Profil klinis pasien dengan gejala gangguan motilitas predominan konstipasi di unit endoskopi gastrointestinal rumah sakit tersier

Godfried Erycesar Yeremia Saragih; I Dewa Nyoman Wibawa; I Ketut Mariadi; Gde Somayana

doi:10.15562/ism.v12i1.855

Profil klinis pasien dengan gejala gangguan motilitas predominan konstipasi di unit endoskopi gastrointestinal rumah sakit tersier

Godfried Erycesar Yeremia Saragih ,

I Dewa Nyoman Wibawa ,

I Ketut Mariadi ,

Gde Somayana ,

PDF |
DOI: https://doi.org/10.15562/ism.v12i1.855 |
Published: 2021-04-22

Abstract

Background: Investigating constipation requires careful evaluation of general examinations cascaded into specifics to identify treatable or significant causes for early detection. This study aims to determine patients' clinical profile with symptoms of motility disorders, predominantly constipation, in the gastrointestinal endoscopy unit of the tertiary hospital.

Methods: This descriptive cross-sectional study involved 82 participants collected through consecutive sampling. Patients with predominant constipation symptoms who underwent colonoscopy in Sanglah Hospital Endoscopy Unit from 2017 to 2018 were recruited. Primary data comprising clinical assessments, laboratory test results, and colonoscopy and histopathology interpretation were analyzed accordingly. Constipation and fecal incontinence severity was indicated by Patient Assessment of Constipation – Symptoms (PAC-SYM) and Jorge-Wexner score. Data was analyzed using SPSS version 25 for Windows.

Results: Most of the respondents were male (62.2%). The PAC-SYM and Jorge-Wexner Score were relatively low, with mean values of 2.44±0.73 and 2.18±0.99, respectively. The prevalence of patients initially assessed with chronic constipation (57.32%) remained high (26.83%) despite adjustment being done after colonoscopic exclusion.

Conclusion: Diagnostic challenges of constipation exceeded the exhaustive efforts utilizing extensive diagnostic modalities. Suboptimal treatment would be inevitable in the absence of a good-quality management algorithm.

Latar Belakang: Investigasi konstipasi memerlukan kecermatan dalam mengevaluasi pemeriksaan umum yang berjenjang menjadi spesifik untuk mengidentifikasi kausa yang dapat ditangani atau bermakna terhadap deteksi dini. Penelitian ini bertujuan untuk mengetahui profil klinis pasien dengan gejala gangguan motilitas predominan konstipasi di unit endoskopi gastrointestinal Rumah Sakit Tersier.

Metode: Penelitian deskriptif potong lintang ini melibatkan 82 responden yang dikumpulkan melalui pengambilan sampel secara konsekutif. Pasien dengan gejala dominan konstipasi yang menjalani kolonoskopi di Unit Endoskopi RSUP Sanglah selama tahun 2017 hingga 2018 direkrut. Data primer yang terdiri dari penilaian klinis, hasil tes laboratorium, dan interpretasi kolonoskopi maupun histopatologi dianalisis. Tingkat keparahan konstipasi dan inkontinensia feses ditunjukkan pada skor Patient Assessment of Constipation – Symptoms (PAC-SYM) dan Jorge-Wexner. Data dianalisis menggunakan SPSS versi 25 untuk Windows.

Hasil: Sebagian besar atau responden berjenis kelamin laki-laki (62,2%). Skor PAC-SYM dan Jorge-Wexner relatif rendah dengan nilai rata-rata masing-masing 2,44±0,73 dan 2,18±0,99. Prevalensi pasien yang awalnya dinilai dengan konstipasi kronis (57,32%) tetap tinggi (26,83%) meskipun penyesuaian dilakukan setelah eksklusi kolonoskopi.

Simpulan: Tantangan diagnostik konstipasi melebihi upaya maksimal dengan memanfaatkan modalitas diagnostik yang luas. Terapi yang kurang optimal tidak dapat dihindari jika tidak ada algoritma manajemen yang berkualitas baik.

