• Parkinson's disease
• constipation
• gastroenterology
• integrated care

• Blunt and sharp objects
• constipation
• foreign body ingestion
• gastrointestinal transit time
• pediatric endoscopy
• spontaneous passage

• Helicobacter pylori
• Abdominal ultrasonography
• Disorders of gut-brain interactions
• Functional abdominal pain
• Gut Microbiome
• Irritable bowel syndrome

• Humans
• Abdominal Pain/therapy
• Abdominal Pain/etiology
• Abdominal Pain/psychology
• Child
• Quality of Life
• Irritable Bowel Syndrome/therapy
• Irritable Bowel Syndrome/psychology

• disorder of brain–gut interaction
• functional gastrointestinal disorder
• intestinal ultrasound
• irritable bowel syndrome

• Hirschsprung Disease
• bowel management
• clinician ultrasound
• rectal ultrasound

• Humans
• Constipation/physiopathology
• Constipation/therapy
• Constipation/diagnosis
• Child
• Manometry/methods
• Gastrointestinal Transit/physiology
• Defecography/methods
• Colon/physiopathology
• Colon/diagnostic imaging

• Contrast studies
• Manometry
• Refractory constipation
• Transit studies

• Child
• Humans
• Consensus
• Manometry/methods
• Constipation/diagnosis
• Constipation/therapy
• Colon
• Chronic Disease
• Gastrointestinal Motility

• chronic constipation
• treatment

• Humans
• Japan
• Chronic Disease
• Constipation/therapy
• Constipation/drug therapy
• Laxatives/therapeutic use

• Disorders of gut-brain interactions
• abdominal X-ray
• abdominal ultrasound
• constipation
• functional MRI
• functional abdominal pain
• functional gastrointestinal disorders
• irritable bowel syndrome

• Child
• Humans
• Brain/diagnostic imaging
• Diagnostic Imaging
• Defecation
• Irritable Bowel Syndrome

• Bowel habits
• Constipation
• Dietary fiber
• Epidemiology
• Laxatives
• Physical activity
• Prognosis
• Quality of life

• Child
• Humans
• Quality of Life
• Constipation/diagnosis
• Constipation/etiology
• Constipation/therapy
• Laxatives/therapeutic use
• Colon
• Diet

• Children
• Constipation
• Herbal
• Laxative
• Toilet training
• Treatment

• Child
• Humans
• Dietary Fiber/therapeutic use
• Constipation/diagnosis
• Constipation/epidemiology
• Constipation/therapy
• Laxatives/therapeutic use
• Physical Therapy Modalities
• Physicians

• Constipation
• colon
• fecal loading
• radiography

Parkinson's disease is neurodegenerative disorder with an initial robust response to levodopa. As the disease progresses, patients frequently develop dyskinesia and motor fluctuations, which are sometimes resistant to pharmacological therapy. In recent years, abnormalities in gut microbiota have been identified in these patients with a possible role in motor manifestations. Dysbiosis may reduce levodopa absorption leading to delayed “On” or “no-On” states. Among 84 consecutive patients with PD, we selected 14 with levodopa-induced dyskinesia and motor fluctuations with a Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part IV ≥ 8 points following a trial of pharmacological adjustment 2–3 months prior to study enrollment or adjustments in deep brain stimulation therapy. Patients received treatment with sodium phosphate enema followed by oral rifaximin and polyethylene glycol for 7 and 10 days, respectively. Evaluations between 14 to 21 days after starting treatment showed improvement in MDS-UPDRS-IV (P = 0.001), including duration (P = 0.001) and severity of dyskinesia (P = 0.003); duration of medication “Off”-state (P = 0.004); functional impact of motor fluctuations (P = 0.047) and complexity of motor fluctuations (P = 0.031); no statistical improvement was observed in “Off” dystonia (P = 0.109) and total motor scores (P = 0.430). Marked to moderate improvement in dyskinesia was observed in 57% of cases with blinded evaluation of videos. About 80% of patients perceived moderate to robust improvement at follow-up. A therapeutic strategy aimed at decontamination of intestines showed benefit in motor fluctuations and dyskinesia. Further studies should confirm and clarify the mechanism of improvement observed in these patients.

