The rapid increase in the global aging population poses a major public health challenge due to the prevalence of stroke. Constipation represents a significant complication of stroke, significantly impacting quality of life. The objective of this study is to investigate the incidence of constipation in acute stroke and to identify the factors that contribute to new-onset constipation (defined as constipation developing after stroke in patients with no prior history) after stroke. A total of 600 acute stroke patients were recruited for a cross-sectional study, with a questionnaire administered to each participant. This study included demographic characteristics, stroke type and focus, medical history, sleep quality, psychological problems, and the NIHSS and Barthel index (BI). Participants with constipation were evaluated for severity, medications, and stroke outcomes at discharge by the investigators. Of the 600 acute stroke patients, 126 (21%) reported a history of constipation. Furthermore, 278 patients (46.3%) demonstrated post-stroke constipation (PSC), while 184 patients (38.8%) experienced new-onset constipation following their stroke. The results indicated that hemorrhagic stroke, posterior circulation stroke, diabetes, osmotic diuretics, antacids, use of bedpans, Difficulty falling asleep, depression, and a higher NIHSS score at admission were significant risk factors for new-onset constipation. In patients demonstrating moderate severity, PSC correlated with adverse stroke outcomes at discharge. The incidence of constipation in acute stroke patients is higher than that in the general population. The results suggest that depression and Difficulty falling asleep may increase the risk of new-onset constipation. Moreover, after adjusting for confounders, new-onset constipation was independently associated with poor discharge outcome, particularly in patients with moderate stroke severity. Early identification of constipation risk in stroke patients can improve the development and optimization of rehabilitation protocols. Identifier ChiCTR2400080663.
Constipation is one of the most common gastrointestinal disorders in the general population. However, its prevalence in patients with chronic kidney disease (CKD) and its association with kidney function have not been comprehensively examined. Using nationwide annual health check-ups and medical claims data collected in Japan from 2015-2023, we identified a total of 903 984 person-year observations from 217 734 unique individuals aged 20-74 years with available estimated glomerular filtration rate (eGFR) data. We evaluated the prevalence of constipation, defined by diagnostic codes or laxative use, and patterns of laxative prescriptions overall and across eGFR categories. Multivariable logistic regression models were used to assess the cross-sectional association between eGFR and constipation, adjusting for demographics, vital signs, comorbidities, and medication use. Participants were 49.5 (SD, 10.4) years old, 72% were male, and 12.1% had diabetes. Among the 903 984 person-year observations, 87,861 (9.7%) had constipation. The prevalence of constipation was higher with lower eGFR, with 9.4%, 13.1%, 20.3%, 25.3%, and 45.2% in participants with eGFR ≥60, 45-59, 30-44, 15-29, and <15 ml/min/1.73 m², respectively. Laxative prescription patterns differed by CKD stages, with less use of magnesium salts and greater use of novel agents in more advanced CKD stages. After multivariable adjustment, compared with eGFR ≥60 ml/min/1.73 m², lower eGFR was significantly associated with a higher odds of constipation in a graded manner [adjusted odds ratios (95% CI), 1.07 (1.04-1.11), 1.14 (1.03-1.25), 1.47 (1.20-1.79), and 2.44 (1.84-3.22), respectively]. Constipation was prevalent in patients with CKD. Lower kidney function was independently associated with higher odds of constipation, with the highest odds seen in the most advanced stage of CKD. These findings highlight the real-world burden of constipation across the CKD spectrum and suggest a potential pathophysiological link between constipation and impaired kidney function.
