기능성 소화불량증과 기능성 변비를 동시에 호소하는 환자에서 주석산 시사프리드의 증상 개선 효과 및 안전성

양웅석(Ung Suk Yang),조중현(Joong Hyean Cho),구자영(Ja Young Koo),이광웅(Kwang Ung Ri),조성락(Seoung Rak Cho),한상영(Sang Young Han),박희욱(Hee Ug Park),송근암(Geun Am Song),주형준(Hyung Jun Chu),김도하(Do Ha Kim),이준상(Joon Sang Le 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.1

N/A Backgrounds/Aims: This study was performed prospectively to evaluate the short - term effect of cisapride tartrate on the frequency and the degree of symptoms in patients with functional dyspepsia and functional constipation. Methods: One-hundred thirty-two patients with a mean age of 44.7 years in men and 43.1 years in women, who presented with symptoms of both functional dyspepsia and functional constipation were recruited, and the frequency and the degree of symptoms corresponding to functional dyspepsia and functional constipation were assessed by an interview in 10 hospitals respectively. In an open, multicenter trial, 132 patients received 10 mg of cisapride tartrate three times a day (TID) for 8 weeks. Patients wrote a defecation diary for 8 weeks and checked symptom scores, which represented the degree of symptoms of dyspepsia and constipation, at the 4th and 8th week. Results: The frequently reported symptoms of functional dyspepsia were epigastric fullness (2.34 0.80), bloating (2.05 0.82), early saety (1.67 0.99), anorexia (1.04 0.95) and nausea (0.94 0.93). The mean defecation frequency per week was 3.07 2.35 and patients showed subjective symptom scores as follows; 97.0 25.26 % in the rate of sense of incomplete evacuation, 1.85 0.73 in the hardness of stool and 1.62 0.57 in difficulty to pass stool. After adminstration of cisapride tartrate in the case of functional dyspepsia, 66.1% of patients at the 4th week and 81.5 % of patients at the 8th week showed good or excellent improvements. In the case of functional constipation, 82.7%of patients also showed good or excellent improvements. Overall improvements of symptoms in both functional dyspepsia and functional constipation were 78.2% at the 8th week. Conclusion: Cisapride tartrate reduced the frequency and the degree of symptoms in functional dyspepsia and functional constipation without significant adverse effects.(Korean Journal of Gastrointestinal Motility 2001;7:36-46)

변비의 분류와 치료

성인경 ( In Kyung Sung ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.1

Constipation is a common symptom affecting 2-27% of general population in Western countries. According to a population-based study on bowel habits in a Korean community, the prevalence was 16.5% for self-reported constipation and 9.2% for functional constipation. There is a broad range of causes for constipation. There are three subtypes in functional constipation, although overlap is not uncommon. Physiologic studies such as colonic transit test, anorectal manometry, balloon expulsion test, and defecography can be helpful in further evaluating and classifying functional constipation. Slow transit constipation is characterized by prolongation of transit time throughout the colon, caused by either myopathy or neuropathy. Functional defecation disorder is characterized as an inability to initiate defecation following the urge to do so, a feeling of incomplete evacuation, tenesmus, excessive straining or manual evacuation. Normal transit constipation is the most common subtype and characterized by constipation occurring in the presence of normal colonic transit time and normal defecatory function. It is important for clinicians to choose appropriate treatment for constipation which are most efficacious for the individual patient. Most patients with functional constipation respond to laxatives, but a small proportion may be resistant to this treatment. In patients with functional defecation disorder, biofeedback is helpful. Sacral nerve stimulation may be helpful in some patients with slow transit constipation. Patients who are resistant to all the conservative modalities may require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit time is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent defecatory disorder. (Korean J Gastroenterol 2008;51:4-10)

만성 변비 환하에서 대장 통과 시간

최제은,최임정,이정아,김성미,정진화,이정호 대한소아과학회 2001 小兒科 Vol.44 No.7

Influence of Age and Body Mass Index on Total and Segmental Colonic Transit Times in Constipated Subjects

Michel Bouchoucha,Marinos Fysekidis,Pierre Rompteaux,Gheorge Airinei,Jean-Marc Sabate,Robert Benamouzig 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.2

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. 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.