• Parkinson's disease
• dysbiosis
• dyskinesia
• microbiota
• motor fluctuations
• parkinsonism
• treatment

Objectives: We determined whether glycerin enemas were appropriately prescribed in pediatric fecal impaction patients using the Leech score and identified factors that influenced the prescription of glycerin enemas in the pediatric emergency department (PED). Methods: We included patients who received a glycerin enema at the PED of a tertiary teaching hospital. We divided the study subjects into two groups on the basis of their Leech scores: an appropriate enema group (Leech score ≥ 8), and an inappropriate enema group (Leech score < 8). Logistic regression was performed to determine the factors associated with glycerin enema administration. Results: The data of 998 patients, including 446 patients in the inappropriate enema group (Leech score 5.2 ± 1.7) and 552 patients in the appropriate enema group (Leech score 10.1 ± 1.7), were analyzed. A discharge diagnosis of fecal impaction was observed significantly more frequently (57.1%) in the appropriate enema group, and nonspecific abdominal pain (8.3%) and acute gastroenteritis (40.8%) were diagnosed significantly more frequently in the inappropriate enema group (p < 0.05). Constipation (2.8%) and irritability (3.0%) were slightly more common in the appropriate enema group than in the inappropriate enema group (p < 0.05). According to multiple logistic regression, subjects aged 2–8 years (2–4 years, OR 4.24; 4–8 years, OR 2.83), with vomiting (OR 1.72), with irritability (OR 4.52), and with a prolonged last defecation day (OR 1.2) were most likely to receive appropriate enema administration (p < 0.05). Conclusion: The results showed that in those aged 2–8 years, with vomiting and irritability, and with a prolonged last defecation day, an enema was generally administered appropriately.

• fecal impaction
• glycerin enema
• pediatric

• Bowel habit
• Bristol stool forms
• Functional constipation
• Functional gastrointestinal disorders
• Gut transit
• Irritable bowel syndrome
• Laxative
• Leech score
• Rome criteria

• Abdominal radiograph
• Bowel habit
• Computed tomography
• Constipation

Irritable bowel syndrome (IBS) is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency. The pathophysiology is poorly understood and seems to be multifactorial. Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.

To compare colon transit time and faecal load between IBS-patients and healthy control subjects.

The study included 140 patients with IBS, with a mean age of 50.0 years. The control group comprised 44 healthy persons with a mean age of 43.4 years, who were selected at random from the National Civil Register. Both the patient group and the control group underwent a marker study to measure colon transit time (CTT) and to calculate a faecal loading score. The patient group underwent treatment with a combined prokinetic regime, after which their CTT and faecal loading were reassessed. Analyses were performed to compare measurements between the control group and the patient group before and after treatment.

Compared to healthy controls, IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P = 0.0002) and significantly greater mean faecal loading scores in all colonic segments (P < 0.001). Among IBS patients, we found no significant differences between the 48 h and 96 h radiographs. Among patients exhibiting increased CTT and faecal loading, approximately half exhibited a palpable mass in the right iliac fossa. After intervention with a prokinetic treatment, the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h (P = 0.091), with the post-treatment CTT not significantly differing from the CTT among control subjects (P = 0.095). The faecal loading score among IBS patients did not significantly differ before and after treatment (P = 0.442). The post-treatment faecal loading score in IBS patients remained significantly higher compared to that in controls (5.3 vs 4.3, P = 0.014). After treatment, half of the IBS-patients were relieved of bloating, while the majority no longer experienced abdominal pain and achieved a daily consistent stool.

IBS-patients exhibited prolonged CTT and heavier faecal loading. These assessments may aid in diagnosis. Faecal retention may contribute to IBS symptoms, which can be treated using a prokinetic regime.

