLUSIONS
To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.
Topics: Humans; Anal Canal; Low Anterior Resection Syndrome; Postoperative Complications; Quality of Life; Rectal Neoplasms; Robotic Surgical Procedures
PubMed: 38091118
DOI: 10.1007/s10151-023-02872-5 -
Obesity Surgery Jan 2024We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients... (Meta-Analysis)
Meta-Analysis Review
We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients were included. The mean age of the patients was 48.11 ± 4.89 years. The mean BMI before surgery and at the time of SIBO diagnosis was 44.57 ± 2.89 kg/m and 31.53 ± 2.29 kg/m, respectively. Moreover, the results showed a 29% and 53% prevalence of SIBO at < 3-year and > 3-year follow-up after RYGB, respectively. Symptoms included abdominal pain, diarrhea, bloating, nausea, vomiting, constipation, soft stool, frequent defecation, flatulence, rumpling, dumping syndrome, and irritable bowel syndrome. SIBO is prevalent after RYGB; digestive symptoms should prompt the consideration of SIBO as a potential etiology. Antibiotic therapy has proven to be therapeutic.
Topics: Humans; Adult; Middle Aged; Gastric Bypass; Obesity, Morbid; Prevalence; Biliopancreatic Diversion; Flatulence; Gastrectomy; Retrospective Studies
PubMed: 38062344
DOI: 10.1007/s11695-023-06974-9 -
Frontiers in Oncology 2023There is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS).
Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials.
INTRODUCTION
There is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS).
MATERIALS AND METHODS
The four databases (PubMed, Embase, Web of Science and Cochrane Library)were comprehensively searched for randomized controlled trials (RCTs) comparing the outcomes of RACS and LACS in the treatment of colorectal cancer from inception to 22 July 2023.
RESULTS
Eleven RCTs were considered eligible for the meta-analysis. Compared with LACS,RACS has significantly longer operation time(MD=5.19,95%CI: 18.00,39.82, P<0.00001), but shorter hospital stay(MD=2.97,95%CI:-1.60,-0.33,P = 0.003),lower conversion rate(RR=3.62,95%CI:0.40,0.76,P = 0.0003), lower complication rate(RR=3.31,95%CI:0.64,0.89,P=0.0009),fewer blood loss(MD=2.71,95%CI:-33.24,-5.35,P = 0.007),lower reoperation rate(RR=2.12, 95%CI:0.33,0.96,P=0.03)and longer distal resection margin(MD=2.16, 95%CI:0.04,0.94, P = 0.03). There was no significantly difference in harvested lymph nodes, the time of first flatus, the time of first defecation,the time of first resume diet, proximal resection margin, readmission rates, mortalities and CRM+ rates between two group.
CONCLUSIONS
Our study indicated that RACS is a feasible and safe technique that can achieve better surgical efficacy compared with LACS in terms of short-term outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023447088.
PubMed: 37965455
DOI: 10.3389/fonc.2023.1273378 -
International Journal of Hygiene and... Jan 2024This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas... (Review)
Review
This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.
Topics: Humans; Female; Sanitation; Extreme Weather; Drinking Water; Developed Countries; Hygiene; Ill-Housed Persons
PubMed: 37925888
DOI: 10.1016/j.ijheh.2023.114285