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Objective: This study aimed to investigate the early, late, and total constipation frequency, related factors, and their effects on the hospitalization day, gastric residual volume, vomiting, distension, and diarrhea, the feeding type, white blood cells, and C-reactive protein levels, and body temperature. Method: Data from this observational cross-sectional study were collected in an anesthesia and reanimation intensive care unit of a public hospital in Bolu, Turkey. The sample included 116 patients who met the criteria of the study. The sample size was determined using power analysis according to the results of a pilot study. The patient information form, daily observation form, and Bristol stool consistency scale were used for collecting the data. Results: The constipation frequency was 63.8% in the unit. The early constipation frequency was 18.9%, and the late constipation frequency was 6.8%. The hospitalization day in these groups was longer than those without constipation. Also, the patients receiving mechanical ventilator support, enteral tube feeding, and diuretic medication had a higher risk for constipation. The enema/laxative was applied to half of the patients who developed constipation in the unit, after which more than half developed diarrhea. Distension and enteral feeding were more frequent in late-type constipation patients. The levels of white blood cells, C-reactive protein levels, and body temperature between all groups were not statistically different (p>0.05). Conclusion: The frequency of constipation was higher in the intensive care unit, even when the defecation period was considered four days. Receiving mechanical ventilator support, enteral tube feeding, and diuretics increased the risk of constipation. Amaç: Bu çalışma erken, geç ve toplam konstipasyon sıklığı, ilişkili faktörler ve bunların hastaneye yatış günü, mide rezidüel hacmi, kusma, distansiyon, diyare, beslenme şekli, beyaz kan hücreleri, C-reaktif protein seviyeleri ve vücut sıcaklığı üzerine etkilerinin incelenmesini amaçladı. Yöntem: Bu gözlemsel kesitsel çalışmanın verileri, Türkiye'de Bolu ilinde bulunan bir devlet hastanesinin anestezi ve reanimasyon yoğun bakım ünitesinde toplandı. Örneklem, çalışmanın kriterlerini karşılayan 116 hastayı içerdi. Örneklem büyüklüğü, pilot çalışmanın sonuçlarına göre güç analizi kullanılarak belirlendi. Verilerin toplanmasında hasta bilgi formu, günlük gözlem formu ve Bristol dışkı kıvam ölçeği kullanıldı. Bulgular: Yoğun bakımda konstipasyon sıklığı %63,8 idi. Erken konstipasyon sıklığı %18,9, geç konstipasyon sıklığı ise %6,8 olarak belirlendi. Bu gruplarda hastanede kalış günü konstipasyonu olmayanlara göre daha uzundu. Ayrıca mekanik ventilatör desteği, enteral tüple beslenme ve diüretik ilaç kullanan hastalarda konstipasyon riski daha yüksekti. Yoğun bakımda konstipasyon gelişen hastaların yarısına lavman/laksatif uygulandı, sonrasında yarısından fazlasında diyare gelişti. Geç tip konstipasyon hastalarında distansiyon ve enteral beslenme daha sık görüldü. Beyaz kan hücreleri, C-reaktif protein seviyeleri ve vücut sıcaklığı tüm gruplar arasında istatistiksel olarak anlamlı değildi (p>0,05). Sonuç: Yoğun bakım ünitesinde dışkılama süresi dört gün olarak kabul edildiğinde bile konstipasyon sıklığının daha yüksek olduğu görüldü. Mekanik ventilatör desteği almak, enteral tüple beslenmek ve diüretik kullanmak konstipasyon riskini artırmaktadır. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults., Methods: We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0., Results: Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus coagulans) (MD = 3.63, 95% CI [1.37, 5.89], moderate certainty), mix6 (consisting of Lactulose and Bifidobacterium coagulans) (MD = 4.30, 95% CI [1.04, 7.54], low certainty), and mix7 (consisting of Lactulose, Bifidobacterium subtilis, and Enterococcus faecium) (MD = 4.58, 95% CI [1.35, 7.78], moderate certainty) exhibited a significant effect. Notably, mix7 demonstrated the highest probability of being the most effective intervention (94.8%). Furthermore, when compared to L. plantarum, four probiotics and two synbiotics showed significant advantages in the Patient Assessment of Constipation Symptoms (PAC-SYM) score. L. reuteri (MD = -13.74, 95% CI [-22.20, -4.66], very low certainty) exhibited a significant effect in improving the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses., Conclusions: Moderate to very low evidence supports the use of lactulose and synbiotics to increase the number of weekly stool movements in patients, particularly highlighting the significant impact of synbiotics in increasing the number of weekly stool movements in patients with constipation. The use of L. paracasei showed improvements in PAC-SYM scores, while L. reuteri demonstrated enhancements in PAC-QoL scores., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Prebiotics modulate metabolism and ensure a healthy gastrointestinal tract that may prevent colorectal cancer (CRC) development. The present study was designed to explore the effects of chicory roots derived fructans, in raw form, against CRC in rats. After acclimatization period, forty male Wistar rats were randomly and equally divided into four groups. Chicory powder treatments were started to group G4 before administering carcinogenic injections. After one-month, groups G2-G4 received four subcutaneous injections of carcinogen 1,2-dimethylhydrazine dihydrochloride (DMH) at dose of 40 mg/kg body weight, twice a week for 2 weeks. After DHM injections, chicory powder treatments were started to group G3 as well and group G2 was DHM control group receiving only basal diet while G1 was normal control group. The amount of chicory roots powder given was 5% w/w mixed in basal diet. It was observed that group G4 showed better results overall. Enzymatic activities of pathogenic bacteria were lowest in this group and were significant (p≤0.05) when compared to group G2. Percentage of total aberrant crypt foci (ACF) inhibition was also higher (30.14%) in group G4 as compared to group G3 (18.55%). Elevated levels of short chain fatty acids were observed in chicory root powder groups particularly in G4 which having significant higher levels of acetate and butyrate compared to group G2. Group G4 also hindered body weight loss due to carcinogenesis effect. It can be concluded that chicory root powder has protective impact against CRC biomarkers particularly if it is taken as preventive measure. [ABSTRACT FROM AUTHOR]

