Introduction

Functional constipation (FCon), a highly prevalent functional gastrointestinal disorder (FGID), often accompanies by mental and psychological disorders. Previous neuroimaging studies have demonstrated brain functional and structural alterations in FCon patients. However, little is known about whether and how regional homogeneity (ReHo) is altered in FCon patients. Moreover, the potential genetic mechanisms associated with these alterations remain largely unknown.

Aims & Methods

A total of 73 patients with FCon and 68 healthy controls were recruited, and we conducted ReHo comparison to identify the abnormal spontaneous brain activities in FCon patients. Based on Allen Human Brain Atlas, we further employed partial least squares regression analysis to explore gene expression profiles associated with ReHo alterations in FCon patients.

Results

Compared with healthy controls, FCon patients demonstrated significantly decreased ReHo in both bilateral caudate nucleus, putamen, anterior insula, thalamus and right middle cingulate cortex, supplementary motor area, and increased ReHo in the bilateral orbitofrontal cortex. Genes related to central nervous system development, fatty acid metabolism, and immunity were spatially correlated with abnormal ReHo patterns.
Table 1. The demographic and clinical characteristics of FCon and HC.

	FCon (N = 73) (Mean ± SD)	HC (N = 68) (Mean ± SD)	FCon vs. HC P value
Age (yrs)	51.14 ± 18.03	53.20±12.24	0.3487
Gender	20M/53F	23M/45F	0.408
BMI (Kg/M2)	21.96 ±4.10	24.78 ± 3.198	< 0.0001
Depression (SDS)	45.54 ± 11.16	37.46 ± 8.15	< 0.0001
Anxiety (SAS)	40.51 ±11.05	35.44± 7.52	0.0019
PAC-QOL	45.16 ± 19.07	N/A	N/A
Wexner constipation score	11.71 ± 3.76	N/A	N/A

Conclusion

Our findings showed significant ReHo alterations in FCon patients, and these changes may be related to complex polygenetic and poly-pathway mechanisms, which provides a new perspective to understand the pathophysiology of FCon.

References

[1]Alame A M, Bahna H. Evaluation of constipation. Clin Colon Rectal Surg. Mar 2012;25(1):5-11.
[2]Drossman D A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. Feb 19 2016.
[3]Black C J, Drossman D A, Talley N J, Ruddy J, Ford A C. Functional gastrointestinal disorders: advances in understanding and management. Lancet. Nov 21 2020;396(10263):1664-1674.
[4]Mugie S M, Benninga M A, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. Feb 2011;25(1):3-18.
[5]Barberio B, Judge C, Savarino E V, Ford A C. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. Aug 2021;6(8):638-648.
[6]Person H, Keefer L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry. Apr 20 2021;107:110209.
[7]Hosseinzadeh S T, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. Summer 2011;4(3):159-163.
[8]Martin B C, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. Dec 2006;19(12):43-49.

Introduction

To observe the long-term efficacy and complications of FMT in the treatment of diseases related to intestinal dysbiosis in China.

Aims & Methods

Collect clinical data of 15000 patients who received FMT treatment and were followed up for more than 3 months from May 2017 to September 2024; The inclusion criteria for cases are patients who meet the indications for FMT treatment; Among them, there were 8258 cases of constipation, 684 cases of CDI, 1730 cases of chronic diarrhea, 510 cases of inflammatory bowel disease, 432 cases of radiation enteritis, 1940 cases of irritable bowel syndrome, 365 cases of autism, 870 cases of postoperative gastrointestinal dysfunction, and 211 cases of neurodegenerative diseases. The treatment methods for intestinal microbiota transplantation include receiving continuous infusion of intestinal microbiota solution through the nasointestinal tube (into the jejunum) for 6 days after placement (upper gastrointestinal tract transplantation group), continuous oral administration of intestinal microbiota capsules for 6 days (oral capsule transplantation), and one-time injection of microbiota solution into the colon through colonoscopy (lower gastrointestinal tract transplantation group);The main observation indicators are the efficacy of intestinal microbiota transplantation treatment at 3, 12, and 36 months. The secondary outcome measures were the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.

