Acquired megacolon in psychiatric patients

Kobak, Mathew W.; Jacobson, Moses A.; Sirca, Dionisie M.

doi:10.1007/bf02616592

Cited by 9 publications

(14 citation statements)

References 7 publications

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“…Whether it consists of a heterogenous group of conditions or is due to a single cause is unknown [ 40 ]. Varying enteric neurochemical and histological findings have been suggested [ 41 – 51 ]. Publications on redundant colon are largely low-level evidence case reports, case series and cohort studies.…”

Section: Introductionmentioning

confidence: 99%

The correlation between diverticulosis and redundant colon

Cuda

Gunnarsson

Costa

2017

Int J Colorectal Dis

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BackgroundDiverticulosis and redundant colon are colonic conditions for which underlying pathophysiology, management and prevention are poorly understood. Historical papers suggest an inverse relationship between these two conditions. However, no further attempt has been made to validate this relationship. This study set out to assess the correlation between diverticulosis and colonic redundancy.MethodsRedundant colon, diverticulosis and patient demographics were recorded during colonoscopy. Multivariate binary logistic regression was performed with redundant colon as the dependent variable and age, gender and diverticulosis as independent variables. Nagelkerke R 2 and a receiver operator curve were calculated to assess goodness of fit and internally validate the multivariate model.ResultsRedundant colon and diverticulosis were diagnosed in 31 and 113 patients, respectively. The probability of redundant colon was increased by female gender odds ratio (OR) 8.4 (95% CI 2.7–26, p = 0.00020) and increasing age OR 1.7 (95% CI 1.1–2.6, p = 0.017). Paradoxically, diverticulosis strongly reduced the probability of redundant colon with OR of 0.12 (95% CI 0.42–0.32, p = 0.000039). The Nagelkerke R 2 for the multivariate model was 0.29 and the area under the curve at ROC analysis was 0.81 (95% CI 0.73–0.90 p–value 3.1 × 10−8).ConclusionsThis study found an inverse correlation between redundant colon and diverticulosis, supporting the historical suggestion that the two conditions rarely occur concurrently. The underlying principle for this relationship remains to be found. However, it may contribute to the understanding of the aetiology and pathophysiology of these colonic conditions.

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Section: Introductionmentioning

confidence: 99%

The correlation between diverticulosis and redundant colon

Cuda

Gunnarsson

Costa

2017

Int J Colorectal Dis

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“…date No. pts Age mean Age range Female Male Kantor [ 7 ] 1924 62 24 38 Kobak et al [ 30 ] 1962 3 61 48–68 0 3 Lane and Todd [ 19 ] 1977 42 21 21 Preston et al [ 9 ] 1985 20 9 11 Koch et al [ 35 ] 1993 6 55 31–76 4 2 Koch et al [ 34 ] 1996 10 64 31–98 4 6 Gattuso et al [ 22 ] 1997 48 12–69 22 26 Gattuso et al [ 32 ] 1997 6 34–66 3 3 Gattuso et al [ 27 ] 1998 1 37 37 0 1 Chen et al [ 33 ] 2002 5 24–41 1 4 Lee et al [ 23 ] 2005 9 30 10–66 2 7 Meier-Ruge et al [ ...…”

Section: Resultsmentioning

confidence: 99%

“…Recent contributions on this topic emphasise colonic diameter as a defining feature [ 9 , 19 , 26 , 27 , 29 – 32 ]. Earlier studies referred to length [ 7 , 30 , 31 , 33 ]. Twelve studies used barium enema or similar studies [ 3 , 7 , 9 , 19 , 27 , 29 , 30 , 32 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

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Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review

2018

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Background: Acquired Megacolon (AMC) is a condition involving persistent dilatation and lengthening of the colon in the absence of organic disease. Diagnosis depends on subjective radiological, endoscopic or surgical findings in the context of a suggestive clinical presentation. This review sets out to investigate diagnostic criteria of AMC. Methods: The literature was searched using the databases -PubMed, Medline via OvidSP, ClinicalKey, Informit and the Cochrane Library. Primary studies, published in English, with more than three patients were critically appraised based on study design, methodology and sample size. Exclusion criteria were studies with the following features: post-operative; megarectum-predominant; paediatric; organic megacolon; non-human; and failure to exclude organic causes. Results: A review of 23 articles found constipation, abdominal pain, distension and gas distress were predominant symptoms. All ages and both sexes were affected, however, symptoms varied with age. Changes in anorectal manometry, histology and colonic transit are consistently reported. Studies involved varying patient numbers, demographics and data acquisition methods. Conclusions: Outcome data investigating the diagnosis of AMC must be interpreted in light of the limitations of the low-level evidence studies published to date. Proposed diagnostic criteria include: (1) the exclusion of organic disease; (2) a radiological sigmoid diameter of~10 cm; (3) and constipation, distension, abdominal pain and/or gas distress. A proportion of patients with AMC may be currently misdiagnosed as having functional gastrointestinal disorders. Our conclusions are inevitably tentative, but will hopefully stimulate further research on this enigmatic condition.