References

Di Lorenzo C, Youssef NN. Diagnosis and management of intestinal motility disorders. Semin Pediatr Surg. 2010;19(1):50-58.
Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179-1187.e3.
Keller J, Bassotti G, Clarke J, Dinning P, Fox M, Grover M, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol. 2018;15(5):291-308.
Curtin B, Jimenez E, Rao SSC. Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders. J Neurogastroenterol Motil. 2020;26(4):423-436.
Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46.
Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018;97(20):e10631.
Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016:S0016-5085(16)00222-5.
Frank L, Kleinman L, Farup C, Taylor L, Miner P Jr. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol. 1999;34(9):870-877.
Neri L, Conway PM, Basilisco G; Laxative Inadequate Relief Survey (LIRS) Group. Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation. Qual Life Res. 2015;24(7):1597-1605.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77-97.
Müller-Lissner S. The pathophysiology, diagnosis, and treatment of constipation. Dtsch Arztebl Int. 2009;106(25):424-432.
Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, Fried M. Diagnosis and treatment of chronic constipation--a European perspective. Neurogastroenterol Motil. 2011;23(8):697-710.
Shin JE, Jung HK, Lee TH, Jo Y, Lee H, Song KH, et al. Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition. J Neurogastroenterol Motil. 2016;22(3):383-411.
Tian H, Ding C, Gong J, Ge X, McFarland LV, Gu L, et al. An appraisal of clinical practice guidelines for constipation: a right attitude towards to guidelines. BMC Gastroenterol. 2016;16(1):52.
Singh S, Bajorek B. Defining 'elderly' in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada). 2014;12(4):489.
Kanasi E, Ayilavarapu S, Jones J. The aging population: demographics and the biology of aging. Periodontol 2000. 2016;72(1):13-18.
Seong MK, Jung SI, Kim TW, Joh HK. Comparative analysis of summary scoring systems in measuring fecal incontinence. J Korean Surg Soc. 2011;81(5):326-331.
Neri L, Basilisco G, Corazziari E, Stanghellini V, Bassotti G, Bellini M, et al. Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation. United European Gastroenterol J. 2014;2(2):138-47.
Yiannakou Y, Tack J, Piessevaux H, Dubois D, Quigley EMM, et al. The PAC-SYM questionnaire for chronic constipation: defining the minimal important difference. Aliment Pharmacol Ther. 2017;46(11-12):1103-1111.
Meinds RJ, van Meegdenburg MM, Trzpis M, Broens PM. On the prevalence of constipation and fecal incontinence, and their co-occurrence, in the Netherlands. Int J Colorectal Dis. 2017;32(4):475-483.
Andy UU, Harvie HS, Pahwa AP, Markland A, Arya LA. The relationship between fecal incontinence, constipation and defecatory symptoms in women with pelvic floor disorders. Neurourol Urodyn. 2017;36(2):495-498.
Krogh K, Chiarioni G, Whitehead W. Management of chronic constipation in adults. United European Gastroenterol J. 2017;5(4):465-472.
Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. Pediatric Health Med Ther. 2017;8:19-27.
Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015;61(2):152-158.
De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastroenterol. 2015;15:130.
Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10:919-930.
ASGE Standards of Practice Committee, Cash BD, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA, et al. The role of endoscopy in the management of constipation. Gastrointest Endosc. 2014;80(4):563-565.

[1] Di Lorenzo C, Youssef NN. Diagnosis and management of intestinal motility disorders. Semin Pediatr Surg. 2010;19(1):50-58.

[2] Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179-1187.e3.

[3] Keller J, Bassotti G, Clarke J, Dinning P, Fox M, Grover M, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol. 2018;15(5):291-308.

[4] Curtin B, Jimenez E, Rao SSC. Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders. J Neurogastroenterol Motil. 2020;26(4):423-436.

[5] Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46.

[6] Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018;97(20):e10631.

[7] Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016:S0016-5085(16)00222-5.

[8] Frank L, Kleinman L, Farup C, Taylor L, Miner P Jr. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol. 1999;34(9):870-877.

[9] Neri L, Conway PM, Basilisco G; Laxative Inadequate Relief Survey (LIRS) Group. Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation. Qual Life Res. 2015;24(7):1597-1605.

[10] Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77-97.

[11] Müller-Lissner S. The pathophysiology, diagnosis, and treatment of constipation. Dtsch Arztebl Int. 2009;106(25):424-432.

[12] Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, Fried M. Diagnosis and treatment of chronic constipation--a European perspective. Neurogastroenterol Motil. 2011;23(8):697-710.

[13] Shin JE, Jung HK, Lee TH, Jo Y, Lee H, Song KH, et al. Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition. J Neurogastroenterol Motil. 2016;22(3):383-411.

[14] Tian H, Ding C, Gong J, Ge X, McFarland LV, Gu L, et al. An appraisal of clinical practice guidelines for constipation: a right attitude towards to guidelines. BMC Gastroenterol. 2016;16(1):52.

[15] Singh S, Bajorek B. Defining 'elderly' in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada). 2014;12(4):489.

[16] Kanasi E, Ayilavarapu S, Jones J. The aging population: demographics and the biology of aging. Periodontol 2000. 2016;72(1):13-18.

[17] Seong MK, Jung SI, Kim TW, Joh HK. Comparative analysis of summary scoring systems in measuring fecal incontinence. J Korean Surg Soc. 2011;81(5):326-331.

[18] Neri L, Basilisco G, Corazziari E, Stanghellini V, Bassotti G, Bellini M, et al. Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation. United European Gastroenterol J. 2014;2(2):138-47.

[19] Yiannakou Y, Tack J, Piessevaux H, Dubois D, Quigley EMM, et al. The PAC-SYM questionnaire for chronic constipation: defining the minimal important difference. Aliment Pharmacol Ther. 2017;46(11-12):1103-1111.

[20] Meinds RJ, van Meegdenburg MM, Trzpis M, Broens PM. On the prevalence of constipation and fecal incontinence, and their co-occurrence, in the Netherlands. Int J Colorectal Dis. 2017;32(4):475-483.

[21] Andy UU, Harvie HS, Pahwa AP, Markland A, Arya LA. The relationship between fecal incontinence, constipation and defecatory symptoms in women with pelvic floor disorders. Neurourol Urodyn. 2017;36(2):495-498.

[22] Krogh K, Chiarioni G, Whitehead W. Management of chronic constipation in adults. United European Gastroenterol J. 2017;5(4):465-472.

[23] Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. Pediatric Health Med Ther. 2017;8:19-27.

[24] Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015;61(2):152-158.

[25] De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastroenterol. 2015;15:130.

[26] Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10:919-930.

[27] ASGE Standards of Practice Committee, Cash BD, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA, et al. The role of endoscopy in the management of constipation. Gastrointest Endosc. 2014;80(4):563-565.

Profil klinis pasien dengan gejala gangguan motilitas predominan konstipasi di unit endoskopi gastrointestinal rumah sakit tersier

Abstract

References

How to Cite

Search Panel