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Introduction: Cirrhosis of liver carries multiple clinical morbidities; portal Hypertension, Minimal and overt Encephalopathy, renal Insufficiency, Esophageal and rectal Varies, Small bowel Ischemia, ascetics and constipation. Usage of lactulose to regulate bowel movements was optimal to relief constipation lowering Encephalopathy. Disaccharides cause Glucose Intolerance and Diarrhea depleting electrolyte provoking Hepato Renal Syndrome. Rifaximin is the standard of care for MHE or OHE, further precipitates constipation. Plecanatide is a natural Uroguanyle Agonist without systemic Absorption, a Ph dependent drug for constipation with minimal side effects. This clinical study evaluates the efficacy of Plecanatide in compensated cirrhosis. Methods: The total study population (n = 60) comprised of Sixty Compensated cirrhotics with a mean MELD 0f 8 were randomized in two groups: A (Lactulose 30 cc Bid with Rifaximin 550 mg BID for 12 weeks) and B (Plecanatide 3 mg orally plus Rifaximin 550 mg bid for 12 weeks). All groups had a washout time two weeks from all existing medications for Constipation or Enemas or Suppository. The daily diet contained Total 3000 cal/day, Total protein 150 gm/day (vegetable), Total Fat 30 gm/day, Total fiber 100 gm/day, Total salt of 2 grams and total fluid 1000cc. All HE was measured by Flicker test and Trial Test Block test. Satisfactory Bowel Movement score was calculated for all the patients (0 - dissatisfactory, 4 -Satisfactory). Modified QOL was obtained. (0-Poor, 1- Good, 2 & 3 - Very good, 4 - Excellent) Exclusion Criteria: Renal failure, TIPS, HCC, post-Transplant, sepsis, HRS, CHF, IBD, Dialysis, Severe Ascites, Uncontrolled DM Cardiac Arrhythmia, BMI Drugs: Calcium Blocker, Anticholinergic medication, Herbal and OTC for Constipation, Miralax, suppositories, Enema, Prostaglandin analogs and other prescription drugs for constipation. Patient Characteristics: Table1 Results: Primary endpoint: Complete Spontaneous Bowel Movement (CSBM) in 24 hours Secondary endpoint: Sustained bowel movement post 12 weeks Table 2 Side Events Table 3 Conclusion: Clinical pilot reveals higher Efficacy of Plecanatide on Complete Spontaneous Bowel movements and Sustained Bowel Movements without drop out. No difference in regard to Overall HE in both groups. Large cohort studies required to validate.

Introduction: Chronic idiopathic constipation (CIC) is characterized by unsatisfactory defecation and difficult or infrequent stools. CIC affects 4-20% of adults in the US, and while prevalent, gaps in knowledge regarding CIC healthcare seeking and medication (med) use remain. Here, we aimed to determine the prevalence and predictors of (1) individuals having discussed their constipation symptoms with a healthcare provider, and (2) use of and satisfaction with constipation therapies. Methods: We partnered with Cint, a survey research firm, to recruit a representative sample of Americans who were >18yrs and had previously experienced constipation. Those who met Rome IV criteria for irritable bowel syndrome were excluded. In addition to demographic profiling, the survey included questions on constipation severity, use of constipation meds and associated satisfaction (Treatment Satisfaction Questionnaire for Medications ([TSQM]), and healthcare seeking around constipation. We used multivariable regression methods to assess for significant associations and to adjust for confounding. Results: 5007 participants with constipation met inclusion criteria. Of these, 39.5% had discussed their constipation with a healthcare provider. Respondents consulted with primary care providers (70.4%), gastroenterologists (27.8%), and urgent care/emergency room providers (1.8%) regarding their symptoms. Insurance status, constipation severity, race, and age were significantly associated with seeking care for constipation (Table 1). We also found that 49.6% of respondents were currently taking a medicine to manage their constipation (Table 2); 92.7% were only on an over-the-counter (OTC) med while 7.3% were taking a prescription med. OTC meds such as fiber, magnesium, and docusate were the most commonly used therapies, while prescription meds such as plecanatide, lubiprostone, and linaclotide were used less often. Table 2 also presents TSQM scores for each therapy; plecanatide, linaclotide, and polyethylene glycol 3350 on average had the highest scores, while bisacodyl, docusate, and senna had lower ratings. There was no significant difference in satisfaction between OTC and prescription med categories. Conclusion: In this large population-based study, we found that 3 out of 5 Americans with constipation have never discussed their symptoms with a healthcare provider. We also noted that use of prescription meds for managing constipation symptoms is low, as patients mainly rely on OTC meds.

Article Title: The ACG Monograph on GI Diseases and Endoscopy in Pregnancy and Postpartum Period.

In the context of professional competence, the management of constipation syndrome (self-diagnosis, self-treatment and provision of preventive measures for constipation in patients of different ages) is a function of doctors of a general practice medicine - family medicine. The authors developed and proposed an algorithm of treatment and management of a patient with constipation syndrome at the ambulatory stage.

Chronic constipation is a prevalent functional gastrointestinal disorder accompanied with intestinal dysbiosis. However, causal relationship between dysbiosis and constipation remains poorly understood. Serotonin transporter (SERT) is a transmembrane transport protein which re-uptakes excessive 5-hydroxytryptamine (5-HT) from effective location to terminate its physiological effects and involves in regulating gastrointestinal motility. In this study, fecal microbiota from patients with constipation and healthy controls were transplanted into the antibiotic depletion mice model. The mice which received fecal microbiota from patients with constipation presented a reducing in intestinal peristalsis and abnormal defecation parameters including the frequency of pellet expulsion, fecal weight and fecal water content. After fecal microbiota transplantation, the SERT expression in the colonic tissue was significantly upregulated, and the content of 5-HT was decreased which negatively correlated with the gastrointestinal transit time. Moverover, fecal microbiota from the mice which received fecal microbiota from patients with constipation also upregulated SERT in Caco-2 cells. Besides, this process accompanied with the decreased abundance of Clostridium, Lactobacillus, Desulfovibrio, and Methylobacterium and an increased tend of Bacteroides and Akkermansia, which also involved in the impairment of intestinal barrier after FMT. Taken together, intestinal dysbiosis may upregulate the SERT expression and contribute to the development of chronic constipation.