The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecati...The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.展开更多
Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. Thes...Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. These patients deserve better evaluation and thorough investigations before their labeling as refractory to treatment. Indeed, several cases of apparent refractoriness are actually due to misconceptions about constipation, poor basal evaluation (inability to recognize secondary causes of constipation, use of constipating drugs) or inadequate therapeutic regimens. After a careful reevaluation that takes into account the above factors, a certain percentage of patients can be defined as being actually resistant to first-line medical treatments. These subjects should firstly undergo specific diagnostic examination to ascertain the subtype of constipation. The subsequent therapeutic approach should be then tailored according to their underlying dysfunction. Slow transit patients could benefit from a more robust medical treatment, based on stimulant laxatives (or their combination with osmotic laxatives, particularly over the short-term), enterokinetics (such as prucalopride) or secretagogues (such as lubiprostone or linaclotide). Patients complaining of obstructed defecation are less likely to show a response to medical treatment and might benefit from biofeedback, when available. When all medical treatments prove to be unsatisfactory, other approaches may be attempted in selected patients (sacral neuromodulation, local injection of botulinum toxin, anterograde continence enemas), although with largely unpredictable outcomes. A further although irreversible step is surgery (subtotal colectomy with ileorectal anastomosis or stapled transanal rectal resection), which may confer some benefit to a few patients with refractoriness to medical treatments.展开更多
AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxative...AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.展开更多
AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were under...AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.展开更多
OBJECTIVE:To investigated the laxative,anti-diarrheal,hepatoprotective and diuretic activity of Sterculia diversifolia and its isolated compounds.METHODS:The laxative activity was studied by counting wet stools while ...OBJECTIVE:To investigated the laxative,anti-diarrheal,hepatoprotective and diuretic activity of Sterculia diversifolia and its isolated compounds.METHODS:The laxative activity was studied by counting wet stools while anti-diarrheal activity was performed by measuring gastrointestinal tract motility.Hepatoprotective activity was studied by biochemical and histo-pathological analysis while diuretic activity was performed by urine collection protocol.RESULTS:Doses of 30 and 100 mg/kg of crude methanolic extract of Sterculia diversifolia(MESD)stem bark and leaves,significantly(P<0.05,P<0.01)produced wet feces in subjects pretreated with atropine while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by increasing fecal weight and water contents without producing diarrhea.MESD stem bark and leaves also dose-dependently lowered diar-rhea while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by producing shaped stools in mice.MESD,8-hydroxyquercetin and dihydroquercetin offered significant protection against histopathological changes in the liver.Diuretic activity of Crude MESD stem bark and leaves extracts shows highly significant diuretic effect while dihydroquercetin showed better results than 8-hydroxyquercetin.CONCLUSION:It is concluded that Sterculia diversifolia and its isolated compounds bears laxative,anti-diarrheal,hepatoprotective and diuretic effects.展开更多
BACKGROUND Small bowel bezoar obstruction(SBBO)is a rare clinical condition characterized by hard fecal masses in the small intestine,causing intestinal obstruction.It occurs more frequently in the elderly and bedridd...BACKGROUND Small bowel bezoar obstruction(SBBO)is a rare clinical condition characterized by hard fecal masses in the small intestine,causing intestinal obstruction.It occurs more frequently in the elderly and bedridden patients,but can also affect those with specific gastrointestinal dysfunctions.Diagnosing SBBO is challenging due to its clinical presentation,which mimics other intestinal obstructions.While surgical intervention is the typical treatment for SBBO,advancements in endo-scopic techniques have led to increased use of non-surgical methods,such as endoscopic lithotripsy.CASE SUMMARY We report a case of small bowel obstruction induced by a phytobezoar.A 49-year-old male with a history of type 2 diabetes and long-term persimmon consumption presented to the hospital with symptoms of vomiting,abdominal distension,and constipation.Computed tomography revealed a small bowel obstruction with foreign bodies.Double balloon enteroscopy identified a phytobezoar blocking the intestinal lumen.The bezoar was successfully fragmented using a snare,and the fragments were treated with 100 mL of paraffin oil to facilitate their passage.This case report aims to enhance the understanding of this rare condition by detailing the clinical presentation,diagnostic process,and treatment outcomes of a patient with SBBO.Special attention is given to the application and effectiveness of non-surgical treatment methods,along with strategies to optimize patient manage-ment.CONCLUSION Double balloon enteroscopy combined with sequential laxative therapy is an effective approach for the treatment of a breakable phytobezoar.展开更多
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri, Via N Colajanni, 4, 00191 Roma, ItalySocietà Italiana di Chirurgia Colo-Rettale, Via Medici, 23, 10143 Torino, Italy
文摘The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.
