Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Mayo Clin Proc. 2019 Nov;94(11):2340-2357. doi: 10.1016/j.mayocp.2019.01.031. Epub 2019 May 1.
Constipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. Although most constipation is self-managed by patients, 22% seek health care, mostly to primary care physicians (>50%) and gastroenterologists (14%), resulting in large expenditures for diagnostic testing and treatments. There is strong evidence that stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted μ-opiate antagonists are effective and safe; the lattermost drugs are a major advance for managing opioid-induced constipation. Constipation that is refractory to available laxatives should be evaluated for defecatory disorders and slow-transit constipation using studies of anorectal function and colonic transit. Defecatory disorders are often responsive to biofeedback therapies, whereas slow-transit constipation may require surgical intervention in selected patients. Both efficacy and cost should guide the choice of treatment for functional constipation and opiate-induced constipation. Currently, no studies have compared inexpensive laxatives with newer drugs that work by other mechanisms.
便秘是一种常见的症状，可能是原发性（特发性或功能性）的，也可能与许多疾病或药物有关。虽然大多数便秘是由患者自行管理的，但仍有 22%的患者寻求医疗保健，主要是向初级保健医生（>50%）和胃肠病学家（14%）寻求医疗保健，这导致了大量的诊断测试和治疗费用。有强有力的证据表明，刺激性和渗透性泻药、肠分泌剂和外周限制 μ 阿片受体拮抗剂是有效和安全的；后者是治疗阿片类药物引起的便秘的重大进展。对于难治性便秘，应使用肛门直肠功能和结肠传输研究来评估排便障碍和慢传输性便秘。排便障碍通常对生物反馈治疗有反应，而慢传输性便秘可能需要在选定的患者中进行手术干预。功能性便秘和阿片类药物引起的便秘的治疗选择应同时考虑疗效和成本。目前，尚无研究比较过廉价的泻药和通过其他机制起作用的新药。
