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변비의 진단과 치료

Diagnosis and Treatment of Constipation

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초록

변비는 비교적 흔한 질환으로 여성 및 노인에서 더 흔하다. 변비의 진단에 있어 자세한 문진과 신체 검진이 중요하다. 경고 증상을 보이는 환자의 경우 반드시 기질적 질환을 배제하기 위한 검사 시행이 필요하다. 변비의 원인이 기능성으로 추정되는 경우, 비약물적 치료와 약물치료에 반응이 없는 경우에 병태 생리 규명 및 치료 방침을 결정하기 위해 대장항문 기능 검사 및 대장 통과시간 측정이 필요하다. 먼저 보존적 요법을 시도해 보고 반응이 없는 경우에 약물 치료를 시도한다. 약제 투여에 대한 명확한 지침은 아직 없으며 경험적으로 단일 혹은 병용 처방을 하게 된다. 골반저기능부전이 동반된 변비 환자는 바이오피드백요법이 도움이 된다. 이러한 치료에 반응이 없는 난치성 변비에 대하여 외과적 치료를 고려 한다.

Abstract

Constipation is a common condition affecting approximately 16.5% of population in Korea. Evaluation of constipation should be done with a history and physical examination at first. In patients with alarm sign, blood test, radiography or colonoscopy should be considered. Additionally, for defining the pathophysiology and treatment of severe constipation, physiologic studies are needed. Treatment of constipation based on the pathophysiology is generally successful. Exercise and fiber are helpful in some patients with constipation. The laxative including osmotic agent, stimulant laxatives and stool softer have been shown to be more effective than placebo at relieving symptoms of constipation. Traditional laxatives are not tolerated and are not effective in all patients with constipation. Promising drug classes, new enterokinetic agents such as 5-hydroxytyptamine-4 receptor agonists and chloride channel activators could be effective in patients with severe constipation. Biofeedback could relieve symptoms in selected patients with pelvic floor dysfunction and severe constipation. Surgical treatment could be helpful in carefully selected patients with refractory constipation. (Korean J Med 2012;83:568-579)

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