肠道微生态参与功能性便秘发生机制的研究进展

功能性便秘(FC)是一种临床上常见的胃肠道动力障碍性疾病.近年来研究显示,FC患者肠道菌群的组成和数量与健康人群有显著差异,肠道微生态环境是FC发生和发展机制中的重要环节.目前对于FC与肠道菌群紊乱之间的因果关系尚未有定论,大量研究表明肠道菌群紊乱可通过多种途径参与FC的发生和发展机制.该文就肠道菌群通过神经系统、肠道...     

针刺调节结肠慢传输便秘ICC相关机制的研究进展

针刺治疗结肠慢传输型便秘(slow transit constipation,STC)已得到临床上证实,应用也越来越广泛,针刺调节Cajal间质细胞(interstitial cells of Cajal,ICC)目前讨论的关键机制之一.针刺可以有效调节ICC的数量,改变其标志物C-kit蛋白的表达,有利于ICC-平滑肌细胞(smooth muscle cell,SMC)网络结构的恢复,使结肠功能得到恢复,这为临床上治疗结肠STC提供了有效的科学依据.本文对近几年针刺治疗结肠慢传输等相关结肠病变的机制进行梳理,以期为针灸治疗疾病提供科学化的依据提供参考资料,为临床制定治疗结肠STC的合理治疗方案做出参考.     

功能性便秘与心理因素及自主神经功能相关性的研究进展

功能性便秘(FC)发病机制目前尚不清楚,有研究显示其与多种因素相关.此文主要从心理因素及自主神经的功能变化这两方面来阐述与功能性便秘之间的相关性.     

电针足三里对直结肠扩张大鼠腰髓神经元和小胶质细胞的影响

针灸对各种疾病包括内脏疼痛的治疗具有独特的疗效,但其作用机制仍不明确。研究发现脊髓是针刺信号和机体伤害刺激信号的初级整合中枢。本实验通过观察电针足三里后直结肠扩张模型大鼠疼痛行为学的变化及腰髓Fos、OX42免疫组化表达的影响,初步探讨脊髓神经元和小胶质细胞参与针刺调控内脏疼痛作用的中枢神经机制。     

不同分型功能性便秘患者结肠传输功能、胃肠激素以及一氧化氮合酶的研究

背景：功能性便秘（FC）是一种常见的功能性胃肠病。其病因和发病机制目前尚不明确。目的：探讨不同分型FC患者结肠传输功能、胃肠激素以及一氧化氮合酶（NOS）的变化。方法：56例符合罗马Ⅲ标准的FC患者和20名健康志愿者纳入本研究。采用不透X线标记物法行结肠传输试验．放射免疫法测定降结肠、直肠黏膜促胃动素（MTL）、P物质（SP）、生长抑素（SS）、血管活性肠肽（VIP）和NOS水平。结果：56例FC患者中,传输时间正常者19例,传输时间延长者37例,其中结肠慢传输型（STC）21例,出口梗阻型（OOC）9例,混合型（MC）7例。与正常对照组相比,传输时间正常组降结肠、直肠黏膜MTL、SP、SS、VIP和NOS水平无明显差异;STC组降结肠、直肠黏膜MTL水平显著降低（P〈0．05）：STC、MC组降结肠、直肠黏膜SP水平显著降低而NOS水平显著升高（P〈0．05）;STC、MC组降结肠黏膜SS水平显著升高（P〈0．05）;STC、OOC组降结肠、直肠黏膜VIP水平显著降低（P〈0．05）。结论：各型FC降结肠、直肠黏膜胃肠激素和NOS水平改变不同．其异常导致胃肠平滑肌功能紊乱．可能与FC的发病有关。     

