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PubMedDate not supplied

[Duphalac (lactulose) in the treatment of chronic constipation in children].

The aim of this study was to estimate the effectiveness of DUPHALAC preparation, produced by Solvay-Pharma, in treatment of functional chronic constipation. 112 children, aged 10 months-15.5 years were examined. DUPHALAC appeared to be very effective, were examined. Only two patients did not accept its taste. Rapidly (approximately after 2.5 weeks) improvement was achieved such as of restoration normal peristalsis and of previously disturbed defecation rhythm, softening of a stool, regression of pain and/or dyspeptic ailments, encopresis and improvement of appetite. In no case undesirable side effects were observed.

Adolescent↗
PubMedDate not supplied

[New methods of rectum and colon x-ray study in patients with constipation].

Rectal and colonic X-ray findings of 100 patients with constipation are presented. The study was performed by the authors' modified irrigoscopic procedure using barium enema. This made it possible not only to determine the shape, dimensions, and position of the rectum and colon, but to reveal a number of anatomic and functional changes in the rectum and pelvic floor (rectocele, rectal intussusception and prolapse, perineal descent, sigmoidocele), which was helpful in choosing a treatment policy for patients with colonic evacuatory dysfunction.

Adolescent↗
PubMed1998

[Constipation in children].

Constipation in childhood is often unrecognized and diagnosed upon manifestations such as pain and pseudo-diarrhoea reflecting of a fecalith. It is sometimes complicated with urinary infection and can be a factor favouring enuresis. In the absence of deterioration in the general condition, it reflects modification of the propulsive functions of the colon or of the reservoir function of the rectum. In a such context, no further explorations are required. Treatment involves dietary recommendations such as good nutritional balance and sufficient fibre intake as well as mineral-based laxatives (paraffin oil) or nonabsorbable osmotic sugars. Enemas and suppositories should be used in case of stool withholding. Sphincter reeducation by biofeedback is indicated in child over 8 years of age after failure of medical therapy.

Biofeedback, Psychology↗
PubMedDate not supplied

Management of constipation in the critically ill patient.

Teamwork and a well-known problem-solving technique are used to give a flexible solution to the problem of bowel management in the critically ill patient. A literature review of constipation is linked to treatment of the critically ill patient. General and specific factors are discussed including nasogastric feeding pharmacology. Design and implementation of a protocol for bowel management for patients in the intensive care field of nursing are demonstrated.

Algorithms↗
PubMedDate not supplied

Constipation.

Although rarely life threatening, constipation can be the cause of misery and discomfort for people suffering from it. Jane Winney shows how appropriate assessment and an understanding of bowel function can help its elimination.

Cathartics↗
PubMed2004

Effects of an exopolysaccharide (kefiran) on lipids, blood pressure, blood glucose, and constipation.

Lactobacillus kefiranofaciens was reported to produce an exopolysaccharide named kefiran. In the present study, we developed a new medium, rice hydrolyzate (RH) medium, for the culture of L. kefiranofaciens. Structural analyses revealed that the exopolysaccharide produced by L. kefiranofaciens from RH medium was composed of a hexasaccharide repeating unit, and essentially identical to the kefiran reported in previous studies. A study on the effects of kefiran in animals demonstrated that kefiran significantly suppressed increase of blood pressure and reduced the serum cholesterol levels in SHRSP/Hos rats when subjects consumed excessive dietary cholesterol. Kefiran supplementation demonstrated the ability to significantly lower blood glucose in KKAy mice. In addition, the administration of kefiran in constipated SD rats caused an obvious improvement in the levels of fecal moisture and wet weights of feces. These results suggest that kefiran could be used as a functional food to prevent some commonly occurring diseases.

Animals↗
PubMed1991

Diagnosis of neuronal colonic dysplasia in primary chronic constipation and sigmoid diverticulosis endoscopic biopsy and enzyme-histochemical examination.

Neuronal colonic dysplasia is a separate clinical entity belonging to the group of congenital defects of intestinal innervation. Its enzyme-histochemical diagnosis is possible by endoscopic biopsy examination of the rectosigmoid. Enzyme-histochemically, it is characterized by dysplasia of the submucous plexus secondary to developmental defects. The principal clinical feature is weak propulsive motility. A clinical study was carried out to investigate the role of neuronal colonic dysplasia in the aetiology and pathogenesis of primary chronic constipation and diverticulosis of the sigmoid colon in adults.

Acetylcholinesterase↗
PubMed2006

Marcel Faber Roundtable: is our antibiotic pipeline unproductive because of starvation, constipation or lack of inspiration?