The exact etiology of labial adhesion (LA) is unknown, however, it is obvious that the disease has multifactorial causes. Although several local and inflammatory factors have been implicated, the potential contribution of functional constipation (FC) has not been previously investigated. The aim of this study is to investigate the role of functional constipation (FC) in the etiology of primary and recurrent LA. This cross-sectional analytical study included 2828 consecutive prepubertal girls evaluated in a pediatric surgery outpatient clinic between May 2021 and December 2024. Patients with inflammatory, dermatologic, traumatic, endocrine, or congenital conditions potentially affecting genital anatomy were excluded. Prevalence, relative risk (prevalence ratio), crude odds ratio, and attributable risk were calculated. Multivariable logistic regression adjusted for age was performed to assess independent association. The overall prevalence of labial adhesion was 5.1% (145/2828). Functional constipation was present in 17.0% of the total study population. The prevalence of labial adhesion was significantly higher in children with constipation (11.4%) compared with those without (3.8%) (P < .001). The relative risk was 2.97 (95% CI: 2.16-4.10). After age adjustment, functional constipation remained independently associated with labial adhesion (OR: 2.6; P < .001). The attributable risk percent was 66.4%. Recurrence was observed in 3.4% of patients during follow-up and was more frequent among children with constipation. Functional constipation was significantly associated with both primary and recurrent labial adhesions, and may represent a potential contributing factor. Evaluation of bowel habits may be clinically relevant in patients presenting with labial adhesion.
Little is known about the optimal treatment for constipation in patients with schizophrenia or depression. Elobixibat is a laxative with a novel mechanism of action that inhibits the ileal bile acid transporter, acting as both an osmotic and a stimulant agent. We conducted a prospective, multicenter, postmarketing surveillance study to assess the safety and effectiveness of elobixibat for patients with chronic constipation in Japan (jRCT1080223950). The surveillance period was between June 2018 and May 2022. Patients were observed from the date of initial administration of elobixibat to 55 days thereafter (4-week treatment groups) or to 419 days thereafter (52-week treatment groups). Safety outcomes included adverse drug reactions (ADRs). Effectiveness outcomes included defecation frequency, Bristol Stool Form Scale (BSFS) scores, and constipation-related symptoms. In the safety analysis set, the 4-week treatment groups comprised 105 patients with schizophrenia and 129 with depression; the 52-week treatment groups included 43 patients with schizophrenia and 55 with depression. Approximately 85% to 95% of patients used antipsychotics, and 40% to 55% used anxiolytics or sedative-hypnotics. The proportions of patients who experienced ADRs were 4.76% in the 4-week treatment group and 2.33% in the 52-week treatment group of patients with schizophrenia, and 3.88% and 9.09% of patients with depression. Diarrhea was the most common ADR in each group. There were no serious ADRs. In the 4-week treatment groups, the mean defecation frequency per week at baseline was 3.3 among patients with schizophrenia and 3.0 among patients with depression, which increased to 5.3 and 4.9, respectively, at week 4. In the 52-week treatment groups, the mean defecation frequency per week at week 52 was higher than that at baseline. After treatment, the proportion of patients with an ideal BSFS score of 4 increased in all groups by week 2 and reached approximately 60% by week 52. All constipation-related symptoms also improved by week 2 in all groups. Elobixibat improved chronic constipation with no new safety signal identified in patients with schizophrenia or depression and with available follow-up in real-world settings. https://jrct.mhlw.go.jp/latest-detail/jRCT1080223950, identifier jRCT1080223950.
Constipation, a prevalent gastrointestinal disorder, urgently requires safe and effective intervention strategies. Natural dietary fibers have gained attention for their potential to alleviate constipation through multiple mechanisms. This study investigated the therapeutic effects of pine pollen fiber (PPF), a by-product from pine pollen processing, on loperamide-induced constipation in mice. The mice were administered low or high doses of PPF for 14 consecutive days, and we evaluated constipation-related indicators, serum levels of gastrointestinal peptides and neurotransmitters, gut microbiota composition, and short-chain fatty acid (SCFA) production. The results showed that PPF supplementation significantly improved defecation function by increasing the fecal moisture content and intestinal propulsion rate. The PPF intervention restored the balance of neuroendocrine factors by upregulating excitatory neurotransmitters (substance P, motilin, gastrin, and acetylcholine) and downregulating inhibitory peptides (vasoactive intestinal peptide and somatostatin). 16S rRNA sequencing revealed that PPF modulated the gut microbiota structure and enhanced microbial diversity. Notably, PPF administration significantly promoted the production of SCFAs, particularly acetate, propionate and butyrate. These microbial metabolites may in turn influence the secretion of gastrointestinal hormones and neurotransmitters, as evidenced by the restored balance of excitatory and inhibitory factors in serum. Collectively, these findings indicate that the alleviation of constipation by PPF involves multi-pathway mechanisms linking gut microbiota modulation, SCFA production, and neuroendocrine regulation, supporting its potential application as a functional food ingredient for intestinal health.