老年功能性便秘患者结肠通过时间测定的临床意义

目的通过分析老年功能性便秘(FC)患者结肠通过时间(CTT)的特点,探讨CTT对进一步诊断及治疗的指导意义。方法以不透X线标志物分别对53例老年FC患者和30例老年健康志愿者进行全结肠通过时间(TCTT)及结肠各段通过时间的测定,并计算结肠运输指数(TI),比较二组间各参数的差异以及各组中结肠各段通过时间的差异。结果老年FC组与老年对照组相比较,TCTT、结肠各段通过时间均有延长,但仅TCTT、乙状结肠直肠通过时间(SRTT)的差异有显著性;53例老年FC患者72 h TI为0.66±0.20,其中有45例(84.9%)72 h TI>0.5,提示为出口梗阻型便秘。结论老年FC患者TCTT延长,但以SRTT延长为主;对老年FC患者进行TCTT和结肠各段通过时间的测定并分析其特点,对老年FC患者的诊断分型及个体化治疗方案的选择具有重要的指导意义。     

慢性便秘患者上消化道动力异常及小肠细菌过度生长情况

目的探索功能性便秘(functional constipation,FC)患者结肠动力障碍与上消化道动力障碍的关系,小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)发生率及其与腹部症状的关系.方法纳入符合功能性胃肠病罗马Ⅲ标准的F C患者,利用便秘患者症状自评量表(Patient Assessment of Constipation Symptom,PACS Y M)评估其便秘症状,通过乳果糖氢呼气试验(lactulose hydrogen breath test,LHBT)检测其SIBO情况及口盲传输时间(orocecal transit time,OCTT),并利用结肠转运实验检测其结肠传输时间(colonic transit time,CTT).比较CTT延长组与正常组之间OCTT延长比例,OCTT延长组与正常组之间SIBO阳性率,及SIBO阳性组与阴性组之间的腹部症状评分.结果45例F C患者CTT延长25例,OCTT延长19例,SIBO阳性20例.CTT延长组OCTT延长比例显著高于CTT正常组(P=0.036);OCTT延长组SIBO阳性率显著高于OCTT正常组(P0.001);SIBO阳性组腹部胀满评分显著高于SIBO阴性组(P=0.043).结论FC患者多伴有小肠动力障碍,小肠动力异常可能导致SIBO发生,SIBO可能与FC患者的腹胀症状相关.     

中药抗结直肠癌作用的研究进展

大肠癌是常见的消化系恶性肿瘤之一,其发病率在我国呈逐年上升趋势.近年来,中药治疗大肠癌已受到研究者的关注.研究发现,中药具有抗结肠癌的作用,主要通过抑制肿瘤细胞增殖、促进细胞凋亡、抑制端粒酶活性、阻滞细胞周期进展、抑制结肠癌血管内皮生长因子形成、诱导结肠癌细胞自噬、抑制结肠癌细胞迁移等多种途径.本文就中药抗大肠癌的作用机制、实验研究及临床应用进行综述.     

非侵入性分子标志物评估临床缓解期炎症性肠病内镜活动度价值研究

目的评估非侵入性分子标志物在临床缓解期炎症性肠病(IBD)患者内镜活动度判断中的效能。方法选择2014年8月至2015年2月在南方医院消化内镜中心行电子结肠镜检查的已确诊临床缓解期结肠或回结肠型克罗恩病(CD)34例,溃疡性结肠炎(UC)25例,均于结肠镜检查前1~3 d留取粪便,检测粪便钙卫蛋白(FC)浓度,并搜集血标本检测C反应蛋白(CRP)、红细胞沉降率(ESR)及降钙素原(PCT)浓度。结肠或回结肠型CD及UC患者内镜活动度评估分别采用简单克罗恩病内镜评分(SES-CD)和Mayo评分。结果 34例临床缓解结肠或回结肠型CD中,FC与SESCD相关性最高(r=0.730),FC在临界值250μg/g时,预测内镜活动度的敏感度和特异度分别为93%和70%。25例UC中,FC与Mayo评分相关性最高(r=0.825),FC在临界值250μg/g时,预测内镜活动度的敏感度和特异度分别为84.6%和100.0%。结论 FC能更有效发现临床缓解期IBD内镜下的活动性炎症。     

