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Slow Transit Constipation.

Arnold Wald1

  • 1University of Pittsburgh Medical Center, Division Gastroenterology, Hepatology, and Nutrition, PUH, Mezzanine Level, C-Wing, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213 walda@msx.upmc.edu

Current Treatment Options in Gastroenterology
|July 4, 2002
PubMed
Summary
This summary is machine-generated.

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Diagnosing slow transit constipation involves specialized tests. Treatment options range from medications like stimulant laxatives and misoprostol to surgical interventions for severe cases.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Slow transit functional constipation (STFC) is diagnosed in patients with idiopathic constipation unresponsive to conservative treatments.
  • Diagnostic evaluation is crucial for identifying STFC and excluding other causes of constipation.

Purpose of the Study:

  • To outline the diagnostic criteria and management strategies for slow transit functional constipation.
  • To review various treatment modalities, including pharmacological and surgical options.

Main Methods:

  • Diagnostic tests include barium enema, colonoscopy, colonic transit studies with radio-opaque markers, anorectal manometry, and balloon expulsion tests.
  • Imaging studies like plain abdominal films and gastrografin studies aid in identifying megacolon.
  • Assessment of anorectal function is essential to rule out outlet dysfunction.

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Main Results:

  • Colonic transit studies reveal marker stasis in the proximal colon, indicative of slow transit.
  • Fiber supplements and osmotic laxatives are often ineffective due to the nature of slow colonic transit.
  • Stimulant laxatives are first-line, with no evidence of harm with intermittent use.
  • Pharmacological options include polyethylene glycol, misoprostol, and colchicine.
  • Biofeedback is effective in approximately 60% of patients without outlet dysfunction.
  • Surgical options like subtotal colectomy with ileorectal anastomosis or ileostomy are considered for refractory cases.

Conclusions:

  • Accurate diagnosis of STFC requires comprehensive testing to guide appropriate management.
  • Treatment selection depends on the presence of colonic inertia, anorectal function, and patient-specific factors.
  • Surgical interventions carry significant morbidity and should be carefully considered.