Mechanisms, Evaluation, and Management of Chronic Constipation

Bharucha, Adil E.; Lacy, Brian E.

doi:10.1053/j.gastro.2019.12.034

Cited by 358 publications

(334 citation statements)

References 165 publications

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“…Continuously monitoring of human gut microbiome after infection or medical treatment has achieved interval of days after the event or interventions 17 , and study into one type of large-scale replacement of gut microbiome, fecal microbiota transplantation (FMT), demonstrated that an foreign microbiome can partially establish and replace the original gut microbiome, resulting in a mosaic of original and new gut microbiome 18 . Osmotic laxatives can remove large portions of GI microbiome and widely used for treating constipation but also before colonoscopy 19, 20 , which is linked with long-term partially alterations of gut microbiota after a week of continuous administration in mice, with negative consequences on host intestinal and immunological homeostasis 5 .…”

Section: Introductionmentioning

confidence: 99%

Reconstruction and dynamics of human intestinal microbiome observedin situ

Liu

Dai

et al. 2020

Preprint

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45Gut microbiome are studied primarily using fecal samples in humans and we gained 46 vital knowledge of compositional and functional capacities of gastro-intestinal 47 microbial communities. Yet, fecal materials limit our ability to investigate microbial 48 dynamics in different locations along GI-tract (in situ), nor in finer temporal scales as 49 they are infrequent. With a technology developed originally for fecal material 50 transplantation, colonic transendoscopic enteral tubing, we were able to sample 51 ileocecal microbiome twice daily, and carried out metagenomic as well as 52 metatranscriptomic analyses. Ileocecal and fecal microbiome are similar in 53 metagenomic profiling, yet their active genes (in metatranscriptomes) are highly 54 distinct. Both were perturbed after laxatives and then became more similar to 55 microbiome prior to treatment, demonstrating resilience as an innate property of gut 56 microbiome. Ileocecal microbiome transcriptomes sampled during day and night 57 revealed diurnal rhythmes exist in certain bacterial species and functional pathways, in 58 particular those related to short-chain fatty acid production. Lastly, metabolomic 59 analysis in fecal and urine samples mirrored the perturbance and recovery in gut 60 microbiome, indicating crucial contribution of gut microbiome to many of the key 61 metabolites involved in host health. Our study provides interesting novel insights into 62 human gut microbiome, and demonstrates the inner resilience, diurnal rhythmes and 63 potential consequences to the host. 64 65 66 (Figure 1, Figure S1). Yet those microbial species do not always occupy the majority 131 in RNA reads, rather, species Ruminococcus torques, Methanobrevibacter, 132

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Section: Introductionmentioning

confidence: 99%

Reconstruction and dynamics of human intestinal microbiome observedin situ

Liu

Dai

et al. 2020

Preprint

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“…[1,5,6] Among the factors that contribute to the appearance or worsening of constipation symptoms are those that are considered unmodi able, such as female sex, advanced age, medication use, and the association with different comorbidities, such as neurologic diseases. [7] On the other hand, there are numerous factors, associated with lifestyle, that are considered modi able, such as low ber intake, [8,9] inadequate water intake, [10,11,12] sedentary lifestyle, and reduced physical activity. [12,13] Nevertheless, evidence on the theme is limited and controversial, given the di culty in conducting prospective studies on the topic.…”

Section: Introductionmentioning

confidence: 99%

Incidence of “new-onset” constipation and associated factors during lockdown due to the coronavirus-19 pandemic.

Remes-Troche

Coss‐Adame

Amieva-Balmori

et al. 2020

Preprint

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Background: A minimum of physical activity and low liquid intake are factors that have been associated with constipation. The health emergency brought on by the COVID-19 pandemic has resulted in adopting behavior, such as sheltering-in-place (less mobility) and dietary changes, creating a scenario we believe to be an adequate model for examining the appearance of symptoms of constipation and its associated factors. Methods: A cross-sectional and descriptive study was conducted on an open population, applying an electronic survey (4 weeks after lockdown due to COVID-19 in Mexico) to evaluate: demographic characteristics, physical activity, water and fiber intake, appearance of constipation symptoms (including stool consistency), and quality of life.Key results: Out of 678 subjects evaluated, 170 (25%, 95% CI 21.7-28.4) developed symptoms of “new-onset” constipation, with a significant decrease in the number of daily bowel movements (p<0.05) and hardness of stool consistency (p<0.05) during lockdown. The multivariate analysis (logistic regression) showed that female sex (p=0.001), water intake (p=0.039), and physical activity (p=0.012) were associated with “new-onset” constipation. Conclusions: Reduced physical activity and less water intake due to mobility restrictions imposed for epidemiologic reasons, such as a pandemic, can lead to symptoms of “new-onset” constipation.

