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Alavi K, Thorsen AJ, Fang SH, Burgess PL, Trevisani G, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation. Dis Colon Rectum 2024; 67:1244-1257. [PMID: 39250791 DOI: 10.1097/dcr.0000000000003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Karim Alavi
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Amy J Thorsen
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sandy H Fang
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | - Pamela L Burgess
- Colon and Rectal Surgery, M Health Fairview Southdale Hospital, Minneapolis, Minnesota
| | - Gino Trevisani
- Colon and Rectal Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Amy L Lightner
- Department of Surgery, Scripps Clinic Medical Group, La Jolla, California
| | - Daniel L Feingold
- Division of Colon and Rectal Surgery, Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Ian M Paquette
- Department of Surgery Section of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
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Lee YJ. Is There a Role for Radiopaque Markers in Identifying Defecation Disorders? J Neurogastroenterol Motil 2021; 27:312-313. [PMID: 34210897 PMCID: PMC8266500 DOI: 10.5056/jnm21115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yoo Jin Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Abe T, Kunimoto M, Hachiro Y, Ohara K, Inagaki M, Murakami M. Rectosigmoid Localization of Radiopaque Markers for Identifying Defecation Disorders in Patients With Chronic Constipation: A Retrospective Cohort Study. J Neurogastroenterol Motil 2021; 27:419-425. [PMID: 34210907 PMCID: PMC8266493 DOI: 10.5056/jnm20204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/31/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Defecation disorders (DD) are part of the spectrum of chronic constipation with outlet obstruction. Although anorectal physiologic tests are required for the diagnosis of DD, these tests are not available in many institutions. This study aims to investigate the predictivity of DD using rectosigmoid localization of radiopaque markers in a colonic transit study. METHODS A total of 169 patients with refractory constipation with a mean age of 67 years were studied. All patients underwent anorectal manometry, a balloon expulsion test, and a colonic transit study. Barium defecography was performed if needed. The relationship between DD diagnosed by these anorectal tests and the rectosigmoid accumulation of markers was examined. RESULTS Seventy-nine (46.7%) patients were identified to have DD based on anorectal test combinations. Rectosigmoid accumulation of markers was observed in 39 (23.1%) patients. The sensitivity and positive predictive value of rectosigmoid accumulation for identifying DD were 31.6% and 64.1%, respectively. Rectosigmoid accumulation provided poor discrimination of DD from normal transit constipation, at a specificity of 82.1% but with a sensitivity of only 10.6%. In discriminating DD from slow transit constipation, rectosigmoid accumulation was found to be useful with a positive likelihood ratio of 5.3. CONCLUSION s Rectosigmoid accumulation of markers can differentiate DD from slow transit constipation. However, non-rectosigmoid accumulation does not exclude the presence of DD.
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Affiliation(s)
- Tatsuya Abe
- Departments of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan
| | - Masao Kunimoto
- Departments of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan
| | - Yoshikazu Hachiro
- Departments of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan
| | - Kei Ohara
- Departments of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan
| | - Mitsuhiro Inagaki
- Departments of Proctology, Kunimoto Hospital, Akebono, Asahikawa, Japan
| | - Masanori Murakami
- Departments of Gastroenterology, Kunimoto Hospital, Akebono, Asahikawa, Japan
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Bouchoucha M, Fysekidis M, Rompteaux P, Airinei G, Sabate JM, Benamouzig R. Influence of Age and Body Mass Index on Total and Segmental Colonic Transit Times in Constipated Subjects. J Neurogastroenterol Motil 2019; 25:258-266. [PMID: 30982242 PMCID: PMC6474702 DOI: 10.5056/jnm18167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/04/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Discordant data are found in the literature for the relationships between total and segmental colonic transit time (CTT) and demographic parameters. The aim of this study is to examine the influence of age, and body mass index (BMI) on total and segmental CTT in constipated subjects. Methods We included 354 constipated patients on this cross-sectional study. According to the Rome III criteria, patients were classified as having irritable bowel syndrome with constipation, or functional constipation. All patients filled the Bristol stool form, and reported the severity of constipation, bloating, and abdominal pain on a 10-point Likert scale. Total and segmental CTT were measured using radiopaque markers. Results Females were 84% of patients, with a mean age of 46.0 ± 15.9 years. The association between total and segmental CTT with age and BMI was significant after adjustment for gender, clinical phenotype, the presence of defecation disorders, and abdominal pain or bloating intensity despite the severity of symptoms, and the frequency of defecation disorders were higher in irritable bowel syndrome with constipation than in functional constipation patients. By comparison with subjects less than 30 years, rectosigmoid transit time (RSTT) was lower in patients between 30 and 60 years. Age was negatively associated with RSTT (P = 0.004). By comparison with patients with normal BMI, RSTT and total CTT were lower in patients of the overweight group. BMI was negatively associated with RSTT (P < 0.001). The severity of constipation was correlated with total (P < 0.001), right (P = 0.002), and left CTT (P = 0.049). Conclusion Age and BMI are both associated with RSTT in constipated patients.
