The impact of laxative use upon symptoms in patients with proven slow transit constipation

<p>Abstract</p> <p>Background</p> <p>Constipation severity is often defined by symptoms including feelings of complete evacuation, straining, stool frequency and consistency. These descriptors are mostly obtained in the absence of laxative use. For many constipated patients laxative usage is ubiquitous and long standing. Our aim was to determine the impact of laxative use upon the stereotypic constipation descriptors.</p> <p>Methods</p> <p>Patients with confirmed slow transit constipation completed 3-week stool diaries, detailing stool frequency and form, straining, laxative use and pain and bloating scores. Each diary day was classified as being under laxative affect (laxative affected days) or not (laxative unaffected days). Unconditional logistic regression was used to assess the affects of laxatives on constipation symptoms.</p> <p>Results</p> <p>Ninety four patients with scintigraphically confirmed slow transit constipation were enrolled in the study. These patients reported a stool frequency of 5.6 ± 4.3 bowel motions/week, only 21 patients reported <3 bowel motions/week. Similarly, 21 patients reported a predominant hard stool at defecation. The majority (90%) of patients reported regular straining. A regular feeling of complete evacuation was reported in just 7 patients. Daily pain and/or bloating were reported by 92% of patients. When compared with laxative unaffected days, on the laxative affected days patients had a higher stool frequency (OR 2.23; <it>P </it><0.001) and were more likely to report loose stools (OR 1.64; <it>P </it><0.009). Laxatives did not increase the number of bowel actions associated with a feeling of complete evacuation. Laxative use had no affect upon straining, pain or bloating scores</p> <p>Conclusions</p> <p>The reporting of frequent and loose stools with abdominal pain and/or bloating is common in patients with slow transit constipation. While laxative use is a significant contributor to altering stool frequency and form, laxatives have no apparent affect on pain or bloating or upon a patients feeling of complete evacuation. These factors need to be taken into account when using constipation symptoms to define this population.</p

Oesophageal involvement in the course of systemic diseases

L'atteinte oesophagienne est possible au cours des maladies systémiques qui se caractérisent par l'atteinte de plusieurs organes ou tissus. La dysphagie s'explique le plus souvent par des troubles moteurs (altération du péristaltisme oesophagien, baisse de la pression du sphincter inférieur et/ou du sphincter supérieur, au maximum tableau manométrique d'achalasie) mais aussi par des lésions en rapport avec un reflux gastro-oesophagien généralement sévère. Dans certains cas, tels que la sclérodermie ou le syndrome de Sjôgren, l'atteinte oesophagienne est quasi constante et prédominante. Elle peut être même isolée. Dans d'autres (lupus, amylose), elle s'intègre à une atteinte digestive plus diffuse. La dysphagie, le plus souvent basse, peut être un symptôme majeur, précoce et parfois révélateur ou, au contraire, un symptôme qui survient tardivement dans l'évolution, témoignant d'une maladie évoluée. Certains traitements comme les AINS ou la D-Penicillamine peuvent jouer un rôle aggravant