• Irritable bowel syndrome
• Functional bowel disease
• Faecal retention
• Colon transit time
• Faecal load

• constipation
• inflammatory bowel disease
• ulcerative colitis

Depression is associated with constipation within and outside Parkinson’s disease (PD). Since inefficient cognitive-processing (bradyphrenia) features in PD and an enterokinetic agent improved cognitive performance in healthy individuals, bradyphrenia may be associated with constipation. We aim to define the archetypical bowel function of PD, and its association with cognition, mood, and motor features within and outside PD. We assessed colonic transit time (oral radio-opaque markers over 6 days), bowel function and psychometric questionnaires and measures of PD facets, including bradyphrenia, in 58 participants with diagnosed PD, and 71 without (controls). The best abdominal X-ray (day 7) predictors of PD status were total retained marker count and transverse colon segmental delay. However, Rome functional constipation status complemented segmental delay better, giving good specificity (85%) but low sensitivity (56%). Transverse colon marker count appeared to be age-associated only in PD. In PD, those correctly classified by bowel dysfunction had higher depression scores (p = 0.02) and longer cognitive-processing times than the misclassified (p = 0.05). Controls misclassified as PD by bowel dysfunction had higher depression and anxiety scores than the correctly classified (p = 0.002 and 0.003, respectively), but not slower cognitive processing. Measures of motor features were independent of sub-classification by bowel function in PD and in controls. In conclusion, constipation in PD has distinct localized pathophysiology, and is associated with bradyphrenia.

• Parkinson’s disease
• anxiety
• cognitive-processing time
• colonic transit-time
• depression
• functional constipation

Gastrointestinal (GI) ultrasound (GIUS) is valuable in the evaluation of GI diseases such as inflammatory bowel disease, but its use in functional GI disorders (FGIDs) is largely unknown although promising. In order to review the current knowledge on current and potential uses of GIUS in FGIDs, information was obtained via a structured literature search through PubMed, EMBASE and Google Scholar databases with a combination of MESH and keyword search terms: “ultrasound”, “functional GI disorders”, “irritable bowel syndrome”, “functional dyspepsia”, “intestinal ultrasound”, “point of care ultrasonography”, “transabdominal sonography”, “motility”, “faecal loading”, “constipation”. GIUS is currently used for various settings involving upper and lower GI tracts, including excluding organic diseases, evaluating physiology, guiding treatment options and building rapport with patients. GIUS can be potentially used to correlate mechanisms with symptoms, evaluate mechanisms behind treatment efficacy, and investigate further the origin of symptoms in real-time. In conclusion, GIUS is unique in its real-time, interactive and non-invasive nature, with the ability of evaluating several physiological mechanisms with one test, thus making it attractive in the evaluation and management of FGIDs. However, there are still limitations and concerns of operator dependence and lack of validation data for widespread implementation of GIUS in FGIDs.

• Ultrasound
• Functional gastrointestinal disorders
• Irritable bowel syndrome
• Functional dyspepsia
• Constipation

Introduction

Constipation represents 3% of all office visits to pediatricians and 10% - 45% of consultations with pediatric gastroenterologists. It has been reliably established that the role of abdominal x-rays (AXR) in the diagnosis of constipation in pediatrics is limited; yet, significant overdiagnosis of constipation exists when plain abdominal x-rays are used in the acute setting for abdominal pain or to screen for other disorders. This results in loss of time, resources, exposure to unnecessary radiation, and potentially missing the primary diagnosis. The purpose of this study is to determine the sensitivity and specificity of AXR in diagnosing constipation in the acute setting.

Objectives

To determine 1) the sensitivity and specificity of plain AXR in the diagnosis of constipation and 2) the effect of age, race, gender, comorbid conditions, and practice setting on the diagnosis of constipation.

Methods

This study was a historical cohort study of children (two to 18 years of age) who were seen at Ascension St. John Children’s Hospital between March 2015 - March 2018 and who had a plain AXR performed during an emergency department (ED) visit or inpatient stay. If AXR results contained keywords, such as “constipation,” “stool load,” “fecal retention,” and “fecal load,” the ambulatory medical record, Athena® (http://www.athenahealth.com), was searched to determine if the child had an ambulatory visit in the ensuing 45 days. Chart review was conducted to assess if the diagnosis of constipation was later confirmed by history and physical examination by a pediatrician or gastroenterologist at that visit. By comparing data from both encounters, the sensitivity and specificity of plain AXR in diagnosing constipation was assessed. All data were analyzed using the Statistical Package for Social Sciences (SPSS), v. 25.0 (IBM SPSS Statistics, Armonk, NY) and a p-value of 0.05 or less was considered to indicate statistical significance.

