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Related Concept Videos

Drugs for Treatment of Constipation-Predominant IBS01:21

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Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
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Managing Irritable Bowel Syndrome (IBS) involves a multifaceted approach, including lifestyle modifications, dietary changes, and medication.
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Laxatives are primarily used to alleviate constipation, a common gastrointestinal disorder characterized by infrequent bowel movements and difficulty passing stools. They work by various mechanisms to increase the volume or frequency of bowel movements. The primary modes of action of laxatives include increasing stool bulk, softening the stool, stimulating intestinal motility, and osmotically drawing water into the intestines.
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Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation
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Optimizing the Management Algorithm for Adults With Functional Constipation Failing a Fiber/Laxative Trial in General

Eric D Shah1, Nitin K Ahuja2, Darren M Brenner3

  • 1Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA.

The American Journal of Gastroenterology
|September 21, 2023
PubMed
Summary

Routine anorectal function testing is a cost-effective strategy for managing functional constipation. This approach helps triage patients to appropriate treatments like pelvic floor physical therapy, improving outcomes and reducing healthcare costs.

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Area of Science:

  • Gastroenterology
  • Health Economics
  • Medical Technology Assessment

Background:

  • Anorectal function testing is often limited to specialized centers.
  • Patients with functional constipation unresponsive to initial therapies require effective management strategies.
  • Office-based anorectal function testing offers a potential solution for triaging care.

Purpose of the Study:

  • To evaluate the cost-effectiveness of routine anorectal function testing in patients with functional constipation.
  • To compare three management strategies: empiric prescription drugs, empiric pelvic floor physical therapy (PFPT), and upfront anorectal function testing.

Main Methods:

  • A cost-effectiveness analysis from the patient perspective and a cost-minimization analysis from the insurer perspective were conducted.
  • Three strategies were compared: (i) drugs then PFPT, (ii) PFPT then drugs, (iii) upfront anorectal function testing.
  • Model inputs were sourced from systematic reviews, national cost data, and observational studies.

Main Results:

  • Upfront anorectal function testing was the most cost-effective strategy for triaging patients to appropriate therapy.
  • Patients without anal hypocontractility and with adequate balloon expulsion time were referred to PFPT.
  • Empiric PFPT was more cost-effective than empiric drugs, except when increasing bowel movement frequency was the primary goal.

Conclusions:

  • Anorectal function testing is an emerging technology for optimizing cost-effective outcomes in functional constipation management.
  • Phenotyping patient care through anorectal function testing can overcome testing costs.
  • Routine implementation could lead to efficient patient referral patterns, with gastroenterologists referring approximately 17 patients per year to PFPT.