Diagnosis and Treatment of Elderly and Senile Chronic Constipation: an Expert Consensus

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies.

A COMPARATIVE CLINICAL STUDY FOR THE EVALUATION OF SNUHI KSHEERA-HARIDRA CHOORNA LEPA AND DEVADALYADI LEPA IN ARSHAS (2ND DEGREE HAEMORRHOID

Today Ano-rectal diseases have emerged as a quite common occurrence with progressive nature. According to the Ayurvedic concept, the aetiology of Arsha is interconnected with Mandagni of the patients. Arsha is a kind of disease that is most unkind towards mankind. A few important causes are sedentary lifestyle, irregular bowel habit, low fibre diet, prolonged straining, sedentary job, suppression of natural urges is some of the causative factors at present. It is a Mamsakeela that obstructs the Gudamarga and thus tortures the patient like an enemy. It can be co-related to haemorrhoids in modern science, the most common ailments of the rectum and anal canal. Intermittent symbolization and embarrassment make people neglect the early stages of haemorrhoids and ultimately end up in complications. The four therapeutic measures of Arshas include Bheshaja chikistha, Shastra karma, Kshara karma, and Agnikarma. Lepa is the foremost effective Bheshaja Chikistha yet less practised and demands further exploration. So based on Arsha Adhyaya of Susrutha Samhita and Arshoghnaadhyaya of Rasa ratnasamucchaya, the present study is intended to evaluate Snuhi ksheera – Haridra Choorna Lepa and Devadalyadi lepa in Arshas. Keywords: Haemorrhoids, Arshas, Snuhi Ksheera- Haridra Choorna Lepa, Devadalyadi Lepa

Abstract 62: Dietary Fibre Attenuates Hypertension By Reducing Macrophage Infiltration Via Gut Microbiota-Derived Metabolite-Sensing Receptors

High dietary fibre is fermented by the gut microbiota, resulting in the release of metabolites called short-chain fatty acids (SCFAs). Both fibre and SCFAs can reduce high blood pressure (BP) and its associated cardio-renal complications. However, the underlying mechanisms remain unclear. SCFAs can be detected by metabolite-sensing receptors GPR41 and GPR43, highly expressed by immune cells such as macrophages. We hypothesised that dietary fibre attenuates hypertension by modulating renal macrophage infiltration via metabolite-sensing receptors GPR41 and GPR43. To test this, we developed a novel GPR41/GPR43 double knockout (DKO) mice and characterised the cardiovascular and immune phenotype in both sham and angiotensin-II (Ang-II, 0.5mg/kg/day) treated DKO and wild-type (WT) mice (n=7-12 per group). WT Ang-II mice fed a high-fibre diet had significantly lower renal galectin-3 (p=0.0004), a macrophage marker, compared to WT Ang-II mice fed a low-fibre diet. Sham DKO mice on standard chow diet had no difference in BP or heart function but had higher kidney/tibia length index (p=0.049) and renal fibrosis levels compared to WT mice (p=0.004). Moreover, untreated DKO mice had higher numbers of renal macrophages compared to WT mice (p=0.002). Ang-II infusion of DKO mice resulted in higher BP (p<0.0001), renal fibrosis (p=0.007), and mortality (hazard ratio=5.6) compared to WT mice. In the gut, we found significant inflammatory changes, gut barrier integrity disruption, gut microbiota and metabolome changes (all p<0.05). We also found evidence of lipopolysaccharides (LPS) translocation from the gut into the circulation of DKO mice. In conclusion, we show that a high-fibre diet attenuates hypertension by modulating renal macrophages via the gut microbiota-derived metabolite-sensing GPR41 and GPR43 receptors. These receptors can be targeted as a novel treatment for hypertension.

Effects of dietary fibre level on rumen pH, total microbial count and methanogenic archaea in Bonsmara and Nguni steers

A study was conducted to evaluate the effect of the level of dietary fibre on rumen pH, total microbial count and methanogenic archaeacount of Bonsmara (225 ± 10.0 kg live weight) and Nguni (215 ± 10.0 kg live weight) steers. Nine steers per breed were used, aged 8 to 9 months. A 3 x 2 factorial experiment was executed with treatments allocated in a completely randomized design. The treatments were diets which included 64.3% neutral detergent fibre (NDF) for diet 1, 40.4% NDF for diet 2, and 29.9% NDF for diet 3. Steers were fed for 90 days and housed in individual pens. Rumen fluid was collected from steers using a stomach tube. Rumen fluid samples were taken immediately to the laboratory for microbial assay. Data were subjected to analysis of variance (ANOVA). The various levels of dietary fibre did not affect rumen pH and methanogenic archaea count. However, a low-fibre diet yielded high rumen total microbial count for Bonsmara steers and low rumen total microbial count for Nguni steers. Therefore, a low-fibre diet can be applied as a viable strategy to enhance rumen total microbial count in exotic beef breeds and crossbred cattle such as Bonsmara. Nguni steers fed a high NDF diet had higher rumen total microbial count than Nguni steers fed a low-fibre diet. Therefore, a high NDF diet can be used efficiently by feeding it to indigenous breeds and purebred cattle such as Nguni.