温针灸对慢传输型便秘大鼠结肠P物质、血管活性肠肽表达的影响

目的 探讨温针灸对慢传输型便秘(STC)大鼠肠道传输功能及结肠P物质(SP)、血管活性肠肽(VIP)阳性表达的影响.方法 选用SD大鼠100只,随机取10只为正常组,其余90只造成STC大鼠模型,并随机分为模型组、针刺组和温针组.分别测定大鼠肠道传输功能及结肠SP、VIP阳性表达面积.结果 针刺组、温针组可明显缩短大鼠首粒黑便排出时间(P＜0.01),且温针灸效果优于针刺组(P＜0.05).STC大鼠结肠SP、VIP阳性表达较正常组明显降低(P＜0.01);针刺和温针灸均能明显提高结肠SP、VIP阳性表达面积(P＜0.01);且温针灸在提高结肠SP阳性表达面积上效果优于单纯针刺(P＜0.01).结论 针灸治疗STC有效,其机制与提高结肠SP、VIP阳性表达有关;温针灸效果更好.     

Drugs acting on serotonin receptors for the treatment of functional GI disorders

In the gut, serotonin (5-hydroxytryptamine: 5-HT) exerts a variety of effects on intrinsic enteric neurons, extrinsic afferents, enterocytes and smooth muscle cells, which are related to the expression of multiple 5-HT receptor types and subtypes regulating motility, vascular tone, secretion and perception. Agonists and antagonists at 5-HT receptors have gained access to the market for the two major variants of the irritable bowel syndrome (IBS), a functional disorder characterized by abdominal pain associated with diarrhea and/or constipation in the absence of any organic abnormality. Indeed, the 5-HT3 receptor antagonist alosetron is available in the US market for the treatment of women with severe, diarrhea-predominant IBS (D-IBS) refractory to conventional therapy, whereas tegaserod, a partial 5-HT4 receptor agonist, has been approved by the FDA and other regulatory agencies for the treatment of women with constipation-predominant IBS (C-IBS) or functional constipation. This review is mainly intended to discuss the role of non-neuronal (paracrine) and neuronal 5-HT in the pathophysiology of functional gastrointestinal disorders (FGIDs), such as IBS and functional dyspepsia, and the mechanisms through which drugs acting on 5-HT receptors regulate visceral motility, perception and secretion in these two conditions.     

Effectiveness and safety of acupuncture in the treatment of chronic severe functional constipation: A protocol for systematic review and meta-analysis

Background:Acupuncture has been widely used clinically to relieve chronic severe constipation. However, the efficacy of acupuncture in the treatment of chronic severe constipation is uncertain. The purpose of this study is to determine the effectiveness and safety of acupuncture in the treatment of chronic severe constipation.Methods:Search PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Science, and Technology Journal Database, China Biomedical Literature Database, and search related randomized controlled trials. Two reviewers will independently select studies, collect data, and evaluate methodological quality through the Cochrane Deviation Risk Tool. Revman V.5.3 will be used for meta-analysis.Results:This study will evaluate the current status of acupuncture treatment for chronic severe constipation, aiming to illustrate the effectiveness and safety of acupuncture treatment.Conclusion:This study will provide a basis for judging whether acupotomy is effective in treating chronic severe constipation.INPLASY registration number:INPLASY202070002     

Acupuncture and regulation of gastrointestinal function

In China, acupuncture has been considered an effective method for treating gastrointestinal (GI) dysfunction diseases for thousands of years. In fact, acupuncture has gained progressive acceptance from both practitioners and patients worldwide. However, the therapeutic effects and underlying mechanisms in treating GI dysfunction have not yet been established due to a lack of systematic and comprehensive review articles. Therefore, the aim of this review is to discuss the efficacy of acupuncture as a treatment for GI dysfunction and the associated underlying mechanisms. A search of PubMed was conducted for articles that were published over the past 10 years using the terms “acupuncture”, “gastrointestine”, and other relevant keywords. In the following review, we describe the effect and underlying mechanisms of acupuncture on GI function from the perspectives of GI motility, visceral sensitivity, the GI barrier, and the brain-gut axis. The dual regulatory effects of acupuncture may manifest by promoting gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. In addition, the regulation of acupuncture on gastric motility may be intensity-dependent. Our findings suggest that further studies are needed to investigate the effects and more systematic mechanisms in treating GI dysfunction, and to promote the application of acupuncture for the treatment of GI diseases.     

