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Related Experiment Videos

Chronic constipation--is the work-up worth the cost?

P C Rantis1, A M Vernava, G L Daniel

  • 1Department of Surgery, Saint Louis University School of Medicine, MO 63110-0250, USA.

Diseases of the Colon and Rectum
|March 1, 1997
PubMed
Summary
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Extensive diagnostic evaluations for chronic constipation are costly and often unrevealing. Few patients benefit from these tests, suggesting a need for more targeted diagnostic approaches.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Chronic constipation is a significant condition that can necessitate colectomy.
  • Patient evaluation for colectomy can be extensive, costly, and yield inconclusive results.

Purpose of the Study:

  • To determine the cost, utilization, and outcomes of diagnostic evaluations in patients with chronic constipation.

Main Methods:

  • A review of 51 patients with chronic constipation, analyzing symptom severity, diagnostic studies, treatments, and outcomes.
  • Cost analysis of diagnostic studies performed at the institution.
  • Assessment of various diagnostic tests including colonoscopy, barium enema, colonic transit studies, defecography, and anal manometry.

Main Results:

  • 84% of colonoscopies/barium enemas were normal; 25% of colonic transit studies were abnormal; 46% of defecography results were abnormal; 14% of anal manometry results were abnormal.

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  • Diagnoses included outlet obstruction (16%), colonic inertia (24%), and unclear etiology (61%).
  • The average diagnostic cost was $2,752 per patient, totaling $140,369 for all patients, with only 23% benefiting from extensive testing.

    • Conclusions:

    • Extensive diagnostic evaluations for chronic constipation are expensive and provide unclear benefits.
    • A significant portion of patients did not benefit from costly diagnostic procedures.
    • The findings suggest a need to re-evaluate the utility and cost-effectiveness of current diagnostic strategies for chronic constipation.