Low-Fibre Diet as an Option for Bowel Preparation Prior to Colonoscopy: ARandomised Controlled Clinical Trial

Introduction: Bowel preparation for colonoscopy plays an important role in the evaluation of the colon. Many methods for preparing the colon for colonoscopy do not work well. Aim: To use a low-fibre diet as a standard and applicable method for bowel preparation in performing colonoscopy and increasing patients’ adherence to colonoscopy. Materials and Methods: Clinical control trial design was used to compare bowel preparation in people receiving a low-fibre diet with those who did not receive food {Nil Per Os (NPO)} for bowel preparation. The participants included 477 patients who were randomly divided into two groups including 223 patients having a low-fibre diet (for dinner) and 254 patients having nothing for dinner (NPO). Data were recorded including age, sex, weight, height, level of education, bowel preparation score, colonoscopy diagnosis and sedative dose. Both groups were given a solution of 3 L of ethylene glycol and 60 mg of bisacodyl at three occasions: 3 pm and 7 pm the day before colonoscopy and 6 am on the colonoscopy day. Scoring criteria for colonoscopy preparation included excellent (clean and free of any liquids), very good (clean with clear fluid, underlying mucus visible in clear fluid), good (clean with dirty liquid), poor (with particles including stools, but can be assessed at 80% mucus), and very poor (containing stool particles, and mucosal evaluation below 80%, colonoscopy was cancelled in this group). The data were analysed by SPSS version 21.0 using Chi-square and Independent Samples Test. Results: About 82% of patients who consumed a low-fibre diet for bowel preparation the night before colonoscopy had an excellent and very good quality of bowel preparation compared with 74.9% of patients not receiving any diet. The number of patients who cancelled the colonoscopy were more in the group not receiving any diet (4.7% versus 2.6%). The data indicated that the quality of colon preparation decreased by age (p=0.0001), whereas Body Mass Index (BMI) did not differ on colon cleansing. When having dinner, patients with Irritable Bowel Syndrome (IBS) had significantly more secretion of air bubble and foam formation than patients not eating dinner (p=0.002). The results showed that the difference in bowel preparation quality between the two groups was not significant (p=0.169), and increased patient adherence to colonoscopy in the first group. Conclusion: Implementing a proper bowel preparation method is very important in improving the quality of colonoscopy and increasing the patient’s adherence to colonoscopy. Using a low-fibre diet on the day before colonoscopy can help achieve this goal.

Energetic parameters in pregnant and lactating rat (Lasiopodomys brandtii) fed high- or low-fibre diets

The effect of diet quality (high-fibre (HF) or low-fibre (LF)) on energetic parameters in pregnant and lactating rats (Lasiopodomys brandtii) was examined. There was no significant difference (p>0.05) in body mass of voles prior to dietary acclimation and during pregnancy. Energetic parameters (dry matter, gross energy, digestible energy intake and digestibility) as well as body mass of pups was not significantly (p>0.05) affected by diet quality. Low fibre diet caused a decreased (p<0.05) in feed and gross energy intake and increased (p<0.001) digestible energy intake at mid lactation while digestibility was significantly increased at early lactation. Liver and kidney were significantly (p<0.05) lighter in voles on low fibre diet. No significant difference was observed between diets for metabolic rate. These results revealed that rats can compensate for poor quality (HF) diet physiologically by increasing food intake and decreasing digestible energy intake and digestibility to keep reproductive performance unaffected. The most energetically demanding period of breeding cycle of rat was mid lactation.

Pregnancy and Healthy Childbirth in a 37 Year-Old Patient with Diverticular Disease

Aim. To describe a clinical case of pregnancy and healthy labour in a young female patient with uncomplicated diverticular disease (DD).Key points. In recent years, DD is more frequently observed in younger patients. A 37-yo woman manifested the symptoms of periodic intense abdominal pain and constant abdominal discomfort. Colonic DD was diagnosed with irrigoscopy. A high-fibre diet, rifaximin-α at 400 mg twice a day for one week, once a month for six months, and topical anti-inflammatory therapy were prescribed. Clinical symptoms were eradicated upon the treatment. Unaware of pregnancy, the patient had another course of rifaximin-α at the second week of gestation, after which the therapy was stopped. Rifaximin-α, which has a poor intestinal absorption, did not affect the foetal development. A caesarean childbirth was healthy, the newborn was delivered on term with no complications (Apgar score 8).Conclusion. DD should be included in differential diagnosis for patients with non-specific symptoms (abdominal pain, bloating and discomfort), regardless of young age. No protocols are currently accepted for the DD management during gestation. In the clinical case reported, a patient having diverticular disease and a rifaximin-α therapy at an early term of gestation proceeded without complications for herself and the foetus.