Mearin Fermín, Ciriza Constanza, Mínguez Miguel, Rey Enrique, Mascort Juan José, Peña Enrique, Cañones Pedro, Júdez Javier
Centro Médico Teknon, España.
Aparato Digestivo, Hospital Universitario Doce de Octubre, España.
Rev Esp Enferm Dig. 2016 Jun;108(6):332-63. doi: 10.17235/reed.2016.4389/2016.
In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.
在本临床实践指南中,我们讨论了患有便秘及腹部不适的成年患者的诊断和治疗方法,这些患者处于肠易激综合征谱系和功能性便秘的交汇处。这两种病症均属于功能性肠病,对个人、医疗保健和社会都有重大影响,会影响到患者的生活质量。第一种是肠易激综合征亚型,其中便秘是主要症状,伴有反复腹痛、腹胀和腹部膨隆。便秘的特征是排便困难或排便频率低,常伴有排便时用力或排便不尽感。大多数病例没有潜在的医学病因,因此被视为功能性肠病。这两种病症在临床和病理生理方面有许多相似之处,对常用药物的反应也相似,它们的主要区别在于是否存在疼痛,尽管并非是“全有或全无”的情况。严重程度不仅取决于肠道症状的强度,还取决于其他生物心理社会因素(胃肠道和肠外症状的关联、受累程度以及感知和行为差异)。功能性肠病使用罗马标准进行诊断。本临床实践指南已与2016年5月底发布的罗马IV标准保持一致,并讨论了初级保健和胃肠病学环境之间的警示标准、诊断测试和转诊标准。此外,还讨论了所有可用的治疗选择(运动、液体摄入、富含可溶性纤维食物的饮食、纤维补充剂、其他饮食成分、渗透性或刺激性泻药、益生菌、抗生素、解痉药、薄荷精华、普芦卡必利、利那洛肽、鲁比前列酮、生物反馈、抗抑郁药、心理治疗、针灸、灌肠、骶神经根神经刺激、手术),并针对每种治疗选择给出了实用建议。
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