— Kiwi tied to fewer adverse events and greater patient satisfaction
by Diana Swift, Contributing Writer October 26, 2020
For patients with chronic constipation, green kiwifruit (a.k.a. Chinese gooseberry) was associated with fewer adverse effects and greater patient satisfaction than psyllium or prunes, although all three were effective, according to a randomized trial.
In a presentation at the American College of Gastroenterology virtual meeting, Samuel W. Chey, MPH, of the University of Michigan HealthSystem in Ann Arbor, said that while psyllium and prunes are proven treatments for chronic constipation, Asian studies, including one from China, have suggested that fresh kiwi may also mitigate symptoms, especially in an era when people with functional bowel problems are increasingly seeking natural solutions.
“The primary reason for undertaking the study was that although there are a number of pharmaceutical options for [chronic constipation], these can be costly and can even exacerbate abdominal symptoms,” Chey told MedPage Today. “And previous studies have shown that only about half of patients actually feel better on these drugs, so we wanted to try three forms of natural treatments.”
For the study, the researchers randomized 79 adults with chronic constipation during May 2018 to July 2019 at the University of Michigan Medical Center to one of the three natural treatments following a 2-week baseline screening period:
- Whole fresh green kiwifruit (Zespri), two a day
- Dried pitted prunes (Kirkland), 12 prunes (approximately 100 g) a day
- Powdered psyllium (Procter & Gamble), 12 g a day for 4 weeks
Eligible participants had to have no more than three complete spontaneous bowel movements (CSBMs) per week. Patients had a mean age of 42.7 years, 87% were female, and 77% were white. Demographic features were similar between groups.
The primary endpoint was the proportion of patients in each group reporting an increase of one or more CSBMs per week compared with baseline for at least 2 of 4 treatment weeks.
Key secondary outcomes included stool frequency, stool consistency (on the Bristol Stool Form Scale), and straining (0-10 scale), all assessed daily, as well as overall treatment satisfaction (yes/no) as evaluated after treatment.
Standard statistical methods were utilized (Chi-square, ANOVA, paired t-tests), and a P<0.05 was considered significant. Adverse events were collected using open-ended questions after treatment.
Complete data were available for 75 patients: 29 on kiwi, 24 on prunes, and 22 on psyllium. For the primary endpoint, the proportions of CSBM responders were as follows: 67% for prunes, 64% for psyllium, and 45% for kiwi.
In a comparison of treatment weeks 3 and 4 with baseline, there was a significant increase in the weekly CSBM rate, with all treatments (P≤0.0003).
Chey said that stool consistency significantly improved with both kiwi (P=0.01) and prunes (P=0.049), and whole straining significantly improved with all three: kiwi (P=0.003), prunes (P<0.001), and psyllium (P=0.04).
Regarding tolerability, adverse events such as pain, bloating, and gas were most common with psyllium (reported by 67% of patients), followed by prunes (45%), and were least common with kiwi (32%). In terms of specific adverse effects, 33% of patients in the psyllium group reported having abdominal pain vs 18% and 0% in the prunes and kiwi groups, respectively.
Gas was reported by 19% in the psyllium group compared with 18% in the prunes and 0% in the kiwi groups. Prunes were tied most frequently to bloating: 36% vs 11% for kiwi and 10% for psyllium.
At the end of treatment, a smaller proportion of patients reported dissatisfaction with kiwi compared with prunes or psyllium (P=0.02).
“These results confirm the benefits of prunes and psyllium and offer the first U.S. data on green kiwifruit as an effective and well-tolerated treatment for [chronic constipation] patients,” Chey and his co-authors wrote.
Asked for his perspective, Richard B. Gearry, MB, ChB, PhD, of the University of Otago in Christchurch, New Zealand, said that he was principal investigator of a similar study funded by kiwifruit producer Zespri, not yet published, showing comparable results across Japan, New Zealand, and Italy.
Disclosures
The study was funded in part by kiwifruit producer Zespri.
Chey reported no relevant financial relationships; a co-author reported financial relationships with multiple companies, including Zespri.
Gearry is a member of the advisory board for Zespri and principal investigator of a multi-country trial of kiwifruit and gut health.
Primary Source
American College of Gastroenterology