Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome
IntroductionThe term “obstructive defecation syndrome” (ODS) describes a complex condition characterized by defecatory disorders. Such a condition represents a significant proportion of patients, which is estimated to be up to 30% of patients affected by chronic constipation. Presently, a broad agre...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1361049/full |
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| author | Sayali Valiyeva Domenico Tiso Paolo Cerri Antonio Pisciaroli Renato Pietroletti |
| author_facet | Sayali Valiyeva Domenico Tiso Paolo Cerri Antonio Pisciaroli Renato Pietroletti |
| author_sort | Sayali Valiyeva |
| collection | DOAJ |
| description | IntroductionThe term “obstructive defecation syndrome” (ODS) describes a complex condition characterized by defecatory disorders. Such a condition represents a significant proportion of patients, which is estimated to be up to 30% of patients affected by chronic constipation. Presently, a broad agreement has been reached on diagnostic studies, whereas the choice of treatment that aims to improve the quality of life and/or correct the prevalent abnormalities or all anatomical abnormalities remains controversial.MethodsThis was a retrospective cohort study on 174 patients out of a total of 232 with ODS who were observed in a specialized university unit of surgical coloproctology between 2018 and 2022. Clinical assessment included examining the values of the Agachan–Wexner constipation score and Patient Assessment of Constipation (PAC)-quality of life (QoL) scores, a full digital anorectal examination, anoscopy, RX defecography, and a urogynecological consultation; a functional anorectal test, an endoanal ultrasound, and colonoscopy were performed in select patients. The patients were reevaluated after an 8–10-week course of medical treatment based on a high-fiber diet and fluid intake and 6 g of psyllium combined with lactobacillus and tryptophan b.i.d. The results were analyzed by means of the Wilcoxon rank-sum test, comparing pretreatment scores with the results at the first follow-up visit.ResultsAfter 8–10 weeks of conservative treatment, 128 patients declared full satisfaction, 29 reported moderate satisfaction, and 17 (9.7%) declared no improvement. Among these 17, there were 5 patients with paradoxical puborectal contractions. The value of the Agachan–Wexner constipation score after treatment decreased from the pretreatment Agachan–Wexner constipation score mean value of 23.4 ± 3.7 (mean ± SD range 15–27) to a mean value of 5.3 ± 0.7 (range 3–8, p < 0.001). The quality of life improved, as shown by the PAC-QoL score, indicating great improvement in social relationships.ConclusionsGiven the benefits of conservative therapies, they represent a cornerstone in the treatment of ODS, a complex disorder. Diet and bulking agents are mandatory forms of treatment prior to making any surgical attempt, also considering the fact that the psychosomatic component of ODS is an essential prerequisite to match patient expectations. |
| first_indexed | 2024-04-24T12:31:03Z |
| format | Article |
| id | doaj.art-c20433c397ea44a4bf5b939424513a2f |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-24T12:31:03Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-c20433c397ea44a4bf5b939424513a2f2024-04-08T04:41:01ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2024-04-011110.3389/fsurg.2024.13610491361049Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndromeSayali Valiyeva0Domenico Tiso1Paolo Cerri2Antonio Pisciaroli3Renato Pietroletti4Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila, L'Aquila, ItalyClinical Nutrition, “Villa Maria” Hospital, Rimini, ItalyGeneral Surgery Department, Val Vibrata Hospital, Sant’Omero, ItalyGeneral Surgery Department, Val Vibrata Hospital, Sant’Omero, ItalyDepartment of Applied Clinical and Biotechnological Sciences, University of L’Aquila, L'Aquila, ItalyIntroductionThe term “obstructive defecation syndrome” (ODS) describes a complex condition characterized by defecatory disorders. Such a condition represents a significant proportion of patients, which is estimated to be up to 30% of patients affected by chronic constipation. Presently, a broad agreement has been reached on diagnostic studies, whereas the choice of treatment that aims to improve the quality of life and/or correct the prevalent abnormalities or all anatomical abnormalities remains controversial.MethodsThis was a retrospective cohort study on 174 patients out of a total of 232 with ODS who were observed in a specialized university unit of surgical coloproctology between 2018 and 2022. Clinical assessment included examining the values of the Agachan–Wexner constipation score and Patient Assessment of Constipation (PAC)-quality of life (QoL) scores, a full digital anorectal examination, anoscopy, RX defecography, and a urogynecological consultation; a functional anorectal test, an endoanal ultrasound, and colonoscopy were performed in select patients. The patients were reevaluated after an 8–10-week course of medical treatment based on a high-fiber diet and fluid intake and 6 g of psyllium combined with lactobacillus and tryptophan b.i.d. The results were analyzed by means of the Wilcoxon rank-sum test, comparing pretreatment scores with the results at the first follow-up visit.ResultsAfter 8–10 weeks of conservative treatment, 128 patients declared full satisfaction, 29 reported moderate satisfaction, and 17 (9.7%) declared no improvement. Among these 17, there were 5 patients with paradoxical puborectal contractions. The value of the Agachan–Wexner constipation score after treatment decreased from the pretreatment Agachan–Wexner constipation score mean value of 23.4 ± 3.7 (mean ± SD range 15–27) to a mean value of 5.3 ± 0.7 (range 3–8, p < 0.001). The quality of life improved, as shown by the PAC-QoL score, indicating great improvement in social relationships.ConclusionsGiven the benefits of conservative therapies, they represent a cornerstone in the treatment of ODS, a complex disorder. Diet and bulking agents are mandatory forms of treatment prior to making any surgical attempt, also considering the fact that the psychosomatic component of ODS is an essential prerequisite to match patient expectations.https://www.frontiersin.org/articles/10.3389/fsurg.2024.1361049/fullobstructive defecation syndromedefecation disorderchronic constipationpsyllium fiberquality of life |
| spellingShingle | Sayali Valiyeva Domenico Tiso Paolo Cerri Antonio Pisciaroli Renato Pietroletti Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome Frontiers in Surgery obstructive defecation syndrome defecation disorder chronic constipation psyllium fiber quality of life |
| title | Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome |
| title_full | Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome |
| title_fullStr | Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome |
| title_full_unstemmed | Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome |
| title_short | Results of medical treatment with psyllium, lactobacillus, and tryptophan (Plurilac® Trio) in obstructive defecation syndrome |
| title_sort | results of medical treatment with psyllium lactobacillus and tryptophan plurilac r trio in obstructive defecation syndrome |
| topic | obstructive defecation syndrome defecation disorder chronic constipation psyllium fiber quality of life |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1361049/full |
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