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Optimal treatment of chronic constipation in managed care: review and roundtable discussion.

J Manag Care Pharm. 2008 Nov;14(9 Suppl A):1-15.

Eoff JC.

University of Tennessee College of Pharmacy, Memphis, TN 38163, USA. jeoff@utmem.edu

BACKGROUND: Prevalence studies estimate that chronic constipation affects 12%-19% of Americans. This prevalence rate exceeds that of many highly publicized chronic conditions, including diabetes and asthma. Identifying the etiology of each patient's constipation is essential for determining treatment and management plans. The etiology of chronic constipation falls into 2 broad categories: primary or idiopathic constipation caused by physical and functional problems, and secondary constipation resulting from a variety of organic conditions as well as the use of certain medications.

Comparative study on two colonic bowel preparations for patients with chronic constipation.

Scand J Gastroenterol. 2008 Nov 13:1-5.

Chen H, Li X, Ge Z.

Department of Gastroenterology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.

Objective: To determine the efficacy, tolerance, and safety of oral sodium phosphate compared with polyethylene glycol in patients with chronic constipation.

Material and methods: From May 2007 to October 2007, 100 patients with chronic constipation were prospectively randomized into two groups for colonoscopy.

Pharmacologic treatment of constipation: what is new?

Curr Opin Pharmacol. 2008 Dec;8(6):724-8. Epub 2008 Aug 20.

Pohl D, Tutuian R, Fried M.

Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.

Constipation is a common gastrointestinal disease affecting 2-27% of the population in Western hemisphere. Approximately in half of patients the diagnosis of functional constipation is made after having ruled out secondary causes. Treatment of chronic functional constipation primarily addresses education on toilet habits, dietary advice, and patient reassurance. Further therapies are guided according to functional subtype slow-transit constipation, dyssynergic defecation, and constipation-predominant irritable bowel syndrome (IBS-C).

Prevalence of atopy in children with chronic constipation.

Arch Dis Child. 2008 Dec;93(12):1044-7. Epub 2008 Jun 18.

Simeone D, Miele E, Boccia G, Marino A, Troncone R, Staiano A.

National Health Service, Pietrelcina (BN) and Trentola Ducenta (CE), Italy.

OBJECTIVES: To evaluate the prevalence of chronic constipation (CC) in unselected children, its association with atopy and the efficacy of a cow's milk protein (CMP) elimination diet on refractory constipation.

STUDY DESIGN: The study was conducted by six primary care paediatricians, serving a population of 5113 children aged from birth through to 12 years; only 2068 children were 6 months to 6 years.

Treatment of Chronic Constipation: Current Pharmacologic Approaches and Future Directions.

Clin Gastroenterol Hepatol. 2008 Dec 13.

Tack J, Müller-Lissner S.

Division of Gastroenterology, University Hospital, Leuven, Belgium.

Chronic constipation is a common condition that affects up to 27% of the population. Dietary and lifestyle measures are usually the first-line therapy, but if these fail to have an effect then a variety of prescription and consumer laxatives are available. Traditional laxatives include bulking agents, osmotic agents, stool softeners, and stimulants of the gastrointestinal tract.

Imaging studies in the diagnosis of functional abdominal disorders.

Ther Umsch. 2009 Jan;66(1):25-30.

Criblez D, Treumann T, Metzger J.

Magendarm-Zentrum Luzern, Luzerner Kantonsspital.

Functional abdominal disorders are predominantly diagnosed on the basis of a thorough history and clinical examination. It is a challenge to clinicians to define the adequate place of imaging studies in order to rule out relevant organic disease. In functional dyspepsia, oesphago-gastroduodensoscopy and abdominal ultrasound are widely used as first line studies.

Use of complementary medicine in pediatric patients with inflammatory bowel disease: results from a multicenter survey.

J Pediatr Gastroenterol Nutr. 2009 Jan;48(1):55-60.

Wong AP, Clark AL, Garnett EA, Acree M, Cohen SA, Ferry GD, Heyman MB.

Department of Pediatrics and Medicine, University of California, San Francisco, CA 94143-0136, USA.

OBJECTIVES: We examined the use of complementary and alternative medicine (CAM) at 3 US pediatric medical centers, comparing a group of children with inflammatory bowel disease (IBD) with children presenting with chronic constipation.

A gap in our understanding: chronic constipation and its comorbid conditions.

Clin Gastroenterol Hepatol. 2009 Jan;7(1):9-19. Epub 2008 Oct 1.

Talley NJ, Lasch KL, Baum CL.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA. talley.nicholas@mayo.edu

Constipation is one of the most common digestive disorders in the United States; however, the association of this condition with related comorbidities, both gastrointestinal and extraintestinal, is poorly documented. Here, we have reviewed the association of constipation with specific comorbidities.

Pilot study on the effect of linaclotide in patients with chronic constipation.

Am J Gastroenterol. 2009 Jan;104(1):125-32.

Johnston JM, Kurtz CB, Drossman DA, Lembo AJ, Jeglinski BI, MacDougall JE, Antonelli SM, Currie MG.

Ironwood Pharmaceuticals, Inc., 320 Bent Street, Cambridge, MA, USA. jjohnston@ironwoodpharma.com

OBJECTIVES: Chronic constipation is a common gastrointestinal disorder with limited treatment options. Oral administration of linaclotide, a novel peptide agonist of guanylate cyclase-C receptors, has been shown in animal studies to stimulate intestinal fluid secretion and transit. In Phase 1 studies in healthy human volunteers, linaclotide was well-tolerated, increased bowel movement frequency, and loosened stool consistency.

Serotonin in the gastrointestinal tract.

Curr Opin Endocrinol Diabetes Obes. 2009 Feb;16(1):53-9.

Camilleri M.

Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota 55905, USA. camilleri.michael@mayo.edu

PURPOSE OF REVIEW: To assess the role of serotonin and its control in the manifestations and treatment of lower functional gastrointestinal disorders.

RECENT FINDINGS: Recent literature has explored several novel concepts in the association of serotonin and symptoms, alterations in tissue levels of serotonin and its reuptake protein, aspects of the genetic determinants of serotonergic function (particularly 5-HTTLPR) and its relationship to gastrointestinal motor and sensory functions, and novel serotonergic agents used in therapy of lower functional gastrointestinal disorders.

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