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Clinical Research: Constipation Sections
Author Biography
Introduction
What is constipation?
Understanding the problem
Objective Measurement
Subjective Measurement
Currently Selected Section: Measuring Components
Precipitating Factors
Therapeutic Comparisons
Research Questions
Conclusion




Chapter 3: Methods for Clinical Research in Constipation: Measuring Compnents - Slow Transit vs. Evacuation Delay
          

Problem 6.1

Case study: Subjective symptoms and objective measures

In a study (Mertz, Naliboff and Mayer, 1999), 108 constipated patients completed questionnaires eliciting the symptoms they associated with constipation. Factor analysis of the symptoms was performed and the results correlated with the findings of:

  • Transit time assessment
  • Anorectal manometry, and
  • Rectal sensory testing.

The attempt was made to identify symptom clusters that would identify either:

  • Delayed transit
  • Pelvic floor dysfunction, or
  • Irritable bowel syndrome.

It proved possible to identify symptoms of:

  • Slow transit (infrequent stools, lack of urge to defecate), and
  • Irritable bowel syndrome (recurrent abdominal pain relieved by defecation, abdominal distension, an irregular pattern of defecation).

Question 6.1.1

However, no symptoms proved specific for those who had anorectal dysfunction, or for those 26% of the total who had no detectable physiological abnormality. What conclusion would you draw from the results summarized from the paper by Mertz et al.?

Selection AA careful history in cases of constipation makes objective measures of bowel function largely redundant.
Selection BWe can identify groups of symptoms that are highly suggestive of certain gut disorders, but there remain conditions which only physiological investigation will elucidate.
Selection CSubjective symptoms are too variable to be worth taking into account in the assessment of chronic constipation, which must be investigated methodically by an array of accepted tests of intestinal and rectal function.

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