文摘Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. These patients deserve better evaluation and thorough investigations before their labeling as refractory to treatment. Indeed, several cases of apparent refractoriness are actually due to misconceptions about constipation, poor basal evaluation (inability to recognize secondary causes of constipation, use of constipating drugs) or inadequate therapeutic regimens. After a careful reevaluation that takes into account the above factors, a certain percentage of patients can be defined as being actually resistant to first-line medical treatments. These subjects should firstly undergo specific diagnostic examination to ascertain the subtype of constipation. The subsequent therapeutic approach should be then tailored according to their underlying dysfunction. Slow transit patients could benefit from a more robust medical treatment, based on stimulant laxatives (or their combination with osmotic laxatives, particularly over the short-term), enterokinetics (such as prucalopride) or secretagogues (such as lubiprostone or linaclotide). Patients complaining of obstructed defecation are less likely to show a response to medical treatment and might benefit from biofeedback, when available. When all medical treatments prove to be unsatisfactory, other approaches may be attempted in selected patients (sacral neuromodulation, local injection of botulinum toxin, anterograde continence enemas), although with largely unpredictable outcomes. A further although irreversible step is surgery (subtotal colectomy with ileorectal anastomosis or stapled transanal rectal resection), which may confer some benefit to a few patients with refractoriness to medical treatments.
文摘AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.
文摘AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.
文摘OBJECTIVE:To investigated the laxative,anti-diarrheal,hepatoprotective and diuretic activity of Sterculia diversifolia and its isolated compounds.METHODS:The laxative activity was studied by counting wet stools while anti-diarrheal activity was performed by measuring gastrointestinal tract motility.Hepatoprotective activity was studied by biochemical and histo-pathological analysis while diuretic activity was performed by urine collection protocol.RESULTS:Doses of 30 and 100 mg/kg of crude methanolic extract of Sterculia diversifolia(MESD)stem bark and leaves,significantly(P<0.05,P<0.01)produced wet feces in subjects pretreated with atropine while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by increasing fecal weight and water contents without producing diarrhea.MESD stem bark and leaves also dose-dependently lowered diar-rhea while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by producing shaped stools in mice.MESD,8-hydroxyquercetin and dihydroquercetin offered significant protection against histopathological changes in the liver.Diuretic activity of Crude MESD stem bark and leaves extracts shows highly significant diuretic effect while dihydroquercetin showed better results than 8-hydroxyquercetin.CONCLUSION:It is concluded that Sterculia diversifolia and its isolated compounds bears laxative,anti-diarrheal,hepatoprotective and diuretic effects.
文摘BACKGROUND Small bowel bezoar obstruction(SBBO)is a rare clinical condition characterized by hard fecal masses in the small intestine,causing intestinal obstruction.It occurs more frequently in the elderly and bedridden patients,but can also affect those with specific gastrointestinal dysfunctions.Diagnosing SBBO is challenging due to its clinical presentation,which mimics other intestinal obstructions.While surgical intervention is the typical treatment for SBBO,advancements in endo-scopic techniques have led to increased use of non-surgical methods,such as endoscopic lithotripsy.CASE SUMMARY We report a case of small bowel obstruction induced by a phytobezoar.A 49-year-old male with a history of type 2 diabetes and long-term persimmon consumption presented to the hospital with symptoms of vomiting,abdominal distension,and constipation.Computed tomography revealed a small bowel obstruction with foreign bodies.Double balloon enteroscopy identified a phytobezoar blocking the intestinal lumen.The bezoar was successfully fragmented using a snare,and the fragments were treated with 100 mL of paraffin oil to facilitate their passage.This case report aims to enhance the understanding of this rare condition by detailing the clinical presentation,diagnostic process,and treatment outcomes of a patient with SBBO.Special attention is given to the application and effectiveness of non-surgical treatment methods,along with strategies to optimize patient manage-ment.CONCLUSION Double balloon enteroscopy combined with sequential laxative therapy is an effective approach for the treatment of a breakable phytobezoar.
