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Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

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World Journal of Gastroenterology 2012年第14期18卷 4994-5013页

作者： antonio bove Massimo Bellini Edda Battaglia Renato Bocchini Dario Gambaccini Vincenzo bove Filippo Pucciani Donato Francesco Altomare Giuseppe Dodi Guido Sciaudone Ezio Falletto Vittorio Piloni Gastroenterology and Endoscopy Unit Department of GastroenterologyAORN "A.Cardarelli"80131 NaplesItaly Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa56100 PisaItaly Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital14100 AstiItaly Gastroenterology Unit M.Bufalini Hospital47023 CesenaItaly Department of Medical and Surgical Critical Care University of Florence50141 FlorenceItaly Department of Emergency and Organ Transplantation University of Bari70124 BariItaly Department of Oncological and Surgical Sciences University of Padua35126 PaduaItaly Division of General and Geriatric Surgery Second University of Naples80131 NaplesItaly Sixth Division of University Surgery Department of General SurgerySan Giovanni Battista Hospital10126 TurinItaly Diagnostic Imaging Centre "N.Aliotta" Villa Silvia-SenigalliaI-60100 AnconaItaly

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.

关键词：外科治疗排便便秘慢性 AIGO 随机对照试验诊断手术治疗

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An extended assessment of bowel habits in a general population

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World Journal of Gastroenterology 2004年第5期10卷 713-716页

作者： Gabrio Bassotti Massimo Bellini Filippo Pucciani Renato Bocchini antonio bove Pietro Alduini Edda Battaglia Paolo Bruzzi Sezione di Gastroenterologia ed Epatologia Dipartimento di Medicina Clinica e SperimentaleUniversità di Perugia Sezione di Gastroenterologia Dipartimento di Medicina InternaUniversità di Pisa Clinica Chirurgica Generale e Discipline Chirurgiche Università di Firenze UO di Medicina Polispecialistica Azienda Sanitaria LocaleCesena UO di Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliera"A.Cardarelli"Napoli Dipartimento di Fisiopatologia Clinica Università di Torino Struttura Complessa di Epidemiologia Clinica IST GenovaItaly

AIM:Bowel habits are difficult to study, and most data on defecatory behaviour in the general population have been obtained on the basis of recalled interview. The objective assessment of this physiological function and its pathological aspects continues to pose a difficult challenge. The aim of this prospective study was to objectively assess the bowel habits and related aspects in a large sample drawn from thegeneral population.METHODS: Over a two-month period 488 subjects were prospectively recruited from the general population and asked to compile a daily diary on their bowel habits and associated signs and symptoms (the latter according to Rome Ⅱ criteria). A total of 298 (61%) participants returned a correctly compiled record, so that data for more than 8000 patient-days were available for statistical analysis.RESULTS:The average defecatory frequency was once per day (range of 0.25-3.25) and was similar between males and females.However, higher frequencies of straining at stool (P=0.001), a feeling of incomplete emptying and/or difficult evacuation (P=0.0001), and manual manoeuvres to facilitate defecation (P=0.046) were reported by females as compared to males.CONCLUSION:This study represents one of the first attempts to objectively and prospectively assess bowel habits in a sample of the general population over a relatively long period of time. The variables we analyzed are coherent with the criteria commonly used for the clinical assessment of functional constipation, and can provide a useful adjunt for a better evaluation of constipated patients.

关键词：肠道习性肠道疾病卫生统计影响因子

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