Meta-analysis on the role of exercise in the treatment of constipation

Current guidelines recommend life-style adjustment (including more exercise) as the first measure for treating constipation. This meta-analysis investigated the influence of exercise therapy on the symptoms of patients with chronic constipation. About half of participants in a exercise programme lasting several weeks experienced a positive effect on their symptoms. Studies with the laxatives bisacodyl and sodium picosulfate showed that these generally alleviated symptoms even within the first day of treatment.

Comparison of Four Bowel Cleansing Agents for Colonoscopy and the Factors Affecting their Efficacy. A Prospective, Randomized Study

Background and Aims: Adequate bowel preparation is essential for successful and effective colonoscopy. Several types of cleansing agents are currently available including low-volume solutions. The aim of this study was to compare the efficacy of four different bowel cleansing agents. Methods: A single-center, prospective, randomized, and single-blind study was performed. Consecutive patients referred for colonoscopy were enrolled and randomized into one of the following types of laxatives: polyethylenglycol 4L (PEG), oral sulfate solution (OSS), 2L polyethylenglycol + ascorbate (2L-PEG/Asc), or magnesium citrate + sodium picosulfate (MCSP). The primary outcome was quality of bowel cleansing evaluated according to the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were polyp detection rate (PDR) and tolerability. Results: Final analysis was performed on 431 patients. The number of patients with adequate bowel preparation (BBPS total scores ≥6 and sub scores ≥2 in each segment) was not significantly different throughout all groups (95.4% PEG; 94.6% OSS; 96.3% 2L-PEG/Asc; 96.2% MCSP; p=0.955). Excellent bowel preparation (BBPS total scores ≥ 8) was associated with younger age (p=0.007). The groups did not have significantly different PDRs (49.5% PEG; 49.1% OSS; 38% 2L-PEG/Asc; 40.4% MCSP; p=0.201). The strongest predictors of pathology identification were age and male gender. The best-tolerated solution was MCSP (palatability: p<0.001; nausea: p=0.024).

Towards Safe Medication Use Among Geriatric Patients: A Combined Tool For Identification of Potential Drug-Related Problems

Background: Drug-related problems (DRP), including potentially inappropriate medications (PIMs), are a common problem in older people with multi-morbidity and polypharmacy. It is important to identify appropriate tools, preferably adjusted to specific patient groups, to deal more effectively with potential or existing DRPs. Our hypothesis is that combining PIM identification tools enables to significantly enhance the determination of DRPs. The aim of this study was to develop a combined tool for identification of DRPs in geriatric multi-morbid and polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The combined PIM identification tool used the information on PIM active ingredients in both databases - the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: very significant PIMs (should be avoided in older patients) as red, significant PIMs (require dose and/or treatment duration adjustment) as yellow, non-significant PIMs/non-PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the red PIMs contains 34 active ingredients, including one combination of two medications and one medication class. According to the Anatomical Therapeutic Chemical classification, most of the red PIMs (n=27, 79.4%) belong to the A, C and N medication groups. Only 41.2% of the red PIMs have marketing authorization in Estonia. In 2019 more frequently used red PIMs in Estonia were sodium picosulfate, propafenone, ginkgo biloba, magnesium hydroxide, and dextromethorphan. The approximate number of the yellow and green PIMs is 248, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics. The complete list of the grey PIMs will be developed in the future Conclusions: The combined PIM tool based on the EU(7)-PIM and EURO-FORTA criteria was created to address the need for more efficient identification of DRP in geriatric multi-morbid patients. The combined PIM tool was developed with a focus on the high-risk medications for older adults and taking into consideration the availability of the PIMs in Estonia. The tool could potentially be applied as a screen to identify DRPs in different health care settings.