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constipation is a common gastroenterology disease, but The inspection and treatment procedures for constipation need to be further standardized. This article will introduce a flow chart of constipation treatment, derived from Gastroenterology (impact factor 19.233), which was developed by Adil E. Bharucha and Brian, Department of Gastroenterology and Hepatology, Mayo Clinic, USA E. Lacy two physicians.
Constipation definition and status< /span>
Constipation is a (group) symptom of dry and hard.
Difficulty defecation includesdifficulty defecation , feeling of incomplete defecation, anorectal blockage, time-consuming defecation, and need for assisted defecation; reduced defecation frequency less than 3 bowel movements per week.
Chronic constipation has a duration of at least 6 months.
Chronic constipation (CC) is one of the most common gastrointestinal diseases worldwide. has a prevalence of 15%.
According to “Chinese Expert Consensus on Chronic Constipation (2019, Guangzhou)”, Chinese adults with chronic constipation The prevalence rate of 4.0% to 10.0%.. The prevalence of chronic constipation increases with age, and the prevalence is higher in women than in men.
The dangers of chronic constipation< /strong>
➤Constipation and anorectal disorders such as hemorrhoids, anal fissures
➤Chronic constipation in colorectal cancer , hepatic encephalopathy, breast disease, Alzheimer’s disease and other diseases may play an important role in the occurrence ;
➤in acute myocardial infarction, cerebrovascular accident strong>In other diseases, excessive defecation may lead to exacerbation or even death.
Common clinically relevant causes associated with constipation
1. Drug effect
Drug-induced constipation is mainly caused by anticholinergic drugs, opioids, calcium antagonists, antidepressants, antihistamines, antispasmodics, and anticonvulsants
strong>, as shown in Table 1, see below:
Table 1 Drugs that can cause constipation (picture from Gastroenterology)< /span>
5-HT, serotonin; constipation-related drugs;
b may be associated with electrolyte disturbances.
Second, mechanical obstruction
➤colon cancer;
➤external compression caused by malignant lesions;
➤stenosis ( diverticulum or post-ischemic stricture);
➤rectocele;
➤megacolon;< /p>
➤Anal fissure.
Alarm signs or abnormal laboratory tests are usually present. Related tips.
III. Metabolic abnormalities
➤diabetes;
➤hypothyroidism;
➤hypercalcemia;
➤hypokalemia;
➤Hypomagnesemia;
➤uremia;
➤heavy metal poisoning;
➤ Uremia.
All of the above can be diagnosed by abnormal laboratory test results, but only when a specific disease is highly suspected This laboratory test should be performed (eg, in patients on diuretics).
Four. Myopathy
➤amyloidosis;
➤scleroderma.
Patients often present with other clinical features of these disorders.
V. Neuropathy
➤Parkinson’s disease;
➤Spinal cord injury;
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➤tumor;
➤cerebrovascular disease;
➤multiple Sexual hardening.
Constipation (slow colonic transit and/or DD) is very common in patients with these conditions.
6. Other diseases
Depression, degenerative joint disease, autonomic neuropathy, cognitive impairment, heart disease, etc.
these diseases themselvesand/or Medications used for theseconditions can cause constipation.
Chronic Constipation “Algorithm” Flowchart
Processing algorithm of Figure 1 CC (Figure from Genterastroology Clinic, by Mayo Clinic Physician); CC, Chronic Constipation.
(click to enlarge)
Reference source: span>
[1]Bharucha
AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic
Constipation. Gastroenterology.2020, 158(5): 1232-1249.e3.
[2] Gastrointestinal Dynamics Group, Gastroenterology Branch of Chinese Medical Association, Functional Gastric Intestinal Diseases Collaborative Group. Expert consensus on chronic constipation in China (2019, Guangzhou) [J]. Chinese Journal of Digestion, 2019, 39(9): 577-598.
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