Overlap Between Constipation and Gastroesophageal Reflux Disease in Japan: Results From an Internet Survey

Naotaka Ogasawara,Yasushi Funaki,Kunio Kasugai,Masahide Ebi,Yasuhiro Tamura,Shinya Izawa,Makoto Sasaki 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.2

Background/AimsDetailed evaluations of overlapping constipation and gastroesophageal reflux disease (GERD) have not been conducted in Japan. The REACTION-J2 study examined the overlap of these diseases in Japan. MethodsThis internet-based survey recruited participants from general public survey panels. Questions included demographic and medical data and assessments based on validated measures for constipation and GERD. Associations between background factors affecting constipation/GERD overlap, disease measures, and treatment were also evaluated. ResultsAmong 10 000 survey responses received, functional constipation (Rome IV diagnostic criteria) was reported by 439 participants; chronic constipation (Japanese guidelines) by 3804 participants; and subjective constipation symptoms by 2563 participants. The number of participants with constipation/GERD overlap ranged from 73 to 1533 depending on the criteria used. Regardless of the definition used, all GERD groups had significantly higher odds of being constipated than non-GERD participants: the OR (95% CI) for all 9 combinations of definitions ranged between 1.56 (1.21, 2.01) and 2.67 (2.44, 2.92) (all P ≤ 0.001). Straining, hard stools, and sensations of incomplete evacuation and anorectal obstruction/blockage, according to chronic constipation criteria, were common. Participants with constipation/GERD overlap had poorer quality of life (P < 0.001) and worse GERD symptom scores (P < 0.001). The frequency of abnormal stools was highest (P < 0.001) in the constipation/GERD overlap group. In the overlap group, 52.4% and 26.0% used gastric and constipation medication, respectively. ConclusionIndividuals with constipation/GERD overlap tend to have worsened symptoms and quality of life.

변비(便秘)에 관(關)한 동서의학적(東西醫學的) 고찰(考察)

류봉하,조남희,Ryu, Bong-Ha,Cho, Nam-Hee 대한한방내과학회 2000 大韓韓方內科學會誌 Vol.21 No.1

Objectives : To satisfy the demand of good treatment of constipation Methods : we investigated the literatures of Oriental Medicine about Constipation. Results: 1. There are three categories of etimological factors of constipation, that is, endogenous, exogenous and non-exo-endogenous factor. The endogenous factor is caused by seven emotions, called depression of Ki and stagnation of Ki. The exogenous factor is six excessive atmospheric influences, for example, wind, cold, dampness, heat and dryness. And the non-exo-endogenous factors are overfatigue, improper diet, stagnated blood and deficiency of Ki and blood that comes from old age, long disease and after delivery. 2. Classification: According to cause of disease it is classified by constipation due to cold, heat, wind, dryness, retention of undigested and phlegm. According to Internal Organs there are constipation due to deficiency syndrome of the stomach, excess syndrome of the stomach, deficiency syndrome of kidney and splenic constipation. And Differentiation of syndromes according to Ki and blood, there are constipation of deficiency type and excess type. There are constipation due to stagnation and deficiency of Ki, deficiency of blood and stagnated blood. 3. Principles and Methods of treatment 1) Herbal Medicine (1) Excess type [1] Constipation due to heat : Seunggitang(承氣湯) and Majainwhan(麻子仁丸) [2] Constipation due to stagnation of Ki : Samatang(四磨湯) and Yukmatang(六磨湯) (2) Deficiency type [1] Constipation due to deficiency of Ki : Whanggitang(黃?湯) [2] Constipation due to deficiency of blood: Yunjangwhan(潤腸丸) [3] Constipation due to cold : Jechunjun(濟川煎) and Banyuwhan(半硫丸) 2) Enema therapy: It is a method to induce defecation by honey or pig's bile juice for weak people. 3) Acupuncture and Moxibustion: Acupoints used to treat constipation are BL25, ST25 and TE6. Moxibustion at CV8, CV6 is good for constipation due to cold. (4) Diet therapy: It is very important that we eat meals regularly and defecate on the same time even if you don't. And we have to eat food like fruits, vegetables and beans. (5) finger pressure: Finger pressing around these points like ST25, SP25, BL25, BL31, BL32, BL33 and BL34 is good for it. (6) Kigong therapy: Abdominal breathing (7) Old man' s constipation: Hip bath or diet therapy is commended. Laxation with lubricant like Supungyunjangwhan(搜風潤腸丸) is used. (8) Women' s constipation: After delivery, we have to administer tonifying prescription Sipjundaebotang(十全大補湯) and enema can be used. Conclusion : We have to examine the cause of disease and bowl movement carefully. After comprehensive analysis of the data gained by the four methods of diagnosis, we diagnose and treat patients on the base of overall of symptoms and signs.