Results

A total of 15000 patients in the group were treated with upper gastrointestinal route in 11125 cases, oral capsule transplantation (oral capsule group) in 3597 cases, and lower gastrointestinal route in 278 cases. At 3, 12, and 36 months after treatment, the overall treatment efficacy rates were 71.8% (10763/15000), 64.4% (7600/11808), and 58.8% (3659/6218), respectively. The clinical improvement rates for constipation were 70.3% (5805/8258), 60.8% (3858/6345), and 56.5% (1894/3352), respectively. The clinical improvement rates for CDI were 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively. The clinical improvement rates for chronic diarrhea were 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively. The clinical improvement rates of intestinal diseases were 64.3% (328/510), 52.3% (249/476), and 46.6% (97/208), respectively. The clinical improvement rates of radiation enteritis were 77.3%, 65.4%, and 53.6%, respectively; The clinical improvement rates of the oral capsule group were 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively; The clinical improvement rates of the lower gastrointestinal pathway group in three time periods were 43.5% (121/278), 36.4% (48/132), and 14.9% (10/67), respectively. No serious adverse reactions occurred during treatment and follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting during capsule swallowing (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; The above symptoms disappeared after the end of treatment. During a follow-up period of 36 months, 19 patients reported worsening of their pre-existing disease symptoms, 16 deaths were not directly related to FMT, and no abnormal systemic diseases were found after FMT.

Conclusion

FMT is effective in treating intestinal dysfunction and related extraintestinal diseases related to gut microbiota disorders in the long term, with no serious adverse events

References

• [1] Wang Y, Huang Y, Chase RC, et al. Global burden of digestive diseases: a systematic analysis of the global burden of diseases study, 1990 to 2019[J]. Gastroenterology, 2023, 165(3):773-783.e15. DOI: 10.1053/j.gastro.2023.05.050.
• [2] Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease[J]. Nat Rev Microbiol, 2021, 19(1):55-71. DOI: 10.1038/s41579-020-0433-9.
• [3] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease[J]. N Engl J Med, 2016, 375(24):2369-2379. DOI: 10.1056/NEJMra1600266.
• [4] Li YT, Cai HF, Wang ZH, et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection[J]. Aliment Pharmacol Ther, 2016, 43(4):445-457. DOI: 10.1111/apt.13492.
• [5] Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial[J]. Lancet, 2017, 389(10075):1218-1228. DOI: 10.1016/S0140-6736(17)30182-4.
• [6] Mincic AM, Antal M, Filip L, et al. Modulation of gut microbiome in the treatment of neurodegenerative diseases: a systematic review[J]. Clin Nutr, 2024, 43(7):1832-1849. DOI: 10.1016/j.clnu.2024.05.036.
• [7] Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4):569-580. DOI: 10.1136/gutjnl-2016-313017.

Disclosure

None

Introduction

Functional Constipation (FC) and Constipation-predominant Irritable Bowel Syndrome (IBS-C) are two common disorders of gut-brain interaction (DGBI) which can often present overlapping symptoms, thus making difficult to distinguish them. ​

Aims & Methods

This study aims to determine whether the demographic and clinical profiles of consecutive patients diagnosed with FC and IBS-C differ in real-world clinical practice.
Demography and clinical information from the first clinical consultation where the diagnosis was made by a single consultant using a standardized clinical letter were retrospectively collected from January 2016 to March 2025 at a single tertiary care neurogastroenterology clinic in the UK Data were collected using a standardised template and were reported as median [interquartile range (IQR)] or frequency (%), and compared using the Chi-square test or Mann-Whitney U test.

