Functional Constipation: Individualising Assessment and Treatment
Functional Constipation: Individualising Assessment and Treatment
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DOI：
10.1007/s40265-020-01305-z
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发表时间：
2020-05-25
期刊：
影响因子：
11.5
通讯作者：
Tack, Jan
中科院分区：
文献类型：
--
作者：
Pannemans, Jasper;Masuy, Imke;Tack, Jan
慢性便秘是胃肠病学家看到的五种最常见的症状之一。在没有警报症状的情况下，通常可以使用Rome标准作出基于症状的可靠诊断。到目前为止，已经确定了三种不同的亚型：正常运输便秘，排便障碍和缓慢运输便秘。这些亚型之间的区分可以通过功能测试来进行，比如用气球排出的肛门直肠测压和放射性不透明标记试验。一般来说，最初建议患者增加液体和纤维的摄入量。当这些一般的生活方式建议不能改善患者的症状时，应采用循序渐进的附加治疗方法。本文综述了区分功能性便秘与其他原因引起的慢性便秘的诊断标准。此外，目前的药物治疗方案，包括讨论新的治疗靶点进行了讨论。此外，实际的治疗方法（选择和剂量），包括讨论联合/增强，治疗失败（坚持/期望）和复发预防。最后，疼痛和腹胀的治疗和管理也包括在内。
Chronic constipation is one of the five most common symptoms seen by gastroenterologist. In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients' symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. Finally, treatment and management of pain and bloating aspects are included.