There are few new antibiotics in the pipeline today. The reasons may include starvation at the front of the pipeline due to inadequate sources of suitable compounds to screen coupled with poorly validated discovery methodologies. A successful antibiotic discovery approach in the past, based upon whole cell antibiotic screening of natural products from actinomycetes and fungi, eventually suffered from constipation in the middle of the pipeline due to rediscovery of known compounds, even though low throughput methodology was employed at the front end. The current lack of productivity may be attributed to the poor choice of strategies to address the discovery of new antibiotics. Recent applications of high throughput in vitro screening of individual antibacterial targets to identify lead compounds from combinatorial chemical libraries, traditional chemical libraries, and partially purified natural product extracts has not produced any significant clinical candidates. The solution to the current dilemma may be to return to natural product whole cell screening. For this approach to work in the current millennium, the process needs to be miniaturized to increase the throughput by orders of magnitude over traditional screening, and the rediscovery of known antibiotics needs to be minimized by methods that can be readily monitored and improved over time.

Actinobacteria↗
PubMed2003

Exocytotic "constipation" is a mechanism of tubulin/lysosomal interaction in colchicine myopathy.

Colchicine, a known microtubule disrupting agent, produces a human myopathy, characterized by accumulation of lysosomes. We have created a reliable animal model of colchicine myopathy that replicates the subacute myopathy seen in humans, reproducing the chronic proximal weakness and vacuolar changes in nonnecrotic myofibers. If a microtubule network plays a role in lysosomal function in muscle, disturbance of it could alter degradation of intrinsic membrane receptors, presumably at some intracellular processing site or at exocytosis. Thus, we examined, as a possible cellular pathogenesis of colchicine myopathy, how the muscle cytoskeleton affects the degradation of membrane proteins, which are processed through the endosomal/lysosomal pathway. We used the acetylcholine receptor as a model membrane component in cultured myotubes allowed to preincubate with colchicine. We tested at which step colchicine interferes with receptor trafficking by accounting for internalization, delivery to lysosomes, hydrolysis, or exocytotic release of debris. We report that colchicine significantly decreases the exocytosis of AChRs but does not affect receptor internalization, lysosomal hydrolysis, or the number of surface membrane receptors. Further, our immunofluorescence observations revealed a morphologic tubulin network in rat skeletal muscle that is more densely distributed in white (mitochondria-poor) muscle fibers than in red (mitochondria-rich) fibers but is present in both. Ultrastructurally, immunogold labeling localized tubulin in the intermyofibrillar region in a long and linear fashion, unassociated with myofibers or mitochondria. Taken together, our findings suggest the following: (1) Microtubules likely play a functional role in the pathway of lysosomal degradation in normal adult skeletal muscle; (2) The observed decrease in overall apparent degradation of membrane receptors by colchicine must be due primarily to inhibition of exocytosis. These data indicate that lysosomal "constipation" underlies colchicine myopathy. (3) An animal model faithful to the human disorder will allow further pathogenetic studies.

Animals↗
PubMed1975

Constipated plasma cells associated with monomeric macroglobulinemia.

Low molecular weight macroglobulinemia was observed in a patient with chronic pulmonary infection. An enlarged cervical lymph node contained many abnormal plasma cells, which were distended with immunoglobulin; this material appeared to be released into lymph spaces when the cells burst. The macroglobulin production is considered to be a non-neoplastic reactive immune response to the pulmonary infection. It is postulated that the association of constipated plasma cells and 7s-IgM can best be explained as an acquired defect in macroglobulin polymerization.

Chronic Disease↗
PubMed2002

Effect of alosetron on left colonic motility in non-constipated patients with irritable bowel syndrome and healthy volunteers.

BACKGROUND: Alosetron is a 5-hydroxytryptamine-3 receptor antagonist reducing symptoms in female patients with diarrhoea-predominant irritable bowel syndrome, and is known to increase the colonic transit time. AIM: To study the effect of alosetron on left colonic phasic motility in ambulant non-constipated patients with irritable bowel syndrome and healthy volunteers. METHODS: In a double-blind, randomized, crossover design, 10 patients with irritable bowel syndrome and 12 sex- and age-matched volunteers were treated for two 7-day periods with alosetron, 4 mg b.d., or placebo b.d. On day 6 of each treatment period, a six-channel solid-state manometric catheter was positioned in the left colon and 24 h motility was studied on day 7. The periprandial phasic motility around dinnertime was evaluated in the descending and sigmoid colon. The high-amplitude propagated contraction frequency and characteristics were calculated. RESULTS: Alosetron appeared to increase the overall periprandial frequency in the sigmoid colon (P=0.043) and the mean amplitude of colonic contractions in the descending colon (P=0.007). The high-amplitude propagated contraction frequency was higher on alosetron during the second half of the day for patients with irritable bowel syndrome (P=0.002), with increased mean propagation length of high-amplitude propagated contractions (P=0.001). The stool frequency (P=0.024) and stool consistency score (P=0.002) were decreased by alosetron. CONCLUSIONS: The 5-hydroxytryptamine-3 receptor antagonist alosetron marginally increased left colonic periprandial phasic motility. Alosetron increased the number and propagation length of high-amplitude propagated contractions, which were paradoxically accompanied by a decrease in stool frequency and a firming of stool consistency.

