Risk Factors for Opioid-induced Constipation in Cancer Patients: a Single-institution, Retrospective Analysis

Purpose: To identify risk factors for opioid-induced constipation (OIC).Methods: This study retrospectively analysed 175 advanced cancer patients who were receiving pain treatment with opioids and were newly prescribed laxatives for OIC at Seirei Hamamatsu General Hospital between November 2016 and June 2021. For the regression analysis of factors associated with OIC, variables were extracted manually from medical charts. The effect of laxatives was evaluated 3 days after administration. The effect of laxatives was evaluated based on whether the OIC was improved. The OIC was defined based on Rome IV diagnostic criteria. Multivariate ordered logistic regression analysis was performed to identify risk factors for OIC. Optimal cut-off thresholds were determined using receiver operating characteristic analysis. Values of P < 0.05 (two-tailed) were considered significant. Results: Significant factors identified included body mass index (BMI) (odds ratio [OR] = 0.141, 95% confidence interval [CI] = 0.027–0.733; P = 0.020), chemotherapy with taxane within 1 month of evaluation of laxative effect (OR = 0.255, 95%CI = 0.068–0.958; P = 0.043), use of naldemedine (OR = 2.791, 95%CI = 1.220–6.385; P = 0.015) and addition or switching due to insufficient prior laxatives (OR = 0.339, 95%CI = 0.143–0.800; P = 0.014).Conclusion: High BMI, chemotherapy including a taxane within 1 month of evaluation of laxative effect, no use of naldemedine and addition or switching due to insufficient prior laxatives were identified as risk factors for OIC in advanced cancer patients with cancer pain.

Laxative Effects of a Standardized Extract of Dendropanax morbiferus H. Léveille Leaves on Experimental Constipation in Rats

Background and Objectives: This study aimed at investigating the laxative effects of a standardized aqueous extract of Dendropanax morbiferus H. Lév. on two different constipation rat models. Materials and Methods: Animal studies were conducted with low-fiber diet-induced and loperamide-induced constipation animal models, and isolated colons were used in ex vivo analysis to determine the changes in colonic motility caused by D. morbiferus H. Lév. leaf extract (DPL). Results: The results showed that DPL administration significantly improved certain reduced fecal parameters (number, weight, and water content of the stools) in a both low-fiber diet and loperamide-induced constipation models without adverse effects of diarrhea. The laxative effect of DPL was confirmed to improve the charcoal excretion time upon DPL treatment in a low-fiber diet or loperamide-induced constipation model through gastrointestinal (GI) motility evaluation using the charcoal meal test. In addition, when DPL was administered to RAW264.7 cells and loperamide-induced constipation model rats, the production of prostaglandin E2 (PGE2) increased significantly in cells and tissue. Furthermore, DPL dose-dependently stimulated the spontaneous contractile amplitude and frequency of the isolated rat colon. Conclusion: Although our study did not provide information on the acute or chronic toxicity of DPL, our results demonstrated that DPL can effectively promote defecation frequency and rat colon contraction, providing scientific evidence to support the use of DPL as a therapeutic application. However, further toxicity studies of DPL are needed prior to the initiation of clinical trials and clinical applications.

Raisins with clarified butter or ghee for the relief of acute and chronic constipation - A Clinical Study

Background: Constipation is a very distressful symptom, affecting to all age group. The only treatment is laxatives, which is having many adverse effects mainly dependency on laxatives. Purpose: To evaluate the laxative effect of raisins and to get relief from daily dependency on laxative medicines for acute and chronic constipation Methods: Interventional / Experimental study of raisins and clarified butter or ghee performed at ‘Vishwaraj Hospital’ Pune, Maharashtra, India from March 2021 to June 2021, after appropriate ethical approval obtained from the Vishwaraj Hospital’s Ethics Committee (Registration number- ECR/1138/Inst/MH/2018). Fifty one patients of constipation who were on laxatives or PR enema enrolled in this study, diagnosis confirmed by gastro-enetrologist. Laxatives had been asked to stop before enrollment. Questionnaire form were given at the time of enrollment and telephonic follow up for OPD patients and by visiting to admit patients had been taken on 2nd day after consumption of raisins and clarified butter or ghee then on 7th and 15th day. Forms were collected once they were visit to their respective doctors for follow up. Results: Statistical tool used in this study is the 95 % confidence interval. The variables of interest were 1) percent of patients have restarted laxatives or not and 2) number of days required to get relief from constipation. 94.12 % of patients (n=48) did not restart laxatives after consumption of raisins and clarified butter or ghee and the population percent of patients that might not restart laxatives would be 88% to 100% with 95 % confidence. Also the number of days to get relief from constipation after consumption of raisins and clarified butter or ghee for a patient in population would be 3-4 days with 95 % confidence. Conclusion: Raisins and CB or ghee had given relief from acute and chronic constipation; worked very well on irritable bowel syndrome, fissure in ano, hemorrhoids and helped to stop PR bleeding and bloating causes by these diseases. Patients got relief from constipation on 3rd and 4th day. This study concluded that raisins with clarified butter or ghee can be taken instead of laxatives or enema to get relief from constipation; this might be the great substitute for laxatives and per rectum enema.

