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Functional gastrointestinal disorders (FGIDs) refer to a group of disorders with chronic symptoms, such as abdominal pain, dysphagia, dyspepsia, diarrhea, constipation, and bloating. Among these, functional constipation significantly impacts the quality of life and is linked with comorbidities, such as anxiety and depression. The exact pathophysiology remains unclear despite the widespread occurrence. Research suggests that the gut-brain axis plays a role in FGIDs. Disruptions in the bidirectional communication between the brain and gastrointestinal (GI) tract contribute to GI symptoms and mood disturbances. The incomplete understanding of FGID pathophysiology has led to limited treatment options. Traditional treatments often focus on single symptoms and come with side effects, prompting the need for alternative approaches that address both GI and psychological components. Alternative approaches including herbal supplements offer a natural alternative to conventional medicine by promoting regularity and gut health. Abelmoschus esculentus L. or okra has a history of use in traditional medicine. Bioactive compounds such as polysaccharides and fibers found in okra offer gastroprotective benefits. Withania somnifera is a plant commonly referred to as ashwagandha. The plant root has been used for its health-promoting effects. Research supports the use of W. somnifera to help with stress and sleep. Digexin is a herbal supplement combining W. somnifera (ashwagandha) and A. esculentus (okra). It has shown promise in improving both GI regularity and mood by modulating the gut-brain axis. Clinical studies support the potential of a novel herbal supplement that aids in the management of FGIDs. This narrative review looks at FGIDs, etiologies, current treatment, and possible therapeutic supplements to aid in symptom management., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The authors note that they have received research and educational funding from companies within the foods, beverages, and dietary supplement industries. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Evans et al.)

The features of functional constipation (FC)-associated halitosis were identified in the author's previous report. In this report, the author aimed to further investigate its treatment and efficacy. This retrospective study reviewed 100 FC patients, including 82 (82%) halitosis patients and 18 (18%) non-halitosis patients. They underwent the organoleptic test (OLT) to diagnose halitosis, and the organoleptic score (OLS) (0-5) was used to evaluated halitosis severity. The Cleveland Clinical Constipation Score (CCCS) (0-30) was used to evaluate FC severity. Patients were treated with the laxative polyethylene glycol electrolyte powder (PGEP) for four weeks. These tests were performed before and after treatment. The author found that, before treatment, the CCCS was 20.00 (18.00-23.00) for all patients, 21.00 (19.00-24.00) for halitosis patients, and 18.00 (17.00-18.25) for non-halitosis patients. A significant difference was observed between halitosis patients and non-halitosis patients ( P < 0.001). The OLS for halitosis patients was 3.00 (3.00-4.00). A positive correlation ( r = 0.814, 95% CI: 0.732-0.872, P < 0.001) was found between OLS and CCCS. A CCCS ⩾18 predicted over 50% probability of halitosis. After treatment, the CCCS significantly decreased to 11.50 (6.00-14.75) ( P < 0.001), and OLS significantly decreased to 1.00 (0.00-2.00) ( P < 0.001). A positive correlation ( r = 0.770, 95% CI: 0.673-0.841, P < 0.001) persisted between OLS and CCCS. A pre-treatment CCCS ⩾21 predicted over 50% probability of post-treatment halitosis, while a post-treatment CCCS ⩾12 predicted over 50% probability of post-treatment halitosis. The author concludes that the severity of FC parallels the severity of FC-associated halitosis, and can predict the probability of halitosis. Laxative treatment with PGEP is effective in improving FC-associated halitosis., (© 2024 IOP Publishing Ltd.)

Background: Functional constipation (FC) is a geriatric syndrome that is common in the older adult's population and can seriously affect the quality of life and may be a frequent cause of hospital visits. In this study, we planned to investigate the relationship between FC and its related factors for in older outpatients., Patients and Methods: Participants aged 65 and over who applied to the geriatrics outpatient were included in the study. The diagnosis of FC was made according to the presence of the Rome IV criteria. Frailty was screened by the using FRAIL scale, ≥ 3 a score of were evaluated as frail. Participants quality of life was evaluated by Euro-Quality of Life Visual Analog Scale (EQ-VAS)., Results: The study included 602 participants. FC prevalence was found 28.7%. In univariate analyses, FC was found related to age, having a diagnosis of depression or Parkinson diseases, frailty, urinary incontinence, sleep disorders, number of chronic diseases, and EQ-VAS. In multivariate analyses, FC was not found to be associated by the frailty while the number of chronic diseases [OR=1.212, 95%CI (1.084-1.355), p=0.001] and EQ-VAS were found to be related [OR=0.988, 95%CI (0.978-0.997), p=0.012]., Conclusion: In the results of this study, FC was not found to be associated by frailty in older outpatients but it emerged as a syndrome that should be screened frequently in patients with a high number of chronic diseases and a low general quality of life., Competing Interests: The authors declare that they have no conflict of interest, (© Acta Gastro-Enterologica Belgica.)

Constipation encompasses symptoms of decreased colonic motility or difficulty with the defecation process. As a broad definition, this can be inclusive of functional constipation (FC) or colonic inertia, obstructed defecation (OD), and irritable bowel syndrome-constipation type (IBS-CS). After excluding IBS-C, FC and OD diagnosis and management require a multidisciplinary approach often involving nutritionists, pelvic floor therapists, urogynecologists, and colon and rectal surgeons. Differentiating the presence or absence of each can direct therapy and prognosticate chances for improvement in this often complex combination of disorders., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: The therapeutic effect of acupuncture treatments (AT) on functional gastrointestinal disorders (FGIDs) is contentious. A meta‐analysis was conducted to assess the efficacy and safety of acupuncture for FGIDs. Methods: The Cochrane Library, EMBASE, PUBMED, Web of Science, Wanfang Database, China National Knowledge Infrastructure, and VIP Database were searched through December 31, 2019 with no language restrictions. Risk ratio (RR) with 95% confidence interval (CI) was calculated to determine the improvement in symptom severity after treatment. Results: A total of 61 randomized controlled trials (RCTs) on FGIDs were included. The pooled results illustrated the following: compared to pharmacotherapy (RR 1.13, 95% CI 1.09–1.17), placebo acupuncture (RR 1.69, 95% CI 1.37–2.08), no specific treatment (RR 1.86, 95% CI 1.31–2.62), and AT as an adjuvant intervention to other active treatments (RR 1.25, 95% CI 1.21–1.30), AT had more favorable improvements in symptom severity; sub‐group analysis results classified according to functional dyspepsia, irritable bowel syndrome, and functional constipation also supported this finding; and the incidence of adverse events was lower in AT than in other treatments (RR 0.75, 95% CI 0.56–0.99). Conclusions: This meta‐analysis found that AT was significantly associated with relief of FGIDs symptoms; however, the evidence level was moderate or low. Further data from rigorously designed and well powered RCTs are needed to verify the effectiveness and safety of AT as a FGIDs treatment. PROSPERO PROTOCOL NUMBER: CRD42020169508. [ABSTRACT FROM AUTHOR]

