SLOW TRANSIT CONSTIPATION - 03/09/11

Doi : 10.1016/S0889-8553(05)70168-0

Adil E. Bharucha, MD, Sidney F. Phillips, MD

Division of Gastroenterology and Hepatology, Gastroenterology Research Unit and Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota

Résumé

Preston and Lennard-Jones^{62 Preston D.M., Lennard-Jones J.E. Severe chronic constipation of young women: 'Idiopathic slow transit constipation' Gut 1986 ; 27 : 41-48 [cross-ref]

Cliquez ici pour aller à la section Références} introduced the term idiopathic slow transit constipation to describe a clinical syndrome characterized by intractable constipation poorly responsive to fiber and laxatives. Other gastrointestinal manifestations include abdominal pain, bloating, malaise, nausea, anorectal symptoms suggestive of difficult fecal expulsion, and delayed colonic transit without megacolon. Extragastrointestinal symptoms in this syndrome included painful or irregular menses, hesitancy in initiating micturition, and somatic symptoms such as cold hands or blackout. Lane^{43 Lane W. Remarks on the results of the operative treatment of chronic constipation BMJ 1908 ; 1 : 126-130 [cross-ref]

Cliquez ici pour aller à la section Références} advocated colonic resection for treating a similar symptom complex in the early 1900s. With the widespread availability of tests to measure colonic transit and pelvic floor function, concepts of slow transit constipation evolved. Patients with chronic constipation are categorized as follows: normal transit or irritable bowel syndrome, pelvic floor dysfunction, and slow transit constipation.^{11 Camilleri M., Thompson W.G., Fleshman J.W. , et al. Clinical management of intractable constipation Ann Intern Med 1994 ; 121 : 520-528 [cross-ref]

Cliquez ici pour aller à la section Références, 56 Nyam D.C., Pemberton J.H., Ilstrup D.M. , et al. Long-term results of surgery for chronic constipation [published erratum appears in Dis Colon Rectum 1997 May;40(5):529] Dis Colon Rectum 1997 ; 40 : 273-279 [cross-ref]

Cliquez ici pour aller à la section Références}Although colonic transit often is delayed in patients with pelvic floor dysfunction or obstructed defecation,^{57 O'Brien M.D., Camilleri M., von der Ohe M.R. , et al. Motility and tone of the left colon in constipation: A role in clinical practice? Am J Gastroenterol 1996 ; 91 : 2532-2538

Cliquez ici pour aller à la section Références, 65 Rao S.S., Welcher K.D., Leistikow J.S. Obstructive defecation: A failure of rectoanal coordination Am J Gastroenterol 1998 ; 93 : 1042-1050 [cross-ref]

Cliquez ici pour aller à la section Références}the term slow transit constipation in the scientific literature generally refers to patients who primarily complain of constipation and have delayed colonic transit but no underlying systemic disorder or pelvic floor dysfunction that explains these symptoms (Box 1). The implication is that slow transit constipation represents a disorder of colonic motor function.