Chronic Constipation |
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| Affiliation: | 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN;2. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI;1. University of Texas Health Science Center at Houston, Houston, TX;2. MedStar Health, Washington, DC;1. Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;2. Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil;1. Key Laboratory for Forest Resources Conservation and Utilization in the Southwest Mountains of China, Ministry of Education, Southwest Forestry University, China;2. Department of Life Technology Teaching and Research, School of Life Science, Southwest Forestry University, China;3. Wenzhou Business College, Wenzhou, China;4. Department of Life Technology Teaching and Research, College of Life Sciences, Southwest Forestry University, China;5. Yuxi Genor Biotechnology Co., Ltd, China;6. Light Industry and Food Engineering College, SWFU, Bailongsi, China;1. Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA;2. Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA;3. Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA;4. Division of Diabetes, Endocrinology, and Gastroenterology, University of Manchester, Manchester, UK;5. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA;1. Hatay Mustafa Kemal University, Faculty of Health Sciences Department of Public Health Nursing, Tayfur Sokmen Campus, 31060, Antakya, Hatay, Turkey;2. Gazi University, Faculty of Health Sciences, Department of Public Health Nursing, Ankara, Turkey;1. Department of Anorectal Surgery, Nanjing University of Chinese Medicine, Nanjing 210023, China;2. Department of Anorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210023, China |
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| Abstract: | Constipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. Although most constipation is self-managed by patients, 22% seek health care, mostly to primary care physicians (>50%) and gastroenterologists (14%), resulting in large expenditures for diagnostic testing and treatments. There is strong evidence that stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted μ-opiate antagonists are effective and safe; the lattermost drugs are a major advance for managing opioid-induced constipation. Constipation that is refractory to available laxatives should be evaluated for defecatory disorders and slow-transit constipation using studies of anorectal function and colonic transit. Defecatory disorders are often responsive to biofeedback therapies, whereas slow-transit constipation may require surgical intervention in selected patients. Both efficacy and cost should guide the choice of treatment for functional constipation and opiate-induced constipation. Currently, no studies have compared inexpensive laxatives with newer drugs that work by other mechanisms. |
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