Behavioural and new pharmacological treatments for constipation: getting the balance right.
Behavioural and new pharmacological treatments for constipation: getting the balance right.
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DOI：
10.1136/gut.2009.199653
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发表时间：
2010-09
期刊：
影响因子：
24.5
通讯作者：
Bharucha AE
中科院分区：
文献类型：
--
作者：
Camilleri M;Bharucha AE
慢性便秘几乎影响六分之一的成年人，在老年人中更为常见。在绝大多数患者中，便秘没有阻塞性粘膜或结构性原因，在排除相对罕见的全身性疾病（其中最常见的是甲状腺功能减退症）后，鉴别诊断很快缩小到三个过程：痉挛（盆底协同失调、无性）或松弛（会阴下降综合征）类型的排空障碍，以及正常或慢传输型便秘。基于确定潜在病理生理学的慢性便秘治疗通常通过靶向治疗是成功的。本综述的目的是讨论慢性便秘的靶向治疗：出口功能障碍的行为治疗和与出口功能障碍无关的便秘的药物治疗。特别是，我们将回顾行为治疗对排便障碍有效的证据，描述与排便障碍无关的便秘的新治疗方案，并展示针对潜在诊断的“靶向治疗”如何为患有这些常见疾病的患者带来平衡的治疗方法。
Chronic constipation affects almost one in six adults and is even more frequent in the elderly. In the vast majority of patients, there is no obstructive mucosal or structural cause for constipation and, after excluding relatively rare systemic diseases (commonest of which is hypothyroidism), the differential diagnosis is quickly narrowed down to three processes: evacuation disorder of the spastic (pelvic floor dyssynergia, anismus) or flaccid (descending perineum syndrome) varieties, and normal or slow transit constipation. Treatment of chronic constipation based on identifying the underlying pathophysiology is generally successful with targeted therapy. The aims of this review are to discuss targeted therapy for chronic constipation: behavioural treatment for outlet dysfunction and pharmacological treatment for constipation not associated with outlet dysfunction. In particular, we shall review the evidence that behavioural treatment works for evacuation disorders, describe the new treatment options for constipation not associated with evacuation disorder, and demonstrate how `targeting therapy' to the underlying diagnosis results in a balanced approach to patients with these common disorders.
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