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Fecal microbiota transplantation (FMT) via colonoscopy or enema has become a commonly used treatment of recurrent C. difficile infection (CDI). To compare the safety and preliminary efficacy of orally administered lyophilized microbiota product compared with frozen product by enema. In a single center, adults with ≥ 3 episodes of recurrent CDI were randomized to receive encapsulated lyophilized fecal microbiota from 100-200 g of donor feces (n = 31) or frozen FMT from 100 g of donor feces (n = 34) by enema. Safety during the three months post FMT was the primary study objective. Prevention of CDI recurrence during the 60 days after FMT was a secondary objective. Fecal microbiome changes were examined in first 39 subjects studied. Adverse experiences were commonly seen in equal frequency in both groups and did not appear to relate to the route of delivery of FMT. CDI recurrence was prevented in 26 of 31 (84%) subjects randomized to capsules and in 30 of 34 (88%) receiving FMT by enema (p = 0.76). Both products normalized fecal microbiota diversity while the lyophilized orally administered product was less effective in repleting Bacteroidia and Verrucomicrobia classes compared to frozen product via enema. The route of delivery, oral or rectal, did not influence adverse experiences in FMT. In preliminary evaluation, both routes appeared to show equivalent efficacy, although the dose may need to be higher for lyophilized product. Spore-forming bacteria appear to be the most important engrafting organisms in FMT by the oral route using lyophilized product. ClinicalTrials.gov NCT02449174.

Background Air enema reduction is the primary non-surgical intervention for pediatric intussusception. The aim of this study was to determine if rapid-cycle deliberate practice (RCDP) with an ex vivo model of intussusception is more effective than traditional teaching methods (TTM) for improving radiology residents’ air enema reduction competency. Methods In this randomized controlled trial, 24 radiology residents were assigned to training with an ex vivo model of intussusception combined with RCDP (the RCDP group, n  = 12) or without RCDP (the TTM group, n  = 12). Both groups underwent assessments of theoretical knowledge and practical skills before and after training in air enema reduction, followed by evaluation of indicators of competency. Satisfaction with training and self-confidence surveys were also completed. Results Pre-training assessments showed that baseline performance was comparable between the two groups (both P  > 0.05). Post-training, both groups showed improvement from baseline (both P  < 0.05), with the RCDP group demonstrating more pronounced improvement than the TTM group (RCDP: effect sizes = 2.06 and 1.94, TTM: effect sizes = 1.16 and 1.20). Furthermore, after training, mean theoretical and practical evaluation scores were significantly better in the RCDP group than in the TTM group ( 88.67 ± 5.88 vs. 82.41 ± 7.31, P  = 0.031 and 89.17 ± 4.64 vs. 80.92 ± 6.65, P  = 0.048, respectively), with a shorter mean procedural time (74.26 ± 8.25 s vs.133.41 ± 9.07 s, P  = 0.044) and a lower mean reduction pressure (5.83 ± 0.27 kPa vs. 6.40 ± 0.10 kPa, P  = 0.023). Residents in the RCDP group reported higher satisfaction scores (mean 4.58 ± 0.42 vs. 3.16 ± 0.38, P  = 0.024) and higher self-confidence scores ( P  = 0.036). Conclusions RCDP simulation is superior to TTM for training residents in air enema reduction skills. It is an effective simulation teaching method that offers a novel perspective for innovative instruction on the skills required to perform this complex clinical procedure.

