Yang L S, Khera A, Kamm M A
Departments of Medicine and Gastroenterology, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2014 Sep;44(9):858-64. doi: 10.1111/imj.12490.
BACKGROUND/AIM: Behavioural therapy is effective in patients with chronic intractable constipation despite standard treatment, but long-term results in unselected patients are unclear. This study investigates the effects of behavioural therapy on symptoms, subjective well-being, and the physical and mental quality of life.
Patients who had failed standard care for idiopathic chronic constipation underwent behavioural therapy in a specialist clinic. Symptom severity and quality of life were assessed before and after therapy using the 'Constipation Scoring System' and the Short-Form 36 questionnaire. The primary outcome was subjective perception of improvement. Secondary outcomes were symptoms of constipation and quality of life scores.
Of 233 consecutive patients with self-reported constipation (median symptom duration 5-10 years, median age 44 years, females 86%), 180 (77%) completed treatment in a median of three (range 1-7) sessions. One hundred and sixty-five patients (71% of all referrals or 92% of those completing treatment) reported subjective improvement. Median bowel frequency improved from once every 2-7 days to 1-3 per day (P = 0.05). Pain and bloating improved in more than 80% of patients. The Short-Form 36 physical (P < 0.05) and mental (P < 0.05) composite scores improved significantly. Patients with a longer duration of symptoms were less likely to complete treatment. Digital evacuation prior to treatment was a predictor of poor outcome.
Behavioural therapy is associated with significant improvement in symptoms of chronic constipation and quality of life. Non-drug therapies that successfully treat patients with functional gut disorders resistant to standard treatment are needed in the mainstream provision of care.
背景/目的：尽管进行了标准治疗，但行为疗法对慢性顽固性便秘患者仍有效，但未经过筛选的患者的长期治疗效果尚不清楚。本研究调查行为疗法对症状、主观幸福感以及身心健康生活质量的影响。
因特发性慢性便秘而标准治疗失败的患者在专科诊所接受行为疗法。治疗前后使用“便秘评分系统”和简明健康调查问卷（Short-Form 36）评估症状严重程度和生活质量。主要结局是主观改善感受。次要结局是便秘症状和生活质量评分。
在连续233例自述便秘的患者中（症状持续时间中位数为5 - 10年，年龄中位数为44岁，女性占86%），180例（77%）在中位数为三次（范围1 - 7次）的治疗中完成了治疗。165例患者（占所有转诊患者的71%或完成治疗患者的92%）报告有主观改善。排便频率中位数从每2 - 7天一次改善为每天1 - 3次（P = 0.05）。超过80%的患者疼痛和腹胀情况有所改善。简明健康调查问卷的身体（P < 0.05）和心理（P < 0.05）综合评分显著提高。症状持续时间较长的患者完成治疗的可能性较小。治疗前的手法排便预示预后不良。
行为疗法与慢性便秘症状和生活质量的显著改善相关。在主流医疗服务中，需要有能成功治疗对标准治疗耐药的功能性肠道疾病患者的非药物疗法。
