Dear Colleagues! This is Asrar Qureshi’s Blog Post #756 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. Please email to email@example.com for publishing your contributions here.
US Food & Drug Administration has approved a new pill for relief from chronic constipation. The pill is called VIBRANT, and has been developed by the company Vibrant Gastro Inc. The pill was approved by USFDA in August last year but has become available to patients now.
The patients will take the pill at bedtime daily. The pill should pass through stomach and small intestine and finally reach large intestine in about 14 hours. It will stimulate the nerve cells in the large intestine and shall cause muscle contractions which will push the food out. The pill shall also leave the body in the process of defecation.
The pill is made of medical grade material similar to what is already being used for pill cameras. It has been shown to have no adverse events, no toxic materials, no risk for infections, not getting stuck along the gastrointestinal system, or interfering with other medical devices.
Constipation is certainly more common than is considered. On a lighter note, it was the running theme of an Indian movie ‘Piku” starring Amitabh Bachhan, Irrfan Khan, and Deepika Pudokone. We, the sub-continent people, are obsessed with it and therefore, strongly believe in purgative home remedies. Medicines are also available in allopathy, homeopathy, and herbal treatment systems.
Functional constipation is defined as the inability to defecate completely and spontaneously three or more times in a week, without any secondary cause. The opinion about full definition of constipation varies, but generally the need for excessive straining, sense of incomplete bowel evacuation, infrequent and hard stools are included.
Prevalence of constipation varies from 2 to 27% worldwide; in Pakistan it was found to be 1.61% in a study in 2004 and has not been updated. Constipation is more common in women than in men, in non-whites than in whites, in elderly than in young, and in children than in adults. Constipation prevalence in children is about 29.6% worldwide. Up to 84% of functionally constipated children suffer from fecal incontinence and one third continue to have this problem beyond adolescence. Factors that may contribute include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines, and family history of constipation. A specific underlying cause may be identified in less than 5% of cases.
Cases, where an underlying cause may be identified can be broadly categorized as under.
- Anatomical causes include anal stenosis (blockage), displaced anus, imperforate anus, intestinal stricture, anal stricture.
- Abnormal Musculature related causes include prune belly syndrome (a rare disorder characterized by partial or complete absence of stomach), gastroschisis (a birth defect where a hole in the belly wall beside the belly button allows the baby’s intestines to extend outside the baby’s body), down syndrome, and muscular dystrophy.
- Intestinal nerve abnormality-related causes include Hirschsprung disease (some of baby’s intestinal nerve cells do not develop properly, delaying the progression of stool through the intestines), spinal cord defects, and spina bifida.
- Drugs such as antidepressants, vitamin D, narcotics, anticholinergics, and intoxication.
- Metabolic and endocrine causes, such as low potassium, high calcium, less functioning thyroid, and diabetes.
- Other causes may include, celiac disease (intolerance to gluten), cystic fibrosis, cow-milk-protein allergy, inflammatory bowel diseases, and scleroderma (autoimmune disease that causes inflammation in the skin
The pattern and frequency of defecation depends on child’s age. During neonatal period and early infancy, bowel movements can present more than four times per day, and trends down to 1 – 2 per day by toddler’s age. By this time, children usually have achieved voluntary control of their sphincter.
Among adult population, though the symptoms associated with constipation are often mild and intermittent, they may become chronic, debilitating, and difficult to treat. Some of the long-term complications of constipation are inguinal hernia and hepatic encephalopathy. A study conducted in Fatima hospital Karachi revealed that 22% patients of inguinal hernia had chronic constipation.
A 2011 study done at the Dow Medical University Karachi and published in Journal of Pakistan Medical Association titled ‘Frequency of functional constipation in 3 different populations and its causative factors’ demonstrated the following about functional constipation.
- 3 populations included hospitalized patients, medical students, and attendants of patients.
- The occurrence in hospitalized patients was 53% – 23% males, 30 females; among medical students 34% – 18% males, 16% females; and among attendants of patients was 52% – 24% males, 28% females.
- The incidence was the highest in the age group of 18 – 30 years.
- Among constipated patients, 51% took laxatives including ispaghol husk, 9% lactulose, and about 4% on homeopathic treatment.
- Among constipated medical students, 29% took laxatives including ispaghol husk, 6% were on lactulose, and the rest on others
- Among constipated patient attendants, 46% took laxatives including ispaghol husk, 11% on homeopathic treatment, and 4% on lactulose.
- Most people took medium fiber diet.
- Physical exercise was reported in 6% of medical students, and 23% of patient attendants at the rate of three times or more per week.
- The study concluded that frequency of constipation was fairly greater in all the three populations studied. Physical inactivity and low fiber intake were prominent risk factors in the constipated individuals.
Constipation is an everyday issue for many people. High fiber diet, regular exercise, regular meals, and plenty of fluids are generally recommended to keep it at bay. Ispaghol husk sells by the tons in Pakistan, so are other forms of relief. The results may be variable.
The newly approved pill, VIBRANT, may not come to Pakistan anytime soon. Meanwhile, we wait to see its results in wider usage.
Disclaimer: Most pictures in these blogs are taken from Google Images and Pexels. Credit is given where known; some do not show copyright ownership. However, if a claim is lodged at any stage, we shall either mention the ownership clearly, or remove the picture with suitable regrets.