We aimed to investigate the shared molecular pathways between Parkinson's disease (PD) and constipation using bioinformatics analysis. Differentially expressed genes (DEGs) were identified via the R limma package, and Weighted Gene Co-Expression Network Analysis (WGCNA) was conducted to identify hub modules. Biological enrichment analysis clarified the biological processes involved. A gene-gene interaction (GGI) network was constructed to identify shared hub biomarkers. Validation of these biomarkers was done in vitro with α-synuclein (α-syn)-treated SH-SY5Y cells and in vivo through α-syn-induced PD mouse models, A53T transgenic mice, and loperamide-induced constipation models. Numerous DEGs were identified in both conditions, with 14 shared DEGs found through the intersection of core modules and upregulated DEGs. These DEGs are primarily involved in energy metabolism, protein modification, and mitochondrial function. Five key hub genes were identified using the GGI network and gene topological analysis. Notably, Serine hydroxymethyltransferase 2 (SHMT2) expression was significantly upregulated after α-syn treatment in vitro. Immunohistochemical and immunofluorescence analyses revealed elevated SHMT2 expression in brain and colon tissues in PD mouse models (p < 0.001), whereas in constipation models, SHMT2 was only elevated in the colon wall with no significant expression in the enteric nervous system. Our findings offer new views on the molecular link between PD and constipation, suggesting SHMT2 as a possible biomarker and therapeutic target for PD symptoms.
Pediatric functional constipation is a highly prevalent disorder associated with significant morbidity and impaired quality of life. Despite widespread use of osmotic and stimulant laxatives, a substantial proportion of children remain symptomatic, highlighting an unmet need for novel therapies. This review provides an overview of the mechanism of action, pharmacokinetics, safety, and clinical efficacy of linaclotide for the treatment of functional constipation in children. Evidence from phase 2 dose-finding studies, a pivotal phase 3 randomized controlled trial, and real-world data is summarized. Prior pediatric experience with other prosecretory and prokinetic agents is discussed to contextualize the current therapeutic landscape. A focused literature review was conducted using PubMed/MEDLINE and regulatory sources (U.S. Food and Drug Administration [FDA]), prioritizing pediatric clinical trials and observational studies evaluating linaclotide in functional constipation. Linaclotide may represent a mechanism-based therapeutic option for pediatric patients with functional constipation who remain symptomatic despite optimized conventional therapy. By targeting guanylate cyclase-C-mediated epithelial secretion, linaclotide is associated with improvements in bowel habits and a predominantly gastrointestinal safety profile. However, the pediatric evidence base remains relatively limited, and further studies are needed to define long-term outcomes, predictors of response, and its role within treatment algorithms.
This study aimed to evaluate point-of-care ultrasound (POCUS) findings in children with functional constipation who achieved complete clinical improvement following standard treatment in accordance with international guidelines. The study included 58 children (31 boys) aged 0.9-16.1 (mean age 5.22 ± 3.24), diagnosed with functional constipation, who attended two visits: First due to constipation-related symptoms and second to evaluate the treatment response. Each patient underwent a complete abdominal ultrasound examination before or during the first visit and a POCUS assessment at follow-up. The median time to follow-up was 3.7 months (IQR: 2.5-7.4), with a range of 0.9-29.2 months. The mean rectal diameter decreased from 38.93 ± 10.7 mm at baseline to 24.46 ± 11.54 mm after treatment. Initially, hard stool predominated in the rectal ampulla (96.6%) and sigmoid colon (93.1%). At follow-up, hard stool decreased to 63.7% in the rectum and 45.5% in the sigmoid colon. Although symptom resolution and physical examination would suggest continuing the current treatment, it was intensified in 51.7% of patients based on POCUS findings. In the studied children with functional constipation, POCUS findings provided additional, clinically meaningful information for evaluating treatment response.
