Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
J Clin Gastroenterol. 2012 Feb;46(2):150-4. doi: 10.1097/MCG.0b013e318231fc64.
Constipation affects up to 28% of Americans in 4 pathophysiologic patterns: slow transit constipation, dyssynergic defecation, a combination of both, and normal colon transit with normal pelvic floor function. Constipation may be a part of a generalized gastrointestinal (GI) tract transit disorder. The purposes of this study were to determine the percentage of constipated patients with the different pathophysiologic subtypes and and to evaluate what percentage of constipated patients has a diffuse GI tract transit disorder.
This was a retrospective analysis of 212 patients who underwent anorectal manometry for intractable constipation. Results of anorectal manometry, electromyography, balloon expulsion testing, defecography, and whole-gut transit scintigraphy were reviewed.
Of 212 patients included in the analysis, 91 (42%) had slow transit constipation, 25 (12%) had dyssynergic defecation, 53 (25%) had both, and 43 (20%) had neither. Of patients (91) with slow transit constipation alone, 31 (34%) had delayed gastric emptying, 9 (10%) had delayed small bowel transit, 7 (8%) had a delay in both, and 41 (48%) had normal upper GI tract transit. A similar distribution of upper GI tract transit disorders was observed for patients with dyssynergic defecation, slow transit constipation and dyssynergic defecation, and normal colon transit with normal pelvic floor function.
Patients with chronic idiopathic constipation have a range of colonic motor disorders. The majority (80%) had slow transit constipation, dyssynergic defecation, or a combination of slow transit constipation and dyssynergic defecation. In addition, many patients (51%) with chronic idiopathic constipation have a concurrent upper GI tract transit disorder.
便秘影响多达 28%的美国人，有 4 种病理生理模式：慢传输型便秘、协同失调性排便、两者结合以及结肠传输正常伴盆底正常。便秘可能是广义胃肠道（GI）传输障碍的一部分。本研究旨在确定不同病理生理亚型的便秘患者比例，并评估有多少便秘患者存在弥漫性胃肠道传输障碍。
这是对 212 例因难治性便秘接受肛门直肠测压的患者进行的回顾性分析。回顾肛门直肠测压、肌电图、球囊排出试验、排粪造影和全胃肠道闪烁显像的结果。
在纳入分析的 212 例患者中，91 例（42%）有慢传输型便秘，25 例（12%）有协同失调性排便，53 例（25%）两者兼有，43 例（20%）两者均无。单纯慢传输型便秘患者中，31 例（34%）有胃排空延迟，9 例（10%）有小肠传输延迟，7 例（8%）两者均延迟，41 例（48%）有正常上胃肠道传输。协同失调性排便、慢传输型便秘伴协同失调性排便和结肠传输正常伴盆底正常的患者也观察到类似的上胃肠道传输障碍分布。
慢性特发性便秘患者存在一系列结肠动力障碍。大多数（80%）有慢传输型便秘、协同失调性排便或两者结合。此外，许多慢性特发性便秘患者（51%）同时存在上胃肠道传输障碍。
