Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota

Background: Assess the effectiveness and safety of combination laxative therapy containing milk of magnesia, liquid paraffin and sodium picosulphate (Cremaffin-Plus®) in management of constipation, in patients with anal fissure/haemorrhoids/obstructive defecation syndrome (ODS).Methods: Patients visiting study site with complaints of constipation secondary to anal fissures/haemorrhoids/ODS, intended to receive combination laxative therapy (as per physicians’ discretion), were enrolled. Primary objectives were to assess the change in number of bowel movements per day and stool consistency; secondary objectives were to assess change in straining, physician global efficacy assessment, quality of life (PAC-QOL score), Constipation Symptoms (CSS), Fecal Incontinence Score (FIS), Patient Assessment of Constipation Symptoms (PAC-SYM) score, along with the Modified Longo Score (MODS) for ODS from baseline to end of 4 weeks. Safety, tolerability and treatment adherence were also assessed.Results: About 32 patients (anal fissure:19, haemorrhoids:5, ODS:8) met inclusion criteria. Significant improvement in stool frequency was observed in all patients pooled together (p=0.016); group wise, statistical significance was noted in patients of anal fissures. Stool consistency was improved in all patients pooled together (p<0.001); group wise, significant improvement was seen in patients of anal fissure and ODS. There was a significant improvement in straining noted in all patients pooled together (p=0.002). Significant reduction (p<0.001) was noted in all the symptom scores (CSS, FIS, PAC-SYM and PAC-QOL) from baseline to 4 weeks in all patients. About 51.44% reduction in MODS score was noted in patients with ODS.Conclusions: Improvement in stool frequency, consistency and straining was noted in all patients with constipation (with fissure/haemorrhoids/ODS) treated with Cremaffin-plus for 4-weeks, improving the quality of life. All patients showed good therapy adherence with better safety and tolerability profile.

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Faculty Opinions recommendation of The neuroactive potential of the human gut microbiota in quality of life and depression.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734997864.793556629 ◽

2019 ◽

Author(s):

Jae-Hyuk Yu ◽

HeeSoo Park

Keyword(s):

Quality Of Life ◽

Gut Microbiota ◽

Human Gut ◽

Human Gut Microbiota

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The neuroactive potential of the human gut microbiota in quality of life and depression

Nature Microbiology ◽

10.1038/s41564-018-0337-x ◽

2019 ◽

Vol 4 (4) ◽

pp. 623-632 ◽

Cited By ~ 294

Author(s):

Mireia Valles-Colomer ◽

Gwen Falony ◽

Youssef Darzi ◽

Ettje F. Tigchelaar ◽

Jun Wang ◽

...

Keyword(s):

Quality Of Life ◽

Gut Microbiota ◽

Human Gut ◽

Human Gut Microbiota

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Effect of fermented milk containing Lactobacillus casei strain Shirota on constipation-related symptoms and haemorrhoids in women during puerperium

Beneficial Microbes ◽

10.3920/bm2014.0076 ◽

2015 ◽

Vol 6 (3) ◽

pp. 253-262 ◽

Cited By ~ 11

Author(s):

T. Sakai ◽

H. Kubota ◽

A. Gawad ◽

L. Gheyle ◽

S. Ramael ◽

...

Keyword(s):

Quality Of Life ◽

Placebo Group ◽

Lactobacillus Casei ◽

Fermented Milk ◽

Stool Consistency ◽

Bowel Habit ◽

Natural Childbirth ◽

Probiotic Group ◽

Abdominal Symptoms

Constipation and haemorrhoids are common complaints after childbirth. The objective of this pilot study was to evaluate impact of fermented milk containing Lactobacillus casei strain Shirota (LcS) on stool consistency and frequency, constipation-related symptoms and quality of life, and incidence of haemorrhoids in women during puerperium. Forty women who had natural childbirth were randomised to group consuming either one bottle/day of fermented milk containing at least 6.5×109 cfu of LcS, or placebo, for 6 weeks after childbirth. Subjects filled in a diary on their bowel habits including number of bowel movement, stool consistency and incidence of haemorrhoids, and answered questionnaires on constipation-related symptoms (PAC-SYM) and quality of life (PAC-QOL) during the study period. The probiotic group showed the better scores on overall PAC-SYM (P=0.013), PAC-SYM subscales of abdominal symptoms (P=0.043) and rectal symptoms (P=0.031), and PAC-QOL satisfaction subscale (P=0.037) in comparison with the placebo group. In the probiotic group, two to four subjects experienced haemorrhoids during the first 3 weeks of treatment. The number decreased in week 4 and no one had haemorrhoids on most days in week 5-6. In the placebo group, on average four subjects had haemorrhoids from the beginning, and no obvious change was observed until week 6. No statistically significant effect was observed on stool consistency and frequency. The study products did not cause any adverse event in the subjects. Results of this study indicate that continuous consumption of fermented milk containing LcS might alleviate constipation-related symptoms, provide satisfactory bowel habit and result in earlier recovery from haemorrhoids in women during puerperium. Nonetheless, there are several limitations in interpretation of the results attributed to the study design, including lack of baseline data. Further study is required in order to confirm the efficacy.

