Diagnosis and treatment of chronic constipation – a European perspective
Identifieur interne : 006174 ( Main/Exploration ); précédent : 006173; suivant : 006175Diagnosis and treatment of chronic constipation – a European perspective
Auteurs : J. Tack [Belgique] ; S. Müller-Lissner [Allemagne] ; V. Stanghellini [Italie] ; G. Boeckxstaens [Belgique] ; M A Kamm [Royaume-Uni] ; M. Simren [Suède] ; J-P Galmiche [France] ; M. Fried [Suisse]Source :
- Neurogastroenterology and Motility [ 1350-1925 ] ; 2011.
Abstract
Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.
We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.
Url:
DOI: 10.1111/j.1365-2982.2011.01709.x
PubMed: 21605282
PubMed Central: 3170709
Affiliations:
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Müller-Lissner</name><affiliation wicri:level="3"><nlm:aff id="au2"><institution>Department of Internal Medicine</institution><addr-line>Park-Klinik Weissensee, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Park-Klinik Weissensee, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Stanghellini, V" sort="Stanghellini, V" uniqKey="Stanghellini V" first="V" last="Stanghellini">V. Stanghellini</name><affiliation wicri:level="1"><nlm:aff id="au3"><institution>Department of Clinical Medicine, University of Bologna</institution><addr-line>Bologna, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Bologna</wicri:regionArea></affiliation></author><author><name sortKey="Boeckxstaens, G" sort="Boeckxstaens, G" uniqKey="Boeckxstaens G" first="G" last="Boeckxstaens">G. 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Tack</name><affiliation wicri:level="1"><nlm:aff id="au1"><institution>Division of Gastroenterology, University Hospital Leuven</institution><addr-line>Leuven, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Leuven</wicri:regionArea></affiliation></author><author><name sortKey="Muller Lissner, S" sort="Muller Lissner, S" uniqKey="Muller Lissner S" first="S" last="Müller-Lissner">S. Müller-Lissner</name><affiliation wicri:level="3"><nlm:aff id="au2"><institution>Department of Internal Medicine</institution><addr-line>Park-Klinik Weissensee, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Park-Klinik Weissensee, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Stanghellini, V" sort="Stanghellini, V" uniqKey="Stanghellini V" first="V" last="Stanghellini">V. Stanghellini</name><affiliation wicri:level="1"><nlm:aff id="au3"><institution>Department of Clinical Medicine, University of Bologna</institution><addr-line>Bologna, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Bologna</wicri:regionArea></affiliation></author><author><name sortKey="Boeckxstaens, G" sort="Boeckxstaens, G" uniqKey="Boeckxstaens G" first="G" last="Boeckxstaens">G. Boeckxstaens</name><affiliation wicri:level="1"><nlm:aff id="au1"><institution>Division of Gastroenterology, University Hospital Leuven</institution><addr-line>Leuven, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Leuven</wicri:regionArea></affiliation></author><author><name sortKey="Kamm, M A" sort="Kamm, M A" uniqKey="Kamm M" first="M A" last="Kamm">M A Kamm</name><affiliation wicri:level="1"><nlm:aff wicri:cut=" and" id="au4"><institution>Departments of Medicine and Gastroenterology, St Vincent's Hospital</institution><addr-line>Melbourne, Australia</addr-line><institution>Imperial College</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Simren, M" sort="Simren, M" uniqKey="Simren M" first="M" last="Simren">M. Simren</name><affiliation wicri:level="1"><nlm:aff id="au5"><institution>Department of Internal Medicine, Sahlgrenska University Hospital</institution><addr-line>Göteborg, Sweden</addr-line></nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Göteborg</wicri:regionArea></affiliation></author><author><name sortKey="Galmiche, J P" sort="Galmiche, J P" uniqKey="Galmiche J" first="J-P" last="Galmiche">J-P Galmiche</name><affiliation wicri:level="1"><nlm:aff id="au6"><institution>Department of Liver and Gastroenterology, Institute of Diseases of the Digestive System Nantes</institution><addr-line>CHU Nantes, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>CHU Nantes</wicri:regionArea></affiliation></author><author><name sortKey="Fried, M" sort="Fried, M" uniqKey="Fried M" first="M" last="Fried">M. Fried</name><affiliation wicri:level="1"><nlm:aff id="au7"><institution>Division of Gastroenterology and Hepatology, University Hospital Zurich</institution><addr-line>Zurich, Switzerland</addr-line></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Zurich</wicri:regionArea></affiliation></author></analytic><series><title level="j">Neurogastroenterology and Motility</title><idno type="ISSN">1350-1925</idno><idno type="eISSN">1365-2982</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.</p></sec><sec><title>Purpose</title><p>We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Belsey, J" uniqKey="Belsey J">J Belsey</name></author><author><name sortKey="Greenfield, S" uniqKey="Greenfield S">S Greenfield</name></author><author><name sortKey="Candy, D" uniqKey="Candy D">D Candy</name></author><author><name sortKey="Geraint, M" uniqKey="Geraint M">M Geraint</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johanson, J" uniqKey="Johanson J">J Johanson</name></author><author><name sortKey="Kralstein, J" uniqKey="Kralstein J">J Kralstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wald, A" uniqKey="Wald A">A Wald</name></author><author><name sortKey="Scarpignato, C" uniqKey="Scarpignato C">C Scarpignato</name></author><author><name sortKey="Kamm, Ma" uniqKey="Kamm M">MA 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Bouteloup</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>France</li><li>Italie</li><li>Royaume-Uni</li><li>Suisse</li><li>Suède</li></country><region><li>Berlin</li></region><settlement><li>Berlin</li></settlement></list><tree><country name="Belgique"><noRegion><name sortKey="Tack, J" sort="Tack, J" uniqKey="Tack J" first="J" last="Tack">J. Tack</name></noRegion><name sortKey="Boeckxstaens, G" sort="Boeckxstaens, G" uniqKey="Boeckxstaens G" first="G" last="Boeckxstaens">G. Boeckxstaens</name></country><country name="Allemagne"><region name="Berlin"><name sortKey="Muller Lissner, S" sort="Muller Lissner, S" uniqKey="Muller Lissner S" first="S" last="Müller-Lissner">S. Müller-Lissner</name></region></country><country name="Italie"><noRegion><name sortKey="Stanghellini, V" sort="Stanghellini, V" uniqKey="Stanghellini V" first="V" last="Stanghellini">V. Stanghellini</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Kamm, M A" sort="Kamm, M A" uniqKey="Kamm M" first="M A" last="Kamm">M A Kamm</name></noRegion></country><country name="Suède"><noRegion><name sortKey="Simren, M" sort="Simren, M" uniqKey="Simren M" first="M" last="Simren">M. Simren</name></noRegion></country><country name="France"><noRegion><name sortKey="Galmiche, J P" sort="Galmiche, J P" uniqKey="Galmiche J" first="J-P" last="Galmiche">J-P Galmiche</name></noRegion></country><country name="Suisse"><noRegion><name sortKey="Fried, M" sort="Fried, M" uniqKey="Fried M" first="M" last="Fried">M. Fried</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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