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Your search term(s) "constipation" returned 61 results.

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Naloxone Treatment for Irritable Bowel Syndrome: A Randomized Controlled Trial with an Oral Formulation. Alimentary Pharmacology and Therapeutics. 16(9): 1649-1654. September 2002.

Opioids change gut motility and secretion, causing delayed intestinal transit and constipation. Endorphins play a role in the constipation troubling some patients with irritable bowel syndrome (IBS); hence naloxone, an opioid antagonist, may have a therapeutic role. This article reports on a study undertaken to assess the efficacy and safety of an oral formulation of naloxone in IBS patients with constipation. The randomized, double-blind, placebo-controlled trial included 25 patients with IBS (constipation-predominant and alternating types) who received 8 weeks of treatment with naloxone capsules, 10 milligrams twice daily, or identical placebo. Adequate symptomatic relief was recorded in six of 14 on naloxone and three of 11 on placebo. Whilst the differences were not significant, improvements in severity gradings and mean symptom scores for pain, bloating, straining and urgency to defecate were greater with naloxone than placebo for all parameters. In addition, quality of life assessments improved to a greater extent in patients taking naloxone. The authors conclude that preliminary results suggest that naloxone is well tolerated and beneficial in patients with irritable bowel syndrome and constipation. A larger clinical trial is needed to provide sufficient statistical power to assess efficacy. 4 figures. 2 tables. 29 references.

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Prucalopride, a Systemic Enterokinetic, for the Treatment of Constipation. Alimentary Pharmacology and Therapeutics. 16(7):1347-1356. July 2002.

Laxatives are frequently ineffective in treating constipation. An alternative therapeutic approach is to target serotonin 4 receptors, which are involved in initiating peristalsis. This article reports on a study undertaken to assess the effectiveness and safety of a systemically active serotonin 4 agonist, prucalopride. In the study, 74 women with constipation were stratified into slow or normal transit groups, and each group was randomized to receive either placebo or 1 milligram prucalopride daily for 4 weeks. Prucalopride, not placebo, increased spontaneous stool frequency and reduced time to first stool. Prucalopride reduced the number of retained markers in all patients compared to placebo. Prucalopride reduced the mean number of retained markers in slow transit, but did not alter the marker count in normal transit. Orocecal transit was accelerated by prucalopride, not placebo. Prucalopride, not placebo, increased rectal sensitivity to distension and electrical stimulation. Prucalopride significantly improved several domains of the Short Form Health Status Survey and the disease specific quality of life. Adverse effects were similar for prucalopride and placebo. 1 figure. 3 tables. 39 references.

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Randomized, Double-blind, Placebo-Controlled Trial of Tegaserod in Female Patients Suffering from Irritable Bowel Syndrome With Constipation. Alimentary Pharmacology and Therapeutics. 16(11): 1877-1888. November 2002.

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which affects up to 20 percent of the population, with a predominance in females. This article reports on a study undertaken to evaluated the effectiveness and safety of the drug tegaserod in female patients with IBS characterized by symptoms of abdominal pain or discomfort and constipation. In the randomized, double-blind, multicenter study, 1519 women received either tegaserod, 6 milligrams twice a day (n = 767), or placebo (n = 752) for 12 weeks, preceded by a 4 week baseline period without treatment and followed by a 4 week open withdrawal period. The primary effectiveness evaluation was the patient's symptomatic response as measured by the Subject's Global Assessment of Relief. Other efficacy variables included abdominal pain or discomfort, bowel habits, and bloating. Results showed that tegaserod produced significant improvements in the Subject's Global Assessment of Relief and other efficacy variables. These improvements were seen within the first week, and were maintained throughout the treatment period. After withdrawal of treatment, the symptoms rapidly returned. Overall, tegaserod was well tolerated. Diarrhea was the most frequent adverse event; however, this led to discontinuation in only 1.6 percent of tegaserod-treated patients. The authors conclude that tegaserod produced rapid and sustained improvement of symptoms in female irritable bowel syndrome patients and was well tolerated. 4 figures. 2 tables. 31 references.

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Sorting out the most Common GI Complaints. Patient Care. 36(3): 21-22, 25-26, 28, 31. February 15, 2002.