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Rapid Changes in Laboratory Parameters and Early Response to Adalimumab: A Pooled Analysis From Patients With Ulcerative Colitis in Two Clinical Trials

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz031 ◽

2019 ◽

Vol 13 (9) ◽

pp. 1227-1233

Author(s):

Stephen Hanauer ◽

William J Sandborn ◽

Jean-Frederic Colombel ◽

Severine Vermeire ◽

Joel Petersson ◽

...

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Clinical Trials ◽

Rectal Bleeding ◽

Mucosal Healing ◽

Pooled Analysis ◽

Stool Frequency ◽

Categorical Variables ◽

Laboratory Parameters

Abstract Background and Aims The efficacy and safety of adalimumab for induction and maintenance of clinical remission in patients with moderately to severely active ulcerative colitis were demonstrated in the ULTRA 1 and 2 clinical trials. This post-hoc, pooled analysis evaluated early changes in laboratory parameters, Mayo subscores, mucosal healing, and health-related quality of life. Methods Mean changes in laboratory parameters including albumin, high-sensitivity C-reactive protein, total protein, haematocrit, haemoglobin, red blood cell and platelet counts, Inflammatory Bowel Disease Questionnaire, and Short Form 36 Health Survey were evaluated from baseline to Weeks 4 and 8. Mean changes in Mayo subscores of rectal bleeding and stool frequency were evaluated from baseline to Weeks 2, 4, 6, and 8. Mucosal healing was assessed with endoscopy at baseline and Week 8. Categorical variables were evaluated with the Cochran-Mantel-Haenszel test; continuous variables were evaluated with analysis of covariance and considered significant if p <0.05. Results Treatment with adalimumab significantly improved laboratory and quality-of-life measures at Weeks 4 and 8 compared with placebo [p <0.05 and p <0.001]. Mean reductions from baseline in rectal bleeding and stool frequency were significantly larger in patients receiving adalimumab compared with placebo at Week 2 and sustained through Week 8 [p <0.01]. Normal mucosa at Week 8 was achieved by 13% of patients receiving adalimumab compared with 6% of those receiving placebo [p <0.001]. Conclusions Adalimumab resulted in rapid improvements in laboratory markers and early reductions in rectal bleeding and stool frequency. Early improvement in quality-of-life scores correlated with the clinical and laboratory findings.

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Probiotics for constipation in Parkinson’s disease: A randomized placebo-controlled study

Neurology ◽

10.1212/wnl.0000000000010998 ◽

2020 ◽

pp. 10.1212/WNL.0000000000010998 ◽

Cited By ~ 1

Author(s):

Ai Huey Tan ◽

Shen-Yang Lim ◽

Kah Kian Chong ◽

Mohammad Addin Azhan A Manap ◽

Jia Wei Hor ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Placebo Group ◽

Treatment Group ◽

Fecal Calprotectin ◽

Stool Consistency ◽

Secondary Outcome ◽

Bowel Movements

Objective:To determine whether probiotics are effective for constipation, a common and often difficult-to-treat problem, in Parkinson’s disease (PD).Methods:In this double-blind, randomized placebo-controlled single-centre trial, 280 PD patients were screened and 72 eligible patients were block-randomized (1:1) to receive either multi-strain probiotics capsules (n=34), or identical-appearing placebo (n=38), for four weeks. The primary endpoint was the change in the average number of spontaneous bowel movements (SBM) per week during the last two weeks of intervention, compared with the two-week pre-intervention phase, recorded by daily stool diary. Secondary outcome measures included changes in stool consistency, constipation severity score, and quality of life related to constipation. Satisfaction with intervention received was assessed. Change in levels of fecal calprotectin, a marker of intestinal inflammation, was an exploratory outcome.Results:SBM increased by 1.0±1.2/week after treatment with probiotics, and decreased by 0.3±1.0/week in the placebo group (mean difference 1.3, 95%CI: 0.8-1.8, P<0.001). Significant improvements were also seen for secondary outcomes after correction for multiple comparisons, including stool consistency (P=0.009) and quality of life related to constipation (P=0.001). In the treatment group, 65.6% reported satisfaction with the intervention, vs. only 21.6% in the placebo group (P<0.001). One patient (2.9%) in the treatment group withdrew due to a non-serious adverse event. Fecal calprotectin did not change significantly during the study.Conclusions:Multi-strain probiotics treatment was effective for constipation in PD. Further studies are needed to investigate the long-term efficacy and safety of probiotics in PD, as well as their mechanisms of action.Classification of evidence:This study provides Class I evidence that for people with PD, multi-strain probiotics significantly increased the average number of spontaneous bowel movements per week.Clinicaltrials.gov identifier:NCT03377322

