Prasad V G M, Abraham Philip
VGM Hospital, 2100, Trichy Road, Coimbatore, 641 005, India.
P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
Indian J Gastroenterol. 2017 Jan;36(1):11-22. doi: 10.1007/s12664-016-0724-2. Epub 2016 Dec 17.
The aim of this review is to provide an overview of the clinical assessment and evidence-based treatment options for managing diabetes-associated chronic constipation.
A literature search of published medical reports in English language was performed using the OVID Portal, from PUBMED and the Cochrane Database of Systematic Reviews, from inception to October 2015. A total of 145 abstracts were identified; duplicate publications were removed and 95 relevant full-text articles were retrieved for potential inclusion.
Chronic constipation is one of the most common gastrointestinal symptoms in patients with diabetes, and occurs more frequently than in healthy individuals. Treatment goals include improving symptoms and restoring bowel function by accelerating colonic transit and facilitating defecation. Based on guidelines and data from published literature, food and dietary change with exercise and lifestyle change should be the first step in management. For patients recalcitrant to these changes, laxatives should be the next step of treatment. Treatment should begin with bulking agents such as psyllium, bran or methylcellulose followed by osmotic laxatives if response is poor. Lactulose, polyethylene glycol and lactitol are the most frequently prescribed osmotic agents. Lactulose has a prebiotic effect and a carry-over effect (continued laxative effect for at least 6 to 7 days, post cessation of treatment). Stimulants such as bisacodyl, sodium picosulphate and senna are indicated if osmotic laxatives are not effective. Newer agents such as chloride-channel activators and 5-HT4 agonist can be considered for severe or resistant cases.
The primary aim of intervention in diabetic patients with chronic constipation is to better manage the diabetes along with management of constipation. The physician should explain the rationale for prescribing laxatives and educate patients about the potential drawbacks of long-term use of laxatives. They should contact their physician if short-term use of prescribed laxative fails to provide relief.
本综述旨在概述糖尿病相关慢性便秘的临床评估及循证治疗方案。
利用OVID平台，检索了PUBMED及Cochrane系统评价数据库中自创建至2015年10月发表的英文医学报告。共识别出145篇摘要；去除重复发表的文献后，检索到95篇相关全文文章以供纳入分析。
慢性便秘是糖尿病患者最常见的胃肠道症状之一，其发生率高于健康个体。治疗目标包括改善症状，通过加速结肠转运和促进排便恢复肠道功能。根据指南及已发表文献的数据，饮食及生活方式的改变（包括运动）应作为管理的第一步。对于那些对这些改变无反应的患者，应使用泻药进行下一步治疗。治疗应首先使用容积性泻药，如车前草、麸皮或甲基纤维素，若效果不佳则使用渗透性泻药。乳果糖、聚乙二醇和乳糖醇是最常用的渗透性泻药。乳果糖具有益生元效应和延续效应（停药后至少6至7天仍有持续的泻药作用）。若渗透性泻药无效，可使用刺激性泻药，如比沙可啶、匹可硫酸钠和番泻叶。对于严重或难治性病例，可考虑使用新型药物，如氯离子通道激活剂和5-HT4激动剂。
对糖尿病慢性便秘患者进行干预的主要目的是在治疗便秘的同时更好地控制糖尿病。医生应解释使用泻药的理由，并告知患者长期使用泻药的潜在弊端。如果短期使用规定的泻药未能缓解症状，患者应联系医生。