Millions of patients have gastrointestinal (GI) symptoms including belching (burping), intestinal gas (flatulence), abdominal distension, and indigestion, among others. Most of these do not signal the presence of a serious illness, but the practitioner's advice on preventing and treating nuisance symptoms can be enormously valuable to patients. This article helps primary care providers sort out the most common GI complaints. The authors stress that even trivial GI complaints deserve careful attention in the history and physical. Ominous symptoms include anemia, dysphagia (swallowing difficulties), bleeding, and weight loss. Once a potentially serious GI disorder has been ruled out, prevention and treatment efforts against the patient's most troublesome complaints can be initiated. Alpha-D-galactosidase may reduce gas associated with bean consumption; patients should be encouraged to incorporate these valuable foods in their diets. Sorbitol containing products may cause excessive gas production, even diarrhea. Patients should not increase their fiber consumption without increasing their fluid intake. Heartburn is usually well managed with H2 receptor antagonists and proton pump inhibitors. The authors caution that testing for gallstones is not indicated, unless the patient has the characteristic severe pain associated with this condition. And eradicating Helicobacter pylori in a patient with nonulcer dyspepsia usually does not reduce the symptoms. 1 figure. 1 table. 6 references.

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What is Constipation Anyway?. Participate. 11(3): 1-3. Fall 2002.

This newsletter article notes that constipation is one of the most difficult gut symptoms to define. The difficulty lies in the many features of constipation. Since more than 98 percent of people have at least 3 bowel movements per week, less is often invoked as abnormal. Many people happily manage will fewer, while others within that range are decidedly uncomfortable with what they believe is constipation. The author stresses that frequency of defecation cannot be considered in isolation. Other factors of equal importance are the consistency or form of the stool, the effort required to expel it, and the accompany abdominal discomfort and distension. The author also discusses acute versus chronic constipation, and different perspectives of constipation, including those of patients, physicians, and physiologists. 1 figure. 2 tables. 8 references.

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Childhood Constipation: Evaluation and Treatment. Journal of Clinical Gastroenterology. 33(3): 199-205. 2001.

This article reviews the evaluation and treatment of childhood constipation, a common condition. The authors estimate that between 5 and 10 percent of pediatric patients have constipation or encopresis (fecal soiling). Constipation is the second most referred condition in pediatric gastroenterology practices, accounting for up to 25 percent of all visits. The authors lay out a practical approach for those physicians not familiar with constipation in children. The diagnosis of constipation requires careful history taking and interpretation. Diagnostic tests are not often needed and are reserved for those who are severely affected. The daily bowel habits of children are extremely susceptible to any changes in routine environment. Constipation and subsequent fecal retention behavior often begins soon after a child has experienced a painful evacuation. Childhood constipation can be difficult to treat and often requires prolonged support by physicians and parents, explanation, medical treatment, and most importantly, the child's cooperation. 1 figure. 5 tables. 31 references.

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Chronic Constipation in Children: Rational Management. Consultant. 42(12): 1723-1732. November 2001.

This article reviews a strategy of rational management of chronic constipation in children. The authors note that irregular bowel habits are a common cause of chronic constipation in children; illness and travel are among the disruptions in daily routine that can result in stool withholding. Medical conditions, such as diabetes and Hirschsprung disease, and medications, including methylphenidate, analgesics, and cough syrups, can also cause constipation. Encopresis (fecal incontinence, or involuntary loss of stool), anal outlet bleeding, and rectal pain caused by anal fissures are associated with chronic constipation; hemorrhoids rarely develop in children. Barium enemas, survey films, and colonic transit studies can detect and define functional or structural obstruction. Physicians should recommend regular postprandial (after a meal) toilet visits; moderate exercise; and increased fluid and fiber intake, using a 'medicinal' fiber product if necessary. Parents should be discouraged from excessive use of laxatives and cathartics. Options for long term therapy include mineral oil and osmotic laxatives. 3 tables. 69 references.

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Chronic Idiopathic Constipation: A Psychological Enquiry. European Journal of Gastroenterology and Hepatology. 13(1): 39-44. January 2001.