Results

Over the three-year study period, 1,383 AXRs were performed on 1,116 patients. The sensitivity of AXR in the diagnosis of constipation was 73.8%, specificity 26.8%, positive predictive value 46.4%, and negative predictive value of 54.3%. Pediatric gastroenterologists were more likely to diagnose constipation (63.2%) compared to pediatricians (41.4%) and pediatric surgeons (33.3%) (p = 0.04).

Conclusions

AXRs are not a reliable means of diagnosing constipation. Overall, we found similar sensitivity and specificity of AXR in diagnosing constipation compared to previous studies. Yet, our study gives new insight into the practices around diagnosing constipation in a single-center community hospital pediatric acute setting and the radiology department. This further emphasizes the need to review current practices and impart more education both in the acute care setting and radiology department. 

• abdominal x-ray
• constipation

• Accidental bowel leakage
• Bloating
• Constipation
• Diarrhea
• Fecal loading
• X-ray

• Abdominal pain
• Constipation
• Dolor abdominal
• Estreñimiento
• Fecal impaction grade
• Grado de coproestasis
• Plain abdominal x-ray
• Radiografía simple de abdomen

• Abdominal Pain/etiology
• Adolescent
• Child
• Child, Preschool
• Constipation/complications
• Cross-Sectional Studies
• Emergency Medical Services
• Fecal Impaction/complications
• Fecal Impaction/diagnostic imaging
• Female
• Humans
• Infant
• Male
• Radiography

• Abdominal radiograph
• Constipation
• Fecal loading
• Utilization
• Value

• X‐rays
• chronic constipation
• laxatives
• macrogol
• polyethylene glycol

• Constipation
• Radiograph
• Stool burden
• X-ray

• Abdominal radiographs
• Advanced cancer
• Constipation
• Palliative care

• EMG lag time
• Non-invasive testing
• Pediatrics
• Uroflowmetry with EMG
• Voiding dysfunction

• Chronic constipation
• Colonic transit time
• Distribution
• Ultrasonography

• Adult
• Chronic Disease
• Constipation/diagnostic imaging
• Constipation/physiopathology
• Constipation/therapy
• Feces
• Female
• Gases/metabolism
• Gastrointestinal Transit
• Humans
• Male
• Middle Aged

• Functional Gastrointestinal Disorders
• Laxatives
• Occult Constipation
• Pediatrics
• Rome III Criteria

• Abdominal Pain/epidemiology
• Abdominal Pain/pathology
• Child
• Child, Preschool
• Constipation/drug therapy
• Constipation/epidemiology
• Female
• Gastrointestinal Agents/therapeutic use
• Humans
• Lactulose/therapeutic use
• Laxatives/therapeutic use
• Logistic Models
• Male
• Odds Ratio
• Polyethylene Glycols/therapeutic use
• Prevalence
• Prospective Studies
• Severity of Illness Index

Objective. To investigate the effects and safety of the aqueous extract of the dried, immature fruit of Poncirus trifoliata (L.) Raf., known as Poncirus fructus (PF), in spinal cord injury (SCI) patients with neurogenic bowel. Methods. Thirty-one SCI patients with neurogenic bowel were recruited. Patients were evaluated based on clinical information, constipation score, Bristol Stool Form Scale, stool retention score using plain abdominal radiograph, and colon transit time. PF was administered in dosages of 800 mg each prior to breakfast and lunch for 14 days. Results. The morphological feature of the stool before and after administration indicated a statistically significant difference from 3.52 ± 1.33 to 4.32 ± 1.44 points (p < 0.05). Stool retention score before and after administration of PF was represented with low significance (7.25 ± 1.60 to 6.46 ± 1.53 points) in the whole colon (p < 0.05), and the colon transit time was significantly shortened (57.41 ± 20.7 to 41.2 ± 25.5 hours) in terms of the whole transit time (p < 0.05). Side effects were observed in 7 people (28.0%) consisting of 2 people with soft stools and 5 people with diarrhea. Conclusion. For SCI patients, PF administration significantly improved defecation patterns, defecation retention, and colon transit time. PF could be an effective aid to improve colonic motility and constipation.