Results

	FC (n= 88)	IBS - C (n=257)	p-value
Demography and general characteristics
Male, n (%) Age (years), median (IQR) Duration of symptoms (year),median (IQR)	24 (27%) 47 (25) 12,5 (17)	42 (16%) 32 (26) 5 (10)	0.036 0.0001 0.0001
Total number of concomitant medical condition, median (IQR) Chronic pain, n (%) Abdominal surgeries, n (%)	1 (2) 12 (14%) 24 (27%)	4 (4,5) 66 (26%) 112 (44%)	0.001 0.02 0.01
Total number of hospital admissions, median (IQR)	1 (2)	1 (5)	1.0
Total number of previous diagnostic investigation at first consultation, median (IQR)	1 (2)	1 (2)	1.0
Concomitant medications
Total number of concomitant medications, median (IQR) Tricyclic antidepressant, n (%) Selective Serotonin Reuptake Inhibitor, n (%) Serotonin-norepinephrinereuptake inhibitors, n (%) Opioids n, (%) Laxatives n, (%) Antispasmodics n, (%)	3 (4,5) 12 (14%) 12 (14%) 8 (9%) 13 (15%) 61 (70%) 3 (3%)	4 (4,5) 44 (18%) 39 (15%) 13 (5%) 82 (31%) 116 (45%) 42 (16%)	0.001 0.550 0.859 0.268 0.003 0.0001 0.003
Gi symptoms
Nausea, n (%) Early satiety n, (%) Vomiting, n (%) Post pandrial fulness, n (%) Heartburn, n (%) Abdominal pain, n (%)	16 (19%) 6 (7%) 7 (8%) 8 (9%) 13 (15%) 9 (10%)	93 (37%) 56 (21%) 45 (17%) 53 (20%) 52 (19%) 234 (91%)	0.002 0.002 0.04 0.02 0.330 0.0001

A total of 88 FC and 257 IBS-C consecutive patients were diagnosed according to Rome IV criteria. FC patients were older and most frequently males, with a longer duration of symptoms. Abdominal pain was largely absent in FC patients and when present this was not related to defecation but reported as result of long-lasting lack of bowel movement. Upper gastrointestinal symptoms were more frequent in IBS-C compared to FC. Comorbidities, particularly chronic pain syndromes, and abdominal surgeries were more frequently reported by IBS-C patients. in addition, IBS-C patients were more frequently on pain medications, while FC on laxatives. Table 1 summarizes the data collected in both groups.

Conclusion

This real-world study suggests that FC and IBS-C patients differ in demographic, clinical profile and comorbidities. IBS-C patients report a more severe clinical picture despite FC patients and had a longer duration of symptoms.

References

Bharucha AE, Sharma M. Painful and Painless Constipation: All Roads Lead to (A Change in) Rome. Dig Dis Sci. 2018 Jul;63(7):1671-1674. doi: 10.1007/s10620-018-5027-2. PMID: 29564675; PMCID: PMC6293467.
Bouchoucha M, Devroede G, Mary F, Bon C, Bejou B, Benamouzig R. Painful or Mild-Pain Constipation? A Clinically Useful Alternative to Classification as Irritable Bowel Syndrome with Constipation Versus Functional Constipation. Dig Dis Sci. 2018 Jul;63(7):1763-1773. doi: 10.1007/s10620-018-4995-6. Epub 2018 Feb 28. PMID: 29492744.

Introduction

Individuals with Disorders of Gut-Brain Interaction (DGBI) may experience avoidant/restrictive food intake disorders (ARFID). However, these findings have been limited to specialist neurogastroenterology clinics. We assessed the association between ARFID and DGBI within the adult general population.

Aims & Methods

A population-based Internet survey with pre-defined demographic quotas was conducted across the UK and USA in 2023. The survey included the Rome IV diagnostic questionnaire for DGBI, the nine-item ARFID screen (NIAS), and questions regarding demographics, body mass index, non-GI somatic symptoms, anxiety and depression, quality of life, and healthcare utilisation.

