Nội dung

CONSTIPATION – CAUSES, DIAGNOSIS AND TREATMENT Edited by Anthony G. Catto-Smith Constipation – Causes, Diagnosis and Treatment Edited by Anthony G. Catto-Smith Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Martina Blecic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Constipation – Causes, Diagnosis and Treatment, Edited by Anthony G. Catto-Smith p. cm. ISBN 978-953-51-0237-3 Contents Preface IX Chapter 1 Diagnostic Approach to Constipation in Children Kathleen H. McGrath and Patrina Caldwell 1 Chapter 2 The Role of Diagnostic Tests in Constipation in Children Anthony G. Catto-Smith and Kathleen H. McGrath Chapter 3 The Role of Interstitial Cells of Cajal (ICC) in Gastrointestinal Motility Disorders – What the Gastroenterologist Has to Know 33 Christian Breuer Chapter 4 Skipping Breakfast is Associated with Constipation in Post-Adolescent Female College Students in Japan 47 Tomoko Fujiwara Chapter 5 Irritable Bowel Syndrome and Constipation Brian C. Dobson Chapter 6 Opioid Induced Constipation 81 Caterina Aurilio, Maria Caterina Pace, Vincenzo Pota and Pasquale Sansone Chapter 7 Drugs in Development for Opioid-Induced Constipation 89 Kelly S. Sprawls, Egilius L.H. Spierings and Dustin Tran Chapter 8 Constipation Treatment in Neurological Disorders Gallelli Luca, Pirritano Domenico, Palleria Caterina and De Sarro Giovambattista Chapter 9 Bowel Dysfunction in Persons with Multiple Sclerosis 117 Elsie E. Gulick and Marie Namey 55 99 19 VI Contents Chapter 10 Multimodal Treatment of Constipation: Surgery, Rehabilitation or Both? 139 Luigi Brusciano, Crescenzo Di Stazio, Paolo Limongelli, Gian Mattia Del Genio, Salvatore Tolone, Saverio Sansone, Francesco Lucido, Ignazio Verde, Antonio D’Alessandro, Roberto Ruggiero, Simona Gili, Assia Topatino, Vincenzo Amoroso, Pina Casalino, Giovanni Docimo and Ludovico Docimo Chapter 11 Core Aspects of Clinical Development and Trials in Chronic Idiopathic Constipation M. Scott Harris and Oranee T. Daniels 147 Preface Constipation is common in both adults and children. Estimates would suggest a median prevalence of around 12-16% in the general population.1 While regarded as a minor nuisance in some cases, its consequences can be severe, with a substantial impact on quality of life.2 Secondary faecal soiling has a profound psychological effect at all ages. This book provides specific contributions which clarify the pathogenesis, diagnosis, and therapy of constipation for the general population and also for certain high risk groups. Surprisingly, consensus definitions of constipation have been hard to achieve, but that achieved by the PACCT group3 for children included having at least 2 of the following features within the last 8 weeks:       Fewer than 3 bowel movements per week More than one episode of fecal incontinence per week Large stools in the rectum or palpable on abdominal examination Passing of stools so large that they obstruct the toilet Retentive posturing and withholding behavior Painful defecation. Importantly, it may not be recognised, only coming to attention because of abdominal pain, soiling or behavioural disturbances. The chapter by Kathleen McGrath critically examines the impact defaecation disorders have in children and the diagnostic criteria used to identify them. Defaecation disorders are also much more prevalent in certain groups. The very young and the elderly4, 5 are at particular risk. They also pose a particular difficulty for both children and adults with developmental disabilities6, neurological dysfunction and spinal cord injury.7 Medical and surgical therapy may also lead to constipation through the use of potent analgesics such as opiods. The chapters by Caterina Aurilio and Kelly Sprawls provide insights into the aetiology of opiod-induced constipation and pharmaceutical approaches to avoiding it and its therapy. Occasionally, constipation may be the presenting feature of another condition such as thyroid disease or colorectal malignancy.8 The relationship between colorectal tumors and colonoscopy is addressed in the chapter by Brusciano. The chapters by Luca Galleli X Preface and Elsie Gulick provide insights into the impact of the broad spectrum of neurological disorders and multiple sclerosis respectively on colorectal dysfunction. In most situations, constipation occurs in otherwise well individuals. The pathogenesis in these cases is usually proposed to be inadequate dietary fibre, a sedentary lifestyle, or poor toileting techniques. The chapter by Tomoko Fujiwara provides an insightful and unique window into the impact of the all too common habit of skipping breakfast on bowel function. Diagnosis is usually straightforward, but it often helpful to make reference to diagnostic criteria such as that achieved by the PACCT group. Further diagnostic testing is not usually required, but can be invaluable in specific instances. The chapter on diagnostic tests (Catto-Smith et al.) provides a review of the available testing techniques. While abdominal radiography is often employed, it is rarely adds much. Studies of colorectal motility9, 10 provide an immense amount of information but are either expensive, invasive, or difficult to interpret11. However, they have enabled a better understanding of the motility dysfunction responsible for constipation.12 Sensory dysfunction is clearly important as many patients are unaware of the extent of rectal filling.13 These type of studies have however meant that entities such as slow transit constipation, anorectal incoordination, sphincteric dysfunction and the basis for constipation in irritable bowel syndrome are now much better understood14. The chapter by Brian Dobson provides a novel hypothesis into the pathogenesis of defaecation disorders in irritable bowel syndrome. In many situations, otherwise uncomplicated constipation will respond to simple interventions such as attention to diet15 and toileting, but in other patients it can be extraordinarily difficult to achieve therapeutic success. Medications generally function through either assisting colorectal contractility or softening the stool.16 Unfortunately, drugs only offer temporary relief if the primary cause is unable to be improved. Recent interest has centred on possibly dysbiotic colonic flora in the hope that probiotics17 may be helpful. There are a variety of traditional and complementary medications that are used widely in the community.18 Behavioural therapies are often very effective in children,19, 20 and biofeedback modalities have attracted a great deal of interest, particularly in adults. 21 Better understanding of the pathophysiology of defaecation disorders has opened the doors to novel treatments. Abnormalities in the excitatory cells primarily responsible controlling gastrointestinal motility have been postulated to have a major role in certain types of constipation such as slow transit22 and even that associated with diabetes.23 The chapter by Christian Breuer provides a good understanding of the Interstitial Cell of Cajal – a central player in gastrointestinal dysmotility and slow transit constipation. Sacral stimulation is certainly effective, but is invasive. A very exciting new area is that of transabdominal electrical stimulation, 24 which appears to offer the unenviable combination of low cost, ease of use, durability of effect to an otherwise treatment-resistant population.25, 26