Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options.
Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options.
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成人慢性特发性便秘：当前指南和新兴治疗方案的回顾。
DOI：
10.2147/ceg.s256364
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发表时间：
2021
影响因子：
2.4
通讯作者：
Bellini M
中科院分区：
文献类型：
--
作者：
Bassotti G;Usai Satta P;Bellini M
慢性特发性便秘（CIC）是一种常见的功能性肠病，其特征在于排便困难、不频繁和/或不完全。它对生活质量和卫生保健系统有很大影响，并造成沉重的经济负担。诊断是基于症状，分类的罗马IV标准。本综述的目的是评估目前成人CIC的治疗指南，并强调新出现的治疗方法。详细地说，已经确定并比较了欧洲、法国、西班牙和韩国的指南。渗透性泻药，特别是聚乙二醇，代表了一线治疗方法。刺激性泻药被推荐作为二线治疗。盆底功能康复建议在患者肛门直肠协同失调。在药物治疗未能改善的患者中，骶神经刺激被认为是手术前的最后一次机会。然而，手术入路在选定病例中的适应症有限。惰性结肠难治性和排便障碍是两个亚型，可以受益于手术。在新兴药物中，普卢卡必利是一种促动力剂，被推荐作为难治性CIC患者的二线治疗。此外，促分泌素利那洛肽和普来坎替以及胆汁酸转运抑制剂依洛昔巴特在二线治疗方案无效的患者中可能有效，尽管它们在全球范围内尚未上市。
Chronic idiopathic constipation (CIC) is a common functional bowel disorder characterized by difficult, infrequent, and/or incomplete defecation. It has a great impact on the quality of life and on health care system and represents a heavy economic burden. The diagnosis is based on symptoms, classified by the Rome IV criteria. The aim of this review was to evaluate the current therapeutic guidelines for adult CIC and highlight new emerging treatments. In detail, European, French, Spanish and Korean guidelines have been identified and compared. Osmotic laxatives, and in particular polyethylene glycol, represent the first-line therapeutic approach. Stimulant laxatives are recommended as a second-line therapy. Pelvic floor rehabilitation is recommended in patients with ano-rectal dyssynergia. In patients who fail to improve with pharmacological therapies sacral nerve stimulation is considered as last chance before surgery. Surgical approach has however limited indications in selected cases. Inertia coli refractory to any approach and obstructed defecation are two subtypes which can benefit from surgery. Among emerging agents, prucalopride, a prokinetic agent, is recommended as a second-line treatment in refractory CIC patients. In addition, the secretagogues linaclotide and plecanatide and the bile acid transported inhibitor elobixibat can be effective in patients not responsive to a second-line therapeutic regimen, although they are not worldwide commercially available.
影响因子：
3.4
作者：
Staller K;Barshop K;Vélez C;Bailey A;Locascio JJ;Chiquette E;Kuo B
通讯作者：
Kuo B