Diagnosis of Functional Gastrointestinal Disorders and Choice of Treatment Regimen in Constipation Patients

Aim. A practical review of functional gastrointestinal disorder diagnosis in constipation patients and the rationale for opting treatment.Key points. Functional constipation commonly afflicts different ages and negatively impacts the quality of life. The current diagnostic algorithm in chronic constipation includes the disease identification according to Rome Criteria IV, red-flag symptom detection and instrumental laboratory examination. Functional constipation is notably often associated with anorectal abnormalities that bear a diagnostic value to elaborate an apt treatment strategy. Anorectal manometry, rectal sensation and balloon expulsion tests are the well-studied and significant probing techniques for objective anorectal zone sensorimotor function assessment in patients with functional constipation. The article reviews modern diagnostic methods in functional defecation disorders.Conclusion. The examination and treatment algorithms presented will help improve diagnosis and apply the most suitable management in a constipation-associated functional digestive pathology.

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Therapeutic Effects of Prebiotics on Constipation: A Schematic Review

Current Clinical Pharmacology ◽

10.2174/1574884715666200212125035 ◽

2020 ◽

Vol 15 (3) ◽

pp. 207-215 ◽

Cited By ~ 3

Author(s):

Maliha Naseer ◽

Shiva Poola ◽

Suleyman Uraz ◽

Veysel Tahan

Keyword(s):

Chronic Constipation ◽

English Language ◽

Functional Gastrointestinal Disorders ◽

Functional Constipation ◽

Gastrointestinal Disorder ◽

Therapeutic Effects ◽

Idiopathic Constipation ◽

Surgical Interventions ◽

Chronic Idiopathic Constipation ◽

Cognitive Therapies

Constipation is a highly prevalent functional gastrointestinal disorder that may significantly affect the quality of life and health care costs. Treatment for constipation has been broadly reviewed by cognitive therapies, medications, and surgical interventions. Gut microbiota such as Bifidobacterium, Clostridium, Bacteroidetes, and Lactobacilli have been demonstrated in functional gastrointestinal disorders and prebiotics to play a role in augmenting their presence. Prebiotics are ingredients in foods that remain undigested, stimulating the bacteria. There are a variety of prebiotics; however, there exists only a handful of studies that describe their efficacy for chronic constipation. The purpose of this study is to review the available literature on the utility of different commercially available prebiotics in patients with functional and chronic idiopathic constipation. To fulfil the objectives of the study, published articles in the English language on databases such as Pubmed, Ovid Medline, and EMBASE were searched. The terms prebiotics, constipation, chronic constipation, functional constipation were used. We reviewed and included 21 randomized controlled trials exploring the role of prebiotics in constipated adults. Prebiotics are effective treatments for chronic idiopathic constipation and showed improvement in the stool consistency, number of bowel moments and bloating. Although which prebiotic formulary would promote improved symptoms of constipation is still not clear.

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Diagnostics of functional disorders of the gastrointestinal tract in patients with constipation

Medical Council ◽

10.21518/2079-701x-2021-12-210-219 ◽

2021 ◽

pp. 210-219

Author(s):

A. N. Kazyulin ◽

A. A. Samsonov ◽

Yu. A. Kucheryavyy ◽

S. V. Cheremushkin ◽

A. V. Gilyuk

Keyword(s):