Results

4002 adults (mean age 47 [range 18-91] years, 50% females) completed the survey, of whom 1704 (42.6%) had symptoms compatible with at least one DGBI.
The prevalence of ARFID-positive screens was significantly higher among participants with DGBI compared to those without DGBI (34.6% vs. 19.4%, OR 2.2), with similar findings noted in each country. Among participants with DGBI, positive ARFID screens by NIAS subscale were poor appetite (21.5%), picky eating (18.1%) and a fear of aversive consequences (9.9%).
ARFID was present in 42.1% of those with oesophageal DGBI, 49.2% with gastroduodenal DGBI, 33.1% with bowel DGBI, and 41.8% with anorectal DGBI. The presence of ARFID among the two widely investigated DGBI, i.e. functional dyspepsia and IBS, was 56.2% and 50.4%, respectively.
The presence of ARFID increased with the number of DGBI regions, ranging from 19.4% in those with no DGBI, 27.5% with DGBI in one region, 40.0% for DGBI in two regions, 49.7% for DGBI in three regions, and 61.1% for DGBI in four regions (p<0.001). A positive correlation was seen between the number of DGBI regions and the severity of ARFID (r=0.29, p<0.001).
Individuals with DGBI plus ARFID, compared to those with only DGBI, were significantly more likely to be underweight (7.9% vs. 1.5%), have greater non-GI somatic symptoms and mood disturbances, reduced mental and physical quality of life, and increased GI healthcare visits; all p<0.001.

Conclusion

Positive ARFID screens are common in DGBI and associated with increased general health burden. Routine screening for ARFID in DGBI will inform the multi-integrated care plan provided by clinicians, dietitians, and psychologists.

Disclosure

Nil

Introduction

To discuss a new surgical strategy: Tongji procedure (subtotal colectomy combined with modified Duhamel procedure), of which the indications, technical notes and outcomes were analyzed.

Aims & Methods

The 220 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2019 and February 2023. The patients induded 60 males and 160 females. Their age were 18-80 years (average 46±14). The 198 patients received laparoscopic-assistant Jinling procedure, and 32 patients with open Jinling procedure. The pre- and post-operation data were collected. The follow up rate were 100%, 95.1%, 92.8% and 91.7% at 3, 6, 12 and 24 months.

Results

There was no surgery-related death. Mean hospital day was (8±1.5) days. Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (3.2%), anastomosis bleeding (5.1%) and anastomosis leakage (3.9%). The gastrointestinal quality of life index score was 72±9 preoperatively and increased to 68±11, 99±6, 105±9, 106±9 at 3, 6, 12 and 24 month follow-up, respectively (t=62.1，-25.1，-126.5，-143.2，P<0.01). The Wexner constipation scale was 21.9±4.5 preoperatively and decreased to 9.6±2.4, 5.9±2.1, 4.6±1.9, 4.5±1.8 at 3, 6, 12 and 24 month follow-up, respectively (t=48.6, 61.8, 58.2, 45.9，P<0.01). The satisfactory rate was 77.5%, 92.1%, 93.0% and 94.1% at 3, 6, 12, and 24 month follow-up.

Conclusion

Tongji procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.

Disclosure

NO

Introduction

Fecal microbiota transplantation (FMT) has been successfully used in a series of diseases in recent years. Most studies have focused on short-term risks, which are mild and generally associated with delivery methods. There have been no reports of FMT safety in the treatment of multiple diseases and long follow-up periods.

Aims & Methods

We performed a retrospective analysis of 11025 patients who underwent FMT in the Tenth People’s Hospital of Tongji University between January 2012 and December 2023. We included patients with various gastrointestinal diseases and patients with extraintestinal diseases that involved intestinal dysfunction. A questionnaire was administered to the included patients during follow-up (2 weeks, 3 months, 1 year, and 5 years after FMT) via telephone and health portal software Haodaifu app).