Objectives: Functional constipation is a gastrointestinal disorder prevalent around the world. Lubiprostone is the first locally acting type‐2 chloride channel activator to be used for treating constipation. This study aimed to evaluate the efficacy and safety of lubiprostone in Chinese adults with functional constipation. Methods: This was a multicenter, randomized, double‐blind, placebo‐controlled study. Patients with functional constipation were randomized to receive either lubiprostone (24 mcg twice daily) or placebo for 4 weeks. The primary end‐point was the frequency of spontaneous bowel movements (SBMs) during the first week of treatment. The secondary end‐points included the median time of the first SBM, SBM frequency at weeks 2, 3 and 4, weekly response rate of SBMs, the stool consistency score and average number of complete spontaneous bowel movements (CSBMs) per week. Results: In total, 259 patients were randomized, with 130 in the lubiprostone group and 129 in the placebo group. SBM frequency was higher in the lubiprostone group (4.88 ± 4.09/wk) than that in the placebo group (3.22 ± 2.01/wk) at week 1 (P < 0.0001). SBM frequency was also higher in the lubiprostone group at weeks 2, 3 and 4. The average number of CSBMs and the stool consistency score in the lubiprostone group were significantly higher than that in the placebo group at each week. No drug‐related serious adverse events (AEs) occurred. The most commonly reported AE was nausea. Conclusion: Lubiprostone was superior to placebo in treating Chinese patients with functional constipation, together with good safety profile. [ABSTRACT FROM AUTHOR]

Purpose of Review: Functional constipation is a common pediatric GI disorder that is responsible for a significant portion of pediatric office visits each year. It presents a significant stressor for patients, their families, and providers alike. There are a variety of over the counter agents available for treatment of pediatric constipation. Recent Findings: Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation. Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios. Summary: There are multiple over the counter pharmacologic agents with various mechanisms of action that have demonstrated efficacy in pediatric functional constipation. These therapies are generally safe and well tolerated by patients. [ABSTRACT FROM AUTHOR]

Intestinal dysmotility is common in many diseases and is correlated with gut microbiota dysbiosis and systemic inflammation. Functional constipation (FC) is the most typical manifestation of intestinal hypomotility and reduces patients' quality of life. Some studies have reported that fecal micriobiota transplantation (FMT) may be an effective and safe therapy for FC as it corrects intestinal dysbiosis. This study was conducted to evaluate how FMT remodels the gut microbiome and to determine a possible correlation between certain microbes and clinical symptoms in constipated individuals. Data were retrospectively collected on 18 patients who underwent FMT between January 1, 2019 and June 30, 2020. The fecal bacterial genome was detected by sequencing the V3–V4 hypervariable regions of the 16S rDNA gene. Fecal short chain fatty acids (SCFAs) were detected by gas chromatography-mass spectrometry, and serum inflammatory factor concentrations were detected via enzyme-linked immunosorbent assay. Comparing the changes in fecal microbiome compositions before and after FMT revealed a significant augmentation in the alpha diversity and increased abundances of some flora such as Clostridiales, Fusicatenibacter , and Paraprevotella. This was consistent with the patients experiencing relief from their clinical symptoms. Abundances of other flora, including Lachnoanaerobaculum , were decreased, which might correlate with the severity of patients' constipation. Although no differences were found in SCFA production, the butyric acid concentration was correlated with both bacterial alterations and clinical symptoms. Serum IL-8 levels were significantly lower after FMT than at baseline, but IL-4, IL-6, IL-10, and IL-12p70 levels were not noticeably changed. This study showed how FMT regulates the intestinal microenvironment and affects systemic inflammation in constipated patients, providing direction for further research on the mechanisms of FMT. It also revealed potential microbial targets for precise intervention, which may bring new breakthroughs in treating constipation. [ABSTRACT FROM AUTHOR]

Background: The Rome IV criteria for disorders of gut‐brain interaction define irritable bowel syndrome (IBS) as a functional bowel disorder associated with frequent abdominal pain of at least 1 day per week. In contrast, functional diarrhea (FD) and functional constipation (FC) are relatively painless. We compared differences in mood and somatization between Rome IV IBS and FC/FD. Methods: A total of 567 patients with Rome IV defined IBS or FD/FC completed a baseline questionnaire on demographics, abdominal pain frequency, mood (hospital anxiety and depression scale, HADS), and somatization (patient health questionnaire, PHQ‐12). The primary analysis compared differences in mood and somatization between IBS and FC/FD, and the relative influence of abdominal pain frequency on these extra‐intestinal symptoms. The secondary analysis evaluated differences across individual IBS subtypes, and also between FC and FD. Key Results: Patients with IBS—in comparison to those with FC/FD—had significantly higher mean PHQ‐12 somatization scores (9.1 vs. 5.4), more somatic symptoms (6.0 vs. 4.3), abnormally high somatization levels (16% vs. 3%), higher HADS score (15.0 vs. 11.7), and clinically abnormal levels of anxiety (38% vs. 20%) and depression (17% vs. 10%). Increasing abdominal pain frequency correlated positively with PHQ‐12, number of somatic symptoms, and HADS; p < 0.001. No differences in mood and somatization scores were seen between individual IBS subtypes, and nor between FC and FD. Conclusion & Inferences: Based on the Rome IV criteria, IBS is associated with increased levels of psychological distress and somatization compared with FD or FC. Patients reporting frequent abdominal pain should be comprehensively screened for psychosomatic disorders, with psychological therapies considered early in the disease course. [ABSTRACT FROM AUTHOR]

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Functional constipation (FC) is common, yet the etiology is not clear. Accumulating evidence suggests an association between FC and abnormal gut microbiota. The relationship between the gut microbiota and the gut transit is likely bidirectional. This review summarizes the current evidence regarding the impact of gut microbiota on the pathogenesis of FC. By modulating the colonic motility, secretion, and absorption, gut microbiota may contribute to the development of FC through microbial metabolic activities involving bile acids, short-chain fatty acids, 5-hydroxytryptamine, and methane. In support of the key roles of the gut microbiota in FC, treatment with probiotics, prebiotics, synbiotics, and traditional Chinese medicine often result in compositional and functional changes in the gut microbiota. Further studies on the pathogenesis of FC and the therapeutic mechanism of microecological agents will provide a knowledge base for better management of FC. [ABSTRACT FROM AUTHOR]

This prospective, cross-sectional study, conducted from July 2018 to March 2019, aimed to determine the causes of constipation using high-resolution anorectal manometry. Among 33 children enrolled in the study, 31 (94%) children presented with complaints of constipation with mean duration of 2.3 ± 2.5 years and 12 (36.4%) children also had associated complaints of faecal incontinence with mean duration of 3.5 ± 2.8 years. Seven children (21.2%) had normal high-resolution anorectal manometry parameters; anal sphincter hypotonia with decreased squeeze in one child, anal sphincter hypertonia with other abnormal parameters were noted in 25 and absent recto-anal inhibitory reflex in two. The causes of constipation determined were functional constipation in 30 (91%) children, suspected Hirschsprung's disease in two and suspected dyssynergic defecatory disorder in one. Almost 90% had functional constipation of which anal hypotension and anal hypertension may be a part of chronic functional constipation. [ABSTRACT FROM AUTHOR]

