Constipação

A terapia medicamentosa é bastante eficaz no alívio dos sintomas de constipação.[116]American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S1-4. http://www.ncbi.nlm.nih.gov/pubmed/16008640?tool=bestpractice.com Em estudos controlados randomizados bem projetados, a terapia medicamentosa mostrou ter um ganho terapêutico de 10% a 30% sobre placebo.[66]Barish CF, Drossman D, Johanson JF, et al. Efficacy and safety of lubiprostone in patients with chronic constipation. Dig Dis Sci. 2010 Apr;55(4):1090-7. http://www.ncbi.nlm.nih.gov/pubmed/20012484?tool=bestpractice.com [74]Quigley EM, Vandeplassche L, Kerstens R, et al. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation - a 12-week, randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2009 Feb 1;29(3):315-28. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2008.03884.x/full http://www.ncbi.nlm.nih.gov/pubmed/19035970?tool=bestpractice.com ​​​[117]Müller-Lissner S, Rykx A, Kerstens R, et al. A double-blind, placebo-controlled study of prucalopride in elderly patients with chronic constipation. Neurogastroenterol Motil. 2010;22:991-998. http://www.ncbi.nlm.nih.gov/pubmed/20529205?tool=bestpractice.com ​​[118]Mueller-Lissner S, Kamm MA, Wald A, et al. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipation. Am J Gastroenterol. 2010;105:897-903. http://www.ncbi.nlm.nih.gov/pubmed/20179697?tool=bestpractice.com [119]Lembo AJ, Kurtz CB, Macdougall JE, et al. Efficacy of linaclotide for patients with chronic constipation. Gastroenterology. 2010;138:886-895. http://www.ncbi.nlm.nih.gov/pubmed/20045700?tool=bestpractice.com ​ A terapia de biofeedback é efetiva em 60% a 80% dos pacientes com dissinergia.[92]Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007 Mar;5(3):331-8. http://www.ncbi.nlm.nih.gov/pubmed/17368232?tool=bestpractice.com [94]Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006 Mar;130(3):657-64. http://www.ncbi.nlm.nih.gov/pubmed/16530506?tool=bestpractice.com ​​​​[93]Heymen S, Wexner SD, Vickers D, et al. Prospective, randomized trial comparing for biofeedback techniques for patients with constipation. Dis Colon Rectum. 1999 Nov;42(11):1388-93. http://www.ncbi.nlm.nih.gov/pubmed/10566525?tool=bestpractice.com ​​[120]Enck P, Van der Voort IR, Klosterhalfen S. Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil. 2009;21:1133-1141. http://www.ncbi.nlm.nih.gov/pubmed/19566591?tool=bestpractice.com ​ Da mesma forma, a cirurgia pode melhorar os sintomas em cerca de 50% a 65% dos pacientes com constipação refratária.[99]Lees NP, Hodson P, Hill J, et al. Long-term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis. 2004 Sep;6(5):362-8. http://www.ncbi.nlm.nih.gov/pubmed/15335371?tool=bestpractice.com ​​[100]Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg. 1991 Oct;214(4):403-11. http://www.ncbi.nlm.nih.gov/pubmed/1953096?tool=bestpractice.com ​[121]Nyam DC, Pemberton JH, Ilstrup DM, et al. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40:273-279. http://www.ncbi.nlm.nih.gov/pubmed/9118740?tool=bestpractice.com