Adult↗
PubMed2002

Treatment of constipation in adults associated with idiopathic megarectum by behavioural retraining including biofeedback.

BACKGROUND: Constipation in adults associated with a grossly dilated rectum and recurrent faecal impaction, idiopathic megarectum, is rare. The aetiology of idiopathic megarectum is unknown, but may involve neuromuscular or behavioural factors. It is unknown whether the condition is reversible. This study aimed to determine the efficacy of behavioural therapy, including biofeedback, in such patients. METHODS: Six patients (4 female; median age 27) with a history of rectal faecal impaction and a grossly dilated rectum on radiological examination were evaluated by structured questionnaire before, immediately after biofeedback therapy, and on follow-up. Physiological testing was performed before treatment, and 2 patients were evaluated by repeat physiological testing and contrast radiology on follow-up. RESULTS: On median follow-up of 18 months (range 11-27), five patients felt major and one patient minor improvement in symptoms, including two with complete symptom relief. Four patients came off laxatives without recurrent faecal impaction. In the 2 studied patients rectal size did not appear to decrease. CONCLUSION: Behavioural retraining, including biofeedback, improved symptoms in most patients with idiopathic megarectum. In some patients symptoms completely resolved, without the need for laxatives. Although further studies are necessary in terms of both larger number of patients and longer follow-up period, behavioural treatment may be useful for such patients.

Journal Article↗
PubMed2003

Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test.

OBJECTIVE: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children. METHODS: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training. RESULTS: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children. CONCLUSION: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis.

Child↗
PubMed2003

[Changes of the position and length of the transverse colon causing abdominal pain and chronic constipation during adolescence].

In 12 patients aged 9 to 17 years (14.1 +/- 2.3 SD years) (11 girls, 1 boy) complaining of abdominal pain and chronic constipation, barium large bowel X-ray examination showed the following anatomical and positional abnormalities: ptosis of the transverse colon to the small pelvis was found in 11/12 patients, ptosis of the hepatic flexure of the transverse colon (2/12), ptosis of both the hepatic and lienal flexures (2/12), dolichocolon (2/12), and dolichosigma (2/12); 10 of 12 children had symptoms characteristic of irritable colon syndrome. It seems that clinical symptoms accompanying these abnormalities begin to manifest mainly in girls during adolescence because at that time the final length of the colon is established, the transit time reaches its maximal value, and the shape of the pelvis becomes characteristic for this gender. These abnormalities are rather constitutional than acquired since previously it has been reported that the vertical ptosis of the kidney(s) occurs also mainly in adolescent girls.

Abdominal Pain↗
PubMed1998

[Constipation and chronic intestinal pseudoobstruction as a clinical expression of intestinal neuronal dysplasia (IND)].

BACKGROUND: Intestinal neuronal dysplasia (IND) belongs to the group of dysganglionosis. It may occur as part of a syndrome of early chronic constipation, neonatal intestinal occlusion, chronic intestinal pseudo obstruction. The aim of this study was to report the cases examined by the Istituto G. Gaslini in Genoa and to discuss the numerous aspects of this disease which are still unclear. METHODS: 787 children were included in the study and underwent biopsy between 1984 and 1997. Rectal biopsies were obtained by suction or in some cases during surgery and were treated using enzymohistochemical techniques, such as acetylcholinesterase, rapid acetylcholinesterase and alpha-naphthylesterase. RESULTS: 574 children were found to be suffering from innervative alterations: 348 (60.6%) presented isolated Hirschsprung's disease, IND was found in 83 (14.5%), in 8 of the latter in association with other dysganglionosis. IND was accompanied by other diseases in 40 cases (48.2%). Over the past three years (since October 1994) a total of 164 dysganglionosis have been diagnosed, including 55 cases of aganglia. During this period IND was the most frequently observed alteration and affected 61 children. CONCLUSIONS: Rectal biopsy is the essential diagnostic test for the diagnosis of intestinal dysganglionosis. Biopsies are performed in outpatient clinics without sedation, and do not represent an invasive procedure for the young patients. Radiological and manometric examinations cannot provide reliable data for the diagnosis of IND. In our experience, the incidence of IND over the past few years has increased and its diagnosis is essential for correct treatment which is not surgical in the majority of cases. The real incidence of IND and its pathogenesis still need to be clarified.

English Abstract↗