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Auswahl: Veröffentlichungen zu Verstopfung 1999
Diese Liste ist nur eine kleine Auswahl einer Datenbankabfrage bei MEDLINE.
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Pathophysiology of chronic constipation and new
therapy recommendation
Author Stelzner F; Hansen H Address Chirurgisches Zentrum, Universität Bonn. Source
Zentralbl Chir, 1999, 124:9, 804-11
Abstract
Three causes of constipation are known: Chagas' disease, congenital megacolon
(Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be
treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic
chronic constipation, observed manly in females. A frequent cause is the laxative abuse
for many years. The possible etiologic factors are discussed. Based on the fact, that
constipation never occurs in patients with a colostomy, reasons for the development of
chronic idiopathic constipation are presumed in a disturbance in the distal colon and the
anorectum. A possible explanation for the malfunction of defecation could be a different
calibre between the usually tight pelvic colon and the wide rectum. In contrast to the
apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An
additional disorder in the feedback mechanism between continence and defecation could
impede the bowel passage. Because of these observations and thoughts, we performed a deep
resection of the rectum in 18 patients instead of resecting the dilated and elongated
colon. All patients operated that way experienced a major improvement of their bowel
function. Postoperatively the bowel movements were regular and normal.
Language of Publication German Unique Identifier 20011721
MeSH Heading (Major) Constipation|ET/PP/*SU; Rectum|PP/*SU MeSH Heading Adult; Aged;
Case Report; Chronic Disease; Defecation|PH; English Abstract; Female; Hirschsprung
Disease|DI/PP/SU; Human; Male; Megacolon|ET/PP/SU; Middle Age; Treatment Outcome
Publication Type JOURNAL ARTICLE ISSN 0044-409X Country of Publication GERMANY
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Dietary and medicamentous therapy of chronic
constipation
Author Schmidbaur W; Wienbeck M Address III. Medizinische Klinik, Zentralklinikum
Augsburg. Source Zentralbl Chir, 1999, 124:9, 825-32
Abstract
Therapy of constipation is complex. It is mainly based on general rules and treatment with
dietary fibers. If drugs are necessary they should be applied according to the type of
constipation as evidenced by the results of special diagnostic procedures. Some patients
may improve with psychotherapeutic procedures. Surgical treatment should be the last
choice. The aim of therapy is to relieve the patient from his symptoms and achieve a habit
of regular defecation, if possible with only a small amount of laxatives or better without
the application of drugs. Most often a highly individualized therapy is necessary. Many
patients consult their doctor only when they have already a grave problem. Therapy then
becomes difficult. Information on bowel movements and on how to prevent constipation by
the way of living, therefore, should be widely spread in the general population in order
to minimize constipation as a medical problem.
Language of Publication German Unique Identifier 20011724
MeSH Heading (Major) Cathartics|*AD/AE; Constipation|ET/*TH; Dietary Fiber|*AD;
Gastrointestinal Agents|*AD/AE MeSH Heading Chronic Disease; English Abstract; Human;
Patient Education
Publication Type JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL ISSN 0044-409X Country of
Publication GERMANY
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Disorders of intestinal innervation as a possible
cause for chronic constipation
Author Wedel T; Roblick U; Gleiss J; Ott V; Eggers R; Kühnel W; Krammer HJ Address
Institut für Anatomie, Medizinische Universität zu Lübeck. Source Zentralbl Chir, 1999,
124:9, 796-803
Abstract
The gastrointestinal tract contains the largest amount of nerve cells apart from the
central nervous system constituting together with glial cells the enteric nervous system
(ENS). The morphology of the ENS is characterized by intramurally located ganglionated and
non-ganglionated plexus of different structure. The diversity of neurotransmitters
synthesized by the different nerve cell types as well as the complex neuronal circuits
establish the basis for the mediation of a coordinated intestinal motility. Subsequently
abnormalities of the ENS may cause severe constipation. The most acknowledged intestinal
innervation disorder represents aganglionosis (Hirschsprung's disease) characterized by
the absence of intramural nerve cells and the hypertrophy of nerve fiber bundles within
the affected intestinal segment. Non-aganglionic intestinal innervation disorders include
intestinal neuronal dysplasia (IND), hypoganglionosis and heterotopic ganglia. The
pathogenesis of intestinal neuronal malformations is mainly attributed to development
disorders of the ENS, in part caused by genetic defects. Furthermore, the ENS can sustain
damage during the postnatal period by ischemic, inflammatory, autoimmunological processes
or neurotoxic agents. The histopathological diagnosis of intestinal innervation disorders
is achieved by enzyme- and immunohistochemical methods. The examination of the ENS can be
carried out on mucosal, deep submucosal or full-thickness biopsies using serial transverse
sections as well as on intestinal whole-mount preparations allowing a three-dimensional
demonstration and assessment of the intramural plexus. Structural abnormalities of the
myenteric and submucosal plexus and an abnormal content of neurotransmitters have been
considered to be responsible for primary chronic constipation. However, until now no
unified pathophysiological concept has been established due to the partly contradictory
findings. Therefore, an important goal in patients with chronic constipation should be a
detailed quantitative and qualitative assessment of the underlying neurohistopathology.
