Clinical efficacy of the traditional Chinese herbal formula, (Tong Bian Decoction) on laxative dependence constipation in elderly persons: A randomized, multicenter, controlled trial
YinziY uea1 Xiaopeng Wangb1 HuijuYangc1Mingming Sunb Shujun Chend Haihua Qiane Tianshu Xuf Shuai Yan
Constipation is a common problem particularly for older people. This study was designed to evaluate the efficacy and safety of treating laxative dependence constipation patients with the Traditional Chinese Herbal Formula (Tong Bian Decoction).
Of 160 patients randomised to the trial, 80 cases in the control group were given an oral administration of mosapride, while the other 80 cases were allocated Tong Bian Decoction. Symptom scores of constipation, rectal pressure, and the assessment of patients with constipation on their quality of life and side-effects were evaluated.
Of the 160 patients, 80 completed the trial. At follow-up, there were remarkable differences between the TBD treatment group and mosapride treatment group for the following parameters: difficult defecation, fecal character, defecation time, endless and dilatation feeling, frequency and abdominal distension scores (P < 0.05); anal rest pressure, maximum systolicpressure and rectal maximum threshold of the rectal pressure (P < 0.05); physical, worry and satisfaction domain of the PAC-QOL (P < 0.05).
Tong Bian Decoction appeared to be clinically effective on symptoms, the rectal pressure and the PAC-QOL of long-term laxative dependence constipation in elderly persons. There were also fewer side effects.
Source : European Journal of Inegrative Medicine
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Suffering from constipation? Self-acupressure can help
About 19 percent of North Americans suffer from constipation, with the digestive condition being more common among women, non-whites, people older than 60, those who are not physically active and the poor.
The costs are significant. Hospital costs to treat the condition were estimated at $4.25 billion in 2010 alone. Constipation can also lead to depression, lower quality of life and a drop in work productivity. Treatments include use of laxatives, increased intake of dietary fiber and fluid, and exercise.
But new research from the UCLA Center for East-West Medicine published online in the Journal of General Internal Medicine shows how Eastern and Western medicine can blend to find solutions to this common medical problem. In a randomized clinical trial, 72 percent of participants said that perineal self-acupressure, a simple technique involving the application of external pressure to the perineum -- the area between the anus and genitals -- helped them have a bowel movement.
The research suggests that all primary care and general internal physicians should consider this technique as a first line intervention together with conventional treatment, said Dr. Ryan Abbott, the study's principal investigator and a visiting assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
"Constipation is very common and can have debilitating symptoms," said Abbott, who is also a researcher and educator with the East-West center. "But patients can perform this simple intervention themselves to treat their own constipation and improve their quality of life. It can also help to limit health care costs and excessive medication use."
The researchers recruited 100 patients, nine of whom dropped out during the trial, age 18 and older whom met the established criteria for functional constipation. Among these criteria are that they have fewer than three defecations per week and that for at least 25 percent of the their bowel movements they:
• Strain during defecation
• Have lumpy or hard stools
• Experience a sensation of incomplete evacuation
• Experience a sense of obstruction or blockage
• Use manual maneuvers such as digital evacuation
After researchers gave patients just three to five minutes of instruction, patients were encouraged to perform the exercises on their own for four weeks when they felt the urge to defecate. Patients reported using the technique three to four times a week on average. The self-acupressure broke up hard stools, relaxed muscles and stimulated nerves responsible for bowel movements.
Among the other findings:
• 72 percent said the technique helped them break up, soften or pass stools
• 54 percent claimed it helped avoid hemorrhoids or lessen the severity of existing hemorrhoids.
• 82 percent said they would continue using the technique
• 72 percent said they would recommend the technique to family and friends
"This unique self-administered acupressure treatment for constipation is just one example of how an integrative approach to medicine helps patients and is cost-effective, too," said Dr. Ka-Kit Hui, Wallis Annenberg Endowed Chair in Integrative East-West Medicine at UCLA and founder and director of the UCLA Center for East-West Medicine. "Utilizing both Eastern and Western approaches helps create a new paradigm of medicine that combines the best of both worlds."
There are some limitations to this study, the authors write. For instance, like all trials of behavioral interventions, this was not a blinded trial. The sample size was also relatively small, with fewer than 100 patients completing the study. Also, the researchers were uncertain whether the technique could prevent constipation or whether similar techniques would result in comparable improvements.
But the study does provide evidence that the technique could be useful in tandem with other treatments.
"As a non-invasive, non-pharmacological treatment intervention for constipation, perineal self-acupressure likely carries a lower risk for side effects and complications than commonly used medications such as stool softeners, fiber supplements, stimulants, laxatives and lubricants," the researchers write. "In addition, perineal self-acupressure may help to control treatment costs because it only requires a brief, initial period of training. Furthermore, not all patients respond favorably to existing treatment options, and perineal self-acupressure may represent an effective alternative to conventional treatment options."