Functional constipation is a significant health issue impacting the lives of an estimated 14 % of the global population. Non-pharmaceutical treatment advice for cases with no underlying medical conditions focuses on exercise, hydration and an increase in dietary fibre intake. An alteration in the composition of the gut microbiota is thought to play a role in constipation. Prebiotics are non-digestible food ingredients that selectively stimulate the growth of a limited number of bacteria in the colon with a benefit for host health. Various types of dietary fibre, though not all, can act as a prebiotic. Short-chain fatty acids produced by these microbes play a critical role as signalling molecules in a range of metabolic and physiological processes including laxation, although details are unclear. Prebiotics have a history of safe use in the food industry spanning several decades and are increasingly used as supplements to alleviate constipation. Most scientific research on the effects of prebiotics and gut microbiota has focussed on inflammatory bowel disease rather than functional constipation. Very few clinical studies evaluated the efficacy of prebiotics in the management of constipation and their effect on the microbiota, with highly variable designs and conflicting results. Despite this, broad health claims are made by manufacturers of prebiotic supplements. This narrative review provides an overview of the literature on the interaction of prebiotics with the gut microbiota and their potential clinical role in the alleviation of functional constipation. [ABSTRACT FROM AUTHOR]

The gut microbiota represents a community of microorganisms (bacteria, fungi, archaea, viruses, and protozoa) that colonize the gut and are responsible for gut mucosal structural integrity and immune and metabolic homeostasis. The relationship between the gut microbiome and human health has been intensively researched in the past years. It is now widely recognized that gut microbial composition is highly responsible for the general health of the host. Among the diseases that have been linked to an altered gut microbial population are diarrheal illnesses and functional constipation. The capacity of probiotics to modulate the gut microbiome population, strengthen the intestinal barrier, and modulate the immune system together with their antioxidant properties have encouraged the research of probiotic therapy in many gastrointestinal afflictions. Dietary and lifestyle changes and the use of probiotics seem to play an important role in easing constipation and effectively alleviating diarrhea by suppressing the germs involved. This review aims to describe how probiotic bacteria and the use of specific strains could interfere and bring benefits as an associated treatment for diarrhea and constipation. [ABSTRACT FROM AUTHOR]