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Effect of a prebiotic supplement on knee joint function, gut microbiota, and inflammation in adults with co-morbid obesity and knee osteoarthritis: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05212-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rafael Fortuna ◽

David A. Hart ◽

Keith A. Sharkey ◽

Rachel A. Schachar ◽

Kelly Johnston ◽

...

Keyword(s):

Quality Of Life ◽

Morbid Obesity ◽

Gut Microbiota ◽

Knee Joint ◽

Systemic Inflammation ◽

Joint Replacement ◽

Health Clinic ◽

Joint Function ◽

Knee Oa

Abstract Background Osteoarthritis (OA) is a chronic and painful condition where the articular cartilage surfaces progressively degenerate, resulting in loss of function and progressive disability. Obesity is a primary risk factor for the development and progression of knee OA, defined as the “metabolic OA” phenotype. Metabolic OA is associated with increased fat deposits that release inflammatory cytokines/adipokines, thereby resulting in systemic inflammation which can contribute to cartilage degeneration. There is currently no cure for OA. Prebiotics are a type of dietary fiber that can positively influence gut microbiota thereby reducing systemic inflammation and offering protection of joint integrity in rodents. However, no human clinical trials have tested the effects of prebiotics in adults with obesity suffering from knee OA. Therefore, the purpose of this double-blind, placebo-controlled, randomized trial is to determine if prebiotic supplementation can, through positive changes in the gut microbiota, improve knee function and physical performance in adults with obesity and knee OA. Methods Adults (n = 60) with co-morbid obesity (BMI > 30 kg/m2) and knee OA (Kellgren-Lawrence grade II–III) will be recruited from the Alberta Hip and Knee Clinic and the Rocky Mountain Health Clinic and surrounding community of Calgary, Canada, and randomized (stratified by sex, BMI, and age) to prebiotic (oligofructose-enriched inulin; 16 g/day) or a calorie-matched placebo (maltodextrin) for 6 months. Anthropometrics, performance-based tests, knee pain, serum inflammatory markers and metabolomics, quality of life, and gut microbiota will be assessed at baseline, 3 months, 6 months (end of prebiotic supplementation), and 3 months following the end of the prebiotic supplementation. Clinical significance There is growing pressure on health care systems for aggressive OA treatment such as total joint replacement. Less aggressive, yet effective, conservative treatment options have the potential to address the growing prevalence of co-morbid obesity and knee OA by delaying the need for joint replacement or ideally preventing its need altogether. The results of this clinical trial will provide the first evidence regarding the efficacy of prebiotic supplementation on knee joint function and pain in adults with obesity and knee OA. If successful, the results may provide a simple, safe, and easy to adhere to intervention to reduce knee joint pain and improve the quality of life of adults with co-morbid knee OA and obesity. Trial registration Clinical Trials.gov NCT04172688. Registered on 21 November 2019.

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Intestinal Microbiota in Common Chronic Inflammatory Disorders Affecting Children

Frontiers in Immunology ◽

10.3389/fimmu.2021.642166 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anna Torun ◽

Anna Hupalowska ◽

Piotr Trzonkowski ◽

Jaroslaw Kierkus ◽

Beata Pyrzynska

Keyword(s):