In today's society, with changes in diet structure and living habits, drug abuse, and psychosomatic diseases, the prevalence of constipation is increasing. Currently, there is a lack of unified diagnostic criteria for constipation, and therapeutic approaches lack standardization. This often leads to an inability to select appropriate treatment methods based on the patient's specific condition. Consequently, a significant proportion of constipation patients do not achieve satisfactory therapeutic outcomes. This is particularly true for slow-transit constipation (STC), which is characterized by a protracted course of the disease and significant diagnostic challenges. Therefore, this review aims to delineate the mechanisms, diagnosis, and therapeutic advances in STC, in order to offer insights for clinical diagnosis and treatment.
Constipation is a common functional gastrointestinal disorder with a complex pathogenesis. Traditional studies have primarily explained its development in terms of reduced intestinal motility or impaired defecatory coordination; however, these mechanisms alone cannot fully account for the multifactorial pathological processes underlying the condition. In recent years, increasing attention has been directed toward the roles of intestinal microbial dysbiosis and alterations in immune homeostasis in the development of constipation. The gut microbiota continuously interacts with the intestinal immune system through its structural components, metabolic products, and secreted molecules. These interactions modulate the mucosal immune microenvironment and participate in the regulation of intestinal motility by influencing the enteric nervous system, interstitial cells of Cajal, and smooth muscle function. Conversely, the immune system can reshape the composition and spatial distribution of the gut microbiota through mechanisms such as the mucosal barrier, immunoglobulin A, and antimicrobial peptides, thereby forming a bidirectional regulatory network. Accumulating evidence suggests that during the onset and progression of constipation, microbial dysbiosis, shifts in immune homeostasis, and abnormalities in intestinal motility may evolve through a progressively amplifying dynamic process, ultimately establishing a self-sustaining chronic cycle. In addition, microbiota-targeted interventions-including probiotics, prebiotics, and fecal microbiota transplantation-have demonstrated potential benefits in improving stool frequency and stool consistency in several clinical studies. However, the immunological mechanisms underlying these effects remain relatively underexplored. This review systematically summarizes the molecular mechanisms by which gut microbiota-immune interactions regulate intestinal motility. By integrating current evidence on disease progression and clinical studies, we propose a conceptual model of the "microbiota-immune-motility regulatory axis," aiming to provide a new perspective for understanding the pathogenesis of constipation and for optimizing microbiota-based therapeutic strategies.
Constipation represents a prevalent gastrointestinal disorder. This study demonstrates that wheat peptides (WP) effectively ameliorate loperamide-induced constipation in mice. Administration of WP orally at 0.5 mg/g body weight led to significant improvements in defecation, small intestinal motility, and the integrity of the intestinal barrier. WP further modulated inflammatory markers and enteric nervous system (ENS) regulators while correcting gut microbiota dysbiosis through restoration of microbial diversity and taxonomic composition. Crucially, colon transcriptomics revealed WP-mediated activation of calcium signaling pathway genes and the acetylcholine receptor gene. RT-qPCR validation confirmed the upregulation of key effectors, including muscarinic acetylcholine receptor Chrm1, inositol trisphosphate receptors (Itpr2/3), and calmodulin-like proteins (Calml3, Calm4). Three-dimensional imaging substantiated WP-induced augmentation of enteric neurons in constipated colons. Collectively, these results indicate that WP alleviates constipation through a multitarget mechanism involving muscarinic receptor activation, potentiation of calcium-dependent signaling, and promotion of enteric nervous system recovery, which collectively restore normal intestinal motility. WP thus emerges as a promising therapeutic candidate for constipation management.