Gastrointestinal Tract ◽

Negative Impact ◽

Objective Assessment ◽

Age Groups ◽

Diagnostic Algorithm ◽

Functional Constipation ◽

Diagnostic Efficiency ◽

Functional Disorders ◽

Balloon Expulsion ◽

Balloon Expulsion Test

The purpose of the review is to acquaint general practitioners, therapists, gastroenterologists with the possibilities of diagnosing functional disorders of the gastrointestinal tract associated with constipation, as well as to draw attention to the need for additional examination methods for a comprehensive assessment of functional disorders of the gastrointestinal tract in patients with constipation on pathogenesis.Functional constipation is an urgent problem today due to its prevalence among different age groups, a negative impact on the quality of life, as well as the variability of the clinical forms of diseases associated with this symptom. The modern diagnostic algorithm for chronic constipation consists of several stages, including the identification of signs of the disease, according to the Rome criteria of the IV revision (2016), the identification of symptoms of “red flags” and laboratory and instrumental research. It should be borne in mind that functional constipation is often based on the pathology of the anorectal zone, which is an important factor in the diagnosis and development of further therapeutic strategies. The article provides an overview of modern and promising methods for diagnosing functional disorders of defecation, taking into account functional disorders of the anorectal zone associated with constipation.Functional methods such as anorectal manometry, rectal sensory test and balloon expulsion test are the most studied and obligatory tests for an objective assessment of the sensorimotor function of the anorectal zone. In Russia, these methods are used very little, which requires extensive familiarization of practitioners with the advantages of these techniques. Knowledge and application of the presented examination algorithms will help the clinician to increase the overall diagnostic efficiency and apply the most justified tactics of managing patients with functional pathology of the digestive system associated with constipation.

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Diagnostic aspects of closed abdominal injuries

Kazan medical journal ◽

10.17750/kmj2016-892 ◽

2016 ◽

Vol 97 (6) ◽

pp. 892-897

Author(s):

I S Malkov ◽

V A Filippov ◽

V N Korobkov ◽

Kh M Khalilov ◽

M R Tagirov ◽

...

Keyword(s):

Abdominal Trauma ◽

Diagnostic Algorithm ◽

Diagnostic Value ◽

Diagnostic Techniques ◽

Diagnostic Methods ◽

Abdominal Injury ◽

Abdominal Injuries ◽

Surgical Department ◽

Abdominal Organs ◽

Radiologic Study

Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.

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Diagnosis and treatment of non-allergic rhinitis

Russian otorhinolaryngology ◽

10.18692/1810-4800-2020-4-27-33 ◽

2020 ◽

Vol 19 (4) ◽

pp. 27-33

Author(s):

M. A. Zavaliy ◽

◽

T. A. Krylova ◽

A. N. Orel ◽

A. G. Balabantsev ◽

...

Keyword(s):

Allergic Rhinitis ◽

Diagnostic Algorithm ◽

The United States ◽

Diagnostic Value ◽

Evidence Base ◽

Convincing Evidence ◽

Diagnostic Methods ◽

Chronic Rhinitis ◽

Icd 10 ◽

Non Allergic Rhinitis

There is considerable disagreement in the views on the problem of rhinitis, which concerns classification issues, as well as the role and place of various treatment methods. There are no official statistics on non-allergic rhinitis in Russia yet, due to the absence of certain types of rhinitis in the ICD-10. The prevalence of non-allergic rhinitis is one third of the prevalence of allergic rhinitis, involving, for example, in the United States about 7% of the population. Against the background of a convincing evidence base and well-structured international reference documents for allergic rhinitis, other forms of rhinitis, especially non-allergic rhinitis, remain almost “white” spots in medicine, and this leads to numerous errors in the therapeutic approach to this disease. The purpose of this scientific study was to justify the conduct of pathogenic therapy of patients with chronic non-allergic rhinitis by using the differential diagnostic algorithm to establish the etiology of chronic rhinitis. The article formulates a treatment and diagnostic algorithm based on summation of the examination results of 1040 patients with chronic rhinitis. The prevalence and comorbidity of non-allergic rhinitis was determined, the diagnostic value for patients with pseudo-allergic rhinitis of various diagnostic methods (nasocytogramma, prik-test with allergens, biochemical markers of various types of pseudo-allergic rhinitis) was analyzed, and treatment approaches are systematized.

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Diagnostic Value of Non-Invasive Prenatal Screening of β-thalassemia by Cell Free Fetal DNA and Fetal NRBC

Current Molecular Medicine ◽

10.2174/1566524019666190226124135 ◽

2019 ◽

Vol 19 (2) ◽

pp. 105-111

Author(s):

Nadia Shafei ◽

Mohammad Saeed Hakhamaneshi ◽

Massoud Houshmand ◽

Siavash Gerayeshnejad ◽

Fardin Fathi ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Multiple Displacement Amplification ◽