Exploration of the profile-effect relationship of Siraitia grosvenorii aqueous extracts related to their laxative effect on the basis of gray correlation analysis

Background Siraitia grosvenorii (binomial name Siraitia grosvenorii (Swingle) C. Jeffrey ex Lu et Z. Y. Zhang), also called Arhat Fruit or Monk’s Fruit, is a dried ripe fruit belonging to the Cucurbitaceae Family. S. grosvenorii has a long history of being used for constipation treatment in folk medicine. However, there are few studies where the laxative effect, related mechanisms, and active constituents of S. grosvenorii were investigated. This research explores the relationship between the common components and the laxative effect of aqueous extracts of S. grosvenorii from different habitats in China. Methods The fingerprints of S. grosvenorii aqueous extracts from different habitats were established by HPLC. The constipation mice model was used to investigate the laxative effect of S. grosvenorii aqueous extracts. The motilin (MTL) level in mice serum, and the water content of the large and small intestines in mice were determined. The profile-effect relationship of S. grosvenorii aqueous extracts was preliminarily clarified using gray correlation analysis. Results Nine common peaks were identified from the fingerprint of aqueous extracts of S. grosvenorii. The aqueous extracts obviously shortened the incubation period of defecation, and significantly increased the number of defecations, and the wet and dry weight of defecation in constipated mice. The profile-effect relationship indicated that seven common peaks were highly correlated with the effect of the incubation period of defecation, the number of defecations, and the wet and dry weight of defecation in mice. Conclusion This work provides a promising method for the fingerprint establishment, pharmacodynamic evaluation, and quality control of S. grosvenorii on the basis of its profile-effect relationship.

The effect of Hylocereus polyrhizus (red dragon fruit) on whole gut transit time of young Malaysian adults

Introduction: The red dragon fruit (Hylocereus polyrhizus) is a popular fruit, not only where it originated from, in Central America, but across the world including in Asia. It contains healthy minerals, vitamins and antioxidants, and has been shown to have gut motility action in animals. Methods: To determine the effect of red dragon fruit on whole gut transit time, a cross-sectional study of whole gut transit time using two different stool markers was conducted among 128 young Malaysian adults. Results: Red dragon fruit, in a half fruit serving of 225±25 grams, reduced mean whole gut transit time from 26.0±12.9 hours to 21.9±12.8 hours (p<0.001) when colour change in stools was used as an indicator. The tests also showed that 14.8-17.3% of individuals had whole gut transit time ≥40 hours with carbon as a stool marker compared to only 7.8-8.6% when red dragon fruit was consumed and used as a marker. Conclusion: This study demonstrated a laxative effect of red dragon fruit among young adults.

Comparative study of the laxative effects of konjac oligosaccharides and konjac glucomannan on loperamide-induced constipation in rats

Dietary fiber is the basic therapeutic method to relieve the symptoms of chronic constipation. The aim of this study was to compare the laxative effect of Konjac Glucomannan (KGM) and...

Croton zambesicus Root Extract Exert Laxative Effect in Rats

Background: Croton zambesicus Muell Arg. (Euphorbiaceace) is a medicinal plant used traditionally in the treatment of some ailments. Aim: The root extract of Croton zambesicus was evaluated for effect on the gastrointestinal tract (GIT). Materials and Methods: The root extract of C. zambesicus (27-81 mg/kg) was investigated for laxative effect in rats using different experimental models to study its effect on the GIT. Results: The extract was found to significantly increase the frequency and output of faecal matters in rats in all the experimental models studied. Conclusion: The findings of this study show that the root extract of C. zambesicus has a significant laxative effect and this supports its use in ethnomedicine for the treatment of gastrointestinal tract disorders.

Evaluation of the Laxative activity of Saponin Enriched Hydroethanolic Pericarp extract of Sapindus emarginatus in Animal models

Background: Constipation is a common, predominant, chronic gastrointestinal functional disorder. The drugs available to treat constipation are limited because of their side effects in long term use. So we need of efficacious drug to treat constipation. Sapindus emarginatus Vahl belongs to the family Sapindaceae, commonly known as soapnut. Traditionally used for the antipruritic, antifertility, constipation, and anti-inflammatory agents. Objective: The present study was undertaken to evaluate the laxative activity of hydroethanolic pericarp extract of Sapindus emarginatus (HESE) in animal models. Methods: The saponin content in extract was measured by gravimetric analysis. The laxative activity of hydroethanolic pericarp extract of Sapindus emarginatus is evaluated by the weight of feces matter, charcoal meal hyperperistalsis test, and loperamide induced constipation model. Results: The saponin content of the soapnut pericarp was 13.48 % and the extract was found to be 11.92 %. The results obtained from these models showed a significant dose-dependent increase in fecal weight, peristalsis index, and moisture content compared to control animals. Conclusion: The present study concluded that the oral administration of HESE showed a significant laxative activity by using different animal models. The presence of triterpene saponins is responsible for this activity. Further studies are needed to confirm their mechanism behind the laxative effect. The administration of extract was found to be a valid candidate in constipation therapy.