#JustIn: Guidelines For Chronic Constipation Mx in Adults
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#JustIn: Guidelines For Chronic Constipation Mx in Adults

#Indian Society of Gastroenterology #Indian Motility and Functional Diseases Association #2019

In a recently released guidance document, the Indian Motility and Functional Diseases Association (IMFDA) and the Indian Society of Gastroenterology (ISG) have released evidence based practice guideline for management of chronic constipation. The guidance document has been recently published in the Indian Journal of Gastroenterology. The guideline is composed of 29 statements that cover epidemiology, clinical presentation, diagnostic criteria, pathophysiology, investigations and treatment. 

The key recommendations are:-

• Constipation should be defined in India by stool forms and patients’ perception rather than by stool frequency
• Detailed clinical evaluation including history and digital rectal examination helps in identifying fecal evacuation disorder
• Alarming features which may necessitate invasive investigations like colonoscopy include:-

- age > 45 years
- visible or occult GI bleed
- family history of colon cancer
- unintended weight loss
- abdominal mass, and fever

Algorithm for diagnosis and treatment of chronic constipation in adults  

Algorithm for diagnosis and treatment of refractory chronic constipation in adults

• Initial treatment of CC should include lifestyle modification and osmotic laxatives
•  Fiber supplement should be avoided if the patient is already on high fiber diet and/or abdominal bloating is a prominent symptom
•  Patients refractory to initial treatment should be investigated for pathophysiological factors like slow colon transit and FED (Fecal Evacuation Disorder)
•  A through rectal examination evaluating resting and squeeze pressure and relaxation during attempted defecation is useful to screen for FED

3 Steps of performing digital rectal examination 

• Multiple test positivity including balloon expulsion test, anorectal manometry, and defecography has better accuracy than a single test for diagnosis of FED
• The top-down approach may be preferred in selected patients with CC in the open healthcare system of India, particularly in the tertiary care environment
• Drugs stimulating colonic motility should be preferred for management of slow transit constipation
• Biofeedback should be the initial treatment for FED
• Surgery should be reserved for patients with refractory CC with specific functional and or structural abnormalities
• Psychological evaluation must be performed before surgical treatment

The Indian Motility and Functional Diseases Association was formed at the Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, in May 2011. For the current consensus activity, which is the first such activity by the Association, the major gastroenterology society of the country, Indian Society of Gastroenterology has also joined hands to undertake this consensus.

Note: This list is a brief compilation of some of the key recommendations included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/2BQw3 

About Author
Dr. Prachi Chhimwal
Dr. Prachi Chhimwal is an Editor at PlexusMD and is a part of the Engagment Team. She curates the Technical Content posted daily on the news feed. She graduated from Army College of Dental Sciences (B.D.S) and went on to pursue her post-graduation (M.D.S) in Oral & Maxillofacial Pathology. After a decade in the field of dentistry she took a leap of faith and joined PlexusMD. A badminton enthusiast, when not working you can find her reading, Netflixing or enjoying stand-up comedy shows.
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