변비의 분류와 치료

성인경 ( In Kyung Sung ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.1

Constipation is a common symptom affecting 2-27% of general population in Western countries. According to a population-based study on bowel habits in a Korean community, the prevalence was 16.5% for self-reported constipation and 9.2% for functional constipation. There is a broad range of causes for constipation. There are three subtypes in functional constipation, although overlap is not uncommon. Physiologic studies such as colonic transit test, anorectal manometry, balloon expulsion test, and defecography can be helpful in further evaluating and classifying functional constipation. Slow transit constipation is characterized by prolongation of transit time throughout the colon, caused by either myopathy or neuropathy. Functional defecation disorder is characterized as an inability to initiate defecation following the urge to do so, a feeling of incomplete evacuation, tenesmus, excessive straining or manual evacuation. Normal transit constipation is the most common subtype and characterized by constipation occurring in the presence of normal colonic transit time and normal defecatory function. It is important for clinicians to choose appropriate treatment for constipation which are most efficacious for the individual patient. Most patients with functional constipation respond to laxatives, but a small proportion may be resistant to this treatment. In patients with functional defecation disorder, biofeedback is helpful. Sacral nerve stimulation may be helpful in some patients with slow transit constipation. Patients who are resistant to all the conservative modalities may require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit time is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent defecatory disorder. (Korean J Gastroenterol 2008;51:4-10)

Constipation is Closely Associated with Depression in Patients with End-Stage Renal Disease Undergoing Hemodialysis or Peritoneal Dialysis

( So Yeon Choi ),( Min Ok Kim ),( Hyun Ju Choi ),( Soon Kil Kwon ),( Hyun Jung Kim ),( Hyun Jeong Baek ),( Eun Hee Jang ),( Su In Yoon ),( Hye Young Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Purpose: Constipation is a frequent complaint among dialysis patients. However, factors that contribute to constipation in these patients have not been evaluated rigorously. The aim of study was to assess the prevalence and factors that contribute to constipation in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) or peritoneal dialysis (PD). Methods: Patients undergoing HD or PD for more than six months in the six dialysis centers were asked to complete a self-administered questionnaire that is designed to assess constipation by Rome-III criteria. Beck depression inventory (BDI) were assessed. A total of 146 patients (HD 91, PD 55) completed the study. Results: The prevalence of constipation was 33% in 91 HD patients and 31% in 55 PD patients. Prevalence of constipation was 32% and did not differ by dialysis mode. Older age, unemployed state, high cumulative illness rating scale and high BDI were associated with constipation. In multivariate analysis, BDI was an independent factor associated with constipation. The prevalence of constipation was 18% and 50% for patients with BDI <15 and ≥15, respectively. The odd ratio for constipation in patients with BDI ≥15 was 3.4 (95% CI, 1.4-8.1). Conclusion: Careful psychogenic attention must be paid to ESRD patients with constipation.

변비의 치료

박무인 ( Moo In Park ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5

Constipation is a common gastrointestinal disease affecting approximately 16.5% of the population in Korea. Systemic diseases such as hypothyroidism or colon cancer and drugs can cause constipation in some patients with constipation, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. Evaluation for secondary causes of constipation is needed to provide appropriate management. Once secondary causes have been excluded, constipation may be classified into normal or slow transit constipation, evacuation disorder of the spastic or flaccid varieties, or both. Treatment of chronic constipation based on the underlying pathophysiology is generally successful. The aims of this review are to discuss the management of functional constipation based on guidelines for the treatment of constipation published in Korean Journal of gastroenterology in 2011: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents such as 5-hydroxytryptamine-4 receptor agonists, intestinal secretagogues, and peripheral opioid antagonists could be effective in patients with constipation who cannotget adequate relief from current laxatives. Biofeedback could relieve symptoms in selected patients with constipation due to pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation.