Background: The association between delivery mode and subsequent development of diseases is a growing area of research. Cesarean delivery affects the diversity of the microbiota in the infant gut, which may be associated with gastrointestinal disorders, including functional constipation, in infants. In this study, we investigated the association between delivery mode and prevalence of functional constipation in 3-year-old Japanese toddlers.Methods: This study used data from the Japan Environment and Children's Study, an ongoing nationwide birth cohort study. We analyzed 71,878 toddler-mother pairs. The presence of functional constipation was determined according to the Rome III diagnostic criteria. Odds ratios and 95% confidence intervals were calculated using logistic regression analysis.Results: The prevalence of functional constipation in 3-year-old Japanese toddlers was estimated to be 12.3%. Logistic regression analysis revealed that the prevalence of functional constipation was higher in toddlers born by cesarean delivery (13.1%) compared with those born by vaginal delivery (12.1%), independent of 22 confounders (adjusted odds ratios = 1.064, 95% confidence interval = 1.004-1.128).Conclusions: We determined the prevalence of functional constipation in 3-year-old Japanese toddlers and found that delivery mode was associated with the prevalence of functional constipation in Japanese toddlers. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of Shouhui Tongbian capsule combined with mosapride on serum substance P (SP), motilin (MTL), nitric oxide (NO) and quality of life in patients with functional constipation. Methods: 127 patients with functional constipation in our hospital from March 2018 to February 2020 were selected, and randomly divided into control group (n=63, mosapride treatment) and study group (n=64, Shouhui Tongbian capsule combined with Mosapride treatment). The efficacy, symptom score, quality of life, serum SP, MTL, NO levels of the two groups were compared, and the adverse reactions of the two groups during treatment were recorded. Results: The total effective rate of the control group after 4 weeks of treatment was 77.78% (49/63), which was lower than 90.63%(58/64) of the study group after 4 weeks of treatment. 4 weeks after treatment, the defecation difficulty, stool characteristics, defecation interval and incomplete defecation scores of the two groups decreased compared with those before treatment, and the study group was lower than the control group(P<0.05). 4 weeks after treatment, the scores of psychological function, physical function, social function and material life state of the two groups were higher than those before treatment, and the study group was higher than the control group (P<0.05). 4 weeks after treatment, serum SP and MTL of the two groups were higher than those before treatment, and the study group was higher than the control group (P<0.05), and serum NO was lower than that before treatment, and the study group was lower than the control group (P<0.05). No obvious adverse reactions occurred in both groups. Conclusion: On the basis of Mosapride, combined with Shouhui Tongbian capsule in the treatment of functional constipation patients, can better alleviate clinical symptoms, alleviate adverse signs, promote the improvement of quality of life, which has definite curative effect, the mechanism may be related to the regulation of serum SP, MTL, NO levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate the Shouhui Tongbian capsule combined with lactulose oral liquid in the treatment of senile functional constipation’s curative effect and its effect on anxiety, depression and serum gastrointestinal hormones in patients. Methods:150 patients with senile functional constipation who came to our hospital from December 2017 to December 2019 were selected, and randomly divided into group A(n=75, lactulose oral liquid treatment) and group B (n=75, Shouhui Tongbian capsule combined with lactulose oral liquid) according to random number table method. The curative effect of the two groups at 2 weeks after treatment and the occurrence of adverse reactions during treatment were recorded. Serum motilin(MTL), substance P(SP), Zung self rating anxiety scale(SAS) score, Zung self rating depression scale(SDS) and clinical symptom score of patients before treatment and 2 weeks after treatment were compared. Results: 2 weeks after treatment, the scores of stool characteristics, defecation difficulty, defecation incomplete feeling and defecation interval of the two groups decreased, and the group B was lower than group A (P<0.05). The total effective rate of group B at 2 weeks after treatment was 85.33%(64/75), and the total effective rate of group A at 2 weeks after treatment was 69.33%(52/75), the total effective rate of group B was higher than that of group A (P<0.05). 2 weeks after treatment, SAS and SDS scores of two groups decreased, and group B was lower than group A (P<0.05). 2 weeks after treatment, Serum MTL and SP of two groups were increased, and group B was higher than group A (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Shouhui Tongbian capsule combined with lactulose oral liquid in the treatment of senile functional constipation, can effectively improve clinical symptoms, regulate anxiety and depression, and improve serum gastrointestinal hormones levels, with good curative effect. [ABSTRACT FROM AUTHOR]

Intestinal dysmotility is common in many diseases and is correlated with gut microbiota dysbiosis and systemic inflammation. Functional constipation (FC) is the most typical manifestation of intestinal hypomotility and reduces patients’ quality of life. Some studies have reported that fecal micriobiota transplantation (FMT) may be an effective and safe therapy for FC as it corrects intestinal dysbiosis. This study was conducted to evaluate how FMT remodels the gut microbiome and to determine a possible correlation between certain microbes and clinical symptoms in constipated individuals. Data were retrospectively collected on 18 patients who underwent FMT between January 1, 2019 and June 30, 2020. The fecal bacterial genome was detected by sequencing the V3–V4 hypervariable regions of the 16S rDNA gene. Fecal short chain fatty acids (SCFAs) were detected by gas chromatography-mass spectrometry, and serum inflammatory factor concentrations were detected via enzyme-linked immunosorbent assay. Comparing the changes in fecal microbiome compositions before and after FMT revealed a significant augmentation in the alpha diversity and increased abundances of some flora such as Clostridiales, Fusicatenibacter, and Paraprevotella. This was consistent with the patients experiencing relief from their clinical symptoms. Abundances of other flora, including Lachnoanaerobaculum, were decreased, which might correlate with the severity of patients’ constipation. Although no differences were found in SCFA production, the butyric acid concentration was correlated with both bacterial alterations and clinical symptoms. Serum IL-8 levels were significantly lower after FMT than at baseline, but IL-4, IL-6, IL-10, and IL-12p70 levels were not noticeably changed. This study showed how FMT regulates the intestinal microenvironment and affects systemic inflammation in constipated patients, providing direction for further research on the mechanisms of FMT. It also revealed potential microbial targets for precise intervention, which may bring new breakthroughs in treating constipation.

