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Approach to Patients with Refractory Constipation

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Evaluation of Gastrointestinal Motility and its Disorders

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Abstract

A review of relevant publications revealed that the criteria for defining refractory constipation were ill-defined. Common treatment for constipation includes osmotic, stimulant, and enterokinetic agents. Prucalopride is a new enterokinetic agent that has been shown in clinical trials to produce significant improvements in bowel functions, gastrointestinal symptoms, and quality of life. Patients who fail pharmacological treatment should be referred to specialized centers for physiological laboratory evaluation like transit studies, balloon expulsion, anorectal manometry, and defecography. Potential pathophysiology of refractory constipation include physiological disturbances like pelvic floor dyssynergia and slow transit constipation. Physical defects such as rectocoele and internal prolapse are uncommon. Psychological disturbances have been linked to persistent GI symptoms. Non-pharmacological treatments to consider include biofeedback and behavioral therapy. More studies are needed before surgery can be recommended. There is the possibility that a wider acceptance of the use of laxatives may substantially reduce the number of patients with refractory constipation.

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Authors and Affiliations

  1. Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore

    Kok-Ann Gwee FRCP, PhD

  2. Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China

    Xiaorong Gong PhD

  3. Division of Gastroenterology and Hepatology, University Medicine Clinic, National University Hospital, National University Health System, Singapore, Singapore

    Kewin Tien Ho Siah MBBS, MRCP

  4. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Kewin Tien Ho Siah MBBS, MRCP

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  1. Kok-Ann Gwee FRCP, PhD
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  2. Xiaorong Gong PhD
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  3. Kewin Tien Ho Siah MBBS, MRCP
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Correspondence to Kok-Ann Gwee FRCP, PhD .

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Editors and Affiliations

  1. Department of Gastroenterology, SGPGIMS , Lucknow, India

    Uday C. Ghoshal

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Gwee, KA., Gong, X., Siah, K.T.H. (2016). Approach to Patients with Refractory Constipation. In: Ghoshal, U. (eds) Evaluation of Gastrointestinal Motility and its Disorders. Springer, New Delhi. https://doi.org/10.1007/978-81-322-0822-8_7

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  • DOI: https://doi.org/10.1007/978-81-322-0822-8_7

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  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-0821-1

  • Online ISBN: 978-81-322-0822-8

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