Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria

Sobrado, Carlos Walter; Neto, Iran Eduardo Lima; Pinto, Rodrigo Ambar; Sobrado, Lucas Faraco; Nahas, Sérgio Carlos; Cecconello, Ivan

doi:10.1016/j.jcol.2018.02.003

Cited by 36 publications

(49 citation statements)

References 40 publications

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“…Therefore, patients with complaints of anal incontinence are not properly examined for their functional problems and the physician proceeds for the anorectal manometry to redeem all doubts left unclear after an inadequate DRE (5)(6)(7) .…”

Section: Discussionmentioning

confidence: 99%

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Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

Pinto

Neto

Nahas

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient’s complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient’s management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient’s history was blinded for the examiner’s knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…Anorectal manometry is a first-line diagnostic tool for dyssynergic defecation and fecal incontinence, and is used to determine anorectal pressure and sensory function (5,6) . ARM is used for the assessment of fecal incontinence by providing an objective measurement of the sphincter function.…”

Section: Is the Physician Expertise In Digital Rectal Examination Of mentioning

confidence: 99%

Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

Pinto

Neto

Nahas

et al. 2019

Arq. Gastroenterol.

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“…Nutraceutical ingredients for different GI disorders are summarized in Table 1. [15][16][17] Cascara TCM/Anthraquinone Constipation human Improve stool frequency and consistency [18] Mixed fiber Fiber Constipation human Alleviate flatulence, bloating [19] Saccharomyces cerevisiae Yeast IBS human Improve abdominal pain and bloating symptoms [20] Andrographis…”

Section: Functional Gastrointestinal Disordersmentioning

confidence: 99%

“…Cascara contains anthraquinone glycosides (such as cascarosides A, B, C, and D) and a small amount of anthraquinone glycosides. Several clinical trials have reported that cascara can improve stool frequency and consistency [15][16][17]. Psyllium is a frequent bulk laxative for constipation.…”

Section: Constipationmentioning

confidence: 99%

A Brief Review of Nutraceutical Ingredients in Gastrointestinal Disorders: Evidence and Suggestions

Gao

et al. 2020

IJMS

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The dietary effect on gut health has long been recognized through the empirical practice of soothing gastric discomfort with certain types of food, and recently the correlation between specific diets with lower incidences of several gastrointestinal diseases has been revealed. Ingredients from those considered beneficial foods have been isolated and studied, and some of them have already been put into the supplement market. In this review, we focus on latest studies of these food-derived ingredients for their proposed preventive and therapeutic roles in gastrointestinal disorders, with the attempt of drawing evidence-based suggestions on consuming these products.

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“…Constipation is a common adverse reaction to many medications (notably opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, aluminium antacids, and iron supplements), and constipation may necessitate their discontinuation, if appropriate. 8,10 Intake of herbal supplements and traditional Chinese medicines should also be considered as potential causes.…”

Section: Statement 3: Differential Diagnoses Of Chronic Idiopathic Comentioning

confidence: 99%

Consensus statements on diagnosis and management of chronic idiopathic constipation in adults in Hong Kong

Chan

Cheung³

et al. 2019

Hong Kong Med J

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The estimated prevalence of chronic idiopathic constipation in Hong Kong is 14%. An expert panel of local gastroenterologists has created a set of consensus statements with the aim of providing localised guidance on the diagnosis and management of this common condition by primary care physicians. Participants: An expert panel consisting of seven local gastroenterologists convened in August 2018 in Hong Kong. Evidence: Published primary research articles, metaanalyses, and guidelines and consensus statements issued by different regional and international societies on the diagnosis and management of chronic idiopathic constipation were reviewed. Consensus process: Draft consensus statements were prepared prior to the meeting. The consensus statements were finalised during the meeting with contributions from the panel members based on their collective knowledge and clinical experience. Conclusions: A total of 11 consensus statements were created, including five concerning patient assessment and diagnosis, two relating to nonpharmacological management, and four on Consensus statements on diagnosis and management of chronic idiopathic constipation in adults in Hong Kong

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Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria

Cited by 36 publications

References 40 publications

Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

A Brief Review of Nutraceutical Ingredients in Gastrointestinal Disorders: Evidence and Suggestions

Consensus statements on diagnosis and management of chronic idiopathic constipation in adults in Hong Kong

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