Constipation in an Elderly Community: A Study of Prevalence and Potential Risk Factors

Objective : The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. Methods: An age-and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). Results : The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. Conclusions : In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.     

Comparison of therapeutic effects of different acupuncture and moxibustion therapies on constipation after stroke treatment: A protocol for systematic review and network meta-analysis

Background:Constipation is a common complication after stroke, which seriously affects patients’ quality of life and recovery. Many evidences show that acupuncture and moxibustion therapy has advantages in the treatment of constipation after stroke. But different types of acupuncture and moxibustion have different effects, and there is no research to prove which one is more effective.Methods:According to the search strategy, we will retrieve the randomized controlled studies of acupuncture and moxibustion in the treatment of constipation after stroke from China Knowledge Network, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to July 2021. Studies will be screened according to inclusion and exclusion criteria, and the quality of the studies will be assessed using the Cochrane Risk Bias Assessment Tool. All data analyses will be performed using Revman 5.4, Gemtc 0.14.3, and Stata 14.0. Finally, we will evaluate the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation method.Results:In this study, the efficacy of different acupuncture and moxibustion therapies in the treatment of constipation after stroke will be evaluated by evaluating defecation frequency, stool property score, constipation symptom score, quality of life score, adverse reactions, etc.Conclusions:This study will provide reliable evidence-based evidence for selecting the best acupuncture and moxibustion therapy for constipation after stroke.     

Obstipation

Constipation is a common problem that is associated with many diseases and can be caused by structural or functional pathology of the colon and rectum. It affects quality of life and results in substantial costs. Depending on the patient’s symptoms and clinical presentation, secondary causes of constipation (e.g., anorectal cancer) must be ruled out. Imaging procedures and anorectal function tests are used to differentiate slow-transit constipation from dyssynergic defecation (anismus), structural outlet obstruction (e.g., intussusception), and irritable bowel syndrome. Patients with chronic functional constipation often respond to dietary and lifestyle modification, bulking agents, and laxatives. The effects of lactulose and polyethylene glycol have been established in randomized controlled trials. With regulatory approval of lubiprostone and methylnaltrexone in Europe, new medications for the treatment of slow-transit constipation will soon become available. Biofeedback therapy is the treatment of choice in patients with anismus and in selected patients with outlet obstruction or abnormal anorectal sensitivity. In refractory cases, surgery may be indicated.     

Anorectal manometry in children with chronic functional constipation

BACKGROUND: The anorectal manometry is a very utilized and well recognized examination in children with chronic functional constipation. The major manometric findings in these children are: anal hypotonia, anal hypertonia, paradoxal contraction of the external anal sphincter, decreased ability of internal anal sphincter to relax during rectal distension and alterations in rectal contractility, sensibility and compliance. AIMS: To evaluate the anal basal pressure and the relaxation reflex before and after standard treatment for a better understanding of the physiopathologic mechanisms involved in pediatric chronic functional constipation. METHODS: Anorectal manometry was performed before treatment on 20 children with chronic functional constipation aged 4 to 12 years and the results were compared to those obtained after standard treatment, with a good outcome. RESULTS: There was a reduction in anal basal pressure after treatment, but no differences were detected between the anorectal manometries performed before and after treatment in terms of amplitude and duration of relaxation, residual pressure, latency time, or descent and ascent angle. CONCLUSIONS: We conclude that the anal basal pressure decreased in children recovering from chronic functional constipation, but the standard treatment did not provide all the conditions necessary for the relaxation reflex of constipated children to return to the values described in normal children.     

