摘要

Constipation is a heterogeneous, polysymptomatic, multifactorial disease. Acute or transient constipation can be due to changes in diet, travel or stress, and secondary constipation can result from drug treatment, neurological or metabolic conditions or, rarely, colon cancer. A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes. Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. If unsuccessful, subspecialist referral should be considered. Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

译文

便秘是一种异质、多症状、多因素的疾病。急性或短暂性便秘可能是由于饮食、旅行或压力的变化，继发性便秘可能是由药物治疗、神经或代谢状况或罕见的结肠癌引起的。排除便秘的次要原因和几种重叠亚型后，对原发性慢性便秘进行诊断。慢传输型便秘的特征是在没有盆底功能障碍的情况下结肠传输延长。这种便秘的亚型可以通过无线电不透明标记试验或无线运动胶囊试验来识别，最好用泻药如聚乙二醇或较新的制剂如利那氯肽或卢比前列酮来治疗。如果不成功，应考虑转诊亚专家。协同排便障碍是直肠和盆底肌肉协调受损的结果，并导致排便困难。这种情况可以通过肛门直肠测压和气球排出试验来确定，最好采用生物反馈疗法。阿片类药物引起的便秘是一个新兴的实体，包括纳洛西酮、甲基纳曲酮和 lubiprostone 在内的几种药物被批准用于治疗。在这篇综述中，我们概述了慢性便秘的负担和病理生理学，并详细讨论了可用的诊断工具和治疗方案。