| Background and purpose:Functional constipation(FC)is a kind of functional gastrointestinal disorders(FGIDs).The core symptom of FC is constipation,for example,decreasing of frequency of defecation,hard stool and difficult defecation.But it does not meet the diagnostic criteria of irritable bowel syndrome(IBS).FC has seriously affected people’s health and quality of life,and brought high medical costs.Therefore,it has attracted more and more attention from researchers.In Europe and America,the prevalence of FC is 20%to 27.2%.There are few reports about cross regional epidemiological studies with large sample on FC in China.The results show that the prevalence of FC in China is lower than that in Europe and America,but the overall trend is increasing year by year.The risk factors of FC are complex and uncertain,which include unhealthy dietary habits,unhealthy habits of defecation,mental disorders,intestinal flora disturbance,pelvic floor dysfunction,drug abuse and genetic defects etc.At present,there are many treatment methods for FC,including auxiliary treatment,drug treatment,biofeedback therapy,traditional Chinese medicine treatment,surgical treatment and so on.However,because of the many factors affecting FC and the long course of disease,many patients are difficult to remission or easy to regenerate after remission.So the overall effect of the current FC treatment remains to be improved.According to the current diagnosis and treatment of FC,it is necessary to conduct a standardized and comprehensive study of it.But at present,there is no standardized clinical database in China to carry out the related research of FC.Therefore,we have established a standardized clinical database of functional gastrointestinal disorders(http://www.fgiddata.com).The database is presented in the form of Internet online website.It is convenient to use,and has statistical functions of management and general retrieval,and it is gradually improved in the actual use process.We have developed a case report(CRF)for the data collection of FC patients according to previous research results.It includes general demographic data,disease performance and duration of disease,past medical history,possible disease related factors,auxiliary examination,treatment plan and effect.After collecting all the data,we will record it to the database.At the same time,a control group was set up.The use of database for FC specification,comprehensive research,it is of great significance for the early prevention and clinical diagnosis and treatment of FC.Part 1 Using database to explore the clinical characteristics and onset factors of functional constipationObjects and methods:1.107 cases of FC patients diagnosed by the standard of Rome III or IV were enrolled in the Department of Gastroenterology,Nanfang Hospital,Southern Medical University,from January 2014 to October 2017;and 90 cases of control group.2.The data of FC patients were collected with the foregoing CRF and entered into the database for general retrieval statistics,to analyze the clinical characteristics of FC.SPSS20.0 software was used to analyze the data of the control group and the related data of FC patients derived from the database,and to explore the clinical characteristics and onset factors of FC.Results:1.The statistics of the clinical characteristics of FC by using the database:Of the 107 cases of FC,there were 35 males and 72 females,the proportion of men and women was 1:2.06.The range of age is from 13 to 85 with the average age of 48.58± 16.11 years,the high incidence population concentrated in 40～69 years(66.3%).Unemployed and retirees(41.1%)and intellectuals(20.6%)were the main ones.Urban people accounted for 70.1%.The range of BMI is from 14.87 to 35.80 with the average BMI of 21.53±3.70kg/m2.The main symptoms were defecation laborious(89.7%),hard or dry stool(82.2%),defecation frequency decreased(77.6%),abdominal distension(37.4%),.The number of stool times per week ranged from 0.5 to 6,the average number of stools per week was 2.27±0.87.The range of duration of disease is from 6 to 360 with the average duration of disease of 83.69±85.61 months.Clinical classification,slow transit constipation(STC)in 76 cases(71.1%),outlet obstructive constipation(OOC)in 31 cases(28.9%).Colorectal polyps were found in 33.6%of the colonoscopy.The anorectal