60 Cases Of Severe Clinical Observation And Analysis Of Functional Bowel Disorder

Functional constipation (FC) is a common functional bowel disorder. According to American Gastroenterological Association (AGA), three categories of FC are described:slow transit constipation (STC), normal transit constipation (NTC), and defecatory disorder(DD). According to Rome Ⅲ criteria, two categories of Functional defecation disorders (FDD) are described:dyssynergia (F3a) and deficiency of ProPulsion (F3b)Objective To investigate the characteristics of main faecal bacteria,fungi and motility in patients with severe FDD,and to further study main faecal bacteria,fungi and motility disorderin the different subtypes of FDD and differences between FDD and other types of constipation.Subjects and Methods Between December2011and April2013,124patients with functional constipation as defined by the Rome Ⅲ criteria were recruited from out-patients of China-Japan Friendship Hospital. All of them were severe constipation based on the symptoms. They were divided into subtypes of STC, NTC, FDD after48h gastrointestinal transit time(GITT) and anorectal high-resolution manometry (AR-HRM).60patientswith FDD were divided into subtypes of F3a and F3b according to AR-HRM.They are asked to complete symptom questionnaire. Patients and23healthy controls underwent quantitative faecal culture with the target flora including bifidobacterium, lactobacillus, enterobacteria、enterococcus、Candida and mould. Results (1) The study included124severe FC patients,60severe FDD patients. The median age was53years old and median duration of constipation was8years.(2) There were28.3%,71.7%patients in subtypes of F3a and F3b respectively. Compared to patients with F3b, patients with F3a are more likely to be male(70.6%vs37.2%,p<0.05). Symptoms scores of obstructed defecation is different among two subtypes.(p<0.01). Patients with F3a have higher scores in obstructed defecation.(3) Between patients with normal and abnormal GITT, there were no differences on the probability of amalgamated with STC(P>0.05).(4) Faecal microflora in patients with FDD:Compared with the controls, the numbers of bifidobacterium and lactobacillus decrease, while the number of enterococcus increase (P<0.05) in FDD patients. There were no differences on the amounts of enterobacteria, Candida and mould between patients and controls (P>0.05).Compared with the controls, the numbers of erium and lactobacillusdecrease in patients of F3a (P<0.05).The numbers of bi f idobacterium decrease, while the numbers of enterococcus increase in patients of F3b(P<0.01).The numbers of monilia increase in patients of F3b(P<0.05).(5)Maxium tolerable volume threshold is different among STCNTC and FDD(P<0.01) There was no difference of maxium tolerable volume threshold between F3a and F3b (P>0.05).Conclusionsl. Male are more likely to suffer F3a type of functional defecation disorder in patients of severe FDD.2.Symptom of obstructed defecation may be a predictor of F3a type of functional defecation disorder.3.Patients with FDD have intestinal dysbiosis,representing decrease in the numbers of bifidobacterium and lactobacillus and increase in the numbers of enterococcus.4. There is difference of maxium tolerable volume threshold among different categories of FC.