Baffy Noemi, Foxx-Orenstein Amy E, Harris Lucinda A, Sterler Susan
Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
Curr Treat Options Gastroenterol. 2017 Sep;15(3):363-381. doi: 10.1007/s11938-017-0142-2.
Chronic constipation is a common gastrointestinal disorder disproportionately affecting the elderly. Immobility, polypharmacy, and physiologic changes contribute to its increased prevalence in this population. Unidentified and undertreated constipation leads to a significant negative impact on quality of life and an increase in healthcare spending. Careful physical examination and exploration of the clinical history can unmask primary and secondary forms of constipation, guiding diagnostic and therapeutic considerations. Non-pharmacologic treatment options include bowel training and biofeedback as well as the addition of fiber. Laxatives are safe and can be used long term; thus, they remain the mainstay of therapy. Newer agents with specific physiologic targets have proven to be effective in adults with chronic constipation, but data is lacking for safety profile in the elderly. Consideration for surgery in medically refractory cases should be entertained, while use of neuromodulation is not ready for prime time. This is a review of the currently available treatment options for chronic constipation in adults and specifically tailored towards the elderly.
慢性便秘是一种常见的胃肠道疾病，对老年人的影响尤为严重。活动不便、多种药物联用以及生理变化导致该疾病在这一人群中的患病率上升。未被识别和治疗的便秘会对生活质量产生重大负面影响，并增加医疗支出。仔细的体格检查和临床病史探究能够揭示便秘的原发性和继发性形式，为诊断和治疗考量提供指导。非药物治疗选择包括肠道训练、生物反馈以及增加膳食纤维。泻药安全且可长期使用，因此仍是治疗的主要手段。具有特定生理靶点的新型药物已被证明对成人慢性便秘有效，但缺乏关于其在老年人中的安全性数据。对于药物治疗无效的病例应考虑手术治疗，而神经调节疗法尚未成熟。本文综述了目前针对成人慢性便秘，特别是针对老年人的可用治疗方案。
