Colon ; physiopathology ; Constipation ; etiology ; surgery ; Humans

BACKGROUNDEndometriosis is a controversial and enigmatic disease. Deep infiltrating endometriosis (DIE) is responsible for painful symptoms and is the least understood type of endometriosis. Little work has been devoted to define the location of DIE lesions and its relationships with pain. The aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain symptoms.

METHODSClinical data from 354 patients between May 2003 and December 2007 with laparoscopically diagnosed endometriosis were collected including 177 DIE patients and 177 non-DIE patients. The pain symptoms, including dysmenorrhea (DM), chronic pelvic pain (CPP, defined as intermittent or permanent pelvic pain, not related to the menstruation and longer than 6 months), deep dyspareunia (pelvic pain at intercourse) and dyschezia (pelvic pain with defecation), were recorded for every patient before operation. Endometriotic lesions were recorded by their anatomical distributions, the depth of infiltration and lesion colors. And the relationship between the anatomical distribution of DIE lesions and pain symptoms was analyzed. Pearson's chi-square test or Fisher's exact test, one-way analysis of variance (ANOVA) and linear regression and binary Logistic regression were used for statistical analysis.

RESULTSThe duration ((13.79 ± 3.94) years) of pain suffering in DIE patients was much longer than that of non-DIE patients (P < 0.01). In DIE patients, 60.7% of the uterosacral ligament (USL) nodules were bilateral (P < 0.01); 44.6% of the cul-de-sacs were completely blocked. Rectum invasion was observed in 19.9% of DIE patients (P = 0.03); pelvic adhesion was also more common. Up to 98.41% of the deep infiltrative lesions were located in the posterior pelvic compartment. DIE lesions were also found in bladder (1.58%), USL (67.08%), cul-de-sac (12.02%), recto-vaginal septum (12.66%), rectum and rectosigmoid junction (2.85%) and ureter (3.80%). The odds ratio of USL-DIE for CPP, deep dyspareunia, dyschezia were 2.52, 1.29 and 2.24 respectively. And the depth of infiltration correlated with the severity of dysmenorrhea.

CONCLUSIONSDIE lesions were associated with severe pain symptoms. The main distribution of DIE lesions was in the posterior pelvic compartment, and was more widespread and severe in DIE patients. Moreover, resection of these DIE lesions are very important to treat the pain symptoms.

Adult ; Constipation ; physiopathology ; Dysmenorrhea ; physiopathology ; Endometriosis ; pathology ; physiopathology ; Female ; Humans ; Pelvic Pain ; physiopathology ; Prospective Studies

Adolescent ; Anal Canal ; physiopathology ; Child ; Constipation ; physiopathology ; Female ; Gastrointestinal Motility ; physiology ; Humans ; Male ; Rectum ; physiopathology

In recent years, according to the etiology and pathology researches of slow transit constipation (STC) STC is considered as a kind of "enteric neuropathy", indicating it is a kind of disease caused by abnormity of the enteric nervous system (ENS). Through reviewing the mechanism of acupuncture to regulate STC, it is found out that there is a close relationship between acupuncture regulating STC and ENS. Through various channels including ganglion cells, nerve plexus, neurotransmitter and TRPV1 (the primary sensory neurons receptor of the ENS) of the ENS, acupuncture is likely to make comprehensive adjustment on STC.
Acupuncture Therapy ; Colon ; innervation ; physiopathology ; Constipation ; physiopathology ; therapy ; Enteric Nervous System ; physiopathology ; Humans

Adult ; Anus/*physiopathology ; Constipation/etiology ; Esophagus/physiopathology ; Female ; Human ; Manometry ; Middle Age ; Rectum/*physiopathology ; Scleroderma, Systemic/*physiopathology

Acupuncture Therapy ; Child ; Child, Preschool ; Constipation ; physiopathology ; therapy ; Gastrointestinal Tract ; physiopathology ; Humans ; Infant ; Male

OBJECTIVETo investigate the structural and functional changes of internal anal sphincter (IAS) in children with functional constipation (FC), and to evaluate the association between the thickness of IAS and the severity of clinical symptoms.

METHODSA total of 35 children with FC(constipation group,17 with incontinence) between June 2008 and December 2008 at the Shengjing Hospital of China Medical University were evaluated using anal manometry and endosonography. These patients were compared to 23 hospitalized children who were excluded for digestive and endocrinal diseases(control group). A validated symptom score(SS) was used to assess the severity of symptoms. The sum of SS ranged between 0 and 65.

RESULTSAnorectal manometry showed reflex relaxation of IAS in response to distension of rectal balloon in all patients. Rectal perceptional threshold in FC group was significantly higher than that in the controls[(42.4 ± 19.5) ml vs.(29.1 ± 15.6) ml, P<0.05]. The lowest volume for inducing reflex relaxation of IAS was significantly higher than that in the controls [(55.6 ± 31.6) ml vs.(30.5 ±13.8) ml, P<0.05]. The thickening of IAS was noted in all the patients[(3.8 ± 1.7) mm vs.(2.5 ± 1.0) mm, P<0.05]. However, there was no significant difference between FC and control in median resting anal sphincter pressure[(170.8 ± 62.3) mm Hg vs. (161.3 ± 51.1) mm Hg, P>0.05]. The median symptom score was 9.3 ± 4.3 in the FC group. The thickness of IAS correlated significantly with total symptom severity score(r=0.407, P<0.05). There was no correlation between thickness of IAS and age, sex, or duration of disease(P>0.05).

CONCLUSIONSStructural and functional changes of internal anal sphincter exist in children with functional constipation. The thickness of internal anal sphincter correlates significantly with symptom severity.