The correlation of these data with functional parameters of intestinal motility may
represent an useful tool for the differential diagnostic and therapeutic considerations.
Language of Publication German Unique Identifier 20011720
MeSH Heading (Major) Constipation|*ET/PA/PP; Enteric Nervous System|PA/*PP;
Intestines|*IR MeSH Heading Chronic Disease; Diagnosis, Differential; English Abstract;
Hirschsprung Disease|DI/PA/PP; Human
Publication Type JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL ISSN 0044-409X Country of
Publication GERMANY
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Diagnostic evaluation of the rectum and pelvic floor
in chronic constipation
Author Herold A; Müller Lobeck H; Jost WH; Duschka L; Leder D Address Abteilung für
Chirurgie/Koloproktologie, Deutsche Klinik für Diagnostik, Wiesbaden. Source Zentralbl
Chir, 1999, 124:9, 784-95
Abstract
In outlet constipation an exact diagnostic evaluation is always necessary because of the
different etiologies, multiple combinations in primary and secondary lesions and the
number of therapeutic alternatives. Basic diagnostics start with the very important,
structured evaluation of the patient's history, colorectal examination including
inspection, palpation, procto-, recto-, sigmoidoscopy and anorectal manometry. Depending
on the results of this primary evaluation the following methods are indicated:
neurophysiologic evaluation (basic neurological examination, EMG, PNTML), defecography ev.
including colon contrast enema and gastrointestinal transit time studies. If the complete
problem could not be ruled out till that point, the following examinations might be
helpful: dynamic pelvic floor MRI, anorectal endosonography, rectal motility studies,
fecoflowmetry, colonoscopy, urological und gynecological examinations.
Language of Publication German Unique Identifier 20011719
MeSH Heading (Major) Constipation|*ET/PP; Intestinal Obstruction|*DI/ET/PP; Pelvic
Floor|*PP; Rectal Diseases|*DI/ET/PP MeSH Heading Adult; Chronic Disease; Diagnosis,
Differential; English Abstract; Female; Human; Male
Publication Type JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL ISSN 0044-409X Country of
Publication GERMANY
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Motility diagnosis in chronic constipation
Author Schiefer B; Stange EF Address Medizinische Klinik I, Medizinische Universität
Lübeck. Source Zentralbl Chir, 1999, 124:9, 775-83
Abstract
Scintigraphy is generally considered as gold-standard for the diagnosis of delayed gastric
emptying. The 13C-acetate and -octanoate breath tests represent an alternative to this
method, which has been extensively validated. Gastric and small bowel manometry are very
important tools for the research of motility disorders. In clinical practice, this method
has only few indications. Sonographic measurement of gastric emptying is a useful
procedure for the diagnosis of delayed gastric emptying, provided that the investigation
is done by an experienced person. It is not clear so far, whether MRI is an alternative to
the methods mentioned above. If delayed gastric emptying is excluded, the H2-lactulose
breath test is a simple screening test for the disorders of small bowel transit. Colonic
transit time can reliably be measured with radiopaque markers. Anorectal disorders are
diagnosed by manometry and defecography. MRI-defecography gives additional information
compared to the conventional defecography. These methods have an important role in the
evaluation of chronic constipation. The rational combination of the displayed methods is
the most appropriate way to approach the patients' problems.
Language of Publication German Unique Identifier 20011718
MeSH Heading (Major) Constipation|DI/*ET/PP; Gastric Emptying|*PH; Gastrointestinal
Motility|*PH MeSH Heading Chronic Disease; Diagnosis, Differential; English Abstract;
Gastrointestinal Transit|PH; Human; Predictive Value of Tests
Publication Type JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL ISSN 0044-409X Country of
Publication GERMANY
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Abnormal colonic endocrine cells in patients with
chronic idiopathic slow-transit constipation.
Author El Salhy M; NorrgÁrd O; Spinnell S Address Dept. of Medicine and Surgery,
University Hospital, UmeÁa, Sweden. Source Scand J Gastroenterol, 1999 Oct, 34:10,
1007-11
Abstract
BACKGROUND: The aim of the present study was to investigate the colonic endocrine
cells in patients with slow-transit constipation, to ascertain the presence of a possible
abnormality. METHODS: Ten patients with chronic slow-transit constipation were
investigated. As controls, macroscopically and histologically normal tissues from the
colon of 12 patients were examined. These patients had polyps, prolapsis, chronic
diverticulitis, volvulus, and haemorrhoids. The endocrine cells were stained by
immunocytochemistry and quantified by computerized image analysis. RESULTS: There were
significantly fewer enteroglucagon- and serotonin-immunoreactive cells in patients with
chronic slow-transit constipation. There was no statistically significant difference
between patients and controls with regard to the number of peptide YY (PYY)-, pancreatic
polypeptide (PP)-, and somatostatin-immunoreactive cells. The cell secretory indexes (CSI)
of enteroglucagon- and somatostatin-immunoreactive cells were significantly decreased.
