Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation

Tanner, Samuel; Chaudhry, Ahson; Goraya, Navneet; Badlani, Rohan; Jehangir, Asad; Shahsavari, Dariush; Malik, Zubair; Parkman, Henry P.

doi:10.3390/jcm10092027

Cited by 15 publications

(11 citation statements)

References 44 publications

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“… 18 This is actually not surprising for two main reasons: (i) the 76.8 h pre-TAI average value was not much higher than normal and (ii) the complexity of the mechanisms underlying the neurogenic bowel dysfunction results from a combined deficit of colon peristalsis and rectal emptying with chronic faecal retention. 28 , 29 Similarly, stool consistency recorded by BSFS, and patient's diet did not vary over time, confirming the dietary imbalances detected in MS patients. 30 TAI by itself cannot change them, unless being associated with a proper dietary regimen and/or supplementation with prebiotics and/or probiotics.…”

Section: Discussionsupporting

confidence: 59%

Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study

Ascanelli¹,

Bombardini²,

Chimisso³

et al. 2022

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Constipation and faecal incontinence are not so uncommon in patients with multiple sclerosis, impairing quality of life. The gut microbiota is altered in multiple sclerosis patients and likely contributes to disease pathogenesis. Trans-anal irrigation has been proven to allow treatment of neurogenic bowel dysfunction and may affect gut microbiota. Objectives The primary outcome was trans-anal irrigation effectiveness on constipation and faecal incontinence. The secondary outcome was gut microbiota profiling compared to healthy subjects and during trans-anal irrigation adoption. Methods We conducted a prospective cohort study on multiple sclerosis patients, screened with Patient Assessment of Constipation Quality of Life questionnaire before undergoing constipation and faecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries and faecal sample collection for gut microbiota analysis before and after 4 weeks of trans-anal irrigation. Results and Conclusions Eighty patients were screened of which nearly half had intestinal symptoms. The included population (n = 37) was predominantly composed of women with significantly longer disease duration, higher mean age and disability than the excluded one ( p < 0.05). Twelve patients completed the trans-anal irrigation phase, which led to significant improvement of bowel dysfunction symptom-related quality of life, increase in gut microbiota diversity and reduction of the proportions of pro-inflammatory taxa ( p < 0.05). Trans-anal irrigation was safe, satisfactory and could help counteract multiple sclerosis-related dysbiosis.

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Section: Discussionsupporting

confidence: 59%

Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study

Ascanelli¹,

Bombardini²,

Chimisso³

et al. 2022

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“…Of the 17 patients with DD included in the study, 14 (82.4%) were female, three were male, and the mean age was 45.6 17.9 years. The patients had symptoms for a median of 84 months [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] . The most common complaints among the patients were constipation (82.4%) and an inability to completely defecate the stool (17.6%).…”

Section: Resultsmentioning

confidence: 99%

“…In 55-64 percent of adults with DD and 12 percent of adolescents with DD, delayed CTT with scintigraphy or radiopaque markers has been reported 6,11 . Tanner et al (13) found DD in 9% of patients with constipation who did not respond to first-line treatment, STC in 42%, DD and STC overlap in 13%, and NTC in 36% of patients in a study of 230 patients with constipation who did not respond to first-line treatment. A total of 50 patients were diagnosed with DD, with 30 of them (60 percent) also having STC.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with STC who do not respond to diet or stimulant treatments have limited treatment options, and the role of BFT in these patients is uncertain 20,22 . According to another study, BFT helps with both normal and slow transit constipation [23][24][25] . However, it was suggested in a later controlled study that while BFT was beneficial only for patients with DD and NTC, it was not beneficial for patients with STC 26 .…”

Section: Discussionmentioning

confidence: 99%

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Colonic Slow Transit in Patients with Dyssynergic Defecation and Effectiveness of Biofeedback Therapy