수기 마사지와 전기 마사지가 기능성 변비에 미치는 효과

심정묘 ( Shim Jungmyo ) 한국보건복지융합학회 2021 노인의료복지연구 Vol.13 No.1

The purpose of this study is to verify the effects of manual massage or electrical massage on functional constipation. For this, this study measured manual massage effects on bowel movement frequency, bowel movement time-duration and stress with comparisons to electrical massage outcomes. This study was random-controlled clinical trial using within group and between group of pre-to-post-test differences. Subjects were 13 college-aged males and 15 females. Participants with functional constipation were assigned to manual massage or electrical massage and received each treatments per-week for 4 weeks. Stress Response Inventory assessed psychological factors, and daily journals recorded bowel movement frequency and bowel movement time-duration. Results showed that stress improved significantly within manual massage and electrical massage but not between groups. Bowel movement frequency improved significantly within manual massage bowel movement time-duration increased significantly within all groups, but not between groups. There is a significant positive correlation between bowel movement time-duration and stress and a significant negative correlation between bowel movement time-duration and bowel movement Frequency and stress and bowel movement frequency. Based on the results of this study, manual massage and electrical massage was found effective for reducing functional constipation with functional constipation and stress.

만성변비에 대한 홍화약침의 효능 연구

박재우,윤성우,김진성,류봉하 대한침구의학회 2008 대한침구의학회지 Vol.25 No.3

Objectives : These days, herbal acupuncture therapy is widely applied to many diseases and symptoms by Korean medical doctors in Korea. The aim of this study was to demonstrate the effect of Carthami-Semen herbal acupuncture(CSHA) on chronic constipation. Methods : This single-blind placebo-controlled randomized parellel study enrolled 24 adults with chronic constipation. After one week’s run-in period, they were randomly assigned to receive CSHA therapy, or placebo therapy for 4 weeks by 2 times per week. After completing 4 week’s therapy, 2 week’s follow-up period was continued. During study, defecation frequency, consistency and ease of evacuation were checked before study, every week and follow-up periods. Also, the VAS of constipation, quality of life(QoL) and heart rate variability (HRV : low frequency, high frequency) were checked 3 times totally. Finally, 21 subjects completed the protocol and 20 subjects were analyzed.(1 subject is excluded for analysis because of not following the protocol.) Results : In CSHA group, defecation frequency (continued after 1 week), consistency and ease of evacuation (at 1 week after and follow-up) were increased significantly. The VAS of constipation in CSHA group was significantly decreased. There was no significant change at QoL and HRV. Conclusions : CSHA therapy was effective in treating adults with chronic constipation. Study that have larger case number and longer follow up will be needed in the future.

소아 만성 기능성 변비의 치료 성적과 장기적 예후

안윤진,박재옥,Ahn, Yoon Jin,Park, Jae Ock 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.2