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“…Chronic constipation, faecal impaction and faecal soiling are particular problems for high-dependency populations (Kobak et al 1962, Thomas et al 1984, von Wendt et al 1990). In the field of learning disability, the implicit assumption that the learning disability itself is the major aetiological factor has caused studies of both prevalence and aetiology to be beset by problems of definition and reliability (Groves 1982), and therefore little study has been devoted to either.…”

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confidence: 99%

A Behavioural Approach to Retraining Bowel Function After Long‐standing Constipation and Faecal Impaction in People With Learning Disabilities

Smith¹,

Franchetti²,

McCoull

et al. 1994

Develop Med Child Neuro

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SUMMARY The authors describe a behavioural programme–involving prompted toilet‐sitting after meals, rewards for appropriate evacuation and increased fibre–for four people with severe learning disabilities. Although treatment times were long, such training resulted in near‐normal bowel function. While this behavioural approach does not ignore the biological aspects of the problem, soiling in intellectually disabled people should not be attributed to the handicapping condition alone. Training at an earlier age should be considered. RÉSUMÉ Approche comportementale de la restriction de la fonction intestinale apres constipation de longue durée et fécalome chez des sujets présentant des difficultés ď apprentissage Les auteurs décrivent une programme comportemental, comprenant des seances imposées a la toilette après les repas, des recompenses pour ľévacuation intestinale appropriée et un régime accru en fibres, chez quatre sujets avec de graves difficultés ď apprentissage. Bien que les temps de traitement soient longs, un tel entraînement a permis une fonction intestinale presque normale. Bien que ľ approche comportementale ne nie pas les aspects biologiques du probléme, ľ incontinence rectale chez les déficients intellectuels ne doit pas étre attribuée a la seule condition handicapante. Ľ apprentissage au jeune âge doit être également considéré. ZUSAMMENFASSUNG Ein Versuch, die Darmfunktion nach einer langen Phase der Obstipation und Stuhlverhaltung bei Patienten mit Lemschwierigkeiten neu zu trainieren Die Autoren beschreiben ein Verhaltensprogramm–Entleerungsversuch gleich nach den Mahlzeiten, Belohungen fur gutes Abführen und verbesserte Stuhlbeschaffenheit–bei vier Patienten mit schweren Lemschwierigkeiten. Obwohl die Behandlungszeiten lang waren, wurde doch eine nahezu normale Darmfunktion erreicht. Dieser Ansatz über das Verhalten vernachlässigt keineswegs die biologischen Aspekte dieses Problems, jedoch sollte das Einkoten bei geistig behinderten Patienten nicht allein der Behinderung zugeschreiben werden. Man sollte ein frühzeitiges Training anstreben. RESUMEN Aproximación conductista a la retencion de la function intestinal después de una constipacion de mucho tiempo e impactación fecal en personas con dificultades en el aprendizaje Los autores describen un programa conductista, que incluye cl sentarse en el inodoro inmediatamente después de la comida, recompensas por una evacuación apropriada y el aumento de fibras en la comida, para cuatro personas con dificultades graves de aprendizaje. Aunque el periodo de tratamiento fue largo, el resultado fue una función intestinal casi normal. Mientras que esta aproximación conductista no ignora los aspectos boilógicos del problema, los problemas del ensuciarse en personas con discapacidad intelectual no deben atribuirse solo a los problemas derivados de la minusvalia. Deberia considerarse el iniciar el aprendizaje a una edad mas temprana.

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Acquired megacolon in psychiatric patients

Cited by 9 publications

References 7 publications

The correlation between diverticulosis and redundant colon

The correlation between diverticulosis and redundant colon

Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review

A Behavioural Approach to Retraining Bowel Function After Long‐standing Constipation and Faecal Impaction in People With Learning Disabilities

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