| Background and ObjectiveFunctional constipation (FC) is a common functional bowel disorder. According to different pathophysiologic mechanisms, the American Gastroenterological Association and the latest FC constipation guide divided the disease into:normal transit constipation (NTC), slow transit constipation (STC), defecation disorders (DD) and mixed constipation (MIX).With the changing of eating habits and pace of life, the prevalence of constipation increased significantly, especially which manifests the syndrome of dampness-heat of spleen and stomach. Our study aim to investigate the gastrointestinal motility and main intestinal microf lora of the patients,and thus to analyze and compare the similarities and differences of FC with syndrome of dampness heat of spleen-stomach and non-dampness heat of spleen-stomach.Subjects and MethodsBetween December2011to March2014, A total of204patients with functional constipation as defined by the Rome â…¢ diagnostic criteria were recruited from the gastroenterology clinic of China-Japan Friendship Hospital. All of them have completed symptom questionnaire, anorectal high-resolution manometry (AR-HRM),48h gastrointestinal transit time (GITT),fecal flora culture. And according to the diagnostic criteria these patient were divided into two group-the syndrome of dampness heat of spleen-stomach group and non-dampness heat of spleen-stomach group. Meanwhile23healthy controls were recruited to undergo fecal flora analysis culture. Questionnaire includes demographic characteristics, symptoms of constipation. High resolution anorectal manometry can determine whether the patients anorectal pressure and the anorectal inhibitory reflex are abnormal. Gastrointestinal transit time can reflect whether the colonic transit is slowed. Fresh stool culture analyze the quantitative of Bifidobacterium, Lactobacillus, Enterococcus, Enterobacter, Candida,filamentous fungi. Results(1)The study included204patients with functional constipation,96Ocases of the syndrome of dampness heat group and108cases of non-dampness heat group. The male to female ratio of syndrome of dampness heat group was1:2.2, non-dampness heat was1:2.375, no statistical difference between the two.(2)The syndrome of dampness heat group median age was52years, with an average duration of14years. non-dampness heat group median age was51years, with an average duration of12years,no significant difference between the groups in terms of age distribution and duration of time.(3) Drinking history of syndrome of dampness heat group was significantly higher than non-dampness heat (22.9%VS12.9%), there was significant different (P=0.047) between the two.(4) There were25%,27%,33%,15%patients in types of MIX,OOC,STC,NTC respectively in syndrome of dampness heat group. And41%,16%,36%,7%patients in types of MIX,OOC,STC,NTC respectively in non-dampness heat group. Syndrome of dampness heat group in OOC distribution ratio was significantly increased than non-dampness heat (P=0.047). Also syndrome of dampness heat group in MIX was significantly decreased than non-dampness heat(P=0.017). Syndrome of dampness heat group in slow transit (MIX+STC) ratio was significantly lower than non-dampness heat (P=0.005).(5)The two groups were significantly different in the symptom score of endless defecate feeling (P=0.000). The most uncomfortable symptoms between the two groups are significantly different, the group with syndrome of dampness heat complain more in endless defecate feeling (P=0.004), and the non-dampness heat suffer more from reducing frequency of defecation (P=0.001).(6) Compared with the controls, the numbers of Bifidobacterium and Lactobacillus was significant reduced, and the Enterococcus number was significantly increased in the syndrome of dampness heat group (P=0.000, P=0.002, P=0.037). Meanwhile the numbers of Bifidobacterium and Lactobacillus was also significant reduced, but the Enterobacter number was significantly increased compared with the control group in non-dampness heat group (respectively, P=0.008, P=0.007, P=0.004). Enterococcus number of the syndrome of dampness heat group was significant increase than the non-dampness heat group(P=0.035). |