목 적: 만성 기능성 변비 환아의 임상 증상과 경과를 관찰하고, 장기적인 치료 성적을 평가하여 치료 결과에 영향을 미치는 요인을 분석함으로써 변비 치료에 도움을 얻고자 하였다. 방 법: 2001년 3월부터 2005년 6월까지 순천향대학교 부천병원에서 만성 기능성 변비로 진단받고 1개월 이상 치료받고 경과를 볼 수 있었던 63명의 환아를 대상으로 임상 증상, 치료에 따른 경과, 치료 결과 및 재발 여부 등을 조사하고 예후와 관련된 요인을 분석하였다. 결 과: 대상 환아들의 성별 분포는 남아가 35명(55.6%), 여아가 28명(44.4%)이었고 남아가 여아에 비해 유분증이 유의있게 많았다. 발병 연령은 평균 $21.1{\pm}23.5$ (1.9~84.0)개월이었으며 진단 당시 평균 연령은 $47.1{\pm}34.2$ (6.9~138.0)개월이었다. 치료 전 주당 배변 횟수는 평균 $3.2{\pm}2.3$ (0.5~10.0)회였고, 변비와 동반된 증상으로는 유분증이 34명(54.0%), 굵은 변이 30명(47.6%), 배변 횟수의 감소가 20명(31.7%), 배변 시 힘주기와 변 참기가 각각 19명(30.2%) 순이었다. 추적 관찰 기간은 평균 $34.2{\pm}14.6$ (3.6~60.0)개월이었으며 전화 통화 당시 변비 증상으로부터 회복된 환아는 44명(69.8%)이었고 증상이 남아있었던 환아는 19명(30.2%)이었다. 변비에서 회복된 환아들의 임상적 경과를 살펴보면 유분증이 있었던 환아들이 유분증이 없어진 시간은 치료 시작 후로 부터 평균 $4.3{\pm}2.4$ (1.0~36.0)개월이었으며, 배변시 힘을 많이 주었던 환아들이 변을 힘주지 않고 누게 된 시간은 평균 $5.0{\pm}1.4$ (0.8~36.0)개월이었고, 변을 참았던 환아들이 변을 참지 않게 된 시간은 평균 $5.0{\pm}3.1$ (1.0~36.0)개월이었다. 변비가 재발한 경우는 15명(23.8%)이었으며 남아가 9명(60%), 여아가 6명(40%)이었다. 치료 종료 후로부터 재발하기 까지의 기간은 평균 $2.9{\pm}1.9$ (1.0~6.0)개월이었으며 성별, 발병 나이, 변비의 증상, 치료 시작 전 증상의 지속 기간, 진단 당시 유분증 유무, 이유식 시작 시기와 대변 가리기 훈련 시기 등은 재발에 영향을 미치지 않았으며 치료 기간이 재발에 영향을 미치는 유일한 인자였다. 결 론: 대부분의 소아 만성 기능성 변비 환아가 치료 시작 후 5개월 경에 증상이 회복되었으나 치료 종료 후 약 3개월 내에 재발할 수 있으며 치료 기간이 재발 여부에 영향을 미치는 것으로 보아 충분한 기간 동안 치료하는 것과 정기적인 추적 관찰이 중요하다고 하겠다. Purpose: The purpose of this study was to evaluate the long term outcome and the factors contributing to treatment outcome for chronic functional constipation in children. Methods: Sixty three children were enrolled who had chronic functional constipation and could be followed by telephone contact. They were treated at the Bucheon Soonchunhyang Hospital for more than 1 month and observed from March 2001 to June 2005. We analyzed the clinical features, symptoms and signs, as well as the course and results of treatment. Results: The male to female ratio was 35 (55.6%) : 28 (44.4%). The mean age at the onset of symptoms and diagnosis was $21.1{\pm}23.5$ (1.9~84.0) months and $47.1{\pm}34.2$ (6.9~138.0) months, respectively. The mean defecation frequency before treatment was $3.2{\pm}2.3$ (0.5~10.0) times per week. The symptoms associated with constipation were as follows: soiling 34 (54.0%) which was more common in males than females, large stools in 30 (47.6%), decreased bowel movements less than three times a week in 20 (31.7%), straining during defecation in 19 (30.2%) and retentive posturing 19 (30.2%). The mean duration of follow-up was $34.2{\pm}14.6$ (3.6~60.0) months and 44 (69.8%) patients had their symptoms resolve ("success") and 19 (30.2%) were not resloved ("fail") from the constipation. The time for recovery from soiling, straining during defecation and retentive posturing after treatment was $4.3{\pm}2.4$ (1.0~36.0), $5.0{\pm}1.4$ (0.8~36.0) and $5.0{\pm}3.1$ (1.0~36.0) months, respectively. A relapse of the constipation occurred in 15 (23.8%) patients, 9 (60%) boys and 6 (40%) girls. The time to relapse after cessation of treatment was $2.9{\pm}1.9$ (1.0~6.0) months and the only risk factor associated with relapse was the initial duration of treatment. Conclusion: Most of the patients had resolution of symptoms within five months after treatment; relapse occurred within three months after the interruption of treatment. The duration of treatment was important for recovery and for the prevention of relapse in the constipated children. Thus a long term maintenance of therapy and follow-up is necessary for chronic functional constipation in children.