The pathogenesis of fibromyalgia (FM) is currently unknown. Many patients with this condition are not effectively treated, and disorders of the intestinal dysbiosis have been identified in patients with FM. This trial aimed to investigate whether ozonated water enema could alleviate the symptoms of FM by improving intestinal dysbiosis in these patients. This trial aims to evaluate the therapeutic advantages of ozonated water enema therapy for patients suffering from FM. A single-center, double-blind, randomized controlled trial. Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China. This is a randomized, double-blind trial conducted on FM patients (n = 66). The selected patients were randomly categorized into the O3 and control groups. The patients in the O3 and control groups received an ozonated and deionized water enema, respectively, at the same dose and frequency. After the treatment, the scores on the numerical rating scale (NRS), widespread pain index (WPI), Hamilton anxiety scale (HAMA), and the Pittsburgh sleep quality index (PSQI) were compared between the 2 groups, as were the doses of duloxetine, to evaluate the treatment effect. Furthermore, the effectiveness of the treatment was assessed by comparing fecal samples from the O3 group collected before and after treatment with 25 healthy individuals from the physical examination department of Shanghai East Hospital. The patients in the O3 group indicated significant relief in pain and reduced NRS, HAMA, PSQI, and WPI scores at each follow-up time point (P < 0.001) when compared to the control group. In addition, the patients in the O3 group used lower doses of duloxetine than did those the control group (P < 0.001). Moreover, FM patients treated with ozonated water indicated improvements to their gut microbiome. The trial's findings might be affected by confounding factors, including medicines, diet, and environmental circumstances. Also, this trial was limited by its sample size, and the symptom severity scores (SSS) of the patients at 3 months after treatment at the given follow-up period were not assessed. This trial confirmed that the symptoms of pain, anxiety, and sleep disorders in FM patients were effectively relieved after treatment with an ozonated water enema. Furthermore, the ozonated water enema was associated with a significant reduction in duloxetine dosage and improved gut microbiome disorder, suggesting that the enema could target disorders related to the gut microbiome and therefore serve as a therapeutic intervention for FM.

INTRODUCTION:Management of intractable childhood constipation is still challenging. The efficacy of retrograde colonic enema (RCE) with fecal microbiota transplantation (FMT) in intractable childhood constipation has not been established, although both have demonstrated potential in gastrointestinal diseases. The aim of this study was to determine the safety and efficacy of RCE-based FMT in the treatment of intractable constipation in children.METHODS:A randomized, double-blind, controlled trial with 110 children was conducted. The patients were randomly assigned to the FMT with RCE group or the placebo with RCE group. All participants received a daily RCE, followed by a 4-week FMT treatment (twice a week) and a 12-week follow-up period. Spontaneous bowel movements ≥ 3 per week were the main outcomes, and the risk ratio with 95% confidence interval (CI) was calculated. Changes in intestinal bacterial profile were analyzed by BOX-PCR-based DNA fingerprinting and sequencing. The adverse effects were assessed based on symptoms.RESULTS:At the end of the follow-up period, 22 patients (40.0%) in the FMT with RCE group and 10 patients (18.2%) in the placebo with RCE group had ≥ 3 spontaneous bowel movements per week (net difference = 21.8%, 95% CI: 13.2%-30.4%; risk ratio: 1.364, 95% CI: 1.063-1.749; P < 0.05). Both RCE and FMT enriched the intestinal bacterial diversity of patients with constipation. The adverse events were all mild self-limiting gastrointestinal symptoms.DISCUSSION:FMT enhances the efficacy of RCE, and the use of RCE-based FMT is a safe and effective method in the treatment of intractable constipation in children.

BackgroundSeveral routes of fecal microbiota transplantation (FMT) administration are available for treating recurrent Clostridioides difficile infections (CDI), the most recent of which are capsules.AimTo assess the efficacy of colonoscopy, capsule, enema, and nasogastric tube (NGT) FMT for the treatment of recurrent CDI.MethodsWe reported clinical outcomes of colonoscopy, capsule, enema, and NGT FMT for the treatment of recurrent CDI according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. During January 2000 to January 2018, three databases were searched: PubMed, EMBASE, and CINAHL. Primary outcome was overall cure rate which was assessed using a random effects model; secondary outcomes included adverse effects as well as subgroup analyses comparing donor relationship, sample preparation, and study design.ResultsTwenty-six studies (1309 patients) were included in the study. FMT was administered using colonoscopy in 16 studies (483 patients), NGT in five studies (149 patients), enema in four studies (360 patients), and capsules in four studies (301 patients). The random effects of pooled FMT cure rates were colonoscopy 94.8% (CI 92.4–96.8%; I2 15.6%), capsule 92.1% (CI 88.6–95.0%; I2 7.1%), enema 87.2% (CI 83.4–90.5%; I2 0%), and NGT/NDT 78.1% (CI 71.6–84.1%; I2 0%). On subgroup analysis of colonoscopy FMT, sample preparation methods had comparable cure rates: fresh 94.9% compared to 94.5%. Similarly, cure rates were unaffected by donor relationship: mixed 94.5% compared to unrelated donor 95.7%.ConclusionCDI cure rates with FMT performed with colonoscopy are superior to enema and NGT FMT, while those with FMT with colonoscopy and capsule are comparable.