Results

Most adverse events during short-term follow-up (2 weeks) were related to the method of delivery. The main adverse events in the nasogastric tube group were tube-related respiratory difficulty (40.6%,include sore throat 14.1%, nasal congestion 8.7%, nasal irritation due to nasogastric intubation 17.8%) and nausea/vomiting (12.6%). In the oral capsules group, nausea and vomiting (8.9%) occurred during oral administration because the capsules are associated with a fecal smell and taste, both of which are difficult to remove completely. For colonoscopy and enema routes, the main adverse events were diarrhea (10.7%, 9.9%) and perianal discomfort (15.3%, 8.4%), respectively. Two cases in the colonoscopy group and one case in the enema group were complicated with colon perforation, but remission with conservative treatment. The most frequently reported adverse events were mild or moderate in severity and transient. Those symptoms associated with nasogastric tube administration disappeared after tube removal at the completion of treatment. Several other new symptoms were reported during short-term follow-up, although none occurred in >1% of patients. The most common symptom reported was bloating/flatulence. Although more adverse events were reported in the nasogastric tube group, most were mild. Additionally, patients are more comfortable with the upper gastrointestinal route because they could use it for enteral nutrition support or gastrointestinal imaging according to their medical needs. Based on our clinical experience, we proposed the “Tongji FMT Requirements”and implemented them in our clinic (beginning in 2019) to standardize the indications and timing of FMT treatment and to improve FMT safety. After the implementation of these requirements for 2 years, we compared safety data collected before and after implementation; The application of the requirements has effectively reduced adverse events. The short-term (mainly FMT-related diseases) incidence rate significantly decreased from 32.6% in 2017–2019 to 17.2% in 2019–2021.

Table 1.Tongji FMT Requirements

Requirements	Descriptions
Informed consent	Informed consent must be obtained from patients and family members before treatment
Safety of the transplanted bacterial solution	Optimize the quality control of bacterial solution preparation and storage. Ensure that the bacterial solution is used within 1 week.
Assessment of patient suitability for FMT	Ensure normal vital signs, as well as the absence of fever, severe infection, sepsis, SIRS, and other inflammatory diseases. Confirm that the patient can tolerate full oral nutrition or enteral nutrition.
Transplantation route safety	The establishment of transplantation pathways must comply with the requirements of the Chinese guidelines*, including transplantation management, safety assessment, patient tolerance, and individualized selection.
Emergency procedures for suspected adverse events during transplantation	During the transplantation process, if adverse events are suspected, the transplantation should be paused. The cause of the event should be identified; the transplantation can be resumed when the adverse event is resolved.

Conclusion

FMT appears safe during both short-term and long-term follow-up. The patient group that received FMT did not exhibit an increased incidence of new diseases, and the risk of infection transmission appears to be low. Considering the widespread use of FMT, there is a need for the establishment of a national clinical and patient-reported FMT safety collection system in future.

References

• 1) Kelly CR, Yen EF, Grinspan AM, et al. Fecal microbiota transplantation is highly effective in real-world practice: initial results from the fmt national registry. Gastroenterology 2021;160:183-192
• 2) Mullish BH, Quraishi MN, Segal JP, et al. The use of faecal microbiota transplant as treatment for recurrent or refractory clostridium diffificile infection and other potential indications: Joint british society of gastroenterology (BSG) and healthcare infection society (HIS) guidelines. Gut 2018;67:1920e41
• 3) Saha S, Mara K, Pardi DS, et al. Long-term Safety of Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection. Gastroenterology 2021;160:1961-1969
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• 5) Parenteral and Enteral Nutrition Branch of Chinese Medical Association, et al. Chinese experts consensus on standardized methodology and clinical application of fecal microbiota transplantation. Zhonghua Wei Chang Wai Ke Za Zhi 2020;23:5-13
• 6) Wang S, Kou C, Liu Y, et al. Rural-urban differences in the prevalence of chronic disease in northeast China. Asia Pac J Public Health 2015;27:394-406