Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence

Rodríguez, David Avelar; Popov, Jelena; Ratcliffe, Elyanne M.; Monjaráz, Erick Manuel Toro

doi:10.3389/fped.2020.595531

Cited by 26 publications

(15 citation statements)

References 101 publications

(115 reference statements)

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“…e actions of actinidin have been linked to digestive health, with studies suggesting that actinidin can enhance the digestion of meat proteins, dairy, and wheat (which have all been associated with IBS symptomatology) and also accelerate gastric emptying [51][52][53]. Given that alterations in the gut microbiota have been implicated in the pathogenesis of constipation and IBS [54][55][56], there has been considerable interest in the potential for kiwifruit to also act on the microbiome. For example, kiwifruit has been shown to promote the growth of beneficial microbiota for gut health, including lactobacilli and bifidobacteria [57], and also to influence the production and absorption of short-chain fatty acids [53].…”

Section: Discussionmentioning

confidence: 99%

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Eltorki

Leong

Ratcliffe

2022

Canadian Journal of Gastroenterology and Hepatology

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Introduction. This systematic review aimed to summarize evidence to determine the effectiveness of kiwifruit or kiwifruit extracts in the treatment of constipation. Methods. Electronic databases were searched from inception to May 2022 without any age or language limitations. Eligible studies enrolled participants with constipation who were randomized to receive kiwifruit or kiwifruit extracts vs. any nonkiwifruit control. Standardized mean difference (SMD) and mean difference (MD) with confidence intervals (CI) were determined for the following outcomes: frequency of spontaneous bowel movements (SBM), abdominal pain and straining, as well as stool type as determined by the Bristol Stool Scale (BSS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to rate the certainty of evidence. Our review was registered on PROSPERO (CRD42021239397). Results. Seven RCTs, including 399 participants (82% female; mean age: 42 years (SD 14.6)), were included. Compared with placebo (n = 95), kiwifruit extracts might increase the weekly frequency of SBM (MD: 1.36; 95% CI: −0.44, 3.16) with low certainty of evidence; moreover, it had an uncertain effect on BSS (SMD: 1.54; 95% CI: −1.33, 4.41) with very low certainty of evidence. Additionally, compared with placebo (n = 119), kiwifruit or its extracts reduced abdominal pain (SMD: −1.44, 95% CI −2.83, −1.66) with moderate certainty of the evidence and improved frequency of straining (SMD: −0.29; 95% CI: −1.03, 0.47). Compared with psyllium, kiwifruit may increase the weekly frequency of SBM (MD: 1.01; 95% CI: −0.02, 2.04) with moderate certainty evidence, and may increase the value on the BSS (indicating softer stools) (MD: 0.63; 95% CI: 0.01, 1.25)with low certainty of evidence. Compared to placebo, kiwifruit-encapsulated extracts may result in an increase in minor adverse events (relative risk: 4.58; 95% CI: 0.79, 26.4). Conclusions. Among individuals with constipation, there is an overall low certainty of evidence indicating that kiwifruit may increase SBM when compared to placebo or psyllium. Although overall results are promising, establishing the role of kiwifruit in constipation requires large, methodologically rigorous trials. Protocol Registration: PROSPERO registration number CRD42021239397.

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Section: Discussionmentioning

confidence: 99%

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Eltorki

Leong

Ratcliffe

2022

Canadian Journal of Gastroenterology and Hepatology

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“…This includes functional constipation (FC), which is characterized by infrequent bowel movements and associated phenotypes therein (e.g., stool consistency, pain when defecating, bloating). [4][5][6][7][8][9] FC afflicts about 25% of children visiting pediatric gastroenterologist practices in the United States. 10 Symptoms of pediatric FC frequently persist into adolescence and adulthood despite treatment with laxatives, indicating the need for alternative treatment paradigms.…”

