변비의 치료
Treatment of Constipation
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참고문헌
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초록
변비는 비교적 흔한 질환이며 특히 노인과 여성에서 더 흔하다. 변비를 일으키는 뚜렷한 원인이 있는 이차성 변비는 그 원인에 대한 치료를 시행하게 되지만 원인이 불분명한 경우는 변비 증상의 완화를 위하여 여러 가지 방법으로 치료하게 된다. 우선 생활 습관의 변화나 고섬유소 식이 및 운동 등의 보존적 요법을 먼저 시도해 보고 이에 반응이 없는 경우에 약물치료를 시도하게 된다. 변비에 사용되는 하제는 여러 가지 종류가 있으며 작용기전도 서로 중첩되어 있기도 하다. 약제 투여에 대한 명확한 지침은 아직 없는 실정이며 임상의들은 경험적으로 단일 혹은 병용 처방을 하게 된다. 비약물적 치료와 약물치료에 반응이 없는 변비에 대해서는 대장 및 항문직장의 기능검사를 시행하여 아형으로 분류하여 적절하게 치료한다. 골반저기능부전이 동반된 변비 환자에서는 바이오피드백 요법이 도움이 된다. 이러한 치료에 반응이 없는 난치성 변비에 대하여 외과적 치료를 고려한다. 변비 치료로서 새로운 약제와 외과적 치료 방법들이 다각도로 연구가 활발히 이루어지고 있으며 일선 임상에서 더욱 더 효과적으로 변비 치료에 이용될 수 있기를 기대한다.
Abstract
Constipation is a common gastrointestinal disease affecting approximately 16.5% of the population in Korea. Systemic diseases such as hypothyroidism or colon cancer and drugs can cause constipation in some patients with constipation, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. Evaluation for secondary causes of constipation is needed to provide appropriate management. Once secondary causes have been excluded, constipation may be classified into normal or slow transit constipation, evacuation disorder of the spastic or flaccid varieties, or both. Treatment of chronic constipation based on the underlying pathophysiology is generally successful. The aims of this review are to discuss the management of functional constipation based on guidelines for the treatment of constipation published in Korean Journal of Gastroenterology in 2011: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents such as 5-hydroxytryptamine-4 receptor agonists, intestinal secretagogues, and peripheral opioid antagonists could be effective in patients with constipation who cannot get adequate relief from current laxatives. Biofeedback could relieve symptoms in selected patients with constipation due to pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation. (Korean J Med 2011;80:510-523)
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