There was no statistically significant difference in the CSI between the patients and
controls with regard to PYY-, PP-, and serotonin-immunoreactive cells. CONCLUSION: The
changes in colonic endocrine cells in patients with slow-transit constipation may be one
cause of the decreased motility in the colon and consequent development of constipation.
Language of Publication English Unique Identifier 20025195
MeSH Heading (Major) Colon|*PA/PH; Colonic Diseases, Functional|*PA/PP;
Constipation|*PA/PP; Endocrine Cells of Gut|*PA; Gastrointestinal Motility|*PH MeSH
Heading Adult; Aged; Biopsy; Chronic Disease; Female; Human; Image Processing,
Computer-Assisted; Immunohistochemistry; Middle Age; Peptide YY|ME; Serotonin|ME;
Statistics, Nonparametric; Support, Non-U.S. Gov't
Publication Type JOURNAL ARTICLE ISSN 0036-5521 Country of Publication NORWAY
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How to deal with chronic constipation. A stepwise
method of establishing and treating the source of the problem.
Author Wong PW; Kadakia S Address Gastroenterology Service, Brooke Army Medical Center,
San Antonio, Texas 78234, USA. BRBPR@aol.com Source Postgrad Med, 1999 Nov, 106:6,
199-200, 203-4, 207-10
Abstract
Chronic constipation is a common medical complaint encountered often in a primary care
setting. Most patients can be treated successfully with simple measures, including
education, bowel habit training, increased fluid and fiber intake, and use of laxatives.
Chronic constipation is usually considered idiopathic, but secondary causes should be
excluded. In about 1% of patients with severe, intractable constipation, further
diagnostic testing (e.g., endoscopy, colonic transit study) is needed. Patients with
colonic inertia can be treated with judicious use of laxatives, but surgery may be
necessary in a few cases. Patients with outlet inertia should be referred for biofeedback
treatment.
Language of Publication English Unique Identifier 20043311
MeSH Heading (Major) Constipation|CL/ET/*TH MeSH Heading Anus Diseases|CO/TH;
Biofeedback (Psychology); Cathartics|TU; Chronic Disease; Colonic Diseases,
Functional|CO/DT/TH; Colonoscopy; Defecation; Dietary Fiber|TU; Drinking; Gastrointestinal
Motility; Gastrointestinal Transit; Human; Patient Education; Physical Therapy; Rectal
Diseases|CO/TH
Publication Type JOURNAL ARTICLE ISSN 0032-5481 Country of Publication UNITED STATES
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Alterations in colonic anatomy induced by chronic
stimulant laxatives: the cathartic colon revisited.
Author Joo JS; Ehrenpreis ED; Gonzalez L; Kaye M; Breno S; Wexner SD; Zaitman D;
Secrest K Address Department of Colorectal Surgery, Cleveland Clinic Florida, Fort
Lauderdale, USA. Source J Clin Gastroenterol, 1998 Jun, 26:4, 283-6
Abstract
Cathartic colon is a historic term for the anatomic alteration of the colon secondary to
chronic stimulant laxative use. Because some have questioned whether this is a real
entity, we investigated changes occurring on barium enema in patients ingesting stimulant
laxatives. Our study consisted of two parts. In part 1, a retrospective review of
consecutive barium enemas performed on two groups of patients with chronic constipation
(group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was
presented to a radiologist who was blinded to the patient group. A data sheet containing
classic descriptions of cathartic colon was completed for each study. Chronic stimulant
laxative use was defined as stimulant laxative ingestion more than three times per week
for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive
patients who were chronic stimulant laxative users underwent barium enema examination, and
data sheets for cathartic colon were completed by another radiologist (part 2). Colonic
redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2,
23.1%) were frequent radiographic findings in both patient groups and were not
significantly different in the two groups. Loss of haustral folds, however, was a common
finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral
markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of
the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2
(13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon
of 2 (13.3%) patients. Loss of haustra was seen in patients chronically ingesting
bisacodyl, phenolpthalein, senna, and casanthranol. We conclude that long-term stimulant
laxative use results in anatomic changes in the colon characterized by loss of haustral
folds, a finding that suggests neuronal injury or damage to colonic longitudinal
musculature caused by these agents.
Language of Publication English Unique Identifier 98311346
MeSH Heading (Major) Cathartics|*AE/TU; Colon|*DE/RA MeSH Heading Aged; Barium
Sulfate|DU; Case-Control Studies; Constipation|DT/RA; Contrast Media; Enema; Female;
Human; Male; Middle Age; Prospective Studies; Retrospective Studies; Support, Non-U.S.
Gov't; Time Factors
Publication Type JOURNAL ARTICLE ISSN 0192-0790 Country of Publication UNITED STATES
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