| BackgroundFunctional constipation (FC) is one of the most prevalent worldwide chronic disease. FC is divided into four types by anorectal physiological testing, including anorectal manometry, balloon expulsion test, and colonic transit test.Laxative therapy is regarded as the first-line treatment for FC. Even though laxative therapy is effective for most FC patients, some still have no response. Researchers have found that most irresponsive patients have abnormal anorectal physiological function and belong to slow transit constipation or defecatory disorder. The relationships among anorectal physiological testing, efficacy of laxative therapy, symptoms of constipation and demographic characteristics are controversial.Chapter 1 Predictors of results of anorectal physiological testing and response to laxative therapy in functional constipation patientsAim:To analyze relationships among anorectal physiological testing, symptoms of constipation and demographic characteristics. To explore whether symptoms of constipation can predict anorectal physiological testing results and constipation type.Method:This was a retrospective study involving patients with functional constipation visiting Sir Run Run Shaw Hospital from March,2010 to June,2015 who accepted at least one of the tests, including anorectal manometry, balloon expulsion test and colonic transit test. A questionnaire containing demographic characteristics and symptoms of constipation was completed and the results of tests have been collected. Logistic regression and Spearman analysis were used.Results:1.457 patients (351 females and 106 males) were enrolled in the study. Among all patients,294 received colonic transit test and 140 (47.6%) had slow colonic transit. 427 received anorectal manometry,177 (41.5%) didn’t have enough rectum impulse,360 (84.3%) exhibited contradictory contraction or incomplete relaxation of anal sphincter.184 had balloon expulsion test and 96 (52.2%) failed the test Most FC patients had abnormal examination results.2. Female patients (OR=0.427,95%CI 0.020-0.904, P=0.026), patients with lower BMI (OR=0.885,95%CI 0.807-0.970, P=0.009), patients with drinking history (OR=2.642,95%CI 1.278-5.461, P=0.009) and history of suppressing defecation (OR=1.864,95%CI 1.044-3.330, P=0.035) predicted slow transit.3. Female (OR=0.438,95% CI 0.231-0.832, P=0.012) and lower BMI (OR=0.892,95%CI 0.830-0.958, P=0.002) were negatively associated with enough rectum impulse. Older patients (OR=1.030,95%CI 1.007-1.052, P=0.009) were more likely to present contradictory contraction or incomplete relaxation of anal sphincter.4. Bowel frequency (OR=0.836,95%CI 0.746-0.936, P=0.002) was a protective factor for cobnic transit test Patients with less than 3 times a week bowel frequency have higher probability to experience slow transit No correlation was found between symptoms of constipation and rectum impulse.5. Patients with low rectum impulse (OR=0.970,95%CI 0.955-0.986, P=0.000) or high anal sphincter defecating pressure (OR=1.032,95%CI 1.015-1.050, P=0.000) were more prompt to fail the balloon expulsion testConclusion:1. Slow transit constipation and defecatory disorder accounted for a large proportion of FC.2. Female and patients with loower BMI were more likely to have slow transit and insufficient rectum impulse.3. Bowel frequency less than 3 times a week predicted slow transit. Straining has a positive correlation with anal sphincter resting pressure, anal sphincter defecating pressure and first sensation volume.4. Patients with low rectum impulse or high anal sphincter defecating pressure were more prompt to fail the balloon expulsion test.Chapter 2 Predictors of results of anorectal physiological testing and response to laxative therapy in functional constipation patientsAim:To analyze the association among laxative therapy, anorectal physiological testing, symptoms of constipation and demographic characteristics. To explore predictors of the efficacy of laxative therapy in FC patients.Method:This was a retrospective study involving patients with functional constipation visiting Sir Run Run Shaw Hospital from March,2010 to June,2015 who have received laxative therapy and accepted at least one of the tests including anorectal manometry, balloon expulsion test, colonic transit test. A questionnaire containing demographic characteristics and symptoms of constipation was completed and the results of tests have been recorded. Efficacy of laxative therapy was divided into 3 groups. Complete response was defined that bowel frequency was more than 3 times a week and symptoms disappear. No response was defined that bowel frequency was less than 3 times a week and symptoms still existed. Partial response was between above. Logistic regression and Spearman analysis were used.Results:1.128 patients were enrolled in the study. Among them,98 received colonic transit test and 45 (45.9%) had slow colonic transit. 119 received anorectal manometry,44 (37.0%) didn’t have enough rectum impulse,97 (81.5%) existed contradictory contraction or incomplete relaxation of anal sphincter.81 had balloon expulsion test and 44 (54.3%) failed the test. 62 (52.1%) patients had defecatory disorder while the rest 57 (47.9%) didn’t.2. Laxative therapy was completely effective for 18 (14.1%) patients, partial effective for 95 (74.2%)patients and had no effect on 15 (11.7%)patients. After therapy, all symptoms of constipation had great improved (P<0.05)3. There was no difference in effectiveness of laxative therapy between patients with or without defecatory disorder. Straining, lumpy or hard stools, sensation of anorectal obstruction or blockage, loose stools rarely present without the use of laxatives, bowel frequency, straining effort, defecation time and Bristol score had great improved in defecatory disorder patients.4. Drinking history (OR=0.150,95%CI 0.039-0.663, P=0.012) and slow transit constipation (OR=0.234,95%CI 0.085-0.645, P=0.005) predicted poor efficacy of laxative therapy. Symptoms of constipation, results of anorectal manometry and balloon expulsion test had no prediction for the effectiveness of laxative therapy (P>0.05)5.25 patients reexamined anorectal manometry. Their anal sphincter defecating pressure had decreased after therapy (before:61.76+20.96mmHg vs after:60.94± 16.73mmHg, P=0.011)Conclusion:1. Laxative therapy significantly improved symptoms of constipation.2. Drinking history and slow transit constipation predicted poor efficacy of laxative therapy.3. Laxative therapy reduced anal sphincter defecating pressure. |
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