Introduction and aimAbdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade.Materials and methodsAn analytic cross-sectional study was conducted that compared 2 radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by 2 different observers, utilizing 2 different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient.ResultsThere was a significant association between pain intensity and the radiographic grade of fecal impaction (P < .05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage.ConclusionsRadiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation. 相似文献
Background: Chronic constipation (CC) often occurs after spinal cord injury (SCI). Prucalopride is a novel, highly selective, specific serotonin 4 receptor agonist with enterokinetic properties. We evaluate the tolerability and pilot efficacy of prucalopride in the treatment of CC due to SCI. Methods: Double-blind, placebo-controlled, pilot, phase II, dose-escalation study. After 4 weeks' run in, patients received prucalopride 1 mg ( n = 8) or placebo ( n = 4); 11 new patients were randomized to prucalopride 2 mg ( n = 8) or placebo ( n = 3) once daily for 4 weeks. Patients recorded bowel function (diary) and assessed constipation severity and treatment efficacy (visual analogue scale (VAS) 0-100 mm). Colonic transit times were determined. Results: Compared with run in, mean changes in constipation severity (VAS) increased with placebo, but decreased with prucalopride 1 and 2 mg. The VAS score for treatment efficacy showed a clear dose response (medians 4, 52 and 73 for placebo, 1 and 2 mg, respectively). Diary data showed an improvement in average weekly frequency of all bowel movements over 4 weeks within the 2 mg group (median 0.6; 95% CI 0.2; 1.2). There was a significant reduction in median colonic transit time with 2 mg ( n = 4; -38.5 h (95% CI-80; -5)). Four patients (2 mg) reported moderate/severe abdominal pain, and two of these discontinued treatment. There were no clinically relevant effects on any of the safety parameters. Conclusion: This pilot study indicates that prucalopride can play an important role in the management of patients with CC due to SCI. 相似文献
Purpose This study was designed to develop and test the validity and reliability of the Constipation Severity Instrument.
Methods Scale development was conducted in two stages: 1) 74 items were generated through a literature review and focus groups of
constipated patients and medical providers; and 2) a preliminary instrument was administered to 191 constipated patients and
103 healthy volunteers. Test-retest reliability of the constipated group was assessed (N = 90). Content, convergent, divergent,
and discriminant validity were evaluated by using other validated measures by performing one-way analysis of variance and
Pearson correlations.
Results Exploratory and confirmatory factor analysis revealed three subscales: obstructive defecation, colonic inertia, and pain.
Internal consistency (α = 0.88–0.91) and test-retest reliability (intraclass correlation coefficients = 0.84–0.91) were high
for all subscales. Constipated patients were grouped by Rome II criteria: functional constipation (22 percent), pelvic floor
dyssynergia (15 percent), constipation predominant irritable bowel syndrome (23 percent), and no specific criteria (40 percent).
Those with constipation predominant irritable bowel syndrome or pelvic floor dyssynergia scored higher on the Obstructive
Defecation and Colonic Inertia subscales than those with functional constipation or no specific criteria (P = 0.001–0.058). Subjects with functional constipation had much lower scores on the pain subscale than constipation predominant
irritable bowel syndrome, functional constipation, or no specific criteria (P < 0.009).The Constipation Severity Instrument subscale and total score correlated very highly with the subscales and total
score of the Patient Assessment of Constipation Symptom measure. The Constipation Severity Instrument subscales discriminated
well between constipated patients and healthy volunteers (P < 0.001) and demonstrated excellent divergent validity. Higher Constipation Severity Instrument scores inversely correlated
with general quality of life.
Conclusions The Constipation Severity Instrument is a reliable and valid instrument for assessing constipated patients. Administration
of the Constipation Severity Instrument to other constipated patients will further validate its use.
Supported by the University of California San Francisco Hellman Family Award for Early Career Faculty.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
Reprints are not available. 相似文献
Background: Linaclotide is approved for treating irritable bowel syndrome with constipation (IBS-C; 290 µg QD) and chronic idiopathic constipation (CIC; 145 µg or 72 µg QD). These analyses aimed to assess linaclotide safety in a large, pooled Phase 3 population.
Methods: In six randomized controlled trials (RCTs), patients received linaclotide (72 µg, 145 µg, 290 µg) or placebo daily for 12–26 weeks; in two long-term safety (LTS) studies, patients received open-label linaclotide for ≤78 additional weeks. Laboratory values, vital signs, and treatment-emergent adverse events (TEAEs) were assessed.
Results: Overall, 3853 patients received ≥1 dose of linaclotide. The most common TEAE was diarrhea (majority [90.5% in RCTs] mild/moderate). Linaclotide patients experienced 1.1 diarrhea TEAE per patient-year in the RCTs (0.2 in placebo), and 0.3 in the LTS studies. In RCTs, 6.9% linaclotide and 3.0% placebo patients discontinued due to any adverse event (AE); 4.0% linaclotide and 0.3% placebo patients discontinued due to diarrhea. In LTS studies, 9.4% patients discontinued due to any AE, and 3.8% due to diarrhea. Serious AEs (SAEs) were rare and similar across treatment groups; there were no SAEs of diarrhea.
Conclusion: These pooled analyses of patients treated for ≤104 weeks confirm linaclotide’s overall safety. 相似文献