To evaluate the efficacy and safety of Lactiplantibacillus plantarum Z6 (L. plantarum Z6) supplementation in infants with functional constipation (FC) and to explore its effects on gut microbiota composition. In this randomized, placebo-controlled trial, 100 infants diagnosed with FC were enrolled and allocated to receive either L. plantarum Z6 or placebo. Clinical outcomes, including weekly bowel movement frequency, Bristol stool scale scores, and Wexner constipation scores, were assessed. Serum 5-hydroxytryptamine (5-HT) levels and fecal microbiota profiles were analyzed to evaluate neurogastrointestinal and microbial responses. L. plantarum Z6 supplementation significantly increased weekly bowel movements and Bristol stool scores while reducing Wexner scores (p < 0.05). Serum 5-HT concentrations were elevated, indicating improved gastrointestinal motility. Gut microbiota analysis revealed enhanced α-diversity, higher abundances of Bifidobacterium, Gemmiger, and Lactobacillus, and reduced Streptococcus. Correlation analysis demonstrated a positive association between L. plantarum Z6 intake and Bifidobacterium enrichment, suggesting targeted modulation of beneficial taxa. L. plantarum Z6 is a safe and effective probiotic intervention for infantile functional constipation. The results highlight its potential to improve bowel function and beneficially reshape the gut microbiota, offering a microbiota-targeted therapeutic strategy for pediatric gastrointestinal disorders. Chinese Clinical Trial Registry ID: ChiCTR2300073079.
Probiotics are increasingly recognized as a promising therapeutic approach for managing constipation, sparking widespread interest in their effects on gastrointestinal health. This study conducts a cluster analysis to systematically map global research trends and hotspots in probiotics for constipation from 1977 to 2024. Relevant publications were retrieved from the Web of Science Core Collection. Bibliometric tools, including VOSviewer, CiteSpace, and R, were applied for cluster analysis, network visualization, and trend mapping. A total of 519 publications were included in the analysis. China led in publication volume, while the United States demonstrated the highest academic influence. Key institutions, such as the University of California System and Harvard University, were identified as major contributors. High-impact journals, including Nutrients, World Journal of Gastroenterology, and Digestive Diseases and Sciences, played central roles in disseminating research. Quigley Eamonn M. M. indicated significant influence in the field. Cluster analysis of keywords revealed 6 principal research hotspots: microbial diversity and mechanisms, gut microbiota-host interaction and pathophysiology, dietary factors and microbiome analysis techniques, epidemiology, prevalence, and population health, clinical management and therapeutic efficacy, and clinical trials and study design. Citation burst analysis indicated a recent research focus shift toward mechanisms, personalized interventions, and gut microbiome modulation. This bibliometric study based on cluster analysis identified 6 major research hotspots in probiotics for constipation, reflecting the evolving trends and collaborative networks of the field. These findings provide a comprehensive perspective on current research priorities and can guide future studies toward innovative and evidence-based clinical applications.
Aim: We aimed to evaluate the clinical efficacy and safety of Shenqu Xiaoshi Oral Liquid in the treatment of functional constipation in children. Methods: A comprehensive literature search was conducted from inception to 20 October 2025, across PubMed, Embase, Scopus, Web of Science, the Cochrane Library, Chinese VIP Information Database, China National Knowledge Infrastructure (CNKI), and Wan Fang Med Database. For quantitative analysis, the mean difference (MD) was used for continuous outcomes and the risk ratio (RR) for dichotomous outcomes. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software. Results: Eight studies involving 692 pediatric patients were included (Shenqu Xiaoshi Oral Liquid group: 345; control group: 347). Compared to the control group, Shenqu Xiaoshi Oral Liquid demonstrated superior clinical effectiveness [RR = 1.36, 95% CI: (1.25, 1.47); z = 7.11, p < 0.00001] and a lower recurrence rate [RR = 0.49, 95% CI: (0.26, 0.93); z = 2.18, p = 0.03]. Both the post-treatment [WMD = -0.91, 95% CI: (-0.97, -0.86); z = 31.94, p < 0.00001] and post-recurrence [WMD = -1.49, 95% CI: (-1.56, -1.41); z = 40.12, p < 0.00001] defecation intervals were shorter in the Shenqu Xiaoshi Oral Liquid group. No significant difference was observed in the incidence of adverse reactions between the two groups [RR = 0.67, 95% CI: (0.35, 1.29); z = 1.20, p = 0.23]. Furthermore, serum levels of motilin [WMD = 41.66, 95% CI: (34.17, 49.16); z = 10.90, p < 0.00001] and gastrin [WMD = 23.74, 95% CI: (7.30, 40.19); z = 2.83, p = 0.005] were significantly higher in the Shenqu Xiaoshi Oral Liquid group. Conclusions: Shenqu Xiaoshi Oral Liquid shows favorable clinical efficacy and an acceptable safety profile for treating functional constipation in children. However, these outcome measures are influenced by the limited sample size and potential heterogeneity of the included studies, warranting cautious interpretation of the results.