Anal Canal ; diagnostic imaging ; physiopathology ; Child ; Child, Preschool ; Constipation ; diagnostic imaging ; physiopathology ; Endosonography ; Female ; Humans ; Male

Slow transit constipation(STC)is the common type of chronic idiopathic constipation. Due to failure of routine conservative treatment, laxatives abuse is the most choice for majority of the patients, which could damage the enteric nervous system and result in aggravation of constipation. Resection of the slow transit colon is the ultimate option for some patients. It is hard to prevent and treat STC clinically because of the unknown pathophysiologic mechanism. Abnormalities of enteric neurotransmitters such as VIP, SP, NOS and decreased number of interstitial cells of Cajal have been described in the colon of the patients with STC. However, long term application of stimulant laxatives can also result in the almost same changes in the colon. Exploration of the potential relationship among the above reported abnormalities is the direction of future study.
Constipation ; physiopathology ; Enteric Nervous System ; physiopathology ; Gastrointestinal Transit ; physiology ; Humans ; Interstitial Cells of Cajal ; cytology

BACKGROUNDThe etiology and pathology of functional constipation (FC) is unclear. Some researches suggest that psychological factors may be related to this common problem. This study aimed to investigate the relationship between attention processing and emotional status in FC patients compared with healthy controls.

METHODSWe investigated selective attention and emotional status in patients with FC using the counting Stroop task. Thirty-five FC patients (FCP group) and 24 healthy controls (HCs) underwent an event-related potential (ERP) study while performing the task. Response time, latency and amplitude of P300 were collected and compared between the two groups. The Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Scale (HAMA), Symptom Checklist-90 (SCL-90) and Eysenck Personality Questionnaire (EPQ) were administered prior to the counting Stroop task.

RESULTSScores for the FCP group differed significantly from those for the HCs on the HAMD-17, HAMA, SCL-90 (Global Severity Index, Positive Symptoms Total, dimensions of somatization, obsessive-compulsive, depression, anxiety, and psychosis), as well as extraversion and neurosis dimensions of the EPQ (P < 0.05). There was no significant difference in response time or accuracy rate between the two groups (P > 0.05). ERP results showed prolonged latency at F4, additionally found enhanced activation at F3, FC1 and T8, and decreased activation at sites FC6 and P7 in the patients with FC. Statistically, significant differences of P300 latency at site F4 (P < 0.05) and P300 amplitude at F3, F4, T8, P7, FC1 and FC6 (P < 0.05) between the patients with FC and the HC were revealed.

CONCLUSIONSThe findings suggest that patients with FC are more susceptible to depression and anxiety, as well as somatization, obsessive-compulsive tendencies and other neurotic personality characteristics. Patients may employ psychological defense mechanisms to avoid the pain of depression and anxiety. ERP results imply there may be some brain dysfunction and attention deficits in patients with FC.

Adolescent ; Adult ; Aged ; Anxiety ; etiology ; physiopathology ; Constipation ; complications ; physiopathology ; Depression ; etiology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo observe the improvements in constipation differentiated as intestine system syndrome and lung system syndrome treated with electroacupuncture (EA) and explore their correlation.

METHODSSeventy cases of severe functional constipation were randomized into an EA group and a pseudo-EA group, 35 cases in each one. In the EA group, the needles were inserted deeply at Tianshu (ST 25) and Fujie (SP 14) on bilateral sides, and directly went to parietal peritoneum. EA was attached to the needles, dense-disperse wave, 2 Hz/15 Hz, and 0.1 to 1.0 mA. The perpendicular insertion was done at Shangjuxu (ST 37), 25 mm in depth. After qi arrival, the needle was lifted, thrusted and rotated once every 10 min, for 3 times totally. The needles were retained for 30 min. In the pseudo-EA group, the pseudo-points lateral to Tianshu (ST 25), Fujie (SP 14) and Shangjuxu (ST 37) on bilateral sides were punctured shallowly. The electric stimulation was pretended to connect but with the electric wire cutting off. The needles were retained for 30 min. The treatment was given 5 times weekly in the first two weeks and 3 times weekly in the later 6 weeks. Totally, 28 treatments were required. TCM intestine and lung syndrome scale was used for evaluation. The changes in TCM syndromes were observed before and after treatment in the patients of the two groups.

RESULTSThe total score of intestine and lung syndrome and the score of individual syndrome were all reduced after treatment as compared with those before treatment in the two groups (both P<0.01). The improvements of the EA group in the total score of intestine system syndrome, the scores of large. intestine syndrome and stomach syndrome, the total score of lung system syndrome and the score of lung dysfunction in dispersing and descending syndrome were superior to those of the pseudo-EA group (P<0.01, P<0.05). The differences in the scores of lung qi deficiency syndrome and throat syndrome were not significant between the two groups (all P>0.05). Simultaneously, the very strong positive correlation (P<0.01) and positive linear correlation (P<0.01) were presented in the total score of intestine and lung syndrome of the two groups.

CONCLUSIONEA obviously improves in intestine system syndrome (including large intestine syndrome and stomach syndrome), as well as lung system syndrome (lung dysfunction in dispersing and descending) in the treatment of constipation. But the improvements are not apparent in the treatment of lung qi deficiency and throat disorder. Additionally, the obvious correlation is displayed in the improvements in intestine and lung syndrome.

Acupuncture Points ; Adult ; Aged ; Constipation ; physiopathology ; therapy ; Electroacupuncture ; Female ; Humans ; Intestines ; physiopathology ; Lung ; physiopathology ; Male ; Middle Aged ; Young Adult