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Frontiers in Surgery 2024Up to 50% of patients who undergo rectal resection suffer from various and partly severe functional problems, despite the preservation of the anal sphincter. These...
BACKGROUND
Up to 50% of patients who undergo rectal resection suffer from various and partly severe functional problems, despite the preservation of the anal sphincter. These complaints are defined as low anterior resection syndrome (LARS). So far, there are no randomized clinical trials regarding the most effective treatment for LARS. Our aim is to evaluate whether transanal irrigation improves bowel function and quality of life in patients following low anterior resection compared to best supportive care.
METHODS
Patients who have undergone low anterior resection will be approached for this study. On patient's visit, complaints regarding the defecation as well as any deterioration in their overall quality of life will be assessed using questionnaires such as the Low Anterior Resection Syndromes score, Wexner score, European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QOL) CR-29, and Measure Yourself Medical Outcome Profile tool. Few additional target questions will be also asked, such as "Would you recommend the treatment to anybody; did you expect the improvement following the treatment; etc." Questionnaires and scales will be filled on follow-up visits every 3 months for 1 year.
DISCUSSION
This multicenter, randomized controlled trial will lead to a better understanding of LARS treatment. Moreover, it will be a hypothesis-generating study and will inform areas needing future prospective studies.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier (NCT05920681).
PubMed: 38803549
DOI: 10.3389/fsurg.2024.1384815 -
Frontiers in Microbiology 2024Microbial population structures within fecal samples are vital for disease screening, diagnosis, and gut microbiome research. The two primary methods for collecting...
INTRODUCTION
Microbial population structures within fecal samples are vital for disease screening, diagnosis, and gut microbiome research. The two primary methods for collecting feline fecal samples are: (1) using a fecal loop, which retrieves a rectal sample using a small, looped instrument, and (2) using the litter box, which collects stool directly from the litter. Each method has its own advantages and disadvantages and is suitable for different research objectives.
METHODS AND RESULTS
Whole-genome shotgun metagenomic sequencing were performed on the gut microbiomes of fecal samples collected using these two methods from 10 adult cats housed in the same research facility. We evaluated the influence of collection methods on feline microbiome analysis, particularly their impact on DNA extraction, metagenomic sequencing yield, microbial composition, and diversity in subsequent gut microbiome analyses. Interestingly, fecal sample collection using a fecal loop resulted in a lower yield of microbial DNA compared to the litterbox method ( = 0.004). However, there were no significant differences between the two groups in the proportion of host contamination ( = 0.106), virus contamination ( = 0.232), relative taxonomy abundance of top five phyla ( > 0.638), or the number of microbial genes covered ( = 0.770). Furthermore, no significant differences were observed in alpha-diversity, beta-diversity, the number of taxa identified at each taxonomic level, and the relative abundance of taxonomic units.
DISCUSSION
These two sample collection methods do not affect microbial population structures within fecal samples and collecting fecal samples directly from the litterbox within 6 hours after defecation can be considered a reliable approach for microbiome research.
PubMed: 38800749
DOI: 10.3389/fmicb.2024.1337917 -
Journal of Parasitology Research 2024In developing countries, intestinal parasitic infections (IPIs) and tuberculosis (TB) coinfections have been perceived to be high. The geographic distributions of...
Prevalence of Intestinal Parasitic Infections and Associated Factors among Presumptive Pulmonary Tuberculosis Patients at Debre Tabor Referral Hospital, South Gondar, Northwest Ethiopia: A Cross-Sectional Study.
BACKGROUND
In developing countries, intestinal parasitic infections (IPIs) and tuberculosis (TB) coinfections have been perceived to be high. The geographic distributions of helminths and TB overlap substantially. Parasitic infections affect the outcome of TB by changing the cell-mediated immune response to a humoral response, while infection favors the immune escape of helminths. There are limited studies on the epidemiology of intestinal parasites among presumptive pulmonary TB (PTB) patients in Ethiopia. Therefore, this study is aimed at determining the prevalence of intestinal parasitic infections and associated factors among patients with presumptive pulmonary tuberculosis at Debre Tabor Referral Hospital.
METHODS AND MATERIALS
A hospital-based cross-sectional study was conducted from March to June 2021. The sociodemographic data and associated factors were collected using a structured questionnaire, and stool samples were collected by convenient sampling technique and processed for the detection of intestinal parasites using a direct wet mount saline preparation and formal ether concentration technique. The data was coded, cleaned, and analyzed by SPSS version 23. Bivariate and multivariable analyses were conducted to determine an adjusted odds ratio (AOR). value < 0.05 was considered statistically significant.