结肠水疗联合针刺治疗慢传输型便秘与胃肠激素关系的研究

背景：近年便秘患者数量呈逐年上升趋势,其中以慢传输型便秘（STC）居多。研究提示STC的发病机制中有胃肠激素参与。目的：观察结肠水疗联合针刺治疗对STC患者的临床疗效,以及胃肠激素水平变化在其中的作用。方法：36例STC患者接受结肠水疗联合针刺治疗,30例健康体检者作为正常对照组。以放射免疫法测定STC组治疗前后空腹血浆生长抑素（SS）、胃动素（MTL）、P物质（SP）和血管活性肠肽（VIP）水平,比色法测定空腹血清一氧化氮合酶（NOS）水平。结果：STC组治疗后临床症状改善总有效率为88．9％。患者治疗前血浆SS、VIP和血清NOS水平显著高于正常对照组,血浆MTL、SP水平显著低于正常对照组（P〈0．05）;经结肠水疗联合针刺治疗后,上述胃肠激素水平均较治疗前显著改善（P〈0．05）：结论：结肠水疗联合针刺治疗能改善STC患者的临床症状,调节胃肠激素水平。血SS、MTL、SP、VIP、NOS水平改变可能参与了该疗法对STC患者临床症状的改善作用。     

Acupuncture for opioid-induced constipation: Protocol for a systematic review and meta-analysis

Background:Opioid-induced constipation (OIC) is one of the most common complications of analgesic therapy for cancer pain patients who suffer moderate to severe pain. Acupuncture as an effective treatment in constipation has been widely applied. But its efficacy has not been assessed systematically. Thus, the purpose of this study is to provide a protocol to explore the efficacy and safety of acupuncture for OIC.Methods:Randomized Controlled Trials (RCTs) of acupuncture treatment for OIC in 4 Chinese electronic databases (China National Knowledge Infrastructure, Chinese Biological and Medical Database, China Scientific Journal Database, Wan-Fang Data) and 3 English electronic databases (PubMed, Embase, Cochrane Library) will be searched from their inception to September 31, 2020. RevMan 5.3 software and Stata 14.0 software will be used for meta-analysis, EndNote X9.2 and Cochrane Risk of Bias Tool will be used for literature screening and quality assessment.Results:This study will present an assessment of the efficacy and safety of acupuncture treatment for OIC patients through summarize high-quality clinical evidence.Conclusion:The conclusion of our systematic review and meta-analysis may provide evidence of whether acupuncture treatment is beneficial to patients with OIC.INPLASY registration number: INPLASY2020100026.     

Constipation: evaluation and treatment

Constipation is a common clinical problem that comprises a constellation of symptoms that include excessive straining, hard stools, feeling of incomplete evacuation, use of digital maneuvers, or infrequent defecation. Although many conditions, such as metabolic problems, fiber deficiency, anorectal problems, and drugs, can cause constipation, when excluded functional constipation consists of two subtypes: slow-transit constipation and dyssynergic defecation. Some patients with irritable bowel syndrome may exhibit features of both types of constipation. The Rome criteria for functional constipation together with modifications proposed here for dyssynergic defecation may serve as useful guidelines for making a diagnosis. Recent advances in technology, together with a better understanding of the underlying mechanisms, have led to real progress in the diagnosis of this condition. Management options are limited, however, and evidence to support these treatments is only modest. The treatment is primarily medical; surgical options should be reserved for refractory disease and after careful diagnostic work-up. Although laxatives remain the mainstay of therapy, prokinetics that are colon-selective are optimal for treating patients with slow-transit constipation, but they are not yet available for clinical use. Recent controlled trials, however, are promising. Biofeedback therapy is the preferred treatment for patients with dyssynergia, but is not widely available. In the near future, user-friendly biofeedback programs including home therapy may facilitate wider use of these methods for patients with dyssynergic defecation.