Arı

Öztürk

ÖZDERİN

et al. 2023

CMJ

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Background: Colonic transit is delayed in two-thirds of patients with dyssynergic defecation. As a result, it's possible that dyssynergic defecation and slow transit constipation are linked. There is a scarcity of research on the coexistence of dyssynergic defecation and slow transit constipation, as well as the efficacy of biofeedback therapy in this group of patients. Methods: The results of anorectal manometry and MR defecography were used to make the diagnosis of dyssynergic defecation. The colon transit time was measured with the help of 24 specially marked markers. All of the patients were given biofeedback therapy. Results: The average age of the 17 patients with dyssynergic defecation in the study was 45.6 years. The colon transit time was prolonged in seven patients (41.2%). In anorectal manometry, 7 patients (41.2%) had improved dyssynergic defecation after dyssynergic defecation. When the relationship between colon transit time and biofeedback therapy was investigated, it was discovered that normal colon transit time was found in 85.7 percent of those who benefited from biofeedback therapy, while slow transit constipation was found in 60% of those who did not. Conclusion: In patients with pre- biofeedback therapy and dyssynergic defecation, colon transit time should be evaluated, and it should be kept in mind that these patients may be resistant to treatment in the case of accompanying slow transit constipation.

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“…Epidemiological data showed that the percentage of FC in adults is as high as 15.3% ( Barberio et al, 2021 ). Slow transit constipation (STC), which accounts for about 55% of FC ( Tanner et al, 2021 ), It is main clinical features are slowing of intestinal motility and delayed passage of intestinal contents. Senna and other laxatives often appear in the treatment of STC.…”

Section: Introductionmentioning

confidence: 99%

Based on Network Pharmacology and Gut Microbiota Analysis to Investigate the Mechanism of the Laxative Effect of Pterostilbene on Loperamide-Induced Slow Transit Constipation in Mice

Yao

Ren

et al. 2022

Front. Pharmacol.

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Background: Pterostilbene (PTE) is a natural polyphenol compound that has been proven to improve intestinal inflammation, but its laxative effect on slow transit constipation (STC) has never been studied. This study aims to investigate the laxative effect of PTE on loperamide (LOP)-induced STC mice and its influence on intestinal microbes through a combination of network pharmacological analysis and experimental verification.Material and Methods: PTE was used to treat LOP-exposed mice, and the laxative effect of PTE was evaluated by the total intestinal transit time and stool parameters. The apoptosis of Cajal interstitial cells (ICCs) was detected by immunofluorescence. The mechanism of PTE’s laxative effect was predicted by network pharmacology analysis. We used western blot technology to verify the predicted hub genes and pathways. Malondialdehyde (MDA) and GSH-Px were tested to reflect oxidative stress levels and the changes of gut microbiota were detected by 16S rDNA high-throughput sequencing.Results: PTE treatment could significantly improve the intestinal motility disorder caused by LOP. Apoptosis of ICCs increased in the STC group, but decreased significantly in the PTE intervention group. Through network pharmacological analysis, PTE might reduce the apoptosis of ICCs by enhancing PI3K/AKT and Nrf2/HO-1 signaling, and improve constipation caused by LOP. In colon tissues, PTE improved the Nrf2/HO-1 pathway and upregulated the phosphorylation of AKT. The level of MDA increased and GSH-Px decreased in the STC group, while the level of oxidative stress was significantly reduced in the PTE treatment groups. PTE also promoted the secretion of intestinal hormone and restored the microbial diversity caused by LOP.Conclusion: Pterostilbene ameliorated the intestinal motility disorder induced by LOP, this effect might be achieved by inhibiting oxidative stress-induced apoptosis of ICCs through the PI3K/AKT/Nrf2 signaling pathway.

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Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation

Cited by 15 publications

References 44 publications

Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study

Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study

Colonic Slow Transit in Patients with Dyssynergic Defecation and Effectiveness of Biofeedback Therapy

Based on Network Pharmacology and Gut Microbiota Analysis to Investigate the Mechanism of the Laxative Effect of Pterostilbene on Loperamide-Induced Slow Transit Constipation in Mice

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