背景:减肥手术和胰高血糖素样肽1(GLP-1)类似物后便秘很普遍。增加远端小肠和结肠的脂肪含量可以增强结肠蠕动,可能缓解便秘症状。
目的:我们研究了油酸是否可以改善减肥手术或接受GLP-1类似物的患者的便秘。
方法:根据罗马IV标准,在减肥手术或GLP-1类似物后,十四名患有慢性便秘的成年人接受稳定的便秘治疗超过4周。这项随机双盲交叉试验比较了在远端小肠或胃中递送的含有21.25g油酸的微胶囊。主要结果是24小时内肠道运动数量的变化。探索性终点包括紧张的改变,腹泻,24小时以上的粪便渗漏和饥饿,丰满度,摄入微胶囊后3小时的恶心和卡路里摄入量。
结果:在小肠远端接受油酸会增加每天的排便次数(2.5vs1.1,p=0.009),并导致大便稠度变软(p=0.03)。对照组的9/14通过运动,干预组的13/14在24小时内通过运动(p=0.059)。在应变方面没有观察到显著差异(p=0.65),快速排便(p=0.08),意外泄漏(p=0.32),饥饿,丰满度,两组之间的恶心或进食量(均p>0.05)。组间安全性没有差异。
结论:在接受减肥手术和/或接受GLP-1类似物的患者中,将含有油酸的微胶囊递送至远端小肠似乎是一种安全有效的缓解慢性便秘的方法。
BACKGROUND: Constipation is prevalent after bariatric surgery and glucagon-like-peptide 1 (GLP-1) analogues. Increasing fat content in the distal small intestine and colon can enhance colonic peristalsis, potentially alleviating symptoms of constipation.
OBJECTIVE: We investigated whether oleic acid can ameliorate constipation in patients undergoing bariatric surgery or receiving GLP-1 analogues.
METHODS: Fourteen adults with chronic constipation according to Rome IV criteria following bariatric surgery or GLP-1 analogues were on stable treatment for constipation for more than 4 weeks. This randomized double-blind crossover trial compared microcapsules containing 21.25 g of oleic acid delivered in the distal small intestine or the stomach. The primary outcome was changed in the number of bowel motions over 24 h. Exploratory endpoints included alterations in straining, diarrhoea, faecal leakage over 24 h and hunger, fullness, nausea and calorie intake for the 3 h after ingesting the microcapsules.
RESULTS: Receiving oleic acid into the distal small intestine increased number of bowel movements per day (2.5 vs 1.1, p = 0.009) and caused softer stool consistency (p = 0.03). 9/14 of the control group passed motions and 13/14 of the intervention group passed motions in 24 h (p = 0.059). No significant differences were observed in straining (p = 0.65), rapid bowel movements (p = 0.08), accidental leakage (p = 0.32), hunger, fullness, nausea or food intake between the groups (all p > 0.05). There were no disparities in safety profile between groups.
CONCLUSIONS: Microcapsules containing oleic acid delivered to the distal small intestine appear to be a safe and effective relief from chronic constipation in patients undergoing bariatric surgery and/or receiving GLP-1 analogues.