Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Gastroenterol Hepatol. 2021 Dec;19(12):2577-2586.e6. doi: 10.1016/j.cgh.2020.08.059. Epub 2020 Aug 31.
BACKGROUND & AIMS: Long-term outcomes of constipation have not been evaluated fully. We investigated the incidence of Parkinson's disease, constipation-related surgery, and colorectal cancer (CRC) in patients with constipation and slow-transit constipation (STC), followed up for up to 20 years.
We collected data from 2165 patients (33.1% men; median patient age, 54 y; median symptom duration, 5.0 y) with a diagnosis of constipation (based on Rome II criteria) who underwent an anorectal function test and a colonic transit time study, from 2000 through 2010, at a tertiary university hospital in Seoul, South Korea. The presence of STC was determined from colonic transit time. We used the Kaplan-Meier method to analyze and compare cumulative probabilities of a new diagnosis of Parkinson's disease or CRC according to the presence of STC. The patients were followed up until the end of 2019.
During a median follow-up period of 4.7 years (interquartile range, 0.7-8.3 y), 10 patients underwent constipation-related surgery. The cumulative probabilities of constipation-related surgery were 0.7% at 5 years and 0.8% at 10 years after a diagnosis of constipation. Twenty-nine patients (1.3%) developed Parkinson's disease; the cumulative probabilities were 0.4% at 1 year, 1.0% at 5 years, and 2.6% at 10 years after a diagnosis of constipation. At 10 years, 1.3% of patients with STC required constipation-related surgery and 3.5% of patients with STC developed Parkinson's disease; in contrast, none of the patients without STC required constipation-related surgery (P = .003), and 1.5% developed Parkinson's disease (P = .019). In multivariate analysis, patient age of 65 years or older at the diagnosis of constipation (hazard ratio, 4.834; 95% CI, 2.088-11.190) and the presence of STC (hazard ratio, 2.477; 95% CI, 1.046-5.866) were associated independently with the development of Parkinson's disease. Only 5 patients had a new diagnosis of CRC during the follow-up period. The risk of CRC did not differ significantly between patients with vs without STC (P = .575).
In a long-term follow-up study of patients with constipation in Korea, most patients had no severe complications. However, patients older than age 65 years with a new diagnosis of STC might be considered for Parkinson's disease screening.
尚未充分评估便秘的长期预后。我们通过长达 20 年的随访，研究了便秘和慢传输型便秘（STC）患者帕金森病、与便秘相关的手术和结直肠癌（CRC）的发病情况。
我们收集了 2000 年至 2010 年期间在韩国首尔一家三级大学医院接受肛门直肠功能检查和结肠通过时间研究的 2165 例（33.1%为男性；中位患者年龄为 54 岁；中位症状持续时间为 5.0 年）的便秘（根据罗马 II 标准诊断）患者的数据。通过结肠转运时间确定 STC 的存在。我们使用 Kaplan-Meier 法分析和比较根据 STC 存在的情况下新发帕金森病或 CRC 的累积概率。患者的随访时间截至 2019 年底。
在中位随访期 4.7 年（四分位距，0.7-8.3 年）期间，有 10 例患者接受了与便秘相关的手术。便秘诊断后 5 年和 10 年，便秘相关手术的累积概率分别为 0.7%和 0.8%。29 例（1.3%）患者发生帕金森病；在便秘诊断后 1 年、5 年和 10 年，累积概率分别为 0.4%、1.0%和 2.6%。在 10 年时，1.3%的 STC 患者需要与便秘相关的手术，3.5%的 STC 患者发生帕金森病；相比之下，没有 STC 的患者均无需接受与便秘相关的手术（P=0.003），且有 1.5%的患者发生帕金森病（P=0.019）。多变量分析显示，便秘诊断时年龄 65 岁或以上（风险比，4.834；95%置信区间，2.088-11.190）和存在 STC（风险比，2.477；95%置信区间，1.046-5.866）与帕金森病的发生独立相关。在随访期间仅有 5 例患者被新诊断为 CRC。STC 患者与无 STC 患者的 CRC 风险无显著差异（P=0.575）。
在韩国对便秘患者进行的长期随访研究中，大多数患者没有严重的并发症。然而，新诊断为 STC 且年龄大于 65 岁的患者可能需要进行帕金森病筛查。