Diagnostic Value ◽

Diagnostic Methods ◽

Beta Thalassemia ◽

Non Invasive ◽

Fetal Dna ◽

Prenatal Diagnostic ◽

Cell Free Fetal Dna ◽

Invasive Techniques

Background: Beta thalassemia is a common disorder with autosomal recessive inheritance. The most prenatal diagnostic methods are the invasive techniques that have the risk of miscarriage. Now the non-invasive methods will be gradually alternative for these invasive techniques. Objective: The aim of this study is to evaluate and compare the diagnostic value of two non-invasive diagnostic methods for fetal thalassemia using cell free fetal DNA (cff-DNA) and nucleated RBC (NRBC) in one sampling community. Methods: 10 ml of blood was taken in two k3EDTA tube from 32 pregnant women (mean of gestational age = 11 weeks), who themselves and their husbands had minor thalassemia. One tube was used to enrich NRBC and other was used for cff-DNA extraction. NRBCs were isolated by MACS method and immunohistochemistry; the genome of stained cells was amplified by multiple displacement amplification (MDA) procedure. These products were used as template in b-globin segments PCR. cff-DNA was extracted by THP method and 300 bp areas were recovered from the agarose gel as fetus DNA. These DNA were used as template in touch down PCR to amplify b-globin gen. The amplified b-globin segments were sequenced and the results compared with CVS resul. Results: The data showed that sensitivity and specificity of thalassemia diagnosis by NRBC were 100% and 92% respectively and sensitivity and specificity of thalassemia diagnosis by cff-DNA were 100% and 84% respectively. Conclusion: These methods with high sensitivity can be used as screening test but due to their lower specificity than CVS, they cannot be used as diagnostic test.

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Functional gastrointestinal disorders in children: agreement between Rome III and Rome IV diagnoses

European Journal of Pediatrics ◽

10.1007/s00431-021-04013-2 ◽

2021 ◽

Author(s):

Desiree F. Baaleman ◽

Carlos A. Velasco-Benítez ◽

Laura M. Méndez-Guzmán ◽

Marc A. Benninga ◽

Miguel Saps

Keyword(s):

Diagnostic Criteria ◽

Functional Dyspepsia ◽

Functional Gastrointestinal Disorders ◽

Functional Constipation ◽

Final Analysis ◽

Gastrointestinal Disorders ◽

Rome Iii ◽

Sample Characteristics ◽

Irritable Bowel ◽

Rome Iv

AbstractTo evaluate the agreement between the Rome III and Rome IV criteria in diagnosing pediatric functional gastrointestinal disorders (FGIDs), we conducted a prospective cohort study in a public school in Cali, Colombia. Children and adolescents between 11 and 18 years of age were given the Spanish version of the Questionnaire on Pediatric Functional Gastrointestinal Disorders Rome III version on day 0 and Rome IV version on day 2 (48 h later). The study protocol was completed by 135 children. Thirty-nine (28.9%) children were excluded because of not following the instructions of the questionnaire. The final analysis included data of 96 children (mean 15.2 years old, SD ± 1.7, 54% girls). Less children fulfilled the criteria for an FGID according to Rome IV compared to Rome III (40.6% vs 29.2%, p=0.063) resulting in a minimal agreement between the two criteria in diagnosing an FGID (kappa 0.34, agreement of 70%). The prevalence of functional constipation according to Rome IV was significantly lower compared to Rome III (13.5% vs 31.3%, p<0.001), whereas functional dyspepsia had a higher prevalence according to Rome IV than Rome III (11.5% vs 0%).Conclusion: We found an overall minimal agreement in diagnosing FGIDs according to Rome III and Rome IV criteria. This may be partly explained by the differences in diagnostic criteria. However, limitations with the use of questionnaires to measure prevalence have to be taken into account. What is Known:• The Rome IV criteria replaced the previous Rome III criteria providing updated criteria to diagnose functional gastrointestinal disorders (FGIDs).• Differences found between Rome IV and historic Rome III FGID prevalence may have been affected by changes in prevalence over time or differences in sample characteristics. What is New:• We found a minimal agreement between Rome III and Rome IV FGID diagnosis, especially in the diagnoses of functional constipation, irritable bowel syndrome, and functional dyspepsia.• The minimal agreement may be partly explained by changes in diagnostic criteria, but limitations with the use of questionnaires to measure prevalence have to be taken into account.

