BackgroundFew studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC.MethodsBetween January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared.ResultsThere were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285).ConclusionsOur findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.

Chronic constipation (CC) is a gastrointestinal disorder that adversely affects the quality of life. MicroRNAs are involved in the pathogenesis of functional gastrointestinal disorders. This study aims to investigate the molecular mechanism of microRNA-128 in CC. Here, we successfully constructed a murine model of CC based on morphine and rhubarb. The expression of stem cell factor (SCF) and neuron-specific enolase (NSE) were low in the models. Using miRNA array and bioinformatic analysis, we predicted and confirmed the expression of miR-128 and its downstream target genes in CC model. Compared to the control group, CC group showed a significant downregulation of miR-128 and upregulation of p38α and macrophage colony stimulating factors (M-CSF). Moreover, we observed elevated inflammatory cytokine and decreased anti-inflammatory cytokine levels in colonic tissues. Furthermore, co-culture assays indicated that regulating expression of miR-128 in colonic epithelial cells induced the secretion of IL-6 and TNF-α by macrophages. In conclusion, our study demonstrated that miR-128 regulated the p38α/M-CSF signaling pathway to promote chronic inflammatory responses and changes in the immune microenvironment of the colon, thereby offering potential insights into the pathogenesis of CC and therapeutic targets for its treatment.

Goal: We aimed to study the density of intramucosal mast cells in histologically normal colonic mucosa biopsied from patients with a clinical diagnosis of irritable bowel syndrome (IBS). Background: Mast cell activation has been thought to implicate in the pathogenesis of inflammatory bowel disease (IBD). Whether it serves a role in the pathogenesis of IBS remains controversial. Study: A total of 127 colonoscopic mucosal biopsies were immunohistochemically stained, including 51 IBS, 66 IBD, and 10 normal control samples. Intact mast cells were quantified in 3 high power fields (HPF) in areas showing the highest density. Results: CD117 was sensitive in detecting mast cells in colonic mucosa. The mast cell counts in all biopsies ranged from 2 to 60 per HPF (mean=17.5±7.2). The density of intramucosal mast cells were similar among IBS, IBD and normal control groups (P=0.6733). IBD in remission versus IBS (17.1±8.0 vs. 18.1±7.0; P=0.4804), Crohn disease versus ulcerative colitis (17.1±10.4 vs. 17.2±5.2; P=0.9463), IBS with diarrhea versus without diarrhea (19.5±6.3 vs. 16.8±6.9; P=0.1404). Forty biopsies (31.5%) showing ≥20 mast cells per HPF appeared to equally distribute among various disease groups (P=0.7283). Conclusions: There is no significant difference in the number of intramucosal mast cells between IBS and IBD that show normal colonic biopsies. In IBS patients, the number of intramucosal mast cell does not correlate with symptoms. The mast cell count (≥20/HPF) is not a reliable criterion for the diagnosis of IBS or for the distinction between patients with IBS and those with IBD in remission.

BACKGROUND: Assessment of colonic transit tend to be more subjective and qualitative. This study aimed to evaluate the capability of our new quantitative scale to predict the subtypes of constipation and assess symptom severity of patients with slow transit constipation. METHODS: A retrospective cohort population was assembled, consisting of adult patients with chronic constipation who underwent both colonic transit test and defecography between 2012 and 2019. Radiological parameters were measured on AXRs. The Luojia score was introduced to convey the vertical distance from the splenic flexure to the lowest point of the transverse colon, representing the degree of transverse colon ptosis. Patients with slow transit constipation only were especially required to complete the Wexner Constipation Scale (WCS) and Hospital Anxiety and Depression Scale (HADS) for clinical severity assessment. FINDINGS: Of 368 patients, 191 patients (51.9%) showed slow colonic transit, and patients with slow colonic transit were more likely to have severe ptosis of the transverse colon on AXRs. Patients with slow colonic transit had a significantly higher Luojia score than those with normal colonic transit (p<0.001). A cut-off of 195 mm was used to distinguish slow colonic transit. A significant difference in Luojia score was also found between patients with obstructed defecation syndrome and normal patients, and a cut-off of 140 mm was identified. In patients with slow transit constipation, there was a strong correlation between Luojia score and WCS (r=0.618) and a moderate correlation between Luojia score and HADS-Anxiety (r=0.507). These results indicated that the Luojia score is a reliable predictor of symptom severity and psychological condition in patients with slow transit constipation. INTERPRETATION: The Luojia score might be a new quantitative, precise method in the assessment of constipation. FUNDING: The National Natural Science Foundation of China and the Clinical Research Special Fund of Wu Jieping Medical Foundation. Keywords: constipation; colonic transit; Abdominal X-ray; transverse colon ptosis; Luojia score