RESULT
The overall prevalence of intestinal parasitosis was 25.6% (81/316); of these, 12.9% (41/316) were protozoan infections and 12.7% (40/316) were helminth infections. Multivariable logistic regression analysis showed that being older than 36 years (AOR: 4.35; 95% CI: 1.26, 13.91; = 0.001), rural residence (AOR: 3.46; 95% CI: 1.18, 9.97; < 0.001), unable to read and write (AOR = 2.62; 95%CI = 2.15, 8.43; = 0.004), and use of river water (AOR: 3.47; 95% CI: 1.62, 8.21; < 0.001) were associated with intestinal parasitic infections.
CONCLUSION
The present study showed that the prevalence of intestinal parasitosis among presumptive pulmonary tuberculosis patients was high in the study area. Age, residence, educational status, and source of water were significant factors in IPIs among presumptive TB patients. Moreover, our findings suggest a proper health education program for good personal hygiene habits, the coloration of water, avoiding open-field defecation, and also preventative measures to avoid the acquisition of IPIs in patients with TB. Presumptive tuberculosis patients should be screened and treated accordingly. Additionally, it needs further research and recommends more assessment for intestinal parasitic infection in PTB patients.
PubMed: 38799382
DOI: 10.1155/2024/8993666 -
Journal of Clinical Medicine May 2024Chewing gum, considered a form of sham feeding, has been shown to improve intestinal motor and secretory function in various types of abdominal surgery. We conducted... (Review)
Review
Effects of Postoperative Gum Chewing on Recovery of Gastrointestinal Function Following Laparoscopic Gynecologic Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Chewing gum, considered a form of sham feeding, has been shown to improve intestinal motor and secretory function in various types of abdominal surgery. We conducted this systematic review to evaluate the effects of postoperative gum chewing on the recovery of gastrointestinal function after laparoscopic gynecologic surgery. We performed a comprehensive literature review of all randomized controlled trials (RCTs) in PubMed, Embase, and a reference list of relevant studies from the inception to 11 March 2024, comparing postoperative gum chewing versus no gum chewing following laparoscopic gynecologic surgery regardless of indications and setting without language restriction. The primary outcome was the time to the presence of bowel sounds and the time to the first passage of flatus. Cochrane's risk of bias tool was used to assess the risk of bias in included studies. Nine RCTs with a total of 1011 patients were included. Overall, three studies were categorized as having a low risk of bias, three had some concerns, and three exhibited a high risk of bias. The time to the presence of bowel sounds (mean difference [MD] -2.66 h, 95% confidence interval [CI] -3.68 to -1.64, < 0.00001) and time to the first passage of flatus (MD -4.20 h, 95% CI -5.79 to -2.61, < 0.00001) was significantly shorter in the gum-chewing group. There was no statistical difference between the two groups with regard to the time to the first defecation (MD -6.52 h, 95% CI -15.70 to 2.66, = 0.16), time to the first postoperative mobilization (MD 24.05 min, 95% CI -38.16 to 86.26, = 0.45), postoperative ileus (MD 0.68, 95% CI 0.39 to 1.19, = 0.17), and length of hospital stay (MD -0.05 day, 95% CI -0.14 to 0.04, = 0.28). Gum chewing following laparoscopic gynecologic surgery appears to promote the recovery of gastrointestinal function, as evidenced by a reduced time to the presence of bowel sounds and the first passage of flatus.
PubMed: 38792393
DOI: 10.3390/jcm13102851 -
Veterinary Sciences Apr 2024The usefulness of antibiotics in dogs with acute diarrhea (AD) is controversial. It is also unclear what effect metronidazole has on potential enteropathogens such as...
The usefulness of antibiotics in dogs with acute diarrhea (AD) is controversial. It is also unclear what effect metronidazole has on potential enteropathogens such as and . Thus, the aim of this study was to evaluate the effect of metronidazole vs. a synbiotic on the clinical course and core intestinal bacteria of dogs with AD. Twenty-seven dogs with AD were enrolled in this prospective, randomized, blinded clinical trial and treated with either metronidazole (METg) or a synbiotic (SYNg; DSM 10663; NCIMB 10415/4b170). The Canine Acute Diarrhea Severity (CADS) index was recorded daily for eleven days. Bacteria were quantified using qPCR. Data were analyzed using mixed models with repeated measures. A higher concentration of was observed in the METg group vs. the SYNg group on Day 6 ( < 0.0001) and Day 30 ( = 0.01). Metronidazole had no effect on was significantly lower in the METg group than in the SYNg group on Days 6 and 30 ( < 0.0001; = 0.0015). No significant differences were observed in CADS index, fecal consistency, or defecation frequency between treatment groups (except for the CADS index on one single day). In conclusion, metronidazole negatively impacts the microbiome without affecting clinical outcomes. Thus, synbiotics might be a preferred treatment option for dogs with AD.