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“…Fecal incontinence (FI) and chronic constipation (CC) are evacuation disorders characterized by high frequency in general population and high impact on the quality of life of affected patients (1,2) . The prevalence of FI, characterized by the involuntary loss of fecal content, is reported to range from 2.2 to 20% (2) .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with CC may show heterogeneous symptoms (decreased evacuation frequency, defecation exertion, feeling of incomplete evacuation, fullness and hardened stools). It is estimated that the prevalence of CC in the adult population is 15% (1) . There are groups with a higher risk of evacuation disorders, including the elderly, institutionalized individuals and individuals with a history of anorectal surgery or obstetric procedures.…”

Section: Introductionmentioning

confidence: 99%

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Main Manometric Findings and Potential for Anorectal Physical Therapy in the Treatment of Patients With Evacuation Disorders

Camargo

Machado

Parra

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Evacuation disorders are prevalent in the adult population, and a significant portion of cases may originate from pelvic floor muscle dysfunctions. Anorectal manometry (ARM) is an important diagnostic tool and can guide conservative treatment. OBJECTIVE: To evaluate the prevalence of pelvic dysfunction in patients with evacuation disorders through clinical and manometric findings and to evaluate, using the same findings, whether there are published protocols that could be guided by anorectal manometry. METHODS: A retrospective analysis of a prospective database of 278 anorectal manometries performed for the investigation of evacuation disorders in patients seen at the anorectal physiology outpatient clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto between January 2015 to June 2019 was conducted. The following parameters were calculated: resting pressure (RP), squeeze pressure (SP), high-pressure zone (HPZ), rectal sensitivity (RS) and rectal capacity (RC). The pressure measurements and manometric plots were reviewed to determine the diagnosis and to propose potential pelvic physical therapy procedures. Analysis of variance (ANOVA) and Fisher’s exact test were used to compare the continuous variables and to evaluate the equality of variances between groups of patients with fecal incontinence (FI) and chronic constipation (CC). Results with a significance level lower than 0.05 (P-value <0.05) were considered statistically significant. Statistical analysis was performed using IBM® SPSS® Statistics version 20. RESULTS: The mean age of the sample was 45±22 years, with a predominance of females (64.4%) and economically inactive (72.7%) patients. The indications for exam performance were FI (65.8%) and CC (34.2%). Patients with FI had lower RP (41.9 mmHg x 67.6 mmHg; P<0.001), SP (85.4 mmHg x 116.0 mmHg; P<0.001), HPZ (1.49 cm x 2.42 cm; P<0.001), RS (57.9 mL x 71.5 mL; P=0.044) and RC (146.2 mL x 195.5 mL; P<0.001) compared to those of patients with CC. For patients with FI, the main diagnosis was the absence of a functional anal canal (49.7%). For patients with CC, the main diagnosis was outflow tract obstruction (54.7%). For patients with FI, the main protocol involved a combination of anorectal biofeedback (aBF) with tibial nerve stimulation (TNS) (57.9%). For patients with CC, the most indicated protocol was aBF combined with TNS and rectal balloon training (RBT) (54.7%). CONCLUSION: There was a high prevalence of pelvic floor changes in patients with evacuation disorders. There was a high potential for performing pelvic floor physical therapy based on the clinical and manometric findings.

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Mechanisms, Evaluation, and Management of Chronic Constipation

Cited by 358 publications

References 165 publications

Reconstruction and dynamics of human intestinal microbiome observedin situ

Reconstruction and dynamics of human intestinal microbiome observedin situ

Incidence of “new-onset” constipation and associated factors during lockdown due to the coronavirus-19 pandemic.

Main Manometric Findings and Potential for Anorectal Physical Therapy in the Treatment of Patients With Evacuation Disorders

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