Effect of Physical Activity on the Association Between Diet and Constipation: Evidence From the National Health and Nutrition Examination Survey 2007-2010

Shijun Lai,Changdong Zhu,Xiaoqing Zhou,Qingfeng Zeng,Lihua Huang,Xiaodong Cao,Qiang Zhou,Yuhua Zhong,Jinjing Huang,Guifang Zeng,Hong Chen 대한소화기 기능성질환∙운동학회 2024 Journal of Neurogastroenterology and Motility (JNM Vol.30 No.3

Background/AimsPrevious studies have shown that diet and physical activity can influence constipation. However, the combined effect of diet and physical activity on constipation remains unclear. MethodsConstipation was defined based on stool consistency and frequency, while overall diet quality was assessed using Healthy Eating Index (HEI)-2015 scores. Participants were categorized into low (metabolic equivalent [MET]-min/wk < 500) and high physical activity groups (MET-min/wk ≥ 500). The association between diet and constipation across physical activity groups was analyzed using survey logistic regression and restricted cubic splines. ResultsHigher HEI-2015 scores were associated with reduced constipation risk in the high physical activity group when constipation was defined by stool consistency (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99). However, in the low physical activity group, increased HEI-2015 scores did not significantly affect constipation risk (OR, 1.01; 95% CI, 0.97-1.05). Similar results were found when constipation was defined based on stool frequency. In the high physical activity group, increased HEI-2015 scores were significantly associated with a reduced constipation risk (OR, 0.96; 95% CI, 0.94-0.98). Conversely, in the low physical activity group, increased HEI-2015 scores did not affect the risk of constipation (OR, 0.96; 95% CI, 0.90-1.03). ConclusionsOur findings suggest that a higher HEI-2015 score is negatively associated with constipation among individuals with high physical activity levels but not among those with low physical activity levels. This association was consistent when different definitions of constipation were used. These results highlight the importance of combining healthy diet with regular physical activity to alleviate constipation.

소아 배뇨장애 환자에서 변비에 대한 보호자 진술의 의미

김아영,이혜영,홍창희,한상원 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.5

Purpose: Dysfunctional voiding is closely related to constipation, and accurate evaluation of constipation is important. We investigated the accuracy and reliability of several methods that are used to evaluate constipation. Materials and Methods: We collected data from the parents of 168 dysfunctional voiders, and the data was collected using the Bristol stool form scale and the Leech method. We then analyzed the results of the questionnaire and compared them with the Paris Consensus on Childhood Constipation Terminology(PACCT). Results: Among the 168 dysfunctional voiders, 71(42%) were diagnosed with constipation according to PACCT. Of the 39 children who were considered constipated, none were constipated according to PACCT. However, 35 of the 129 children whose parents denied they were constipation were in fact diagnosed with constipation. When the Leech method and the Bristol stool form scale were both used, the sensitivity of diagnosis rose to as high as 75%, and when the statement of the guardian was added, the sensitivity rose to as high as 85%. Conclusions: Since constipation can be a rather subjective condition, it would be appropriate to respect and incorporate the parents' statement into the diagnosis. However, for making a more accurate diagnosis, comprehensive evaluation based on specific symptoms and the Bristol stool form scale and the Leech method may be helpful. (Korean J Urol 2008;49:439-442) Purpose: Dysfunctional voiding is closely related to constipation, and accurate evaluation of constipation is important. We investigated the accuracy and reliability of several methods that are used to evaluate constipation. Materials and Methods: We collected data from the parents of 168 dysfunctional voiders, and the data was collected using the Bristol stool form scale and the Leech method. We then analyzed the results of the questionnaire and compared them with the Paris Consensus on Childhood Constipation Terminology(PACCT). Results: Among the 168 dysfunctional voiders, 71(42%) were diagnosed with constipation according to PACCT. Of the 39 children who were considered constipated, none were constipated according to PACCT. However, 35 of the 129 children whose parents denied they were constipation were in fact diagnosed with constipation. When the Leech method and the Bristol stool form scale were both used, the sensitivity of diagnosis rose to as high as 75%, and when the statement of the guardian was added, the sensitivity rose to as high as 85%. Conclusions: Since constipation can be a rather subjective condition, it would be appropriate to respect and incorporate the parents' statement into the diagnosis. However, for making a more accurate diagnosis, comprehensive evaluation based on specific symptoms and the Bristol stool form scale and the Leech method may be helpful. (Korean J Urol 2008;49:439-442)

만성 변비 환하에서 대장 통과 시간

최제은,최임정,이정아,김성미,정진화,이정호 대한소아과학회 2001 小兒科 Vol.44 No.7

원저 : 커피관장이 변비정도의 변화 및 만족도에 미치는 영향

송미영 ( Mi Young Song ),김호준 ( Ho Jun Kim ),이명종 ( Myung Jong Lee ) 한방비만학회 2005 한방비만학회지 Vol.5 No.1