Section: Introductionmentioning

confidence: 99%

Functional response to a microbial synbiotic in the gastrointestinal system of children: a randomized clinical trial

et al. 2022

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Background Oral microbial therapy has been studied as an intervention for a range of gastrointestinal disorders. Though research suggests that microbial exposure may affect the gastrointestinal system, motility, and host immunity in a pediatric population, data have been inconsistent, with most prior studies being in neither a randomized nor placebo-controlled setting. The aim of this randomized, placebo-controlled study was to evaluate the efficacy of a synbiotic on increasing weekly bowel movements (WBMs) in constipated children. Methods Sixty-four children (3–17 years of age) were randomized to receive a synbiotic (n = 33) comprising mixed-chain length oligosaccharides and nine microbial strains, or placebo (n = 31) for 84 days. Stool microbiota was analyzed on samples collected at baseline and completion. The primary outcome was a change from baseline of WBMs in the treatment group compared to placebo. Results Treatment increased (p < 0.05) the number of WBMs in children with low baseline WBMs, despite broadly distinctive baseline microbiome signatures. Sequencing revealed that low baseline microbial richness in the treatment group significantly anticipated improvements in constipation (p = 0.00074). Conclusions These findings suggest the potential for (i) multi-species-synbiotic interventions to improve digestive health in a pediatric population and (ii) bioinformatics-based methods to predict response to microbial interventions in children. Impact Synbiotic microbial treatment improved the number of spontaneous weekly bowel movements in children compared to placebo. Intervention induced an increased abundance of bifidobacteria in children, compared to placebo. All administered probiotic species were enriched in the gut microbiome of the intervention group compared to placebo. Baseline microbial richness demonstrated potential as a predictive biomarker for response to intervention.

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“…Its pathophysiology is thought to be multifactorial. Risk factors include stress, dietary habits, physical activity, obesity, family history of FC, poor toilet training, psychological difficulties, child maltreatment, and dysbiosis of gut microbiota [11,12]. Stooling avoidance is seen as the key factor of paediatric FC [13,14].…”

Section: Introductionmentioning

confidence: 99%

The use of two Comfort Young Child Formulas in the dietary management of toddlers with functional constipation: a randomized controlled trial

Sevilla¹,

Hofman

Madero³

et al. 2022

BMC Pediatr

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Background Pharmacological intervention with laxatives is the conventional treatment for functional constipation (FC). Data to support the dietary management of FC is lacking. This study compared the efficacy of two Comfort young child formulas (YCFs) with regards to the maintenance of healthy stooling parameters in toddlers with a history of constipation. It was registered in the Netherlands Trial Registry [identifier: NL7420 (NTR7653)], registration date 20/09/2018. Methods Ninety-five healthy toddlers, aged 12 to 32 months, diagnosed with FC (Rome III criteria) were randomized to receive one of two study formulas after pharmacological treatment. For the first month of the intervention, subjects received a laxative in a decreasing maintenance dose alongside a test or control formula (maintenance phase). Subsequently, subjects only consumed formula for another month (post-maintenance phase). Stooling parameters were obtained weekly using the Bristol Stool Scale and the modified Rome III Questionnaire on Paediatric Gastrointestinal Symptoms for infants and toddlers. Differences in percentages of hard stools (primary outcome) and other stooling parameters were analysed using analysis of covariance and Chi-Square methods. Results Both formulas resulted in similar overall percentage of hard stools during the intervention period, respectively 5.02% in the test and 2.99% in the control group (n.s.). In the test group, percentages dropped from 7.11% at the end of the maintenance phase, to 3.92% at the end of the post-maintenance phase. In contrast, the percentage of hard stools in the control group was similar at the end of the maintenance (3.18%) and post-maintenance phase (2.83%; n.s.). No difference was found in the overall stool frequency between groups. At the end of the maintenance phase, only 22% and 19% of toddlers consuming the test and control formulae, respectively, met 2 or more of the criteria for FC. At the end of the study, this percentage of subjects decreased further to 9% in the test group, which tended to be lower compared to the 21% found in the control (p = 0.107). No laxative use was reported in either study group during the post-maintenance phase. Conclusion Both Comfort YCF support the maintenance of improved stooling over time in toddlers with a history of constipation. The percentage of subjects suffering from functional constipation tended to be lower after the intervention period when receiving the formula with intact protein.

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Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence

Cited by 26 publications

References 101 publications

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Functional response to a microbial synbiotic in the gastrointestinal system of children: a randomized clinical trial

The use of two Comfort Young Child Formulas in the dietary management of toddlers with functional constipation: a randomized controlled trial

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