[The Latin-American Consensus on Chronic Constipation].
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.
Schmulson Wasserman
Max
M
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
Francisconi
Carlos
C
Olden
Kevin
K
Aguilar Paíz
Luis
L
Bustos-Fernández
Luis
L
Cohen
Henry
H
Passos
Maria Carmo
MC
González-Martínez
Marina Alejandra
MA
Iade
Beatriz
B
Iantorno
Guido
G
Ledesma Ginatta
Carlos
C
López-Colombo
Aurelio
A
Pérez
Cesar Louis
CL
Madrid-Silva
Ana María
AM
Quilici
Flavio
F
Quintero Samudio
Isaac
I
Rodríguez Varón
Alberto
A
Suazo
Jorge
J
Valenzuela
Jorge
J
Zolezzi
Alberto
A
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
D004043:Dietary Fiber; D054368:Laxatives; D017366:Serotonin Receptor Agonists