Background and Objectives : Constipation is a common digestive disorder and enema is one of the external intervention for constipation. Coffee enema was originated by Dr. Gerson for the purpose of colon cleansing and detoxification. However there has been no study about the effect of coffee enema on constipation. Therefore, this study was planned to evaluate the effect of coffee enema on constipation in the terms of constipation degree and satisfaction questionnaire. Methods : 42 patients were treated of the coffee enema 2 times a week. The constipation score(Constipation Assessment Scale) and frequency of defecation were checked 3 times (before treatment, 1 week and 1 month later). The satisfaction score was also checked 1 week and 1 month later. The interval differences of constipation score between pre- and post-treatment according to body mass index were also analyzed. Results and Conclusions : The constipation scores, frequency of defecation scores checked 1 week and 1 month later were significantly(p<0.01) improved as compared with those before the treatment. The satisfaction scores were close to "moderately satisfied" 1 week and 1 month later. The scores of 6 parameters in constipation assessment scale, frequency of defecation scores and satisfaction scores were maintained until 1 month later. There was no significant difference in the change of constipation scores between normal BMI and overweight group. 4.2% of the patients reported adverse effects, which were nausea, abdominal distension each.

Influence of Age and Body Mass Index on Total and Segmental Colonic Transit Times in Constipated Subjects

Michel Bouchoucha,Marinos Fysekidis,Pierre Rompteaux,Gheorge Airinei,Jean-Marc Sabate,Robert Benamouzig 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.2

Background/Aims Discordant data are found in the literature for the relationships between total and segmental colonic transit time (CTT) and demographic parameters. The aim of this study is to examine the influence of age, and body mass index (BMI) on total and segmental CTT in constipated subjects. Methods We included 354 constipated patients on this cross-sectional study. According to the Rome III criteria, patients were classified as having irritable bowel syndrome with constipation, or functional constipation. All patients filled the Bristol stool form, and reported the severity of constipation, bloating, and abdominal pain on a 10-point Likert scale. Total and segmental CTT were measured using radiopaque markers. Results Females were 84% of patients, with a mean age of 46.0 ± 15.9 years. The association between total and segmental CTT with age and BMI was significant after adjustment for gender, clinical phenotype, the presence of defecation disorders, and abdominal pain or bloating intensity despite the severity of symptoms, and the frequency of defecation disorders were higher in irritable bowel syndrome with constipation than in functional constipation patients. By comparison with subjects less than 30 years, rectosigmoid transit time (RSTT) was lower in patients between 30 and 60 years. Age was negatively associated with RSTT (P = 0.004). By comparison with patients with normal BMI, RSTT and total CTT were lower in patients of the overweight group. BMI was negatively associated with RSTT (P < 0.001). The severity of constipation was correlated with total (P < 0.001), right (P = 0.002), and left CTT (P = 0.049). Conclusion Age and BMI are both associated with RSTT in constipated patients. Background/Aims Discordant data are found in the literature for the relationships between total and segmental colonic transit time (CTT) and demographic parameters. The aim of this study is to examine the influence of age, and body mass index (BMI) on total and segmental CTT in constipated subjects. Methods We included 354 constipated patients on this cross-sectional study. According to the Rome III criteria, patients were classified as having irritable bowel syndrome with constipation, or functional constipation. All patients filled the Bristol stool form, and reported the severity of constipation, bloating, and abdominal pain on a 10-point Likert scale. Total and segmental CTT were measured using radiopaque markers. Results Females were 84% of patients, with a mean age of 46.0 ± 15.9 years. The association between total and segmental CTT with age and BMI was significant after adjustment for gender, clinical phenotype, the presence of defecation disorders, and abdominal pain or bloating intensity despite the severity of symptoms, and the frequency of defecation disorders were higher in irritable bowel syndrome with constipation than in functional constipation patients. By comparison with subjects less than 30 years, rectosigmoid transit time (RSTT) was lower in patients between 30 and 60 years. Age was negatively associated with RSTT (P = 0.004). By comparison with patients with normal BMI, RSTT and total CTT were lower in patients of the overweight group. BMI was negatively associated with RSTT (P < 0.001). The severity of constipation was correlated with total (P < 0.001), right (P = 0.002), and left CTT (P = 0.049). Conclusion Age and BMI are both associated with RSTT in constipated patients.