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

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 

机构地区：[1]Gastroenterology and Endoscopy Unit,Department of Gastroenterology,AORN "A.Cardarelli",80131 Naples,Italy [2]Gastrointestinal Unit,Department of Gastroenterology,University of Pisa,56100 Pisa,Italy [3]Gastroenterology and Endoscopy Unit,Cardinal Massaja Hospital,14100 Asti,Italy [4]Gastroenterology Unit,M.Bufalini Hospital,47023 Cesena,Italy [5]Department of Medical and Surgical Critical Care,University of Florence,50141 Florence,Italy [6]Department of Emergency and Organ Transplantation,University of Bari,70124 Bari,Italy [7]Department of Oncological and Surgical Sciences,University of Padua,35126 Padua,Italy [8]Division of General and Geriatric Surgery,Second University of Naples,80131 Naples,Italy [9]Sixth Division of University Surgery,Department of General Surgery,San Giovanni Battista Hospital,10126 Turin,Italy [10]Diagnostic Imaging Centre "N.Aliotta",Villa Silvia-Senigallia,I-60100 Ancona,Italy

出　　处：《World Journal of Gastroenterology》2012年第36期4994-5013,共20页世界胃肠病学杂志（英文版）

基　　金：Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri, Via N Colajanni, 4, 00191 Roma, Italy;Società Italiana di Chirurgia Colo-Rettale, Via Medici, 23, 10143 Torino, Italy

摘　　要：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 re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil 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 treat- ment in dys-synergic defecation. Many surgical proce- dures 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.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：LAXATIVES PROKINETICS BIOFEEDBACK Pelvicfloor rehabilitation Outlet obstruction Stapled trans-anal rectal resection Delorme operation COLECTOMY Pelvic organ prolapse Mesh 

分 类 号：R574.62[医药卫生—消化系统]