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Prevalence of functional gastrointestinal disorders in infants and young children in China

BMC Pediatrics ◽

10.1186/s12887-021-02610-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying Huang ◽

Serene Yaling Tan ◽

Panam Parikh ◽

Vanitha Buthmanaban ◽

Shaman Rajindrajith ◽

...

Keyword(s):

Young Children ◽

Maternal Education ◽

Functional Gastrointestinal Disorders ◽

Gastrointestinal Symptoms ◽

Functional Constipation ◽

Gastrointestinal Disorders ◽

Cross Sectional ◽

Validated Questionnaire ◽

Rome Iv ◽

Infants And Young Children

Abstract Background The prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China. Methods A prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0–4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria. Results According to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0–6 months old while functional constipation (7.0%) was the most common among the 1–4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally. Conclusions Infantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children. Trial registration Netherlands Trial Registry Identifier: NL6973/NTR7161.

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Clostridioides difficile Infection, Still a Long Way to Go

Journal of Clinical Medicine ◽

10.3390/jcm10030389 ◽

2021 ◽

Vol 10 (3) ◽

pp. 389

Author(s):

Eleftheria Kampouri ◽

Antony Croxatto ◽

Guy Prod’hom ◽

Benoit Guery

Keyword(s):

Fecal Microbiota Transplantation ◽

Diagnostic Algorithm ◽

Fecal Microbiota ◽

Diagnostic Methods ◽

Special Focus ◽

Surveillance Systems ◽

Main Question ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

The Right

Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them.

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Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

Respiration ◽

10.1159/000515664 ◽

2021 ◽

pp. 1-11

Author(s):

Xinxin Zhi ◽

Junxiang Chen ◽

Lei Wang ◽

Fangfang Xie ◽

Xiaoxuan Zheng ◽

...

Keyword(s):

Lymph Nodes ◽

Multimodal Imaging ◽

Single Mode ◽

Diagnostic Value ◽

Diagnostic Methods ◽

Endobronchial Ultrasound ◽

Diagnostic Efficiency ◽

Validation Group ◽

Model Group ◽

Structure Heterogeneity

Background: Endobronchial ultrasound (EBUS) imaging is valuable in diagnosing intrathoracic lymph nodes (LNs), but there has been little analysis of multimodal imaging. This study aimed to comprehensively compare the diagnostic performance of single and multimodal combinations of EBUS imaging in differentiating benign and malignant intrathoracic LNs. Methods: Subjects from July 2018 to June 2019 were consecutively enrolled in the model group and July 2019 to August 2019 in the validation group. Sonographic features of three EBUS modes were analysed in the model group for the identification of malignant LNs from benign LNs. The validation group was used to verify the diagnostic efficiency of single and multimodal diagnostic methods built in the model group. Results: 373 LNs (215 malignant and 158 benign) from 335 subjects and 138 LNs (79 malignant and 59 benign) from 116 subjects were analysed in the model and validation groups, respectively. For single mode, elastography had the best diagnostic value, followed by grayscale and Doppler. The corresponding accuracies in the validation group were 83.3%, 76.8%, and 71.0%, respectively. Grayscale with elastography had the best diagnostic efficiency of multimodal methods. When at least two of the three features (absence of central hilar structure, heterogeneity, and qualitative elastography score 4–5) were positive, the sensitivity, specificity, and accuracy in the validation group were 88.6%, 78.0%, and 84.1%, respectively. Conclusions: In both model and validation groups, elastography performed the best in single EBUS modes, as well as grayscale combined with elastography in multimodal imaging. Elastography alone or combined with grayscale are feasible to help predict intrathoracic benign and malignant LNs.

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The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America

BMJ Global Health ◽

10.1136/bmjgh-2018-001069 ◽

2018 ◽

Vol 3 (5) ◽

pp. e001069 ◽

Cited By ~ 21

Author(s):

Albert Picado ◽

Israel Cruz ◽

Maël Redard-Jacot ◽

Alejandro G Schijman ◽

Faustino Torrico ◽

...

Keyword(s):

Latin America ◽

Chagas Disease ◽

Diagnostic Algorithm ◽

Diagnostic Methods ◽

Diagnosis And Treatment ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Molecular Tests ◽

Epidemiological Impact ◽

And Performance

It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.

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