Intractable idiopathic (of undetermined cause) constipation in women is often associated with psychosocial problems. This article reports on a study undertaken to determine the past and current psychological factors associated with slow and normal transit constipation. Consecutive female patients (n = 28) referred for biofeedback treatment were interviewed before the procedure. Transit studies revealed that 12 had slow transit constipation (STC) and 16 had normal transit constipation (NTC). Patients were assessed for evidence of previous and current psychiatric diagnoses; family and social history was noted; and self-rating scales were used to measure psychological distress, abnormal attitudes to eating, and current psychosocial functioning. The mean age of the 28 patients was 38.2 years (plus or minus 10.8 years) with a mean duration of symptoms of 17.6 years (plus or minus 16.9 years). Seventeen (61 percent) had a current psychiatric disorder and 18 (64 percent) a previous episode of psychiatric illness. The mean age of the 16 NTC patients was 38.4 years (plus or minus 10.1 years) with a mean duration of symptoms of 12.4 years (plus or minus 15.9 years). By contrast, the 12 STC patients had a much longer mean duration of constipation (24.3 years; plus of minus 16.4 years), a mean age of 37.9 years (plus of minus 12.1 years), with half having an onset in childhood. The STC patients reported more psychosocial distress on the rating scales than those with NTC, and only one did not experience some form of adverse life event or gynecological procedure in the 6 months before the onset of constipation. Eleven (39 percent) of the 28 women had had a hysterectomy at a mean age of 36 years, but only four (14 percent) reported a history of sexual abuse. Of the nine (32 percent) patients who reported markedly distorted attitudes to food, six had NTC and three had STC. The authors conclude that although STC is a chronic disorder accompanied by high rates of psychological distress, it does not appear to be associated with gross functional impairment. The authors suggest that patients who present to surgical departments with chronic intractable constipation should routinely have a psychological assessment. 2 figures. 3 tables. 31 references.

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Colectomy for Slow-Transit Constipation: Preoperative Functional Evaluation Is Important but Not a Guarantee for a Successful Outcome. Diseases of the Colon and Rectum. 44(4): 577-580. April 2001.

This article reports on a study designed to assess the results of preoperative functional evaluation of patients with severe slow transit constipation in relation to functional outcome. The study included 439 patients with chronic intractable constipation who were evaluated by marker studies. Of these patients, 21 underwent colectomy (removal of a portion of the colon) and ileorectal anastomosis (reconnection of the ileum portion of the small intestine to the rectum) for slow transit constipation. Mean colorectal transit time was 156 hours (normal time is usually less than 45 hours). Small bowel transit time was normal in 10 patients and delayed in 5 patients. Six patients were nonresponders. Morbidity (illness or complications) was 33 percent. Small bowel obstruction occurred in 6 patients; relaparotomy was done in 4 patients. Follow up varied from 14 to 153 months. After three months, defecation frequency was increased in all patients. mean stool frequency improved from one bowel movement per 5.9 days to 2.8 times per day. Sixteen patients felt improved after surgery. Seventeen patients continued to experience abdominal pain, and 13 still used laxatives and enemas. Satisfaction rate was 76 percent (16 patients). After one year, defecation frequency was back at the preoperative level in 5 patients. An ileostomy was created in two more patients because of incontinence and persistent diarrhea. Eleven patients (52 percent) still felt improved. A relation between small bowel function and functional results could not be demonstrated. The authors conclude that preoperative evaluation is important but not a guarantee for successful outcome. Colectomy remains an ultimate option for patients with disabling slow transit constipation, but patients should be informed that, despite an increased defecation frequency, abdominal symptoms might persist. Any common use of colectomy to treat constipation should be discouraged. 1 table. 16 references.

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Constipation and Fecal Incontinence in the Elderly. Gastroenterology Clinics of North America. 30(2): 497-515. June 2001.

Continence and defecation are complex functions that require the interaction of visceral and pelvic muscles and the nerves that regulate their activity. These activities may be abnormal in elderly patients and can produce symptoms, such as chronic constipation or fecal incontinence (involuntary loss of stool). This article, from a special issue on gastrointestinal (GI) disorders in the elderly, addresses constipation and fecal incontinence in this population. The author emphasizes that, contrary to widespread opinion, much can be done to improve constipation and incontinence in the elderly and relieve a considerable burden in these patients. Relatively little research has been done to differentiate physiologic changes in rectoanal function resulting from aging and pathologic changes resulting from diseases occurring as patients age. Treatment includes identification and treatment of the underlying disease, if possible, protective skin care, continence aids, psychologic support, drug therapy (for stimulation of defecation at intervals, antidiarrheal drugs), biofeedback, and surgical therapy. Results of therapy often can be good, leading to alleviation of suffering and the ability to lead a fuller life. 1 figure. 4 tables. 92 references.

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