Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Abstract

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

“…Defecography is useful in identifying anatomical abnormalities, such as paradoxical contraction of the puborectalis muscles. 25,26 However, the technique of defecography is incompletely standardized and has limited reproducibility in terms of anorectal angle measurements. 27 Furthermore, there were risks of X-ray exposure and barium impaction, even though these risks are minimal.…”

Effects of Dielectric Monopolar Radiofrequency with Vacuumtherapy in the Treatment of Chronic Constipation in Patients with Intellectual Developmental Disorders

“…The recruitment process was performed in accordance with the Declaration of Helnsinki and the corresponding Ethics Comitte's approvals. The participants recruited were over eighteen years old, interned in the center ATADES Huesca (Spain) and diagnosed with chronic constipation according to Rome IV criteria [7]. Those patients who did not fulfill any of these criteria, where unable to understand the information about the treatment or the informed consent and those whose guardians did not agree on their participation in this study were excluded.…”

“…Laxative drugs are frequently prescribed; however, these are specifically recommended to normalize constipation periods of several days because its common use may generate tolerance towards treatment and a consequent decrease in effectiveness. That is why it is essential to use them as the last option [7].…”

Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta‐analysis

“…6 In young adults, faecal calprotectin (FC) is often assessed to distinguish between IBS and IBD, but this approach is not usually recommended as the sole screening tool for people over 50 because of their higher risk of organic GID, including neoplasms. [7][8][9][10][11][12] The high prevalence of IBS and low incidence of organic GID in people over 50 have led to suggestions that diagnosing functional GIDs in people over 50 should be based on their medical history, and that the number of investigations, including FC testing, should be kept to a minimum. [7][8][9][10][11][12] Despite recommendations that functional GIDs be diagnosed and managed in primary care, large numbers of patients with probable functional GIDs are unnecessarily referred for further assessment, including colonoscopy.…”

“…[7][8][9][10][11][12] The high prevalence of IBS and low incidence of organic GID in people over 50 have led to suggestions that diagnosing functional GIDs in people over 50 should be based on their medical history, and that the number of investigations, including FC testing, should be kept to a minimum. [7][8][9][10][11][12] Despite recommendations that functional GIDs be diagnosed and managed in primary care, large numbers of patients with probable functional GIDs are unnecessarily referred for further assessment, including colonoscopy. [13][14][15] Inflammation is the key characteristic that distinguishes organic from functional GIDs.…”