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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Chronic functional constipation is strongly linked to vitamin D deficiency
Alba Panarese, Francesco Pesce, Piero Porcelli, Giuseppe Riezzo, Palma Aurelia Iacovazzi, Carla Maria Leone, Massimo De Carne, Caterina Mammone Rinaldi, Endrit Shahini
Alba Panarese, Massimo De Carne, Endrit Shahini, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte (Bari) 70013, Italy
Francesco Pesce, Nephrology section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70013, Italy
Piero Porcelli, Department of Psychological, Health, and Territorial Sciences, D'Annunzio University of Chieti-Pescara, Chieti 70013, Italy
Giuseppe Riezzo, Palma Aurelia Iacovazzi, Carla Maria Leone, Department of Clinical Pathology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte (Bari) 70013, Italy
Caterina Mammone Rinaldi, Department of Radiology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte (Bari) 70013, Italy
Endrit Shahini, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Author contributions: Panarese A has conceived the protocol; Shahini E and Panarese A drafted the initial and final manuscript; Panarese A enrolled patients; Panarese A, and Leone CM collected in a database the baseline and on-treatment information; Shahini E, Pesce F and Porcelli P systematically reviewed the data entries for completeness and consistency, checked for completeness of information and performed the statistical analysis; all the authors reviewed and approved the final draft.
Institutional review board statement: National Institute of Gastroenterology “S. De Bellis” Research Hospital (0807/16) and by the Research Ethics Committee of the National Oncological Institute of Bari (CAAE:147/16) (Trial registration number: NCT03096704).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Corresponding author: Alba Panarese, MD, Doctor, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Turi Street n. 27, Castellana Grotte (Bari) 70013, Italy. alba.panarese@irccsdebellis.it
Telephone: +39-3471401487; +39-0804994251 Fax: +39-0804994250
Received: February 16, 2019
Peer-review started: February 18, 2019
First decision: February 26, 2019
Revised: March 11, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: April 14, 2019
BACKGROUND
Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined.
AIM
To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.
METHODS
We performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).
RESULTS
We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group (P < 0.001), which significantly correlated with low vitamin D levels (r = - 0.57, P < 0.001; r = 0.21, P = 0.01; r = - 0.48, P < 0.001; r = - 0.57, P < 0.001; r = - 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).
CONCLUSION
Vitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.
Core tip: Intestinal motility disorders, which are disabling conditions associated with chronic constipation, have been examined in only A few studies. Patients with intestinal motility disorders are frequently affected by vitamin D deficiency, which is strongly associated to anxiety, depression symptoms and to severe impairment of quality of life. These data suggest that vitamin D serum levels should be routinely measured, and its supplementation should be evaluated in patients with intestinal motility disorders.