Background: Polyethylene glycol (PEG) is recommended as first-line treatment of pediatric functional constipation. However, the oral route of administration is often poorly feasible in children mostly due to poor palatability. Promelaxin microenemas exert a topical evacuative action and may offer a valuable option in pediatric FC.Aim: To assess whether Promelaxin microenemas would be non-inferior to PEG 4000 in young children with FC.Methods: This is a randomized, open-label, multi-centric, non-inferiority trial enrolling infants and young children aged 6–48 months, with FC according to Rome III criteria. After 1 week of run in, children were randomized to 2 weeks of Promelaxin or PEG, followed by a 6-week on-demand treatment period. Primary endpoint was response rate to randomized treatment, with “response” defined as at least 3 evacuations per week and an average increase of at least one evacuation per week as compared to baseline. Safety, stool consistency and the analysis of fecal microbiota were secondary endpoints.Results: Out of the 158 patients who entered the trial, 153 patients were treated (77 and 76, PEG and Promelaxin arm, respectively). In the primary analysis, the 95% confidence interval (CI) for the treatment's effect lay entirely above the non-inferiority margin in both Full Set (FAS) and Per Protocol (PP) analyses, providing evidence of the non-inferiority of Promelaxin vs. PEG 4000 [response rate difference: 16.5% (CI 1.55–31.49%) and 11.03% (CI −5.58 to 27.64%), FAS and PP analyses, respectively]. Mean compliance to the randomized treatment was >80% in both arms. Secondary endpoints did not significantly differ between the two arms, except for the average number of total days of on-demand treatment that was significantly lower in the Promelaxin arm [14.6 (12.7) vs. 9.8 (9.1), mean (SD); primary endpoint responders in PEG and Promelaxin arm, respectively; p = 0.027]. Microbiota evenness significantly increased in the PEG 4000 arm at V4 as compared to the Promelaxin arm (p < 0.05). In addition, at V5, patients treated with PEG showed a significantly decreased microbiota density as compared to patients treated with Promelaxin (p = 0.036).Conclusions: Promelaxin microenemas are non-inferior to oral PEG in children with FC.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02751411.

Functional constipation (FC) is prevalent worldwide and is an increasingly prominent problem among university students. However, there is a paucity of research on FC in university students. This study aimed to assess the prevalence of FC among Chinese university students by the Rome III criteria and investigate its associated factors. This cross-sectional study was conducted by online questionnaires among 929 university students at a Chinese university. Food consumption was assessed with the Semi-Quantitative Food Frequency Questionnaire (SQFFQ) and dietary patterns were analyzed using factor analysis. A binary logistic regression model was applied to clarify FC-associated factors. The prevalence of FC among university students was 5.1%. Interestingly, among university students, the prevalence of FC with “complex” dietary pattern was significantly higher than those with “vegetable, fruit, egg and milk-based” and “livestock and aquatic product-based” dietary pattern (9.9% vs. 3.1% vs. 2.8%, p < 0.001). The prevalence of FC was significantly higher among university students with moderate to severe sleep disorders than those with the other sleep status (χ2 = 18.100, p < 0.001). Furthermore, after adjusting the covariates, “complex” dietary pattern (OR = 4.023, p < 0.001), moderate to severe sleep disorders (OR = 3.003, p = 0.006), overeating (OR = 2.502, p = 0.032), long mealtime (>30 min) (OR = 6.001, p = 0.007), and poor defecation habits (OR = 3.069, p = 0.042) were positively associated with FC among university students. Based on the above-associated factors for FC, improving dietary patterns and sleep status and developing good bowel and dietary habits are essential to prevent and alleviate university students’ FC.

Background: The prevalence of functional constipation (FC) among children varies widely. A survey among healthcare professionals (HCPs) was conducted to better understand the HCP-reported prevalence and (nutritional) management of FC in children 12–36 months old. Methods: An anonymous e-survey using SurveyMonkey was disseminated via emails or WhatsApp among HCPs in eight countries/regions. Results: Data from 2199 respondents were analyzed. The majority of the respondents (65.9%) were from Russia, followed by other countries (Indonesia (11.0%), Malaysia (6.0%)), Mexico, KSA (5.1% (5.7%), Turkey (3.0%), Hong Kong (2.2%), Singapore (1.1%)). In total, 80% of the respondents (n = 1759) were pediatricians. The prevalence of FC in toddlers was reported at less than 5% by 43% of the respondents. Overall, 40% of the respondents reported using ROME IV criteria in > 70% of the cases to diagnose FC, while 11% never uses Rome IV. History of painful defecation and defecations < 2 x/week are the two most important criteria for diagnosing FC. In total, 33% of the respondents reported changing the standard formula to a specific nutritional solution, accompanied by parental reassurance. Conclusion: The most reported prevalence of FC in toddlers in this survey was less than five percent. ROME IV criteria are frequently used for establishing the diagnosis. Nutritional management is preferred over pharmacological treatment in managing FC.

Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.

During constipation, indigestible foods, such as probiotics, prebiotics, and dietary fiber, may improve the bowel environment and activity. In this randomized, double-blind, and placebo-controlled study, the effects of ID-HWS1000, composed of Lactobacillus and Bifidobacterium species, xylooligosaccharide, and dietary fiber, were evaluated to determine whether it improves the perception of bowel activity or cause changes in the gut microbiome. Thirty Korean adults with "functional constipation" according to the Rome III criteria were randomly assigned to the following groups: 20 in the ID-HWS1000 group and 10 in the placebo group. ID-HWS1000 or the placebo was consumed by the participants for 4 weeks. To assess the changes in the perception of bowel activity, clinical data and gut microbiome analyses were conducted before and after the experiment. There were significant differences between the groups in the response to 9 of the 12 survey questions (the number and duration of bowel movements, amount of feces, number of irritant bowel movements, number of times bowel movements felt incomplete, shape of the feces, amount of gas in the gut, discomfort after defecation, and discomfort owing to constipation) (P < .05). There was a decrease in the proportion of Firmicutes (Ruminococcaceae and Lachnospiraceae) and an increase in Bacteroidetes (Bacteroidaceae) (P < .05). Moreover, ID-HWS1000 directly improved the discomfort associated with bowel movements, decreased the proportion of Lachnospiraceae, and increased the proportion of Bacteroidaceae. These results confirmed that ID-HWS1000 improves the perception of bowel activity and exerts positive changes in individuals with functional constipation. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the transverse diameter and thickness of the anterior wall of the rectum in children with normal bowel movement and children with functional constipation in different age groups. Another objective was to find correlations of rectum sizes with faecal incontinence and constipation duration. Methods: In the study, we included children with normal bowel movement and functional constipation diagnosed based on the Rome III and Rome IV criteria. We collected clinical data from the parents. We measured the rectum transverse diameter and the thickness of the anterior wall by abdominal ultrasound. Results: The study included 65 children, 31 with normal bowel movement and 34 with functional constipation. The rectum transverse diameter and the thickness of the anterior wall had statistically significant higher values in patients with constipation (P < 0.05). There was a moderate and significant correlation between the duration of the disease (mean ± standard deviation = 31.7 ± 33.1 months) and rectum transverse diameter (r = 0.54; P = 0.0009). The rectum transverse diameter correlated moderately with the presence of faecal incontinence (r = 0.62; P = 0.003), but the thickness of the anterior wall did not correlate with this symptom (r = 0.02; P = 0.39). Conclusions: We found statistically significant differences between the transverse rectal diameter and thickness of the rectum anterior wall, measured by abdominal ultrasound, in children with functional constipation compared with normal defaecation patterns. Faecal incontinence and long‐term constipation were correlated with the increased rectum diameter. [ABSTRACT FROM AUTHOR]

