Constipation And GI Diagnoses In Children With Solid Tumours: Prevalence And ManagementⅡ

METHODS 

Data source 

Data for this retrospective multicentre cohort study were obtained from the Pediatric Hospital Information System (PHIS) database. Managed by the Children’s Hospital Association (CHA) (Overland Park, Kansas), the PHIS database provides detailed information about hospital-based discharges from 48 of the largest free-standing children’s hospitals across the USA. The participating institutions represent all US census geographical regions and the majority of US tertiary care paediatric hospitals. Reliability and validity are continuously assured by data quality assessments from both CHA and participating institutions. Patient data are deidentified and given a unique patient identification number, thus allowing patients to be tracked over time and across multiple admissions. 

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Study population 

Our study population included patients aged 0 to 21 years with a solid tumour diagnosis admitted to the hospital between October 2015 and December 2019. To ensure patients were receiving chemotherapy for an active solid tumour malignancy, patients were required to have an ICD-10-CM diagnosis code for a solid tumour and a billing code for a central line supply code, chemotherapy administration procedural code or a chemotherapy medication code at any point during the study time period. Solid cancers of interest were grouped by organ system and included CNS, bone, liver/biliary, kidney, retinal, non-specific abdominal/pelvic and non-specific adrenal tumours, and the remaining diagnoses, including soft-tissue sarcomas, were classified as other solid tumours. Hodgkin’s and non-Hodgkin’s lymphomas (NHLs) were also identified (online supplemental file 1). Patients with cancer diagnoses in multiple cancer groups were excluded. 

Study definitions

 Previously published methods were used for consistency.9 ICD-10-CM codes were used to identify diagnoses of constipation (K59.XX) and other GI diagnoses, such as appendicitis, gastritis and ulcers; and GI symptoms, such as nausea and abdominal pain (online supplemental file 1). Billing codes were used to identify the receipt of chemotherapy agents, opioids and constipation medications, as well as operating room (OR) and total parenteral nutrition (TPN) charges. Patients who lacked a diagnosis code of constipation but received at least two unique constipation medications were also defined as a case of constipation. Dates of medication administration were extracted to calculate the start and duration of medication use. To evaluate the possible effect of opioid use on the risk of constipation during admission, we categorised patients into four groups to best distinguish opioid use between anaesthesia and pain: (1) no occurrences of opioid use, (2) patient received fentanyl only, (3) patient received other, non-fentanyl opioids for 1 or 2 days, and (4) patient received ≥2 days of other, nonfentanyl opioids. Demographic information, such as patient sex, race and geographical region, and hospitalisation information, including length of stay, intensive care utilisation and mortality, was also obtained from the PHIS database. Patient age was calculated as the age at their last encounter during the study period.

Statistical analysis 

All data were summarised using descriptive statistics. Median and range were used to describe quantitative variables and frequency and percentage were used for qualitative variables. The prevalence of constipation among all solid cancers (as well as in specific cancer groups) was calculated as a percentage. The management of constipation was summarised descriptively. Univariate comparisons between those with and without constipation were performed using χ2 tests for qualitative variables and Wilcoxon rank-sum tests for quantitative variables. Statistical significance was determined by p-value <0.05. Statistical analyses were performed using Statistical Analysis System software V.9.4 (SAS Institute, Cary, NC).

Natural Herbal Medicine For Relieving Constipation-Cistanche 

Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to ageing, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.

Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research specifically on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. Promoting hydration and lubrication of the Intestines, it may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. By reducing inflammation in the intestines, it may help improve bowel movement regularity and relieve constipation.