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Actualización de las Guías Clínicas de la AGA sobre Evaluación y Manejo del Estreñimiento Refractario: Revisión de
Kyle Staller1, Leila Neshatian2, Anthony Lembo3
1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Resumen
El estreñimiento refractario (ER) requiere la exclusión de causas secundarias y la confirmación de tránsito colónico lento. La cirugía es una opción para el ER grave, pero requiere una evaluación cuidadosa, incluida la evaluación psicológica, debido a los posibles riesgos y resultados.
Área de la Ciencia:
- Gastroenterología
- Cirugía Colorrectal
Sus antecedentes:
- Un subconjunto de pacientes experimenta estreñimiento refractario (ER) a pesar de la terapia médica, lo que presenta desafíos diagnósticos y terapéuticos.
- El ER es relativamente raro y requiere un enfoque sistemático para el diagnóstico y manejo.
Objetivo del estudio:
- Proporcionar orientación experta sobre el diagnóstico y manejo del estreñimiento refractario.
- Esbozar las mejores prácticas para la evaluación de pacientes antes de considerar intervenciones quirúrgicas para el estreñimiento crónico.
Principales métodos:
- Revisión de expertos encargada y aprobada por la American Gastroenterological Association (AGA).
- Declaraciones derivadas de una revisión de la literatura publicada y la opinión de expertos.
- Proceso de revisión interna y externa por pares.
Principales resultados:
- La exclusión sistemática de causas secundarias corregibles (medicamentos, trastornos neurológicos, trastornos de la defecación [TD]) es crucial.
- La confirmación del tránsito colónico lento y la realización de ensayos adecuados de terapias médicas/no farmacológicas son esenciales antes de considerar la cirugía.
- El tratamiento quirúrgico (p. ej., colectomía) requiere una cuidadosa selección de pacientes, excluyendo TD concurrentes, evaluando la dismotilidad del tracto gastrointestinal superior y considerando comorbilidades psicológicas.
Conclusiones:
- El tratamiento quirúrgico para el ER conlleva riesgos y potencial de resultados insatisfactorios, lo que exige una evaluación preoperatoria exhaustiva.
- Se recomienda la evaluación psicológica para valorar la idoneidad para la cirugía y predecir los resultados.
- La colectomía con anastomosis ileorrectal debe reservarse para pacientes sin trastornos de la defecación en curso.
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