Background and Aim: Functional constipation (FC) is one of the functional bowel disorders with symptoms of constipation in the Rome IV criteria. This study aimed to examine the epidemiology of FC in a large‐scale survey of individuals undergoing a medical check‐up in Japan. Methods: A total of 13 729 subjects who underwent a medical check‐up at MedCity21 between April 2018 and March 2019 were given a questionnaire that inquired about bowel habits. Among them, 10 658 subjects participated in this study, and FC was diagnosed based on the Rome IV criteria. Results: The number of subjects who fulfilled diagnostic criteria of FC was 220, and the prevalence of FC was 2.1%. Compared with subjects with non‐FC, those with FC were more complaining of abdominal bloating and distension, feeling stressed, getting annoyed, lack of motivation, fatigue upon waking, and feeling depressed. The risk of FC was significantly lower among subjects who drank alcohol more than 5 days a week, exercised for more than 30 min at least twice a week for more than 1 year, and were getting enough rest by sleeping, whereas it was significantly higher among women and subjects who were eating faster than other people. Conclusions: The prevalence of FC in Japanese subjects during a medical check‐up was relatively low compared with that in Western countries. Subjects with FC had troublesome symptoms, and it might be suggested that female sex, lack of regular exercise with moderate activity, insufficient rest by sleeping, and eating faster were a risk of FC. [ABSTRACT FROM AUTHOR]

Background: One of the criteria for functional constipation (FC) in Rome IV criteria is the presence of hard or painful bowel movements. In adults and children, the Rome IV criteria recommend the use of the Bristol Stool Scale (BSS). This scale is thought not to be appropriate for evaluation of stool consistency in young children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed as a scale for children wearing diapers. There are no prior studies comparing BITSS with BSS in a clinical setting. Our main aim was that BITSS behaves differently than the BSS as it reflects better stool characterization by parents. Methods: Surveys were provided to parents of participants in two cities from Colombia which included the Rome IV‐validated questionnaire and stool consistency assessment using pictures for BSS and BITSS. Key Results: A total of 666 responses were obtained for non‐toilet‐trained children, mean age was 16.6 months. Detection for normal stools was higher using BSS (58.6%) when compared to BITSS (13.6%), and conversely was more likely to be abnormal through BITSS (86.4%) than BSS (41.4%) (p < 0.0001). BITSS (57.4%) was better than BSS (25.3%) identifying hard stools in FC (p = 0.000). For hard stools per parental classification, BITSS' definition was better than BSS (75.8% vs 44%, respectively, p = 0.000). Conclusions: The BITSS and BSS behave differently. The BITSS seems to be more sensitive to detect hard stools and FC than BSS. More studies are needed to better define whether BITSS is appropriate to replace BSS in non‐toilet‐trained infants and toddlers. [ABSTRACT FROM AUTHOR]

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1–12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039). Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs. [ABSTRACT FROM AUTHOR]

Objectives: Both Functional constipation and attention deficit hyperactivity disorder (ADHD) have a high prevalence among children. The aim of this study was to determine the relationship between functional constipation and ADHD. Materials and Methods: In this case-control study, 4-12-year-old children who were diagnosed with functional constipation were included in the case group and children with no functional constipation were included in the control group. Diagnosis of functional constipation was performed according to ROME III criteria. All participants were interviewed for ADHD using the Persian version of Conners' Parent Rating Scale (short form). Statistical analysis was performed by Chi-square test for investigating the relationship between functional constipation and ADHD. Conclusions: Functional constipation has a relationship with ADHD. The chance of having ADHD is 3 times higher in children with functional constipation. Further studies, particularly cohort studies, are recommended to assess the incidence of ADHD symptoms in infants with functional constipation in the future. Further studies on the possible pathophysiology of the digestive system and bacterial intestinal flora, especially in early childhood and infancy, are suggested for investigating the development of behavioral disorders and ADHD. [ABSTRACT FROM AUTHOR]

Objective To explore the mechanism of Liqi Tongbian Formula (Qi-regulating Bowel-opening Decoction, LQTBF) in the treatment of functional constipation (FC). Methods Rat FC models with qi stagnation pattern were established by using intragastric gavage of compound diphenoxylate and tail-clamping irritation. The rat models were randomly divided (Random Number Table) into blank group, model group, mosapride group(2 mg/kg), low-dose LQTBF(5.15 g/kg), mid-dose LQTBF group(10.3 g/kg), and high-dose LQTBF group(20.6 g/kg) (n=8 in each group) and received intervention for 14 continuous days. The general condition, time to first black bowel movement after intragastric gavage of ink, and the dry and wet weight of feces in each group of rats were evaluated. The levels of 5-HT, VIP and NE in the serum were detected by using ELISA. The mRNA expression of SP and CRF in rat colon tissue was measured with real time PCR. The expression of SP and CRF protein in colon tissue was measured with Western blot assay. Results Before treatment, compared with the blank group, time to first black bowel movement in the model group and interventional groups was prolonged (P< 0.01), and the fecal moisture content was lowered (P< 0.01). After 7 days of treatment, compared with the model group, time to the first black bowel movement in each treatment group was shortened (P< 0.05, P< 0.01), and the fecal moisture content in the high-dose LQTBF group was increased (P< 0.05). After 14 days of treatment, compared with the model group, time to first black bowel movement in each treatment group was shortened (P< 0.01); The fecal water content of rats in mosapride group and mid-dose, high-dose LQTBF groups increased (P< 0.05, P< 0.01); Compared with Mosapride group, time to first black bowel movement in the high-dose group was shortened (P< 0.05). After 14 days of treatment, compared with the blank group, the content of 5-HT in the model group, mosapride group and LQTBF groups were decreased (P< 0.05, P< 0.01). The content of NE in model group, mosapride group and low-dose LQTBF group increased (P< 0.01), while the content of NE in high-dose LQTBF group decreased (P< 0.01). The content of VIP in model group, mosapride group and LQTBF groups increased (P< 0.05, P< 0.01). The expression levels of SP, CRF mRNA and SP protein in model group, mosapride group and low-dose LQTBF group were decreased (P< 0.05, P< 0.01), the expression levels of SP protein in mid-dose and high-dose LQTBF groups were increased (P< 0.05, P< 0.01), and the expression levels of CRF protein in model group, mosapride group and LQTBF groups were decreased (P< 0.05, P< 0.01); Compared with the model group, the content of 5-HT in mosapride group and each dose group of LQTBF formula was increased (P< 0.01). the content of NE in mosapride group and middle and high dose groups of LQTBF formula was decreased (P< 0.01), and the content of VIP in mosapride group and LQTBF groups was decreased (P< 0.01). The expression levels of SP mRNA and SP protein were increased in mid-dose and high-dose LQTBF groups (P< 0.05, P< 0.01), and the expression levels of CRF mRNA and CRF protein were increased in all LQTBF groups (P< 0.05, P< 0.01). The expression of SP protein decreased in low-dose LQTBF group (P< 0.01); Compared with mosapride group, the contents of NE and VIP in low-dose LQTBF group were increased (P< 0.01). In the middle dose LQTBF group, the content of NE were decreased (P< 0.01), and the content of VIP were increased (P< 0.05). The contents of NE and VIP in high-dose LQTBF group were decreased (P< 0.05, P< 0.01). the content of 5-HT, the expression levels of SP mRNA and SP protein in middle and high-dose LQTBF groups were increased (P< 0.01). the expression levels of CRF mRNA and protein were increased (P< 0.05, P< 0.01). Conclusion LQTBF could improve gastrointestinal motility and intestinal water metabolism in rats. Its mechanism may be related to regulating the secretion of brain-gut peptides. [ABSTRACT FROM AUTHOR]