Purpose The Malone antegrade continence enema (MACE) offers a minimally invasive and potentially reversible option for managing chronic constipation and fecal incontinence (FI). This systematic review evaluates its efficacy, safety, and long-term outcomes in adults. Methods A comprehensive search was conducted across PubMed, EMBASE, and CENTRAL databases up to April 2025 to identify studies on MACE in adults. Study quality was assessed using the Newcastle–Ottawa scale. The primary outcome was the proportion of patients continuing MACE at follow-up (treatment success); failure was defined as conversion to definitive colostomy. Results Seventeen studies with 404 patients were included. Study quality was rated moderate to good. The most common indications were neurological disorders (25.8%), prior surgeries (16.8%), idiopathic constipation (14.2%), and traumatic spinal injuries (11.6%). Techniques included terminal ileal loop (37.9%), percutaneous endoscopic cecostomy (26.0%), and appendicostomy (24.8%). Minor stoma-related complications were most frequent (39.1%), followed by fecal leakage (16.2%) and stoma stenosis (11.3%). Median follow-up was 28.5 months. At final follow-up, 75.1% of patients continued using MACE, while 9.8% required colostomy. Satisfactory outcomes were reported by 60%–83% of patients, with improvements in symptoms and quality of life. Conclusions MACE is a safe and effective option for adults with refractory constipation or FI, especially in those aiming to avoid a permanent colostomy.

Colon hydrotherapy devices serve as a physiotherapeutic modality to manage colonic disorders by promoting intestinal peristalsis and enhancing gastrointestinal functionality. This study aims to assess and compare the effectiveness, safety, and tolerability of two remedial strategies for inadequate bowel preparation: colon hydrotherapy device enema and oral polyethylene glycol electrolyte powder. A retrospective analysis was performed on 109 patients who failed to adequately prepare for colonoscopy. These patients received remedial bowel preparation on the same day as their procedure, with 55 undergoing colon hydrotherapy enema and 54 receiving oral polyethylene glycol electrolyte powder. Patient satisfaction and tolerance were evaluated through telephone follow-up. Key metrics included the Boston Bowel Preparation Scale scores, preparation time, incidence of adverse reactions, and patient tolerance and satisfaction. No significant differences were observed in baseline characteristics between groups (P >  0.05). The Boston Bowel Preparation Scale scores for the entire colon were 7 (3) in the hydrotherapy group and 6.5 (1) in the oral group (z =  -2.075, P =  0.038). Notably, scores for the left colon were significantly higher in the hydrotherapy group [3 (1) vs. 2 (0), z =  -5.586, P <  0.001]. The hydrotherapy group also exhibited a shorter preparation time [80 (20) min vs. 92.5 (20) min, z =  -3.961, P <  0.001] and a lower incidence of adverse effects (36.4% vs. 88.9%, χ² =  32.035, P <  0.001). Patient satisfaction metrics, including re-selection rates and tolerance of side effects, were significantly higher in the hydrotherapy group. The colon hydrotherapy device enema is an effective, efficient, and well-tolerated method for bowel cleansing, demonstrating a low incidence of adverse events. It is recommended as an effective and safe remedial therapy for patients with inadequate bowel preparation prior to colonoscopy.

ObjectivesRectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT).MethodsFrom 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson’s χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted.ResultsOf 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p<0.001), male partners (med:6, p<0.001) and substance use (any of methamphetamine/hallucinogens/dissociative/poppers) (p<0.001) were associated with increased odds of RI. Controlling for potential confounders, odds of prevalent RI were 3.59 (p<0.001, 95% CI 1.90 to 6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78 to 8.39) when douching weekly or more compared with not douching. MSM with more than six male partners had 5.34 (p=0.002, 95% CI 1.87 to 15.31) increased odds of RI when douching weekly or more compared with not douching.ConclusionRectal hygiene with RD is a common practice (66%) among HIV-uninfected MSM on PrEP in this study, which increases the odds of acquiring rectal NG and/or CT independent of sexual risk behaviour, substance use and other factors. This suggests interventional approaches targeting rectal hygiene products and practices could reduce sexually transmitted infections.