An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation

Aziz, Imran; Whitehead, William E.; Palsson, Olafur S.; Törnblom, Hans; Simrén, Magnus

doi:10.1080/17474124.2020.1708718

Cited by 226 publications

(162 citation statements)

References 53 publications

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“…For constipation, lifestyle modifications such as exercise and gradually increased fiber and fluid intake are often advised for the general population with functional constipation [127]. Although this has not been specifically investigated in PD patients, it is often recommended for this population as well [124].…”

Section: Treatment Of Gastrointestinal Symptoms In Pdmentioning

confidence: 99%

Gastrointestinal Dysfunction in Parkinson’s Disease

Skjærbæk

Knudsen

Horsager

et al. 2021

JCM

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Parkinson’s disease (PD) is the second most common neurodegenerative disease. Patients show deposits of pathological, aggregated α-synuclein not only in the brain but throughout almost the entire length of the digestive tract. This gives rise to non-motor symptoms particularly within the gastrointestinal tract and patients experience a wide range of frequent and burdensome symptoms such as dysphagia, bloating, and constipation. Recent evidence suggests that progressive accumulation of gastrointestinal pathology is underway several years before a clinical diagnosis of PD. Notably, constipation has been shown to increase the risk of developing PD and in contrast, truncal vagotomy seems to decrease the risk of PD. Animal models have demonstrated gut-to-brain spreading of pathological α-synuclein and it is currently being intensely studied whether PD begins in the gut of some patients. Gastrointestinal symptoms in PD have been investigated by the use of several different questionnaires. However, there is limited correspondence between subjective gastrointestinal symptoms and objective dysfunction along the gastrointestinal tract, and often the magnitude of dysfunction is underestimated by the use of questionnaires. Therefore, objective measures are important tools to clarify the degree of dysfunction in future studies of PD. Here, we summarize the types and prevalence of subjective gastrointestinal symptoms and objective dysfunction in PD. The potential importance of the gastrointestinal tract in the etiopathogenesis of PD is briefly discussed.

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Section: Treatment Of Gastrointestinal Symptoms In Pdmentioning

confidence: 99%

Gastrointestinal Dysfunction in Parkinson’s Disease

Skjærbæk

Knudsen

Horsager

et al. 2021

JCM

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“…is shows that constipation occurs in a wide range of groups, and people of any age group have a certain chance of getting sick. e specific clinical manifestations of FC include difficulty in defecation, inconstant defecation, and abdominal pain [4,5]. According to the current level of diagnosis and treatment, there is no clinically specific medicine for the treatment of functional constipation.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Biofeedback Therapy Combined with Comprehensive Nursing Intervention on the Quality of Life of Patients with Functional Constipation Based on Dynamic Magnetic Resonance Defecation

Kuang

Dai

Xiao

et al. 2021

Journal of Healthcare Engineering

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In order to study the quality of life of patients with functional constipation based on dynamic magnetic resonance defecation, the biofeedback therapy combined with comprehensive nursing intervention was used to diagnose and treat the patients, so as to explore its clinical efficacy and its impact on patients’ quality of life. The obstructed defecation surgical treatment carries frequent recurrences, and dynamic magnetic resonance imaging defecography evaluated and elucidated the underlying anatomic features. This research selected 80 patients who came to our hospital for treatment of functional constipation and evaluated and recorded various clinical indicators before and after treatment in the form of questionnaire survey. The results showed that the clinical symptom scores of patients with functional constipation before and after treatment were greatly different P < 0.05 . Thus, the biofeedback therapy combined with comprehensive nursing intervention showed a good clinical effect in the treatment of patients with functional constipation and significantly improved the quality of life of patients, showing high clinical application and promotion value. A convenient diagnostic procedure is represented by the dynamic magnetic resonance imaging in females, especially pelvic floor organs dynamic imaging during defecation.

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“…Many guidelines and reviews summarize stepwise clinical therapeutic approaches from appropriate lifestyle and dietary modifications to various drug administration, including osmotic agents, stimulant laxatives, prosecretory agents, serotonin (5-HT4) receptor agonists, and probiotics, and so on [7,8]. Anorectal biofeedback, nerve stimulation, and colonic surgery may be used to treat FC [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta‐Analysis

Wang

Zheng

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Objective. The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC). Methods. A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3. Results. The merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p<0.00001; MD = 0.84 [95% CI, 0.65 to 1.03]; I2 = 0%) and improving constipation symptoms (p=0.03; SMD = −0.4 [95% CI, −0.78 to −0.03]; I2 = 74%), stool formation (p<0.00001; MD = 0.24 [95% CI, 0.15 to 0.34]; I2 = 0%), quality of life (p<0.00001; N = 1, MD = −0.33 [95% CI, −0.45 to −0.21]), and responder rates (p=0.02; RR = 2.16; [95% CI, 1.1 to 4.24]; I2 = 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p=0.44; RR = 1.18; [95% CI, 0.77 to 1.81]; I2 = 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p=0.004; MD = 0.53 [95% CI, 0.17 to 0.88]; I2 = 88%) and improving patients’ quality of life (p<0.00001; SMD = −0.73 [95% CI, −1.02 to −0.44]; I2 = 64%), with high heterogeneity. However, there were no significant differences in responder rate (p=0.12; RR = 1.31; [95% CI, 0.94 to 1.82]; I2 = 53%), BSFS (p=0.5; MD = 0.17 [95% CI, −0.33 to 0.68]; I2 = 93%), or CSS (p=0.05; SMD = −0.62 [95% CI, −1.23 to −0.01]; I2 = 89%). Regarding safety evaluation, acupuncture was safer than medications (p<0.0001; RR = 0.3; [95% CI, 0.18 to 0.52]; I2 = 30%). Conclusions. Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

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An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation

Cited by 226 publications

References 53 publications

Gastrointestinal Dysfunction in Parkinson’s Disease

Gastrointestinal Dysfunction in Parkinson’s Disease

The Effect of Biofeedback Therapy Combined with Comprehensive Nursing Intervention on the Quality of Life of Patients with Functional Constipation Based on Dynamic Magnetic Resonance Defecation

The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta‐Analysis

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