Objective: Little research exists on Rome IV disorders of gut–brain interaction (DGBI; formerly called functional gastrointestinal disorders) in outpatients with eating disorders (EDs). These data are particularly lacking for avoidant/restrictive food intake disorder (ARFID), which shares core features with DGBI. We aimed to identify the frequency and nature of DGBI symptoms among outpatients with EDs. Method: Consecutively referred pediatric and adult patients diagnosed with an ED (n = 168, 71% female, ages 8–76 years) in our tertiary care ED program between March 2017 and July 2019 completed a modified Rome IV Questionnaire for DGBI and psychopathology measure battery. Results: The majority (n = 122, 72%) of participants reported at least one bothersome gastrointestinal symptom. Sixty‐six (39%) met criteria for a DBGI, most frequently functional dyspepsia—post‐prandial distress syndrome subtype (31%). DGBI were surprisingly less frequent among patients with ARFID (30%) versus EDs that are associated with shape or weight concerns (45%; X2[1] = 3.61, p =.058, Cramer's V =.147). Among those with ARFID, DGBI presence was associated with the fear of aversive consequences prototype and multiple comorbid prototype presence. Discussion: We demonstrated notable overlap between DGBI and EDs, particularly post‐prandial distress symptoms. Further research is needed to examine if gastrointestinal symptoms predict or are a result of greater ED pathology, including ARFID prototypes. [ABSTRACT FROM AUTHOR]

The Rome IV criteria are used to characterize constipation and its subtypes, but not its severity. Conversely, the constipation scoring system (CSS) is a tool designed to assess the level of constipation severity and assist clinicians in selecting suitable therapeutic strategies. Although validated for adults, this score has yet to be validated for children. To adapt and validate the CSS for the pediatric population. Children and adolescents of 4–17 years of age with no morphological or neurological abnormalities of the gastrointestinal system were randomly selected during general consultation with a pediatrician and evaluated between November 2021 to April 2022. The Rome IV criteria were considered the gold-standard detection method. The adapted version was initially assessed on 30 children to assess comprehension and then administered to another 100 children. The internal consistency of the adapted questionnaire was assessed in a test-retest procedure with a two-week interval. One hundred patients with a mean age of 8.61 ± 3.25 years were assessed. Of these, 51 (51 %) were male. Most children (n = 91) received a score of 1–10 (the total CSS score can range from 0 to 30 points). The correlation between the pediatric version of the CSS and the Rome IV criteria was substantial, as shown by a positive Spearman correlation (r2) of 0.553 (p < 0.001). Cronbach's alpha between the test-retest responses was 0.97. When each item of the questionnaire was assessed individually, a greater level of internal consistency was found, indicating adequate internal reliability. The current study broadens the horizon with the emergence of new diagnostic aid for FC in Brazilian children and adolescents. In addition, this study provides the cornerstone for future research to determine the diagnostic accuracy of the CSS and its prognostic value for monitoring the treatment. The loss of a follow-up rate (26 %) during the telephone "test-retest" phase was a limitation. Using a subjective questionnaire such as the Rome IV criteria as the gold standard method may also represent a limitation. Further research is required on the use of objective diagnostic tools for FC including colonic transit time, anal manometry, cine-defecography, and electromyography. The CSS was successfully adapted for use with the pediatric population and was well accepted, confirming its language and psychometric validity in aiding the diagnosis of functional constipation. This was the first step towards validating the use of this score in other countries and cultures to assess the severity of constipation in children. [Display omitted] [ABSTRACT FROM AUTHOR]

Pediatricians face a problem of functional constipation in children and adolescents in one-third of cases of observation. Functional disorders of the gastrointestinal tract are based on disregulatory processes of the cortical-vegetative-endocrine complex. Magnesium deficiency is one of the factors influencing the formation of functional constipation in children, and an important link in the pathogenesis of the disease. Correction of magnesium level by means of magnesium-containing mineral water is one of the safe, effective and complex factors influencing a number of pathogenetic mechanisms of formation of functional constipation in children and teenagers.

Abstract Background Acupuncture is effective in functional constipation (FC) treatment, but the central mechanism has not been well investigated. This trial will combine functional magnetic resonance imaging (fMRI) and positron emission tomography-computed tomography (PET-CT) to investigate the potential central mechanism of acupuncture treatment for FC. Methods This is a multimodal neuroimaging randomized controlled trial. In total, 140 FC patients will be randomly allocated into four groups: the verum acupuncture group; the sham acupuncture group; the PEG 4000 group; and the waiting-list group. This trial will include a two-week baseline period and a two-week treatment period. Patients will receive 10 sessions of acupuncture, sham acupuncture, PEG 4000, or no intervention during the treatment period. The stool diary, Cleveland Constipation Score (CCS), Patient Assessment of Constipation Symptom (PAC-SYM), and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QoL) will be used to assess the clinical efficacy of different interventions. The MRI and PET-CT scans will be performed to detect cerebral functional changes in 15 patients in each group at baseline and at the end of treatment/waiting. Multimodal imaging data will be associated with clinical data to investigate possible correlation between brain activity changes elicited by different interventions and symptoms improvement. Discussion We hypothesize that acupuncture can treat FC through normalizing the pathological alteration of the cerebral activity. The results of this trial will allow us to re-testify the therapeutic effects of acupuncture treating for FC and to investigate the potential central mechanism of acupuncture treatment for FC from direct (cerebral glucose metabolism) and indirect (contrast of oxyhemoglobin and deoxyhemoglobin) approaches. Trial registration Chinese Clinical Trial Registry, ChiCTR1800016658. Registered on 14 June 2018.

Constipation, which is currently one of the global problems of mankind, requires modern approaches to its pharmacological correction. Constipation that occurs in the absence of organic digestive pathology is in most cases considered a symptom of functional constipation or irritable bowel syndrome, the diagnosis of which is based on the compliance of the patient’s complaints and anamnestic data with the Rome IV criteria for the diagnosis of these functional disorders. Regulax Picosulphate, an intravenous droplet, is a modern laxative drug with a possibility of precise and easy dosing that does not have a local irritant effect on the gastric and duodenal mucous membranes; the efficacy and safety of this drug has been proven in controlled clinical trials.

As of now, constipation in children, especially in infants, is a common complaint during a visit to a pediatrician and a gastroenterologist. Despite the fact that the current internationally recognized guidelines for the management of these patients have been elaborated, domestic specialists have no consensus regarding the therapy and prevention of constipation in children so far. The article discusses the diagnosis and treatment of functional constipations in children. Recommendations on the diagnosis, comprehensive prophylaxis and treatment of functional constipations in children with the inclusion the laxatives are provided, as well as own observations and experience with the polyethylene glycol 4000 (Macrogol) in the therapy of constipation in children.

Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p

Functional constipation (FCon) is a common functional gastrointestinal disorder. A considerable portion of patients with FCon is associated with anxiety/depressive status (FCAD). Previous neuroimaging studies mainly focused on patients with FCon without distinguishing FCAD from FCon patients without anxiety/depressive status (FCNAD). Differences in brain functions between these two subtypes remain unclear. Thus, we employed resting-state functional magnetic resonance imaging (RS-fMRI) and graph theory method to investigate differences in brain network connectivity and topology in 41 FCAD, 42 FCNAD, and 43 age- and gender-matched healthy controls (HCs). FCAD/FCNAD showed significantly lower normalized clustering coefficient and small-world-ness. Both groups showed altered nodal degree/efficiency mainly in the rostral anterior cingulate cortex (rACC), precentral gyrus (PreCen), supplementary motor area (SMA), and thalamus. In the FCAD group, nodal degree in the SMA was negatively correlated with difficulty of defecation, and abdominal pain was positively correlated with nodal degree/efficiency in the rACC, which had a lower within-module nodal degree. The salience network (SN) exhibited higher functional connectivity (FC) with the sensorimotor network (SMN) in FCAD/FCNAD, and FC between these two networks was negatively correlated with anxiety ratings in FCAD group. Additionally, FC of anterior insula (aINS)–rACC was only correlated with constipation symptom (i.e., abdominal pain) in the FCNAD group. In the FCAD group, FCs of dorsomedial prefrontal cortex–rACC, PreCen–aINS showed correlations with both constipation symptom (i.e., difficulty of defecation) and depressive status. These findings indicate the differences in FC of the SN–SMN between FCAD and FCNAD and provide neuroimaging evidence based on brain function, which portrays important clues for improving new treatment strategies.

Background: The abnormalities in brain function and structure of patients with functional constipation (FC) have been identified using multiple neuroimaging studies and have confirmed the abnormal processing of visceral sensation at the level of the central nervous system (CNS) as an important reason for FC. As an important basis for central information transfer, the role of the white matter (WM) networks in the pathophysiology of FC has not been investigated. This study aimed to explore the topological organization of WM networks in patients with FC and its correlation with clinical variables.Methods and Analysis: In this study, 70 patients with FC and 45 age- and gender-matched healthy subjects (HS) were recruited. Diffusion tensor imaging (DTI) data and clinical variables were acquired from each participant. WM networks were constructed using the deterministic fiber tracking approach, and the global and nodal properties of the WM networks were compared using graph theory analysis between patients with FC and HS. The relationship between the representative nodal characteristics–nodal betweenness and clinical parameters was assessed using partial correlation analysis.Results: Patients with FC showed increased nodal characteristics in the left superior frontal gyrus (orbital part), right middle frontal gyrus (orbital part), and right anterior cingulate and paracingulate (P < 0.05, corrected for false discovery rate) and decreased nodal characteristics in the left caudate and left thalamus (P < 0.05, corrected for false discovery rate) compared with HS. The duration of FC was negatively correlated with the nodal betweenness of the left thalamus (r = −0.354, P = 0.04, corrected for false discovery rate).Conclusion: The results indicated the alternations in WM networks of patients with FC and suggested the abnormal visceral sensation processing in the CNS from the perspective of large-scale brain WM network.

Background: Our objective is to describe the prevalence of patients with internal anal sphincter achalasia (IASA) without Hirschsprung disease (HD) among children undergoing anorectal manometry (ARM) and their clinical characteristics. Methods: We performed a retrospective review of high‐resolution ARM studies performed at our institution and identified patients with an absent rectoanal inhibitory reflex (RAIR). Clinical presentation, medical history, treatment outcomes, and results of ARM and other diagnostic tests were collected. We compared data between IASA patients, HD patients, and a matched control group of patients with functional constipation (FC). Key results: We reviewed 1,072 ARMs and identified 109 patients with an absent RAIR, of whom 28 were diagnosed with IASA. Compared to patients with FC, patients with IASA had an earlier onset of symptoms and were more likely to have abnormal contrast enema studies. Compared to patients with HD, patients with IASA were more likely to have had a normal timing of meconium passage, a later onset of symptoms, and were diagnosed at an older age. At the latest follow‐up, the majority of patients diagnosed with IASA (54%) were only using oral laxatives. Over half of patients with IASA had been treated with anal sphincter botulinum toxin injection, and 55% reported a positive response. Conclusions and Inferences: Patients diagnosed with IASA may represent a more severe patient population compared to patients with FC, but have a later onset of symptoms compared to patients with HD. They may require different treatments for their constipation and deserve further study. [ABSTRACT FROM AUTHOR]

Chronic functional constipation (CFC) is the most prevalent type of constipation. Considering the proven effect of pelvic floor muscles dysfunction in these patients' symptom and the fascial connection between pelvic floor and abdominal and lumbopelvic muscles, this study aimed to examine the possible relationship between this muscles and CFC. We conveniently selected 100 patients with CFC and 100 healthy participants based on the Rome IV criteria. Two groups were asked to complete the international physical activity questionnaire and food frequency questionnaire. Then both groups were assessed for the presence of trigger points in more prevalent pain sites for each muscle by pressure algometer with 50% of their caught pressure pain threshold. There were no statistical differences between two groups in the intake of calories, carbohydrates, proteins, sugar, fiber, vegetables, and wheat products. Patients had a higher consumption of fat and dairy products. for the physical activity level, a statistical difference showed that patients were less physically active. The comparison of the presence and the number of trigger points for each muscle in patients and control groups indicated more than 50% impairment, and there was a significant difference between two groups. This study revealed that the relationship between myofascial trigger points of abdominal and lumbopelvic muscles and constipation. In addition to that, it seems that a sedentary life may influence CFC patients' condition. Moreover, it seems that the results of the dietary condition in patients could be because of conscious consumption of some certain foods. [ABSTRACT FROM AUTHOR]

Urotherapy is an umbrella term for all non-surgical, non-pharmacological interventions for lower urinary tract disorders (LUTD) in children and adolescents. Urotherapy is a specialized practice, which has become mainstay therapy not only for daytime urinary incontinence, but also for nocturnal enuresis, functional constipation and fecal incontinence. The aim of urotherapy is to achieve the normalization of the micturition and bowel pattern and to prevent further functional disturbances by repeated training. It is well known that in the treatment of adult and childhood incontinence a team approach is best, where there are shared areas of expertise and also discipline-specific expertise available. We present a consensus view from a cross-professional team of experts affiliated with the International Children's Continence Society on definitions, indications and practice of urotherapy. This is a selective, non-systematic review with practical recommendations for the implementation and research on urotherapy. The document uses the globally accepted ICCS terminology. Evidence-based literature serves as the basis, but in areas lacking in primary evidence, expert consensus is used. Before submission, a full draft was made available to all ICCS members for additional comments. Urotherapy uses non-pharmacological, non-surgical methods and focuses on behavioral interventions, largely based on cognitive-behavioral psychotherapy (CBT). Standard urotherapy comprises components such as provision of information, instructions, life-style advice, counselling and registration of symptoms. Specific urotherapy is tailored towards specific disorders and includes alarm treatment, biofeedback training, pelvic floor training, neurostimulation and other interventions. Fig. 1. Urotherapy is a treatment that addresses all aspects of incontinence, leading to the best clinical outcome. This includes somatic, psychosocial, and behavioral problems and quality of life. Therefore urotherapy is recommended by the ICCS as the first-line treatment for most types of LUTD. The document is intended to be clinically useful in primary, secondary and tertiary care. [Display omitted] [ABSTRACT FROM AUTHOR]