Constipation, a prevalent gastrointestinal disorder, significantly impairs quality of life. Emodin, a bioactive anthraquinone found in traditional herbal remedies like Rheum palmatum, is empirically known for its laxative effects, yet its precise molecular mechanism remains incompletely understood. This study aimed to elucidate the laxative potential of emodin and delineate its underlying mechanism, with a specific focus on the activation of the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. This therapeutic effect was abrogated in W1282X cystic fibrosis mice lacking functional CFTR, demonstrating CFTR-dependency. In HT-29 human colonic epithelial cells, emodin activated the CFTR chloride channel detected by a fluorescence-based membrane potential assay in a concentration-dependent manner with a half-maximal effective concentration (EC₅₀) of 10⁻⁵·⁷ M and a maximal effect reaching 68.3% of that induced by the positive control, genistein. Mechanistic investigations revealed that emodin did not alter the total protein abundance of CFTR but significantly enhanced its phosphorylation. Pharmacological inhibition of the cAMP/protein kinase A (PKA) pathway attenuated emodin-induced CFTR activation and laxative effects. Consistently, emodin upregulated the mRNA expression of key cAMP/PKA pathway components, PRKACB and CREB1. In conclusion, our findings demonstrate that emodin alleviates constipation by activating the CFTR chloride channel. This effect is mediated through the cAMP/PKA signaling pathway, which enhances CFTR phosphorylation and channel activity, thereby promoting chloride-dependent fluid secretion into the colonic lumen. This study clarifies a pivotal molecular mechanism for emodin's laxative action and supports its therapeutic potential.
Chronic constipation and depression are highly prevalent worldwide. These two conditions frequently co-occur in clinical practice. Accumulating evidence indicates that gut microbiota dysbiosis mediates this comorbidity through the microbiota-gut-brain axis (MGBA). This narrative review systematically summarizes current research on MGBA bidirectional communication mechanisms, gut microbiota alterations in comorbid patients, and microbiota-targeted intervention strategies. The MGBA facilitates bidirectional communication through four major pathways: neural pathways via the vagus nerve, immune pathways via cytokines, endocrine pathways via the HPA axis, and metabolic pathways via short-chain fatty acids and neurotransmitter precursors. Gut dysbiosis is associated with comorbidity and may contribute to its pathogenesis through multiple mechanisms. First, neurotransmitter metabolism becomes dysregulated, particularly in the serotonin and GABA systems. Second, chronic low-grade inflammation develops with elevated pro-inflammatory cytokines. Third, intestinal barrier dysfunction occurs, leading to increased permeability and bacterial translocation. Fourth, HPA axis hyperactivity emerges. Fifth, production of microbial metabolites is altered, including short-chain fatty acids and tryptophan metabolites. Comorbid patients exhibit characteristic microbiota signatures. These include reduced abundance of butyrate-producing bacteria such as Faecalibacterium, Roseburia, and Coprococcus. Microbial diversity decreases significantly. Pro-inflammatory taxa become enriched. Several evidence-based interventions show promise. These include psychobiotics, fecal microbiota transplantation, and dietary modifications such as Mediterranean diet and high-fiber intake. Exercise and integrative approaches including traditional Chinese medicine also demonstrate beneficial effects. The gut microbiota represents a critical hub connecting gastrointestinal and mental health. Microbiota-targeted therapies offer promising strategies for managing chronic constipation-depression comorbidity. Future research should establish causal relationships and develop reliable microbial biomarkers. Precision medicine approaches based on individual microbiome profiles are needed to optimize therapeutic outcomes.