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Affiliation(s)
- Michel Bouchoucha
- Université Paris V René Descartes, Paris, France.,Service de'gastroentérologie, Hôpital Avicenne, Bobigny, France
| | - Marinos Fysekidis
- Service d'endocrinologie et diabétologie, Hôpital Avicenne, Bobigny, France
| | | | - Gheorge Airinei
- Service de'gastroentérologie, Hôpital Avicenne, Bobigny, France
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Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, Steele SR. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum 2016; 59:479-92. [PMID: 27145304 DOI: 10.1097/dcr.0000000000000599] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Staller K, Barshop K, Ananthakrishnan AN, Kuo B. Rectosigmoid Localization of Radiopaque Markers Does Not Correlate with Prolonged Balloon Expulsion in Chronic Constipation: Results from a Multicenter Cohort. Am J Gastroenterol 2015; 110:1049-55. [PMID: 25964224 DOI: 10.1038/ajg.2015.140] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 04/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Ingestion of radiopaque markers (ROMs) is a common means of assessing colonic transit time in chronic constipation. Because anorectal manometry (ARM) testing for pelvic floor dysfunction is mostly limited to academic centers, clinicians frequently use rectosigmoid accumulation of markers as a surrogate for pelvic floor dysfunction. We sought to determine whether rectosigmoid localization of markers on a ROM study correlated with measures of pelvic floor dysfunction by ARM and balloon expulsion testing. METHODS We assembled a multicenter, retrospective cohort of patients diagnosed with chronic constipation who underwent both transit testing by ROM transit testing and ARM with balloon expulsion testing. We compared the proportion of patients with outlet obstruction by rectoanal pressure gradient or prolonged balloon expulsion stratified by marker location. RESULTS There were 610 patients with both ROM testing and ARM with balloon expulsion testing. The mean age was 44 years and 526 were women (86%). Eighty-one (13%) patients had markers confined to the rectosigmoid area alone and were compared with 529 patients with markers elsewhere (51%) or no retained markers (49%). Of those with markers confined to the rectosigmoid colon, 48 (59%) had a prolonged balloon expulsion compared with 276 (52%) who did not have rectosigmoid markers (P=0.28). The mean rectoanal gradient for patients with markers in the rectosigmoid colon was -29±46 mm Hg compared with -34±59 mm Hg for all others (P=0.59). CONCLUSIONS Among patients with chronic constipation undergoing ROM transit testing, there is no association between rectosigmoid location of markers and rectoanal gradient or prolonged balloon expulsion.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Boston, Massachusetts, USA
| | - Kenneth Barshop
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Boston, Massachusetts, USA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Boston, Massachusetts, USA
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Khan U, Mason JM, Mecci M, Yiannakou Y. A prospective trial of temporary sacral nerve stimulation for constipation associated with neurological disease. Colorectal Dis 2014; 16:1001-9. [PMID: 25251843 DOI: 10.1111/codi.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/12/2014] [Indexed: 02/08/2023]
Abstract
AIM This study assessed the effectiveness of temporary sacral nerve stimulation (SNS) in patients with constipation associated with neurological disease using an off-on-off design, and evaluated the long-term response in patients undergoing permanent SNS. METHOD Patients with chronic constipation associated with neurological disease receiving specialist clinic care at the University Hospital North Durham over a 2-year period were recruited to a trial of SNS. Recordings of bowel function were made for 6 weeks (baseline) and a temporary electrode was then inserted and recordings were made for the next 3 weeks (stimulation). The electrodes were then removed and assessment was continued for a further 3 weeks (posttreatment). Patient-completed questionnaires were used to determine the severity of constipation (Global Assessment of Symptoms, Constipation, GA Constipation), symptoms (Patient Assessment of Constipation Symptoms score, PAC-SYM) and quality-of-life (Patient Assessment of Constipation-Quality Of Life score, PAC-QOL; European Quality of Life-Five-Domain score; European Quality of Life-Visual Analogue Score). Information was obtained on bowel function and medication. Physiological data were also available for transit and laser Doppler flow cytometry to measure mucosal blood flow. RESULTS Twenty-two patients were recruited, of whom 18 completed the trial. GA Constipation reduced significantly during temporary SNS: -1.09 (95% CI -1.59 to -0.59; P = 0.0003). PAC-SYM and PAC-QOL scores showed similar improvements. There was also a significant fall in the time spent in the toilet (P = 0.04) and a decrease in laxative use (P = 0.03). Twelve (67%) patients responded to temporary SNS and received a permanent implant with long-term success in 50%. CONCLUSION Sacral nerve stimulation can be effective in treating some patients with refractory severe neuroconstipation. A response to temporary SNS may predict long-term benefit in only half the patients undergoing permanent SNS.