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Source : Science Daily
Variation in Gastric pH May Determine Kiwifruit’s Effect on Functional GI Disorder: An in Vitro Study
Bruce Donaldson 1,* , Elaine Rush 1, Owen Young 1 and Ray Winger
Consumption of kiwifruit is reported to relieve symptoms of functional gastrointestinal (GI) disorder. The effect may be related to the proteases in kiwifruit. This in vitro study aimed to measure protein hydrolysis due to kiwifruit protease under gastric and duodenal conditions. A sequence of experiments incubated meat protein, with and without kiwifruit, with varying concentrations of pepsin and hydrochloric acid, at 37 °C for 60 min over the pH range 1.3–6.2 to simulate gastric digestion. Duodenal digestion was simulated by a further 120 min incubation at pH 6.4. Protein digestion efficiency was determined by comparing Kjeldahl nitrogen in pre- and post-digests. Where acid and pepsin concentrations were optimal for peptic digestion, hydrolysis was 80% effective and addition of kiwifruit made little difference. When pH was increased to 3.1 and pepsin activity reduced, hydrolysis decreased by 75%; addition of kiwifruit to this milieu more than doubled protein hydrolysis. This in vitro study has shown, when gastric pH is elevated, the addition of kiwifruit can double the rate of hydrolysis of meat protein. This novel finding supports the hypothesis that consumption of kiwifruit with a meal can increase the rate of protein hydrolysis, which may explain how kiwifruit relieves functional GI disorder.
Source : Journal Nutrients
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Prunes beat psyllium for constipation relief: RCT
Fifty grams of prunes, providing a daily fiber dose of 6 grams, outperformed an equal fiber dose from psyllium for constipation relief over three weeks, with the fruit’s laxative effects linked to its sorbitol, fiber, and polyphenol contents, according to findings of a study supported by the California Dried Plum Board.
“Given their palatability, tolerability and availability, dried plums should be considered in the initial approach to the management of mild to moderate constipation in the general population,” write the authors, led by Satish Rao, MD, PhD., from the University of Iowa Carver College of Medicine in Alimentary Pharmacology & Therapeutics.
According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), over four million Americans suffer from constipation every year. As a result, approximately $725 million is spent on laxatives in the US.
Constipation, considered a symptom and not a disease, is defined as fewer than three bowel movements per week.
Dietary approaches to alleviate constipation are well known, with prunes ranking high on the list of foods to help maintain regularity. However, while traditional use is well known, the University of Iowa researchers state that efficacy of this approach is not currently known.
Indeed, the European Food Safety Authority's (EFSA) Panel on Dietetic Products, Nutrition and Allergies (NDA) rejected an article 13.1 health claim in October 2010 of the long-standing association between prunes and bowel function due to insufficient evidence. The new study appears to fill some of the scientific gaps.
Dr Rao and his co-workers recruited 40 people with constipation to participate in their randomized control crossover trial. The average age of the participants was 38. Volunteers were randomly assigned to consume 50 grams per day of prunes, or 11 grams per day of psyllium (Metamucil, Proctor and Gamble Pharmaceuticals) for three weeks. One week of ‘washout’ separated the interventions.
Results showed that daily prune consumption significantly improved spontaneous bowel movements per week, compared with psyllium. The prune intervention increased spontaneous bowel movements per week from an average of 1.8 at the start of the study to 3.5, while psyllium was associated with an increase from an initial average of 1.6 to 2.8.
In addition, stool consistency measures also improved more in the prune group, compared with psyllium.
In terms of tolerability and palatability, there were no reported differences between prunes and psyllium, said the researchers.
“These findings confirm the general notion that dried plums that are widely consumed can be useful for the treatment of constipation,” wrote the authors.
Commenting on the potential benefits of prunes, the authors note that prunes contain about 15 grams of sorbitol per 100 grams, and this is known to act as an “osmotic laxative and holds on to water”, while there is also 184 milligrams of polyphenols per 100 grams, and six grams of fiber per 100 grams.
“Since we tested an equivalent dose of dietary fiber, it is likely that the clinical improvement observed with dried plums is most likely due to the other beneficial components of plums over and above its fiber content and ⁄ or the blend of soluble and insoluble fiber in this compound,” they added.
Source: Alimentary Pharmacology & Therapeutics
Volume 33, Issue 7, April 2011, Pages: 822–828, DOI: 10.1111/j.1365-2036.2011.04594.x
“Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation”
Authors: A. Attaluri, R. Donahoe, J. Valestin, K. Brown and S. S. C. Rao
Source : Nutraingredients (07/03/2011)
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