A Prospective, Descriptive Study to Assess the Effect of Dietary and Pharmacological Strategies to Manage Constipation in Patients with a Stoma.
A Prospective, Descriptive Study to Assess the Effect of Dietary and Pharmacological Strategies to Manage Constipation in Patients with a Stoma.
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一项前瞻性、描述性研究，旨在评估饮食和药理学策略对造口患者便秘的治疗效果。
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
T. Banasiewicz
中科院分区：
文献类型：
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作者：
L. Krokowi̇cz;A. Bobkiewicz;M. Borejsza;B. Kuczyńska;A. Lisowska;U. Skowrońska;J. Paszkowski;J. Walkowiak;M. Drews;T. Banasiewicz
与造口患者相关的术语便秘定义为与粪便稠度增加或长时间无排便相关的排便受损，导致不适、肠胃气胀和腹痛。关于造口患者便秘的信息有限。在2011年1月至2014年12月期间在波兹南（波兰）的造口和直肠科门诊就诊的患者中进行了一项前瞻性描述性研究，以评估饮食和药物策略在造口患者便秘管理中的作用。如果患者经历了3天的无排便期，导致腹部不适和腹胀，则将其纳入。因肿瘤疾病而患绝症或无法提供参与研究的知情同意书的患者没有资格参加研究。患者间隔3个月进行3次评估：第一次评估粪便通过造口的问题，此时患者被告知增加纤维和液体摄入。在接下来的2次访视中，询问患者症状是否改善。如果饮食改变不成功，建议进行一线药物干预（泻药、渗透剂和益生菌）。如果在第三次评估期间未报告改善，则处方二线药物治疗（例如，刺激性泻药）。在最初评估参与的405例患者中，331例符合初始筛选标准并计划进行随访。其中，93例（28%）有便秘; 50例（15%）因形态学造口变化需要手术转诊，43例（12.9%）符合饮食建议的研究入选标准。几乎所有患者（42例）均行结肠造口术，大多数患者（28例）有憩室病造口史。25名男性和18名女性（平均年龄55.9 ± 9.3岁）在首次访视期间接受了饮食建议。饮食调整有效且足以解决超过一半（24）患者的便秘问题。在其余19例患者中，只有2例在使用一线或二线药物管理策略后没有改善。1例患者因复杂性结肠憩室病（穿孔）需要紧急手术。这项研究的结果表明，便秘患者的造口可以与形态的造口变化，在没有形态变化的情况下，大多数患者对饮食的变化反应良好。需要更多的研究来增加对造口患者便秘发病率和最佳管理策略的了解。
The term constipation with regard to patients with a stoma is defined as impaired bowel movements associated with increased stool consistency or long periods without bowel movements that lead to discomfort, flatulence, and abdominal pain. Information about constipation in patients with a stoma is limited. A prospective, descriptive study was conducted among patients attending ostomy and proctology outpatient clinics in Poznan, Poland between January 2011 and December 2014 to assess the role of dietary and pharmacological strategies in the management of constipation in patients with a stoma. Patients were included if they experienced a 3-day period without bowel movements leading to abdominal discomfort and bloating. Patients who were terminally ill from neoplastic disease or could not provide informed consent for study participation were not eligible to participate. Patients underwent 3 evaluations 3 months apart: the first assessed problems with passing stool through the stoma, at which time patients were told to increase fiber and fluid intake. During the next 2 visits, patients were asked if their symptoms had improved. If dietary changes were not successful, first-line pharmacological interventions were suggested (laxatives, osmotic agents, and probiotics). If no improvement was reported during the third assessment, second line pharmacologic therapy (eg, stimulant laxatives) were prescribed. Of the 405 patients initially assessed for participation, 331 met the initial screening criteria and were scheduled for followup. Of those, 93 (28%) had constipation; 50 (15%) required a surgical referral for morphological stoma changes and 43 (12.9%) met the study inclusion criteria for dietary recommendations. Almost all (42) had a colostomy and most (28) had a history of stoma creation due to diverticular disease. Twenty-five (25) men and 18 women (average age 55.9 ± 9.3 years) received dietary recommendations during the first visit. Diet modifications were effective and sufficient to resolve the problem with constipation in more than half (24) of the patients. Among the remaining 19 patients, only 2 did not improve after using first-line or second-line pharmacological management strategies. One patient required emergency surgery due to complicated colonic diverticulosis (perforation). The results of this study suggest constipation among patients with a stoma can be associated with morphological stoma changes and in the absence of morphologic changes the majority of patients respond well to a change in diet. Additional studies are needed to increase understanding about the incidence and optimal management strategies of constipation in persons with a stoma.