Quality Of Life ◽

Immune System ◽

Gut Microbiota ◽

Autoimmune Diseases ◽

Pediatric Population ◽

Genetically Engineered ◽

Intestinal Microbiome ◽

Antigen Receptors ◽

Inflammatory Disorders

The incidence and prevalence rate of chronic inflammatory disorders is on the rise in the pediatric population. Recent research indicates the crucial role of interactions between the altered intestinal microbiome and the immune system in the pathogenesis of several chronic inflammatory disorders in children, such as inflammatory bowel disease (IBD) and autoimmune diseases, such as type 1 diabetes mellitus (T1DM) and celiac disease (CeD). Here, we review recent knowledge concerning the pathogenic mechanisms underlying these disorders, and summarize the facts suggesting that the initiation and progression of IBD, T1DM, and CeD can be partially attributed to disturbances in the patterns of composition and abundance of the gut microbiota. The standard available therapies for chronic inflammatory disorders in children largely aim to treat symptoms. Although constant efforts are being made to maximize the quality of life for children in the long-term, sustained improvements are still difficult to achieve. Additional challenges are the changing physiology associated with growth and development of children, a population that is particularly susceptible to medication-related adverse effects. In this review, we explore new promising therapeutic approaches aimed at modulation of either gut microbiota or the activity of the immune system to induce a long-lasting remission of chronic inflammatory disorders. Recent preclinical studies and clinical trials have evaluated new approaches, for instance the adoptive transfer of immune cells, with genetically engineered regulatory T cells expressing antigen-specific chimeric antigen receptors. These approaches have revolutionized cancer treatments and have the potential for the protection of high-risk children from developing autoimmune diseases and effective management of inflammatory disorders. The review also focuses on the findings of studies that indicate that the responses to a variety of immunotherapies can be enhanced by strategic manipulation of gut microbiota, thus emphasizing on the importance of proper interaction between the gut microbiota and immune system for sustained health benefits and improvement of the quality of life of pediatric patients.

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Faculty Opinions recommendation of The neuroactive potential of the human gut microbiota in quality of life and depression.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734997864.793566843 ◽

2019 ◽

Author(s):

Stanley Brul

Keyword(s):

Quality Of Life ◽

Gut Microbiota ◽

Human Gut ◽

Human Gut Microbiota

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A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients: A Systematic Review and Meta-Analysis

Frontiers in Nutrition ◽

10.3389/fnut.2021.683191 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jinsheng Wang ◽

Pengcheng Yang ◽

Lei Zhang ◽

Xiaohua Hou

Keyword(s):

Systematic Review ◽

Irritable Bowel Syndrome ◽

Meta Analysis ◽

Risk Of Bias ◽

Stool Frequency ◽

Stool Consistency ◽

Controlled Trials ◽

Irritable Bowel ◽

Fodmap Diet

Background: A low-fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet has been reported to be associated with improving the symptoms of irritable bowel syndrome (IBS); however, its efficacy as evaluated by different studies remains controversial.Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to explore the efficacy of a low-FODMAP diet (LFD) in alleviating the symptoms of IBS.Methods: A search of the literature for RCTs that assessed the efficacy of an LFD in treating IBS patients was conducted using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. The searches in each database were conducted from the inception of the database to February 2021. Two independent reviewers screened citations and a third reviewer resolved disagreements. Two independent reviewers also performed eligibility assessments and data extraction. The RCTs that evaluated LFDs vs. a normal IBS or usual diet and assessed changes of IBS symptoms were included in the search. Data were synthesized as the relative risk of global symptoms improvement, mean difference of IBS Severity Scoring System (IBS-SSS) score, sub-items of IBS-SSS irritable bowel syndrome-related quality of life (IBS-QOL), hospital anxiety and depression scale (HADS), stool consistency/frequency, and body mass index (BMI) using a random effects model. The risk of bias was assessed using Risk of Bias Tool 2 (RoB 2). The bias of publication was assessed based on Egger's regression analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results: A total of 2,768 citations were identified. After full-text screening, a total of 10 studies were eligible for the systematic review and were subsequently used to compare an LFD with various control interventions in 511 participants. An LFD was associated with the improvement of global symptoms [n = 420; Risk Ratio (RR) = 1.54; 95% Confidence Interval (CI) 1.18 to 2; I2 = 38%], improvement of stool consistency [n = 434; Mean difference (MD) = −0.25; 95% CI −0.44 to −0.06; I2= 19%), and a reduction trend of stool frequency (n = 434; MD = −0.28; 95% CI −0.57 to 0.01; I2 = 68%) compared with control interventions. There was no statistically significant change in IBS-QOL (n = 484; MD = 2.77; 95% CI −2 to 7.55; I2 = 62%), anxiety score (n = 150; MD = −0.45; 95% CI −3.38 to 2.49; I2 = 86%), depression score (n = 150; MD = −0.05; 95% CI −2.5 to 2.4; I2 = 88%), and BMI (n = 110; MD = −0.22; 95% CI −1.89 to 1.45; I2 = 14%). The overall quality of the data was “moderate” for “global improvement of IBS symptom,” “stool consistency,” “stool consistency for IBS with diarrhea (IBS-D),” and “stool frequency for IBS-D,” and “low” or “very low” for other outcomes according to GRADE criteria.Conclusion: An LFD is effective in reducing the global symptoms and improving the bowel habits of adult IBS patients. The efficacy for IBS-D patients can also be more pronounced.Systematic Review Registration: CRD42021235843.

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