Diagnosis of Constipation: a Systematic Review

변비의 진단: 체계적인 문헌고찰

Myung, Seung-Jae;Lee, Tae-Hee;Huh, Kyu-Chan;Choi, Suck-Chei;Sohn, Chong-Il
명승재;이태희;허규찬;최석채;손정일

  • Published : 20100000

Abstract

To diagnose constipation accurately in self-reported constipated patients is very important not to miss organic disease and prevent therapeutic abuse. To investigate the etiology of functional constipation is also important to determine the therapeutic modality of constipation. In this systemic review, the clinical usefulness of symptom evaluation, diagnostic tests to rule out organic and systemic disease, and functional tests to discriminate underlying pathophysiology in the diagnosis of constipation were discussed. No specific symptoms or tests were available to predict organic versus functional constipation or differentiate slow transit constipation versus evacuation disorder. Therefore, collaborative studies are necessary to determine the pathophysiology of this disorder.

Keywords

References

  1. Jun DW, Park HY, Lee OY, et al. A population-based study on bowel habits in a Korean community: prevalence of functional constipation and self-reported constipation. Dig Dis Sci 2006;51:1471-1477 https://doi.org/10.1007/s10620-006-9087-3
  2. Choi H, Choi MG, Kim SW, et al. Functional gastrointestinal disorders in patients with gastrointestinal symptoms. Korean J Gastroenterol 1999;34:741-748
  3. Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003;349:1360-1368 https://doi.org/10.1056/NEJMra020995
  4. Choi MG. Evidence based guideline for diagnosis and treatment: diagnostic guideline for constipation. Korean J Neurogastroenterol Motil 2005;11:44-50
  5. Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987;32:841-845 https://doi.org/10.1007/BF01296706
  6. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45(suppl 2):II43-47
  7. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006;130:1377-1390 https://doi.org/10.1053/j.gastro.2006.03.008
  8. Rao SS, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol 2005;100:1605-1615 https://doi.org/10.1111/j.1572-0241.2005.41845.x
  9. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005;100(suppl 1):S5-S21 https://doi.org/10.1111/j.1572-0241.2005.50613_2.x
  10. Baker JT, Harvey RF. Bowel habit in thyrotoxicosis and hypothyroidism. Br Med J 1971;1:322-323 https://doi.org/10.1136/bmj.1.5744.322
  11. Muller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol 2005;100:232-242 https://doi.org/10.1111/j.1572-0241.2005.40885.x
  12. Qureshi W, Adler DG, Davila RE, et al. ASGE guideline: guideline on the use of endoscopy in the management of constipation. Gastrointest Endosc 2005;62:199-201 https://doi.org/10.1016/j.gie.2005.04.016
  13. Pepin C, Ladabaum U. The yield of lower endoscopy in patients with constipation: survey of a university hospital, a public county hospital, and a Veterans Administration medical center. Gastrointest Endosc 2002;56:325-332 https://doi.org/10.1016/S0016-5107(02)70033-3
  14. Gupta M, Holub J, Knigge K, Eisen G. Constipation is not associated with an increased rate of findings on colonoscopy: results from a national endoscopy consortium. Endoscopy 2010;42:208-212 https://doi.org/10.1055/s-0029-1243843
  15. Patriquin H, Martelli H, Devroede G. Barium enema in chronic constipation: is it meaningful? Gastroenterology 1978;75:619-622
  16. Gerson DE, Lewicki AM, McNeil BJ, Abrams HL, Korngold E. The barium enema; evidence for proper utilization. Radiology 1979;130:297-301
  17. Wald A. Colonic transit and anorectal manometry in chronic idiopathic constipation. Arch Intern Med 1986;146:1713-1716 https://doi.org/10.1001/archinte.146.9.1713
  18. Abrahamsson H, Antov S, Bosaeus I. Gastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ray in healthy subjects and constipated patients. Scand J Gastroenterol 1988;152(suppl):S72-S80
  19. Bouchoucha M, Devroede G, Arhan P, et al. What is the meaning of colorectal transit time measurement? Dis Colon Rectum 1992;35:773-782 https://doi.org/10.1007/BF02050328
  20. Ghoshal UC, Gupta D, Kumar A, Misra A. Colonic transit study by radio-opaque markers to investigate constipation: validation of a new protocol for a population with rapid gut transit. Natl Med J India 2007;20:225-229
  21. Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology 1987;92:40-47
  22. Lundin E, Graf W, Garske U, Nilsson S, Maripuu E, Karlbom U. Segmental colonic transit studies: comparison of a radiological and a scintigraphic method. Colorectal Dis 2007;9:344-351 https://doi.org/10.1111/j.1463-1318.2006.01153.x
  23. Rao SS, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004;16:589-596 https://doi.org/10.1111/j.1365-2982.2004.00526.x
  24. Lee JH, Rhee PL, Suh SW, et al. Comparison of 4-day and 7-day methods in the evaluation of colon transit time. Korean J Gastroenterol 2001;38:241-246
  25. Jung HK, Kim DY, Moon IH, Hong YS. Colonic transit time in diabetic patients - comparison with healthy subjects and the effect of autonomic neuropathy. Yonsei Med J 2003;44:265-272