Background: Drug administration through feeding tubes presents many challenges to the healthcare provider. There is little information available on medications than can be delivered safely when crushed and what efforts can be implemented to minimize clogging the feeding tube. Our institution requested a comprehensive examination of all oral medications for the feeding tube route. Methods: This report is a synopsis of the physical evaluation of 323 different oral medications for their appropriateness for feeding tube administration with distal site in either the stomach or jejunum. A worksheet was created for each medication. This document contained a review of the chemical and physical properties that would contribute to delivery of the medication. Each medication was then studied for the degree of disintegration, pH, osmolality, and potential to form clogs. For drugs that needed to be crushed, the volume of water needed to dissolve the drug, time for that process, and volume needed to rinse the tube after administration was also studied. Results: The results of this review are summarized in a table and based on a composite of the documents cited, tests conducted, and author's judgements based all the data collected. Thirty‐six medications were identified as inappropriate for feeding tube administration, and an additional 46 medications were identified as inappropriate for direct jejunal administration. Conclusion: The information produced by this study will enable clinicians to make informed choices in selecting, compounding, and rinsing medications through feeding tubes. Using the template provided, they will be able to evaluate a drug not studied here for potential issues in feeding tube administration. [ABSTRACT FROM AUTHOR]

Background: The maternal diet during gestation and lactation affects the health of the offspring. Konjac glucomannan (KGM) is a significantly functional polysaccharide in food research, possessing both antioxidant and prebiotic properties. However, the mechanisms of how KGM regulates maternal nutrition remain insufficient and limited. This study aimed to investigate maternal supplementation with KGM during late gestation and lactation to benefit both maternal and offspring generations., Results: Our findings indicate that KGM improves serum low density lipoprotein cholesterol (LDL-C) and antioxidant capacity. Furthermore, the KGM group displayed a significant increase in the feed intake-related hormones neuropeptide tyrosine (NPY), Ghrelin, and adenosine monophosphate-activated kinase (AMPK) levels. KGM modified the relative abundance of Clostridium, Candidatus Saccharimonas, unclassified Firmicutes, and unclassified Christensenellaceae in sow feces. Acetate, valerate, and isobutyrate were also improved in the feces of sows in the KGM group. These are potential target bacterial genera that may modulate the host's health. Furthermore, Spearman's correlation analysis unveiled significant correlations between the altered bacteria genus and feed intake-related hormones. More importantly, KGM reduced interleukin-6 (IL-6) levels in milk, further improved IL-10 levels, and reduced zonulin levels in the serum of offspring., Conclusion: In conclusion, maternal dietary supplementation with KGM during late gestation and lactation improves maternal nutritional status by modifying maternal microbial and increasing lactation feed intake, which benefits the anti-inflammatory capacity of the offspring serum. © 2024 Society of Chemical Industry., (© 2024 Society of Chemical Industry.)

Purpose: Maltodextrin (MDX) is a polysaccharide food additive commonly used as oral placebo/control to investigate treatments/interventions in humans. The aims of this study were to appraise the MDX effects on human physiology/gut microbiota, and to assess the validity of MDX as a placebo-control. Methods: We performed a systematic review of randomized-placebo-controlled clinical trials (RCTs) where MDX was used as an orally consumed placebo. Data were extracted from study results where effects (physiological/microbial) were attributed (or not) to MDX, and from study participant outcomes data, before-and-after MDX consumption, for post-publication 're-analysis' using paired-data statistics. Results: Of two hundred-sixteen studies on 'MDX/microbiome', seventy RCTs (n = 70) were selected for analysis. Supporting concerns regarding the validity of MDX as a placebo, the majority of RCTs (60%, CI 95% = 0.48–0.76; n = 42/70; Fisher-exact p = 0.001, expected < 5/70) reported MDX-induced physiological (38.1%, n = 16/42; p = 0.005), microbial metabolite (19%, n = 8/42; p = 0.013), or microbiome (50%, n = 21/42; p = 0.0001) effects. MDX-induced alterations on gut microbiome included changes in the Firmicutes and/or Bacteroidetes phyla, and Lactobacillus and/or Bifidobacterium species. Effects on various immunological, inflammatory markers, and gut function/permeability were also documented in 25.6% of the studies (n = 10/42). Notably, there was considerable variability in the direction of effects (decrease/increase), MDX dose, form (powder/pill), duration, and disease/populations studied. Overall, only 20% (n = 14/70; p = 0.026) of studies cross-referenced MDX as a justifiable/innocuous placebo, while 2.9% of studies (n = 2/70) acknowledged their data the opposite. Conclusion: Orally-consumed MDX often (63.9% of RCTs) induces effects on human physiology/gut microbiota. Such effects question the validity of MDX as a placebo-control in human clinical trials. [ABSTRACT FROM AUTHOR]