• Abdominal Radiograph
• Gastroenterology

Colon transit time (CTT) is a useful diagnostic tool in chronic constipation, but requires good patient compliance. We analyzed the correlation between the gas volume score (GVS) and CTT in patients with chronic constipation.

The study included 145 consecutive patients (65 men) with chronic constipation. The primary outcome was the correlation between the colon GVS and CTT. Secondary outcomes were the differences in colon GVS according to CTT and subtypes of chronic constipation.

There were 81 patients with “CTT < 45 hours” and 64 patients with “CTT ≥ 45 hours.” In addition, 88 patients were classified as having functional constipation and 57 were classified as having constipation predominant irritable bowel syndrome (IBS-C). There was no significant correlation between CTT and colon GVS. However, the right colon GVS showed a positive correlation with right CTT (r = 0.255, P = 0.007). The median total colon GVS was significantly higher in patients with “CTT ≥ 45 hours” than in those with “CTT < 45 hours” (5.65% vs 4.15%, P = 0.010). There were no significant differences in colon GVS between the functional constipation and IBS-C.

We were unable to detect a correlation between GVS and CTT in patients with chronic constipation. However, total colon GVS may be a method of predicting slow transit in patients with chronic constipation.

• Colon
• Constipation
• Gastrointestinal transit
• Irritable bowel syndrome

To evaluate the diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction.

A total of 59 stroke patients were recruited and assigned into constipation or non-constipation group. Patients were interviewed to obtain clinical information, constipation score, and Bristol stool form scale. The total and segmental colon transit time (CTT) was measured using radio-opaque markers (Kolomark). The degree of stool retention was evaluated by plain abdominal radiography and scored by two different methods (Starreveld score and Leech score). The relationship between the clinical aspects, CTT, and stool retention score using plain abdominal radiography was determined.

Average constipation score was 4.59±2.16. Average Bristol stool form scale was 3.86±1.13. The total and segmental CTTs showed significant differences between the constipation and non-constipation groups. There was statistically significant (p<0.05) correlation between the total CTT and constipation score or between Starreveld score and Leech score. Each segmental CTT showed significant correlation (p<0.05) between segmental stool retention scores.

The stool retention score showed significant correlation with constipation score as well as total and segmental CTT. Thus, plain abdominal radiography is a simple and convenient method for the evaluation of bowel dysfunction in stroke patients.

• Abdominal radiography
• Colon transit time
• Constipation
• Stroke

• AXR
• Abdominal radiograph
• ED
• Emergency department

• Bowel and bladder dysfunction
• Constipation
• MiraLAX
• Overactive bladder
• Polyethylene glycol
• Urinary urgency

• Child
• Child, Preschool
• Constipation/drug therapy
• Double-Blind Method
• Female
• Humans
• Laxatives/therapeutic use
• Male
• Polyethylene Glycols/therapeutic use
• Surveys and Questionnaires
• Treatment Outcome
• Urinary Bladder, Overactive/drug therapy
• Urinary Incontinence, Urge/drug therapy

• UL1 TR001105 NCATS NIH HHS
• UL1RR024982 NCRR NIH HHS
• UL1 RR024982 NCRR NIH HHS
• KL2RR024983 NCRR NIH HHS
• KL2 TR001103 NCATS NIH HHS
• KL2 RR024983 NCRR NIH HHS

To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI).

Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography.

The constipation scores ranged from 1 to 13, and the average was 4.19±3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13±1.45. CTTs were 19.3±16.17, 19.3±13.45, 15.32±13.15, and 52.42±19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4±0.7, 1.8±0.86, 2.83±0.82, 2.14±1, and 10.19±2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28±0.7, 2.8±0.8, 2.35±0.85, and 8.45±1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05).

Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.

• Abdominal radiography
• Colon transit time
• Neurogenic bowel
• Spinal cord injuries