title: [The Latin-American Consensus on Chronic Constipation].
abstract: The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review of the literature published in the previous 10 years, since 1995. Seventeen members participated with the support of their local gastroenterology societies. The members reviewed the different subjects based on the levels of evidence and grades of recommendation; the topics were then discussed in a plenary session. A written report was drafted and the coordinators prepared the final declarations to be submitted to a vote by all the members in October 2006. The consensus concluded that chronic constipation has an estimated prevalence of 5-21% in the region, with a female-to-male ratio of 3:1. Among individuals with constipation, 75% use some type of medication, with more than 50% using home remedies. A diagnosis based on Rome Criteria was recommended and diagnostic testing only in persons older than 50 years or with alarm symptoms. The use of barium enema as an initial investigation was recommended only in countries with a high prevalence of idiopathic megacolon or Chagas' disease. Recommendations on treatment included an increase in dietary fiber of up to 25-30 g/day (grade C). No evidence was found to recommend measures such as exercise, increased water intake, or frequent visits to the toilet. Fiber supplements such as Psyllium received a grade B and pharmacological treatments such as tegaserod and polyethylene glycol, both grade A. There was insufficient evidence to recommend lactulose, but the consensus did not disadvise its use when necessary. Complementary investigations such as colonic transit followed by anorectal manometry and defecography were only recommended to rule out colonic inertia and/or obstructive defecation in patients not responding to treatment. Biofeedback was recommended (grade B) for those with pelvic dyssynergia.
authors.affiliation: Laboratorio de Hígado, Páncreas y Motilidad (HIPAM). Departamento de Medicina Experimental. Facultad de Medicina. Universidad Nacional Autónoma de México (UNAM). Hospital General de México. México. maxjulio@avantel.net
authors.forename: Max
authors.initials: M
authors.lastname: Schmulson Wasserman
authors.forename: Carlos
authors.initials: C
authors.lastname: Francisconi
authors.forename: Kevin
authors.initials: K
authors.lastname: Olden
authors.forename: Luis
authors.initials: L
authors.lastname: Aguilar Paíz
authors.forename: Luis
authors.initials: L
authors.lastname: Bustos-Fernández
authors.forename: Henry
authors.initials: H
authors.lastname: Cohen
authors.forename: Maria Carmo
authors.initials: MC
authors.lastname: Passos
authors.forename: Marina Alejandra
authors.initials: MA
authors.lastname: González-Martínez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Iade
authors.forename: Guido
authors.initials: G
authors.lastname: Iantorno
authors.forename: Carlos
authors.initials: C
authors.lastname: Ledesma Ginatta
authors.forename: Aurelio
authors.initials: A
authors.lastname: López-Colombo
authors.forename: Cesar Louis
authors.initials: CL
authors.lastname: Pérez
authors.forename: Ana María
authors.initials: AM
authors.lastname: Madrid-Silva
authors.forename: Flavio
authors.initials: F
authors.lastname: Quilici
authors.forename: Isaac
authors.initials: I
authors.lastname: Quintero Samudio
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodríguez Varón
authors.forename: Jorge
authors.initials: J
authors.lastname: Suazo
authors.forename: Jorge
authors.initials: J
authors.lastname: Valenzuela
authors.forename: Alberto
authors.initials: A
authors.lastname: Zolezzi
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D003082:Colectomy; D000529:Complementary Therapies; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019841:Defecography; D004043:Dietary Fiber / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis; D007843:Latin America / Q000453:epidemiology; D054368:Laxatives / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015995:Prevalence; D017366:Serotonin Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D004043:Dietary Fiber; D054368:Laxatives; D017366:Serotonin Receptor Agonists