便秘的诊断与治疗：来自BMJ Best Practice的专业指南

便秘的诊断与治疗：来自BMJ Best Practice的专业指南

便秘是一种常见的消化系统疾病，其症状包括排便次数减少、排便困难、粪便干结等。本文将从定义、诊断到治疗，全方位解析便秘这一疾病，帮助读者更好地了解和应对这一健康问题。

小结

便秘最初需通过详细的病史采集和体格检查（包括直肠指检）评估。诊断评估包括结肠镜（如需要）结肠传输试验、肛门直肠测压以及气囊排出检查。基础治疗包括生活方式调节和使用泻药。治疗方案应该根据基础病因而制定。如果药物治疗对便秘无效，则患者可能需要接受针对盆底功能障碍的专业评估，并进行生物反馈治疗。仅在极少数情况下才需要进行手术。

定义

慢性便秘是具有多种症状的异质性疾病。患者基于排便特别费力、排便不尽感、排便失败或时间延长、粪便干结以及少数情况下根据每周排便的次数定义便秘。

美国胃肠病学会将便秘定义为排便不满意，特征为排便次数减少、排便困难或者同时有排便次数减少和排便困难。

本专题重点探讨成人原发性便秘（急性：＜3 个月和慢性：≥3 个月）及阿片类药物诱发的便秘。与肠易激综合征相关的便秘，请参阅“肠易激综合征”。另请参阅“儿童便秘”。

病史和体格检查

关键诊断因素

• 存在的危险因素
• 排便次数减少
• 排便困难
• 排便不尽感
• 特别费力

其他诊断因素

• 粪便干结
• 腹部肿块
• 提示潜在疾病的体征
• 肛门直肠病变
• 直肠指检（DRE）异常

危险因素

• 女性
• 年龄＞65 岁
• 非洲人血统
• 社会经济状况较差
• 家族史
• 久坐不动的生活方式
• 低纤维摄入
• 热量摄入不足
• 液体摄入不足
• 外科手术及分娩
• 诱发便秘的药物

诊断性检查

首要检查

• 全血细胞计数 (FBC)
• 甲状腺功能检测
• 血清电解质、钙和镁
• 血糖
• 粪便免疫化学定量检测
• 腹部 X 线检查
• 钡灌肠

需考虑的检查

• 钡剂排粪造影
• 磁共振排便粪造影
• 结肠镜检查
• 结肠传输试验
• 肛门直肠测压
• 气囊排出检查
• 结肠测压

治疗流程

• 急症处理
• 阿片类药物诱导的
• 非阿片类药物诱发：症状持续时间＜3 个月
• 持续性治疗
• 非阿片类药物诱发：症状持续时间≥3 个月
• 怀疑存在协同障碍或药物治疗无效

作者

Satish Rao, MD, PhD, FRCP (Lon), FACG, AGAF

Professor of Medicine
Chief, Section of Gastroenterology and Hepatology
Director, Digestive Health Center and Neurogastroenterology and GI Motility
Medical College of Georgia
Georgia Regents University
Augusta
GA

利益声明
SR serves on the advisory board for Vibrant Limited, Sanofi Pharmaceuticals, Viatris Pharmaceuticals, and Takeda Pharmaceuticals of North America. SR is an author of a number of references cited in this topic.

Dariush Shahsavari, MD
Senior Gastroenterology Fellow
Internal Medicine, Division of Gastroenterology/Hepatology
Augusta University
Augusta
GA

利益声明
DS declares that he has no competing interests.

鸣谢
Dr Satish Rao and Dr Dariush Shahsavari would like to gratefully acknowledge Dr Amol Sharma, Dr Humberto Sifuentes, and Dr Ashok Attaluri, previous contributors to this topic.

利益声明
AS declares that he is on the advisory board for Ironwood Pharmaceuticals. HS declares that he has no competing interests. AA is an author of one reference cited in this topic.

同行评议者

Stefan Muller-Lissner, MD
Professor
Abteilung fur Innere Medizin
Park-Klinik Weissensee
Berlin
Germany

利益声明
SML declares that he has no competing interests.

Eamonn M.M. Quigley, MD, FRCP, FACP, FACG, FRCPI
Professor of Medicine and Human Physiology
Department of Medicine
Clinical Sciences Building
Cork University Hospital
Cork
Ireland

利益声明
EMMQ has served as a consultant or on advisory boards for the following companies: Sucampo, Movetis, Norgine, Procter and Gamble, Boehringer Ingelheim, Reckitts Benckiser, Schering, Novartis, Salix, Ironwood, and McNeill Consumer Health and has been paid for his time involved. EMMQ is an author of several references cited in this topic.

Ned Snyder, MD
Chief of Gastroenterology and Hepatology
Kelsey-Seybold Clinic
Adjunct Professor of Medicine
University of Texas Medical Branch
Houston
TX

利益声明
Not disclosed.

本文原文来自BMJ Best Practice