Slow Transit Constipation
Conditions
Keywords
Fecal Microbiota Transplantation, Soluble Dietary Fiber, Slow Transit Constipation
Brief summary
The purpose of this study is to evaluate the synergism of Soluble Dietary Fiber with Fecal Microbiota Transplantation in Adult Patients with Slow Transit Constipation.
Detailed description
Constipation is a chronic disease estimated to affect about 10% - 15% of the worldwide general population. Recent evidence in the literature and collected in our laboratory confirm that constipation can be a consequence of intestinal dysbiosis, which may affect the motility and metabolic environment of colon. Fecal Microbiota Transplantation (FMT) is temporarily effective for patients with slow transit constipation. However, the transplanted microflora cannot maintain for a long time. Along with the gut microbiota returning to the original state, the symptoms relapse. Pectin is a kind of soluble dietary fiber, producing short chain fatty acids (SCFAs) after a series of fermentation by gut flora to supply the energy for epithelial cells, regulate intestinal PH, promote intestinal motility and join effort in immune regulation with intestinal lymphoid tissue. Therefore, we conceive that pectin could promote the colonization of probiotics and reduce adhesion of pathogens.
Interventions
DRUGPectin
Patients allocated to experiment group will receive 12 g pectin each day for 12 weeks.
OTHERPlacebo
Patients allocated to experiment group will receive 12 g maltodextrin each day for 12 weeks.
PROCEDUREFecal microbiota transplantation (FMT)
Standardized Frozen Fecal Microbiota will be infused via nasointestinal tube.
Sponsors
Jinling Hospital, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Chronic constipation according to Rome III criteria, defined as two or fewer spontaneous, complete bowel movements (SCBMs) per week for a minimum of 6 months; * Age ≥ 18 years; * BMI: 18.5-25 kg/m2; * Slow colonic transit confirmed by colonic transit test (colonic transit time (CTT) \> 48 hours); * Normal anorectal manometry, with no evidence of dyssynergia and confirmed ability to expel rectal balloon; * No radiographic evidence of functional (i.e. pelvic floor dyssynergia) or anatomical (i.e. significant rectocele and intussusception) impediment to the expulsion of the radio-opaque contrast; * Disease duration \> 1 year; * Traditional treatment with dietary modification, laxatives (including osmotic and stimulant laxatives), and biofeedback tried over the past 6 months without success;
Exclusion criteria
* Bowel constipation due to innate factor (i.e. megacolon) or secondary interventions (i.e. drugs, endocrine, metabolic, neurologic or psychologic disorders); * History or evidence of gastrointestinal diseases (i.e. obstruction, cancer, inflammatory bowel diseases) ; * Previous abdominal surgery, except cholecystectomy, appendicectomy, tubal ligation and cesarean section; * Previous proctological or perianal surgery; * A constipation condition meeting the Rome III criteria for IBS or functional abdominal pain syndrome; * Pregnant or breast-feeding women; * Infection with enteric pathogen; * Usage of probiotics, prebiotics and/or synbiotics within the last month; * Usage of antibiotics and/or PPIs within the last 3 months; * Smoking or alcohol addiction within the last 3 months; * Uncontrolled hepatic, renal, cardiovascular, respiratory or psychiatric disease; * Disease or therapy with drugs (i.e. antidepressants, opioid narcotic analgesics, anticholinergics, calcium antagonists, nitrates, antimuscarinics) that, in the opinion of the investigator, could affect intestinal transit and microbiota.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients having on average three or more SCBMs/week | 12 weeks | Proportion of patients having on average three or more spontaneous, complete bowel movements (SCBMs) per week was evaluated at week 4 and 12. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Constipation-related symptoms assessments | 12 weeks | Constipation-related symptoms were evaluated using the validated Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire at week 4 and 12. |
| Quality-of-Life assessments | 12 weeks | Quality-of-Life was evaluated using the validated Patient Assessment of Constipation Quality of Life (PACQOL) self-report questionnaire at week 4 and 12. |
| Bowel habit assessments | 12 weeks | Patients kept daily diaries about times of bowel movements each day, stool consistency, degree of straining severity during defecation, and degree of sensation of incompleteness of evacuation. |
| Usage of laxatives or enemas as rescue medication | 12 weeks | If patients did not have a bowel movement for 3 or more consecutive days, they were permitted to take up to 20 g of Macrogol 4000 powder (Forlax). If ineffective, enema were used. Patients kept daily diaries about the rescue medication when used. |
| Adverse events | 12 weeks | Adverse events include fever, diarrhea, abdominal pain, increased bloating, borborygmi, flatulence, nausea, vomiting, nasopharyngitis, and any other disorders. |
| Colonic transit time measurements | 12 weeks | Colonic transit time (CTT) was measured at week 4 and 12 with the Metcalf method. |
Countries
China
Contacts
Primary ContactJianfeng Gong, MD
Backup ContactNing Li, MD
Outcome results
None listed