소아변비에 대한 추나요법의 효과 : 체계적 문헌 고찰

박인화,박선영,황의형 척추신경추나의학회 2018 척추신경추나의학회지 Vol.13 No.2

Objectives : This review aims to evaluate the effects and the safety of Chuna manual therapy(CMT) for pediatric functional constipation. Methods : We searched 10 electronic databases(Pubmed, EMBASE, Cochrane Library, CAJ, Oasis, RISS, KISS, NDSL, KMBASE, KISTI) and related 2 journals until October 2018. We included randomized controlled trials(RCTs) of testing CMT for pediatric functional constipation. The methodological quality of RCTs related assessed by the Cochrane risk of bias tool. Results : 16 RCTs were eligible in our inclusion criteria. The meta-analysis of 11 studies showed positive for use CMT for pediatric functional constipation. CMT significantly improved total efficancy rate compared with medications (P < 0.00001). Conclusions : There is evidence of CMT for pediatric functional constipation with meta-analysis. However, our systematic review has limited evidence to support CMT for pediatric functional constipation. because the quality of relevant trials is relatively poor.Further well-designed RCTs should be encouraged. the quality of relevant trials is relatively poor.

The Effects of Interferential Current and Kaltenborn-Evjenth Orthopedic Manual Therapy on Functional Constipation

Ja Pung Koo,Ho Jung An,Hee Seo Koo,Ji Hwan Park,Suhn Yeop Kim,Yong Kwon Kim,Jung Hyun Choi,Soon Hee Kim,Kyung Ok Min 국제물리치료학회 2010 Journal of International Academy of Physical Ther Vol.1 No.1

2 week study was conducted to investigate the effects of Interferential Current(IC) and Kaltenborn-Evjenth Orthopedic Manual Therapy(KEOMT) on functional constipation. Interventions were applied to spinal segments between T9-L2 which provides innerva˗ tions to the gastrointestinal tract. Subjects(n=24) were randomly allo˗ cated to two treatment groups: the IC group or the KEOMT group. Results for the IC therapy demonstrated significant decrease with the colonic transit time(CTT) as well as scores on the constipation assessment scale(CAS). The frequency of defecations per week had increased significantly(p<0.05). The KEOMT displayed decreased CTT in the left colon region. The scores on the CAS were reduced and frequency of defecations per week had increased significantly (p<0.05). This study not only showed that both modes of therapy improved symptoms of constipation, but also optimized gastrointesti˗ nal content movement, eventuating in a more normalized CTT. In conclusion, both the IC therapy and the Kaltenborn-Evjenth Orthopedic Manual Therapy have shown to be effective interventions for improving functional constipation.

만성 기능성 변비

신정은 ( Jeong Eun Shin ),박경식 ( Kyung Sik Park ),남광우 ( Kwangwoo Nam ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.2

Constipation is a common functional problem of the digestive system and may occur secondary to diet, drugs, endocrine diseases, metabolic diseases, neurological diseases, psychiatric disorders, or gastrointestinal obstruction. When there is no secondary cause, constipation is diagnosed as functional constipation. The first steps that should be taken to relieve symptoms are diet and lifestyle modifications, and if unsuccessful, laxative therapy should be initiated. If a patient does not respond to laxative therapy, diagnostic anorectal physiological tests are performed, though they are not routinely recommended. However, these tests may be considered earlier in patients strongly suspected to have a defecatory disorder. The revised guideline on the diagnosis and treatment of chronic constipation will undoubtedly aid the individualized management of chronic constipation in clinical practice. (Korean J Gastroenterol 2019;73:92-98)