Small intestinal bacterial overgrowth (SIBO) is highly prevalent in irritable bowel syndrome (IBS). The eradication of bacterial overgrowth with antibiotics is the first-line treatment. However, focusing only on the antimicrobial effects without taking care to improve lifestyle factors, especially dietary patterns, may predispose patients to intestinal microbiota dysfunction. The objective of this study is to determine whether the current recommendations regarding nutrition in IBS are suitable for patients with SIBO. A narrative literature review was carried out using databases, including PubMed, ScienceDirect and Google Scholar. Recent studies indicate that dietary manipulation may have a role in alleviating SIBO gastrointestinal symptoms. A low FODMAP diet proposed for IBS may promote a negative shift in the gut microbiota and deepen the existing state of dysbiosis in SIBO patients. Supplementation with soluble fiber can lessen the symptoms in IBS and SIBO. Targeted probiotic therapy may also increase the effectiveness of antibiotic treatment and regulate bowel movements. Therefore, optimal dietary patterns play a key role in the treatment of SIBO. Based on currently available literature, the potential efficacy of the IBS diet in SIBO is largely hypothetical. Future research is needed to characterize a specific diet for the treatment of SIBO. [ABSTRACT FROM AUTHOR]

Fermentation of available sugars in milk by yogurt starter culture initially and later by Saccharomyces boulardii (Probiotic yeast) improves the bioavailability of nutrients and produces bioactive substances and volatile compounds that enhance consumer acceptability. The combination of S. boulardii, a unique species of probiotic yeast, and inulin, an exopolysaccharide used as a prebiotic, showed remarkable probiotic and hydrocolloid properties in dairy products. The present study was designed to study the effect of fermentation and storage on antioxidant and volatile capacities of probiotic and synbiotic yogurt by incorporation of S. boulardii and inulin at 1%, 1.5%, and 2% (w/v), compared with the probiotic and control plain yogurt. All samples were stored at 4 °C, and during these four weeks, they were analyzed in terms of their antioxidant and volatile compounds. The synbiotic yogurt samples having inulin and S. boulardii displayed significantly higher DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical activity values and more values of TPC (total phenol contents) than control plain yogurt. A total of 16 volatile compounds were identified in S5-syn2 and S4-syn1.5, while S3-syn1 and S2-P had 14, compared with the control S1-C plain yogurt samples, which had only 6. The number of volatile compounds increased with the increasing concentration of inulin throughout the storage period. Therefore, this novel synbiotic yogurt with higher antioxidant and volatile compounds, even with chilling storage conditions, will be a good choice for consumer acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults., Methods: The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations., Results: The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone., Discussion: This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation., (Copyright © 2023 by The American College of Gastroenterology and the American Gastroenterological Association.)

Purpose of Review: Epidemiologic studies and clinical trials have demonstrated the benefits of dietary fiber. This occurs through a combination of the physiochemical properties of fiber and through microbial fermentation that occurs in the colon which result in the production of short-chain fatty acids (SCFA). The purpose of this review is to highlight the physiochemical properties of fiber that result in the range of physiologic effects and to review the literature on the health benefits of acetate, propionate, and butyrate., Recent Findings: Of the variety of properties and functions exerted by dietary fibers, the fermentability and production of SCFA's are emphasized in this review. Studies done in both animal and humans reveal the anti-obesity, anti-inflammatory, and possible anti-neoplastic roles SCFAs exert at the mucosal level. Many clinical questions remain regarding the optimal dose, type, and method of delivery of fiber to exert the desired beneficial effects. It has the potential to be used in the management of clinical symptoms, prevention of disease, and improvement in human health. Further studies to address this novel use of fiber has the potential to make a large impact in clinical practice., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)