Wald A, Hinds J P, Caruana B J
Department of Medicine, Montefiore Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
Gastroenterology. 1989 Oct;97(4):932-7. doi: 10.1016/0016-5085(89)91500-x.
This study prospectively evaluated psychological profiles and selected parameters of colonic and anorectal sensorimotor function in 25 consecutive patients who were referred for severe idiopathic constipation. Measurement of colonic transit of radiopaque markers divided patients into those with normal transit (n = 10) and those with slow transit (n = 15). As measured by the Hopkins Symptom Checklist, patients with normal transit constipation demonstrated significantly higher scores for psychological distress in the global symptoms index and nine clinical subscales than did those with slow transit constipation and gastrointestinal control subjects (n = 25). Both groups with constipation had decreased rectal sensation compared with controls but there was no relationship to rectal compliance or threshold of internal sphincter relaxation. There was also no relation between abnormalities of anorectal parameters, including expulsion dynamics, and psychological profiles in two groups. Measurement of colonic transit and psychological profiles in patients with severe idiopathic constipation identify two groups of patients with respect to possible pathogenesis of symptoms. Accordingly, different therapeutic approaches may be required, one behaviourally and psychologically based and the other focused on the possible modification of disordered colonic transit.
本研究前瞻性评估了25例因严重特发性便秘前来就诊的连续患者的心理状况以及结肠和肛门直肠感觉运动功能的选定参数。通过不透X线标志物的结肠转运测量，将患者分为转运正常组（n = 10）和转运缓慢组（n = 15）。根据霍普金斯症状清单测量，与转运缓慢便秘患者及胃肠功能正常对照者（n = 25）相比，转运正常便秘患者在总体症状指数和九个临床子量表中的心理困扰得分显著更高。与对照组相比，两组便秘患者的直肠感觉均降低，但与直肠顺应性或内括约肌松弛阈值无关。两组患者的肛门直肠参数异常（包括排出动力学）与心理状况之间也无关联。对严重特发性便秘患者进行结肠转运测量和心理状况评估，根据症状的可能发病机制确定了两组患者。因此，可能需要不同的治疗方法，一种基于行为和心理，另一种侧重于对紊乱的结肠转运进行可能的调整。