  26. Rao SS, Kuo B, McCallum RW, et al. Investigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation. Clin Gastroenterol Hepatol 2009;7:537-544 https://doi.org/10.1016/j.cgh.2009.01.017
  27. Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997;92:469-475
  28. Rao SS, Hatfield R, Soffer E, Rao S, Beaty J, Conklin JL. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773-783 https://doi.org/10.1111/j.1572-0241.1999.00950.x
  29. Sun WM, Rao SS. Manometric assessment of anorectal function. Gastroenterol Clin North Am 2001;30:15-32 https://doi.org/10.1016/S0889-8553(05)70165-5
  30. Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: review of collective experience. Am J Gastroenterol 2002;97:232-240
  31. Bilali S, Pfeifer J. Anorectal manometry: are fatigue rate and fatigue rate index of any clinical importance? Tech Coloproctol 2005;9:225-228 https://doi.org/10.1007/s10151-005-0232-3
  32. Morio O, Meurette G, Desfourneaux V, D'Halluin PN, Bretagne JF, Siproudhis L. Anorectal physiology in solitary ulcer syndrome: a case-matched series. Dis Colon Rectum 2005;48:1917-1922 https://doi.org/10.1007/s10350-005-0105-x
  33. Chang SH, Min UG, Choi OJ, et al. Diagnostic efficacy of anorectal manometry for the diagnosis of Hirschsprung's disease. Korean J Pediatr Gastroenterol Nutr 2003;6:24-31
  34. Vasudevan SP, Scott SM, Gladman MA, Lunniss PJ. Rectal hyposensitivity: evaluation of anal sensation in female patients with refractory constipation with and without faecal incontinence. Neurogastroenterol Motil 2007;19:660-667 https://doi.org/10.1111/j.1365-2982.2007.00922.x
  35. Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association. Gastroenterology 1999;116:732-760 https://doi.org/10.1016/S0016-5085(99)70194-0
  36. Rao SS, Azpiroz F, Diamant N, Enck P, Tougas G, Wald A. Minimum standards of anorectal manometry. Neurogastroenterol Motil 2002;14:553-559 https://doi.org/10.1046/j.1365-2982.2002.00352.x
  37. Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 2007;102:850-855 https://doi.org/10.1111/j.1572-0241.2007.01069.x
  38. Kim SH, Hwang YH, Choi KP. A role of anorectal physiologic study for the diagnosis of chronic constipation. J Korean Soc Coloproctol 2000;16:231-238
  39. Jang GY, Lee JS, Lim HH, et al. Anorectal symtoms and anorectal pathophysiologic findings in patients with levator ani syndrome and protalgia fugax. Korean J Gastrointest Motil 2003;9:37-41
  40. Jung SH, Myung SJ, Yang SK, et al. Manometric classification of pelvic floor dyssynergia and its clinical significance in patients with constipation. Korean J Gastroenterol 2003;41:456-464
  41. Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin North Am 2007;36:687-711 https://doi.org/10.1016/j.gtc.2007.07.013
  42. Bharucha AE, Fletcher JG. Recent advances in assessing anorectal structure and functions. Gastroenterology 2007;133:1069-1074 https://doi.org/10.1053/j.gastro.2007.08.051
  43. Minguez M, Herreros B, Sanchiz V, et al. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 2004;126:57-62 https://doi.org/10.1053/j.gastro.2003.10.044
  44. Kim DH, Myung SJ, Yang SK, et al. Clinical parameters for differentiating pelvic floor dyssynergia (PFD) in constipated patients. Korean J Gastrointest Motil 2002;8:167-176
  45. Agachan F, Pfeifer J, Wexner SD. Defecography and proctography. Results of 744 patients. Dis Colon Rectum 1996;39:899-905 https://doi.org/10.1007/BF02053989
  46. Liu BH, Fang SW, Tong WD, Gong SG, Zhang SB. Role of pelvicography and colpocystodefecography in diagnosis of outlet obstructive constipation. Int J Colorectal Dis 2005;20:317-320 https://doi.org/10.1007/s00384-004-0637-x
  47. Murad-Regadas S, Peterson TV, Pinto RA, Regadas FS, Sands DR, Wexner SD. Defecographic pelvic floor abnormalities in constipated patients: does mode of delivery matter? Tech Coloproctol 2009;13:279-283 https://doi.org/10.1007/s10151-009-0533-z
  48. Taylor SA. Imaging pelvic floor dysfunction. Best Pract Res Clin Gastroenterol 2009;23:487-503 https://doi.org/10.1016/j.bpg.2009.06.005
  49. Roos JE, Weishaupt D, Wildermuth S, Willmann JK, Marincek B, Hilfiker PR. Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. Radiographics 2002;22:817-832 https://doi.org/10.1148/radiographics.22.4.g02jl02817
  50. Murad-Regadas SM, Regadas FS, Rodrigues LV, Silva FR, Soares FA, Escalante RD. A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography. Surg Endosc 2008;22:974-979 https://doi.org/10.1007/s00464-007-9532-1
  51. Park KS, Chung JJ, Kim MH, Park S, Yang HC. Usefulness of colon transit time and defecography in patients with chronic constipation. J Korean Radiol Soc 2006;54:409-415 https://doi.org/10.3348/jkrs.2006.54.5.409
  52. Yang JH, Lee JS, Hong SJ, et al. The rectal perception in patients with constipation-predominant irritable bowel syndrome and functional constipation. Korean J Gastrointest Motil 2005;11:58-65
  53. Chung EJ, Myung SJ, Kim AY, et al. Utility of dynamic MR defecography in chronic functional constipation. Korean J Gastrointest Motil 2003;9:142-150