The combination of the functional disorders of urination and defecation constitutes the Dysfunctional Elimination Syndrome (DES). DES refers to an abnormal pattern of elimination of unknown etiology characterized by bowel and bladder incontinence and withholding, with no underlying anatomic or neurologic abnormalities. Essential precondition for a child to be subsumed under this entity is the exclusion of either anatomical or neurological causative factors. In the present review study the individual entities of dysfunctional filling, such as the unstable or lazy bladder, or dysfunctional urination, such as the detrusor sphincter dyssynergia and the functional constipation are being described comprehensively. Subsequently, the analysis of the pathophysiological effects of the dysfunctional elimination syndrome such as incontinence, urinary tract infections and the conservation or the deterioration of vesicoureteric reflux, is being accentuated. With the documentation of DES, the therapeutic strategy should aim at treating both the functional disorder of the vesicourethral unit and the functional constipation. The first part does not specify depending on the type of this disorder. Rarely, surgical treatment of functional urinary disorders may be required. [ABSTRACT FROM AUTHOR]

Infrequent bowel movements are a common feature of constipation, but fecal loading as a cause of symptoms in patients with regular bowel movements has not previously been evaluated. The aim of this preliminary study was to assess prospectively if fecal loading may be a cause of bowel symptoms in patients with regular bowel movements. Consecutive patients attending a gastroenterology clinic for functional bowel symptoms (FBD) not including infrequent bowel movements and who did not fulfil the criteria for constipation-predominant irritable bowel syndrome or functional constipation underwent plain abdominal radiography. Those with fecal loading received dietary advice and laxative treatment. The reproducibility of determination of fecal loading using the Leech score was assessed 'blindly' by a consultant radiologist. Twenty-six of 74 patients with FBD but not infrequent bowel movements had fecal loading demonstrated on abdominal radiology. Their Leech scores were significantly higher than those of control patients matched for age, sex and hospital (median 6 vs. 4, IQR 5–7 vs. 3.5–5, p < 0.001). Three out of 20 patients (15%) who returned for review after dietary advice and laxatives were asymptomatic and 17/20 (85%) had improved. Fecal loading may therefore cause bowel symptoms in patients who move their bowels regularly and dietary and laxative treatment may then improve these symptoms. This approach may prove cost-effective as an empirical interim measure especially where healthcare resources are limited and where sophisticated imaging is not readily available. [ABSTRACT FROM AUTHOR]

Functional constipation (FCon) is a common functional gastrointestinal disorder (FGID); neuroimaging studies have shown brain functional abnormalities in thalamo-cortical regions in patients with FGID. However, association between FCon and topological characteristics of brain networks remains largely unknown. We employed resting-state functional magnetic resonance imaging (RS-fMRI) and graph theory approach to investigate functional brain topological organization in 42 patients with FCon and 41 healthy controls (HC) from perspectives of global, regional and modular levels. Results showed patients with FCon had a significantly lower normalized clustering coefficient and small-worldness, implying decreased brain functional connectivity. Regions showed altered nodal degree and efficiency mainly located in the thalamus, rostral anterior cingulate cortex (rACC), and supplementary motor area (SMA), which are involved in somatic/sensory, emotional processing and motor-control. For the modular analysis, thalamus, rACC and SMA had an aberrant within-module nodal degree and nodal efficiency, and thalamus-related network exhibited abnormal interaction with the limbic network (amygdala and hippocampal gyrus). Nodal degree in the thalamus was negatively correlated with difficulty of defecation, and nodal degree in the rACC was negatively correlated with sensation of incomplete evacuation. These findings indicated that FCon was associated with abnormalities in the thalamo-cortical network. [ABSTRACT FROM AUTHOR]

Background: The abnormalities in brain function and structure of patients with functional constipation (FC) have been identified using multiple neuroimaging studies and have confirmed the abnormal processing of visceral sensation at the level of the central nervous system (CNS) as an important reason for FC. As an important basis for central information transfer, the role of the white matter (WM) networks in the pathophysiology of FC has not been investigated. This study aimed to explore the topological organization of WM networks in patients with FC and its correlation with clinical variables. Methods and Analysis: In this study, 70 patients with FC and 45 age- and gender-matched healthy subjects (HS) were recruited. Diffusion tensor imaging (DTI) data and clinical variables were acquired from each participant. WM networks were constructed using the deterministic fiber tracking approach, and the global and nodal properties of the WM networks were compared using graph theory analysis between patients with FC and HS. The relationship between the representative nodal characteristics–nodal betweenness and clinical parameters was assessed using partial correlation analysis. Results: Patients with FC showed increased nodal characteristics in the left superior frontal gyrus (orbital part), right middle frontal gyrus (orbital part), and right anterior cingulate and paracingulate (P < 0.05, corrected for false discovery rate) and decreased nodal characteristics in the left caudate and left thalamus (P < 0.05, corrected for false discovery rate) compared with HS. The duration of FC was negatively correlated with the nodal betweenness of the left thalamus (r = −0.354, P = 0.04, corrected for false discovery rate). Conclusion: The results indicated the alternations in WM networks of patients with FC and suggested the abnormal visceral sensation processing in the CNS from the perspective of large-scale brain WM network. [ABSTRACT FROM AUTHOR]

Functional constipation (FCon) is a common functional gastrointestinal disorder. A considerable portion of patients with FCon is associated with anxiety/depressive status (FCAD). Previous neuroimaging studies mainly focused on patients with FCon without distinguishing FCAD from FCon patients without anxiety/depressive status (FCNAD). Differences in brain functions between these two subtypes remain unclear. Thus, we employed resting-state functional magnetic resonance imaging (RS-fMRI) and graph theory method to investigate differences in brain network connectivity and topology in 41 FCAD, 42 FCNAD, and 43 age- and gender-matched healthy controls (HCs). FCAD/FCNAD showed significantly lower normalized clustering coefficient and small-world-ness. Both groups showed altered nodal degree/efficiency mainly in the rostral anterior cingulate cortex (rACC), precentral gyrus (PreCen), supplementary motor area (SMA), and thalamus. In the FCAD group, nodal degree in the SMA was negatively correlated with difficulty of defecation, and abdominal pain was positively correlated with nodal degree/efficiency in the rACC, which had a lower within-module nodal degree. The salience network (SN) exhibited higher functional connectivity (FC) with the sensorimotor network (SMN) in FCAD/FCNAD, and FC between these two networks was negatively correlated with anxiety ratings in FCAD group. Additionally, FC of anterior insula (aINS)–rACC was only correlated with constipation symptom (i.e., abdominal pain) in the FCNAD group. In the FCAD group, FCs of dorsomedial prefrontal cortex–rACC, PreCen–aINS showed correlations with both constipation symptom (i.e., difficulty of defecation) and depressive status. These findings indicate the differences in FC of the SN–SMN between FCAD and FCNAD and provide neuroimaging evidence based on brain function, which portrays important clues for improving new treatment strategies. [ABSTRACT FROM AUTHOR]