변비의 분류와 치료 = Review : Classification and Treatment of Constipation

다국어 초록 (Multilingual Abstract)

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)

참고문헌 (Reference)

1 Chung EJ, "Utility of dynamic MR defecography in chronic functional constipation" 9 : 142-150, 2003

2 Yu CS, "Surgical treatment in the treatment of chronic constipation in: Korean Society of Neurogastroenterology and Motility" Jin 239-251, 2000

3 Metcalf AM, "Simplified assessment of segmental colonic transit" 92 : 40-47, 1987

4 Preston DM, "Severe chronic constipation of young women: ‘idiopathic slow transit constipation’" 27 : 41-48, 1986

5 Minguiz M, "Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation" 126 : 57-62, 2004

6 Mertz H, "Physiology of refractory chronic constipation" 94 : 609-615, 1999

7 Sonnenberg A, "Physician visits in the United States for constipation: 1958 to 1986" 34 : 606-611, 1989

8 Kenefick NJ, "Permanent sacral nerve stimulation for treatment of idiopathic constipation" 89 : 882-888, 2002

9 Preston DM, "Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation" 30 : 289-294, 1985

10 Song HK, "Noninvasive sacral nerve stimulation for idiopathic slow transit constipation: short term clinical and physiological effects" 9 : 134-141, 2003

11 O’Brien MD, "Motility and tone of the left colon in constipation: a role in clinical practice?" 91 : 2532-2538, 1996

12 von der OHE, MR, "Measurement of small bowel and colonic transit: indication and methods" 67 : 1169-1179, 1992

13 Fletcher JG, "Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders" 98 : 399-411, 2003

14 Johanson JF, "Lubiprostone, a locally acting chloride channel activator, in adult patients with chronic constipation: a double-blind, placebo-controlled, dose-ranging study to evaluate efficacy and safety" 25 : 1351-1361, 2007

15 Rao SS, "Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus)" 16 : 589-596, 2004

16 Bassotti G, "Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation" 38 : 1040-1045, 1993

17 Choi H, "Functional gastrointestinal disorders in patients with gastrointestinal symptoms" 34 : 741-748, 1999

18 Longstreth GF, "Functional bowel disorders" 130 : 1480-1491, 2006

19 Parks AG, "Experimental study of the reflex mechanism controlling the muscles of the pelvic floor" 5 : 407-414, 1962

20 Stewart WF, "Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features" 94 : 3530-3540, 1999

21 Bertschinger KM, "Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit" 223 : 501-508, 2002

22 Shorvon PJ, "Defecography in normal volunteers: results and implications" 30 : 1737-1749, 1989

23 Agachan F, "Defecography and proctography. Results of 744 patients" 39 : 899-905, 1996

24 He CL, "Decreased interstitial cells of Cajal volume in patients with slow-transit constipation" 118 : 14-21, 2000

25 Lee JH, "Comparison of 4-day and 7-day methods in the evaluation of colon transit time" 38 : 241-246, 2001

26 Wald A, "Colonic transit and anorectal manometry in chronic idiopathic constipation" 146 : 1713-1716, 1986

27 Bassotti G, "Colonic mass movements in idiopathic chronic constipation" 29 : 1173-1179, 1988

28 Voderholzer WA, "Clinical response to dietary fiber treatment of chronic constipation" 92 : 95-98, 1997

29 Lembo A, "Chronic contipation" 349 : 1360-1368, 2003

30 Wald A, "Chronic constipation: advances in management" 19 : 4-10, 2007

31 Rhee PL, "Biofeedback therapy in the treatment of functional defecation disorder in: Korean Society of Neurogastroenterology and Motility" Jin 183-185, 2000

32 Thomson AG, "Anorectal physiology" 82 : 1115-1123, 2002

33 Ashraf W, "An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation" 91 : 26-32, 1996

34 Pare P, "An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking" 96 : 3130-3137, 2001

35 Rao SS, "Ambulatory 24-h colonic manometry in healthy humans" 280 : 629-639, 2001

36 Jun DW, "A population-based study on bowel habits in a Korean community: prevalence of functional constipation and self-reported constipation" 51 : 1471-1477, 2006