The efficacy and adverse reactions of Maren Runchang Pills among patients of different genders remain unclear. This study aims to analyze the efficacy and safety differences of Maren Runchang Pills in patients of different genders, providing a basis for the implementation of gender-precise treatment in clinical practice. Gender-stratified analysis was adopted to include constipation-predominant irritable bowel syndrome (IBS-C) patients who met the syndrome of intestinal heat and accumulation. The efficacy and safety of Maren Runchang Pills were evaluated after 4 weeks of treatment. The main evaluation indicators include the complete spontaneous bowel movement response rates, visual analogue scale scores for abdominal pain and distension, traditional Chinese medicine syndrome scores, irritable bowel syndrome-symptom severity scale/irritable bowel syndrome-quality of life scale scores, and safety indicators. A total of 126 patients were included, among whom 101 were female and 25 were male. After 4 weeks of treatment, the proportion of female patients with a complete spontaneous bowel movement response rate of ≥75% was significantly higher than that of male patients (71.29% vs 48%, P = .0270), and the improvement in abdominal distension visual analogue scale score was also significantly better in females (decrease of 2.78 points vs 1.84 points, P = .0199). However, the total score of traditional Chinese medicine syndromes in male patients was higher than that in female patients (7.08 points vs 5.09 points, P = .0341). There were no statistically significant differences in the scores of the irritable bowel syndrome-symptom severity scale, irritable bowel syndrome-quality of life scale and safety indicators between the 2 groups. Maren Runchang Pills can effectively alleviate the constipation symptoms of patients with IBS-C, and the therapeutic effect is even better in female patients. The research results support considering gender factors in the clinical treatment of IBS-C to achieve individualized and precise intervention.
Opioids are indicated for pain that occurs with cancer and other disorders that become more prevalent with aging. The most prevalent and persistent adverse effect of opioid therapy is opioid-induced constipation (OIC). OIC impairs patient quality of life (QoL) and leads to suboptimal pain management due to medication non-adherence. Unlike other adverse effects, OIC persists and is not associated with pharmacological tolerance, necessitating long-term management. The objective of this study is to evaluate current clinical strategies for OIC by comparing recommendations from American, European, and Japanese clinical guidelines. We reviewed the clinical evidence for the peripherally acting μ-opioid receptor antagonist (PAMORA) naldemedine (the only PAMORA approved in Japan) and the rationale for early intervention in OIC. The clinical guidelines and recent clinical trial data, including the COMPOSE program (phase III clinical trials of naldemedine for OIC in patients with chronic non-cancer pain), were reviewed to establish an evidence-based framework for the management of chronic cancer and non-cancer pain. Conventional laxatives frequently provide inadequate relief as they address secondary symptoms rather than the underlying receptor-mediated cause. PAMORAs (including naldemedine, methyl naltrexone, and naloxegol) antagonize gastrointestinal opioid receptors without compromising central analgesia. Early initiation of PAMORAs stabilizes bowel function and reduces the incidence of treatment-related diarrhea that occurs when using conventional laxatives to treat OIC. The 2023 Japanese guidelines advocate the proactive use of the PAMORA naldemedine as a primary treatment option. This mechanism-based early intervention model offers a promising framework for optimizing QoL and implementing effective analgesia in an aging global population.