PubMed: 38787169
DOI: 10.3390/vetsci11050197 -
The Korean Journal of Gastroenterology... May 2024Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the... (Review)
Review
Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.
Topics: Constipation; Humans; Chronic Disease; Biofeedback, Psychology; Electric Stimulation Therapy; Botulinum Toxins
PubMed: 38783620
DOI: 10.4166/kjg.2024.044 -
The Korean Journal of Gastroenterology... May 2024Chronic constipation is a common disease that can impair the quality of life, with a prevalence of 14% globally and 16.5% in South Korea. Straining, hard stools, the... (Review)
Review
Chronic constipation is a common disease that can impair the quality of life, with a prevalence of 14% globally and 16.5% in South Korea. Straining, hard stools, the sensation of incomplete evacuation, the sensation of anorectal blockage, and manual maneuvers to facilitate defecation are the related symptoms of chronic constipation. On the other hand, medications commonly referred to as laxatives are the essentials of treatment for constipation compared to non-pharmacological treatment, such as lifestyle modifications, biofeedback, or surgery. Unfortunately, there is still an unmet need to determine if pharmacological treatment for constipation is being administered appropriately. Therefore, there are many disadvantages as to whether the indications and side effects of laxatives are adequately considered and prescribed as the primary treatment modality for constipation in a real clinical situation in Korea. Laxatives are generally recommended as the next step for patients in whom organic causes have been excluded and have not responded to initial non-pharmacologic therapies such as dietary fiber intake and exercise. Laxatives can be classified as bulk-forming laxatives, osmotic laxatives, stimulant laxatives, and other novel laxatives. On the other hand, there are distinct mechanisms underlying constipation, and appropriate administration is the most decisive. Therefore, the present investigators prepared this review to discuss appropriate pharmacological strategies for chronic constipation in Korea. Moreover, this paper also includes suggestions for appropriate pharmacological treatment options for special patient populations.
Topics: Constipation; Humans; Laxatives; Chronic Disease; Dietary Fiber
PubMed: 38783619
DOI: 10.4166/kjg.2024.045 -
The Korean Journal of Gastroenterology... May 2024Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a... (Review)
Review
Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. In clinical practice, healthcare providers need to check for 'alarm features' indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation. If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.
Topics: Constipation; Humans; Chronic Disease; Manometry; Colonoscopy; Digital Rectal Examination; Defecography; Gastrointestinal Transit
PubMed: 38783618
DOI: 10.4166/kjg.2024.039 -
BMC Pediatrics May 2024Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.
BACKGROUND
Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.
OBJECTIVES
The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.
DESIGN AND SETTINGS
A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.
INDEPENDENT VARIABLES
(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.
RESULTS
Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).
CONCLUSION
Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.
Topics: Humans; Infant; Risk Factors; Case-Control Studies; Female; Retrospective Studies; Male; Child, Preschool; Rectal Fistula; Defecation; Breast Feeding; Pregnancy; Infant, Newborn
PubMed: 38783262
DOI: 10.1186/s12887-024-04826-8 -
ENeurologicalSci Jun 2024Constipation is one of the most common non-motor symptoms of Parkinson's disease (PD) and is associated with reduced quality of life in patients with PD. The aim of this...
INTRODUCTION
Constipation is one of the most common non-motor symptoms of Parkinson's disease (PD) and is associated with reduced quality of life in patients with PD. The aim of this study was to evaluate the effect of lactulose on defecation status in patients with PD.
METHODS
In this open-label, single-center, exploratory pilot study, twenty-nine patients with PD received lactulose for three weeks for the treatment of constipation. The primary endpoint was the number of spontaneous bowel movements (SBMs). The secondary endpoints were stool consistency (Bristol Stool Form Scale [BSFS]) and the number of rescue laxatives used.
RESULTS
Twenty-five patients with PD completed the study. The number of SBMs recorded during the lactulose intervention period was significantly increased compared with that recorded during the pre-intervention period. During the intervention period, the BSFS scores of the patients increased significantly, whereas the number of rescue laxatives they used decreased significantly. No serious adverse events were observed during the study period. Lactulose was well-tolerated.
CONCLUSIONS
The results of this study suggest that lactulose may be effective in improving defecation status in patients with PD. Further randomized controlled trials are needed to confirm the effects of lactulose on constipation in patients with PD.
PubMed: 38779414
DOI: 10.1016/j.ensci.2024.100503