Mearin F, Ciriza C, Mínguez M, Rey E, Mascort J J, Peña E, Cañones P, Júdez J
Coordinación de la GPC, Comité Roma de Trastornos Funcionales Intestinales, Asociación Española de Gastroenterología (AEG), Centro Médico Teknon, Barcelona, España.
Grupo de Trastornos Funcionales, Sociedad Española de Patología Digestiva (SEPD), Hospital Universitario Doce de Octubre, Madrid, España.
Aten Primaria. 2017 Mar;49(3):177-194. doi: 10.1016/j.aprim.2017.01.003. Epub 2017 Feb 24.
In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each.
在本临床实践指南中,我们探讨了患有便秘和腹部不适的成年患者的诊断和治疗管理,这些患者处于肠易激综合征和功能性便秘的交集范围内。两者都属于功能性肠道疾病范畴,对个人、健康和社会有重大影响,会改变受影响患者的生活质量。前者是肠易激综合征的一种亚型,其中便秘和排便习惯改变占主导,常伴有反复腹痛、腹胀和腹部膨隆。便秘的特征是排便次数少或排便困难,常伴有排便时用力或排便不尽感。大多数情况下没有潜在的器质性病因,被认为是一种功能性肠道疾病。这两种情况在临床和病理生理方面有许多相似之处,便秘对常用药物的反应相似,根本区别在于是否存在疼痛,但并非“全有或全无”的方式。这些疾病的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、感知和行为形式。功能性肠道疾病使用罗马标准进行诊断。本临床实践指南符合2016年5月底发布的罗马IV标准。第一部分(96、97、98)探讨了概念和病理生理方面、警示标准、诊断测试以及初级保健和胃肠病学之间的转诊标准。第二部分回顾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、骶神经根神经刺激和手术),并针对每种治疗给出了实用建议。
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