We reported a middle-aged man who initially presented with anhidrosis for 20 years and subsequently developed severe orthostatic hypotension, gastrointestinal dysmotility, and urogenital dysfunction. Due to progressive symptom aggravation, he was hospitalized and underwent comprehensive clinical assessment, neurophysiological studies, autonomic function tests, and multidisciplinary team (MDT) evaluation. The final diagnosis was pure autonomic failure (PAF). This case describes in detail the patient's long diagnostic course, differential diagnostic reasoning, the pivotal role of MDT management, and individualized treatment strategies and outcomes. The report aims to enhance the understanding of primary autonomic disorders characterized by neurogenic orthostatic hypotension for physicians, emphasizing the importance of systematic etiological screening and multidisciplinary collaboration in rare disease diagnosis and management to reduce misdiagnosis and improve prognosis and quality of life. 本文报道了1例以长达20年的无汗为首发症状，后续出现严重直立性低血压、胃肠功能紊乱及泌尿生殖功能障碍的中年男性患者。患者因症状进行性加重入院，经过系统的临床评估、神经电生理检查、自主神经功能测试及多学科团队（MDT）诊疗，最终明确诊断为单纯自主神经功能衰竭。本文详细记述了该患者从症状出现到明确诊断的曲折过程、全面的鉴别诊断思路、MDT在诊疗中的关键作用以及个体化的综合治疗方案与转归。通过本病例，旨在提高临床医生，特别是内科医生，对以神经源性直立性低血压为核心表现的原发性自主神经系统疾病的认识，强调系统性病因筛查和多学科协作对于罕见病诊治的重要性，从而减少漏诊、误诊，改善患者预后和生活质量。.
Gastrointestinal symptoms in Parkinson's disease (PD), in particular chronic constipation, are common and are treated in China using the traditional Chinese medicine (Jia-Wei-Ji-Chuan-Jian decoction) (JWJCJ)). However, information on therapeutic targets and the underlying mechanism is limited. A total of 72 PD patients with constipation attending Departments of Neurology in Shanghai, China (Shanghai Pudong New Area Gongli Hospital and Shuguang Hospital Affiliated to Shanghai University) were recruited into the study and allocated to a Treatment group (n = 36) and a Control group (n = 36). Patients in the Control group received a combination treatment comprising anti-Parkinson agents (Western drug regimen) with the addition of a traditional Chinese patent medicine (Huang-Xing Run-Chang Tablets*) over a period of 5 weeks, whereas patients in the Treatment group received the same anti-PD Western drug regimen together with the JWJCJ decoction, also for a period of 5 weeks. An evaluation using clinical efficacy scores was carried out together with network pharmacology analysis. Identified drug targets for JWJCJ using the traditional Chinese medicine Swiss Target Prediction database (TCMSP) and disease targets for chronic constipation in PD were obtained from Genecards and the OMIM database. Therapeutic targets for JWJCJ in the treatment of chronic constipation were identified by intersecting drug targets and disease targets. GO functional enrichment analysis, KEGG pathway analysis, and disease association analysis were carried out using the DAVID database and visualized using Cytoscape 3.9.1 software. CSS efficacy scores in the Treatment group were higher than that in the Control group (88.57 vs. 52.94%, p < 0.001). No significant differences were seen prior to treatment in the CSS, PDQ-39 and MDS-UPDRS scores and the corresponding total scores for the two groups. After treatment, CSS values for patients in the Treatment group were higher than values before treatment (p < 0.01). Network pharmacology analysis identified 172 active components, 9,542 drug targets, and 421 intersecting target genes for JWJCJ. PPI analysis identified 10 main and possibly key targets for JWJCJ in the treatment of chronic constipation. KEGG analysis identified 198 signaling pathways, where pathways in cancer, specific cancer pathways such as prostate cancer and non-small cell lung cancer, lipid and atherosclerosis, hepatitis B, and the AGE-RAGE signaling pathway in diabetic complications were among the pathways most significantly enriched. These findings are evidence that the active ingredients in JWJCJ in the treatment of chronic constipation in PD mainly target TP53, SRC, AKT1, PIK3R1, and PIK3CA. The efficacy of JWJCJ in treating chronic constipation in PD involves the targets SRC, PIK3R1, JUN, TP53, STAT3, PIK3CA, EGFR, ESR1, MAPK1, and AKT1 domains. These findings provide theoretical basis for the clinical application of JWJCJ decoction in the treatment of chronic constipation in PD.