Functional Constipation: Individualising Assessment and Treatment
Chronic constipation is one of the five most common symptoms seen by gastroenterologist. In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory di...
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| Veröffentlicht in: | Drugs (New York, N.Y.) N.Y.), 2020-07, Vol.80 (10), p.947-963 |
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| creator | Pannemans, Jasper Masuy, Imke Tack, Jan |
| description | Chronic constipation is one of the five most common symptoms seen by gastroenterologist. In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients’ symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. Finally, treatment and management of pain and bloating aspects are included. |
| doi_str_mv | 10.1007/s40265-020-01305-z |
| format | Article |
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In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients’ symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. 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In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients’ symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. Finally, treatment and management of pain and bloating aspects are included.</description><subject>Abdomen</subject><subject>Anorectal</subject><subject>Balloon treatment</subject><subject>Biofeedback</subject><subject>Colon</subject><subject>Constipation</subject><subject>Constipation - drug therapy</subject><subject>Constipation - metabolism</subject><subject>Diagnostic systems</subject><subject>Expulsion</subject><subject>Functional testing</subject><subject>Gastrointestinal Transit</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Irritable bowel syndrome</subject><subject>Laxatives</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Motility</subject><subject>Pain</subject><subject>Pathophysiology</subject><subject>Pelvis</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Signs and symptoms</subject><subject>Smooth muscle</subject><subject>Therapeutic applications</subject><subject>Therapy in Practice</subject><subject>Transit</subject><issn>0012-6667</issn><issn>1179-1950</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kE9PwyAchonRuDn9Ah5MEy9eUP6UAt6WxanJEi_zTCjQpUtLZ2lN3KeX2qmJB7mQF57fS3gAuMToFiPE70KKSMYgIggiTBGD-yMwxZhLiCVDx2CKECYwyzI-AWchbIcomTwFE0pShiVJp2C-7L3pysbrKlk0PnTlTg_xPnn2tnwvba-rMpR-k8xDcCHUzneJ9jZZt053QzoHJ4Wugrs47DPwunxYL57g6uXxeTFfQZNi2UFBci2w09QaU-ScYINYjkXmmCiYpthQIgg11AotmLY5NzaeOSILl3HLOJ2Bm7F31zZvvQudqstgXFVp75o-KJKiTDIsOIvo9R902_Rt_OJAYSEQiStSZKRM24TQukLt2rLW7YfCSA2C1ShYRcHqS7Dax6GrQ3Wf187-jHwbjQAdgRCv_Ma1v2__U_sJlXCGlg</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Pannemans, Jasper</creator><creator>Masuy, Imke</creator><creator>Tack, Jan</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7QO</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7313-020X</orcidid></search><sort><creationdate>20200701</creationdate><title>Functional Constipation: Individualising Assessment and Treatment</title><author>Pannemans, Jasper ; 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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdomen Anorectal Balloon treatment Biofeedback Colon Constipation Constipation - drug therapy Constipation - metabolism Diagnostic systems Expulsion Functional testing Gastrointestinal Transit Humans Internal Medicine Irritable bowel syndrome Laxatives Medicine Medicine & Public Health Motility Pain Pathophysiology Pelvis Pharmacology/Toxicology Pharmacotherapy Signs and symptoms Smooth muscle Therapeutic applications Therapy in Practice Transit |
| title | Functional Constipation: Individualising Assessment and Treatment |
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