manometry was perfected in 31 patients with FC,among them,38.7%of the anal canal relaxation was not complete when forced to defecate,the increase of the maximum rectal tolerance threshold was 51.6%.2.Comparison of the general features between the FC group and the control group:The proportion of group FC was significantly higher than that of the control group in insufficient vegetables and fruits,mental and light physical labor,lack of exercise,long meditation,combined anxiety or depression(all P<0.05).There was no significant difference between the two groups in urban and rural distribution,average BMI,BMI group,insufficient drinking water,smoking,long-term drinking and conscious pressure(all P>0.05).3.Logistic regression analysis of etiology related to FC:Female(P=0.028,OR=2.747),Insufficient vegetables and fruits(P=0.047,OR=2.757),lack of exercise(P=0.000,OR=5.614),combined anxiety or depression(P=0.000,OR=8.975)were risk factors of FC.Conclusion:The incidence of FC in female is more than that of male.The high incidence population was in the age of 40～69.Most of them are unemployed,retirees and intellectuals urban population.Most of them are urban population.The most important clinical symptoms are defecation laborious,hard or dry stool,defecation frequency decreased.And it is more likely to have intestinal polyps.Female,Insufficient vegetables and fruits,lack of exercise,combined anxiety or depression were risk factors of FC.Part 2 Using database to explore the treatment effect and influencing factors of functional constipationObjects and methods:1.107 cases of FC diagnosed by the standard of RomeⅢorⅣ which collected in previous work were studied.2.Therapeutic method:They were divided into two groups.One group used prokinetics,the other group used the prokinetics and probiotics.In the two groups of patients,if there was obvious anxiety and depression,the anti anxiety and depression treatments were added.The curative effects of 2 weeks,4 weeks and 8 weeks were observed in each group.3.In the database,the general retrieval and statistics of efficacy by different drug treatment schemes and time were carried out.The SPSS20.0 software was used to further analyze the related data of FC patients derived from the database,and to explore the effect and influencing factors of FC.Results:1.Overall efficacy and comparison of therapeutic effects of different treatments:at 2 weeks,20 cases(18.69%)were ineffective,82 cases(76.64%)improved,5 cases(1.67%)markedly effective,0 case(0%)recovered,5 cases were effective(markedly effective and recovered),the overall efficiency was 4.67%;at 4 weeks,1 case(0.93%)were ineffective,37 cases(34.58%)improved,66 cases(61.68%)markedly effective,3 cases(2.81%)recovered,69 cases were effective,the overall efficiency was 61.49%;at 8 weeks,1 case(0.93%)were ineffective,23 cases(21.50%)improved,22 cases(20.56%)markedly effective,61 cases(57.01%)recovered,83 cases were effective,the overall efficiency was 77.57%.The effective rate of STC group and OOC group was compared at 2,4,8 weeks:5.26%vs 3.23%,P=1.000;75.00%vs 38.71%,P=0.000;89.47%vs 48.39%,P=0.000.The effective rate of prokinetics and probiotics group and single prokinetics group was compared at 2,4,8 weeks:2.78%vs 5.63%,P=0.860;77.78%vs 57.75%,P=0.041;88.89%vs 71.83%,P=0.046.The effective rate of add-anti-anxiety depression drugs group and without anti-anxiety depression drugs group of patients with anxiety and depression was compared at 2,4,8 weeks:25.00%vs 3.57%,P=0.118;87.50%vs 57.14%,P=0.228;100.00%vs 71.43%,P=0.156.2.Factors influence the effect of single prokinetics using Logistic regression analysis:Lack of exercise or long meditation(P=0.034,OR=1.895),Insufficient vegetables and fruits(P=0.041,OR=6.178)were risk factor for poor treatment.Conclusion:After 2 weeks of drug treatment,most of the FC patients improved,after 4 weeks of drug treatment,most of the FC patients markedly effective,after 8 weeks of drug treatment,most of the FC patients markedly recovered or effective.The effect of drug treatment for OOC is worse than that of STC.Use probiotics on the basis of prokinetics can improve the curative effect.Factors such as lack of exercise or long meditation,insufficient vegetables and fruits,may reduce the efficacy of single use prokinetic drugs. |
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