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Affiliation(s)
- U Khan
- Wrexham Maelor Hospital, Wrexham, UK
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Abstract
OBJECTIVES The aim of the study was to test the clinical efficacy and effect on colonic transit time (CTT) of a dietary fiber mixture given to children with controlled chronic constipation (CC) after the withdrawal of stool softeners and enemas. METHODS This randomized, placebo-controlled, double-blind clinical trial involved 54 patients aged 4 to 12 years and had CC that was controlled by the use of low-dose stool softeners. The use of these softeners was discontinued when the patients were admitted to the clinical trial. The patients were randomized into 2 groups for the 4-week study period. One group received a dietary fiber mixture and the other group received a placebo (maltodextrin). The primary outcome was therapeutic failure (oral stool softeners or enemas was required to prescribe during the trial). Secondary outcomes included defecation frequency, stool consistency (measured using the Bristol Stool Form Scale), and CTT. RESULTS Therapeutic failure was observed in 34.6% (9/26) of the patients in the dietary fiber mixture group and in 35.7% (10/28) in the control group (P = 0.933). The mean increase in daily bowel movements was 0.53 in the dietary fiber mixture group and 0.23 in the control group (P = 0.014). The patients in the dietary fiber mixture group (60.0%) passed nonhardened stools more frequently than did those in the control group (16.7%, P = 0.003). The CTT was similar for both groups. CONCLUSIONS The fiber mixture did not prevent the suspension of stool softeners or lead to reduced CTT; however, the mixture promoted an increased frequency of defecation and an improvement in the stool consistency.
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Zhang T, Chon TY, Liu B, Do A, Li G, Bauer B, Wang L, Liu Z. Efficacy of acupuncture for chronic constipation: a systematic review. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2013; 41:717-42. [PMID: 23895148 DOI: 10.1142/s0192415x13500493] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study was to evaluate the efficacy and safety of acupuncture for chronic functional constipation. Randomized controlled trials were searched in several databases. The primary outcome was a change in the number of weekly spontaneous bowel movements. The secondary outcomes included colonic transit activity, effective rate, Cleveland Clinic Score, and health-related quality of life score. Meta-analysis was done by using RevMan 5.1. After strict screening, 15 RCTs were included, containing 1256 participants. All of them were conducted in China and published in Chinese journals. Meta-analysis indicated that acupuncture for chronic functional constipation was probably as effective as conventional medical therapy in the change of bowel movements. For the colonic transit activity, acupuncture might be the same as conventional medical therapy and could be better than sham acupuncture. For the Cleveland Clinic Score, acupuncture was unlikely inferior to conventional medical therapy and the deep acupuncture was better than normal depth acupuncture in abdominal region. No obvious adverse event was associated with acupuncture for constipation. In conclusion, acupuncture for chronic functional constipation is safe and may improve weekly spontaneous bowel movements, quality of life, and relevant symptoms. However, the evidence was limited by the small sample size and the methodological quality.
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Affiliation(s)
- Tao Zhang
- Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Nagaviroj K, Yong WC, Fassbender K, Zhu G, Oneschuk D. Comparison of the Constipation Assessment Scale and plain abdominal radiography in the assessment of constipation in advanced cancer patients. J Pain Symptom Manage 2011; 42:222-8. [PMID: 21458216 DOI: 10.1016/j.jpainsymman.2010.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/19/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Constipation is a distressing condition for advanced cancer patients and is frequently underdiagnosed. OBJECTIVES The primary objective of this study was to determine if a strong correlation existed between the use of the Constipation Assessment Scale (CAS) and a plain abdominal radiograph in the interpretation of constipation in patients with advanced cancer. The secondary aim of the study was to compare the plain film radiographic constipation scores among three palliative medicine physicians. METHODS The study was a prospective cross-sectional study of 50 advanced cancer patients admitted to a tertiary palliative care unit. These patients completed the CAS shortly after their admission to the unit. Around the same time, they underwent a flat plate of abdomen that was scored from 0 to 12, based on the amount of stool in the colon, by three palliative medicine physicians who were blinded to the CAS results and each other's radiographic interpretations. Kendall Tau correlation coefficient was used to estimate and test the correlations between the CAS and radiographic constipation scores. RESULTS There was no concordant correlation between the CAS scores and each physician's radiographic constipation score. There also was no concordant correlation between the CAS score and the combined radiographic constipation scores of the three palliative medicine physicians (Kendall Tau coefficient=0.04; P=0.72). The degree of correlation between the radiographic constipation scores from the three palliative medicine physicians was moderate. CONCLUSION Our study failed to yield a strong correlation between the CAS and the plain abdominal radiographic scores for constipation completed by three palliative medicine physicians. It is advisable that constipation in advanced cancer patients be assessed both clinically and radiographically.
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Affiliation(s)
- Kittiphon Nagaviroj
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Siproudhis L, Eléouet M, Desfourneaux V, Abittan S, Bretagne JF. Stratégie diagnostique d’une dyschésie. ACTA ACUST UNITED AC 2009; 33:F68-74. [DOI: 10.1016/j.gcb.2009.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pomerri F, Dodi G, Nardin M, Muzzio P. Colonic total and segmental transit times in healthy Italian adults. Radiol Med 2009; 114:925-34. [DOI: 10.1007/s11547-009-0409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/03/2008] [Indexed: 12/15/2022]
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