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Chronic Constipation
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DOI：10.1016/j.mayocp.2019.01.031.png)
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Abstract
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Constipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. Although most constipation is self-managed by patients, 22% seek health care, mostly to primary care physicians (>50%) and gastroenterologists (14%), resulting in large expenditures for diagnostic testing and treatments. There is strong evidence that stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted m-opiate antagonists are effective and safe; the lattermost drugs are a major advance for managing opioid-induced constipation. Constipation that is refractory to available laxatives should be evaluated for defecatory disorders and slow-transit constipation using studies of anorectal function and colonic transit. Defecatory disorders are often responsive to biofeedback therapies, whereas slow-transit constipation may require surgical intervention in selected patients. Both efficacy and cost should guide the choice of treatment for functional constipation and opiate-induced constipation. Currently, no studies have compared inexpensive laxatives with newer drugs that work by other mechanisms. (C) 2019 Mayo Foundation for Medical Education and Research.
Keywords:
IRRITABLE-BOWEL-SYNDROME
CHRONIC IDIOPATHIC CONSTIPATION
RESOLUTION ANORECTAL MANOMETRY
SLOW-TRANSIT CONSTIPATION
PLACEBO-CONTROLLED TRIAL
OPIOID-INDUCED CONSTIPATION
DIGITAL RECTAL EXAMINATION
3350 PLUS ELECTROLYTES
DIRECT MEDICAL COSTS
LONG-TERM EFFICACY
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