Characteristics of Korean Patients with Constipation Who Visited a Tertiary Referral Center / 대한내과학회지

BACKGROUND/AIMS: Korean patients with constipation have differences, both among themselves and as compared to other populations, with regard to race, diet, and cultural factors and are expected to have different characteristics to those of western patients, but few studies have been conducted in this regard. We evaluated the epidemiological and physiological characteristics of patients with constipation who visited a tertiary referral center. METHODS: A total of 338 patients with constipation were included. They completed a questionnaire and took physiological tests such as defecography, colon transit time, and anorectal manometry. We classified the types of constipation according to the physiological tests and analyzed the results. RESULTS: The mean age of the study patients was 53.8 +/- 16.3 years and 42.3% of the patients were > or = 60 years old. Patients who had tried folk remedies reached 64.3%. Among the self-reported patients with constipation, 89.1% satisfied the Rome III criteria for constipation. However, 84% of the patients who did not satisfy the criteria showed abnormal results on the physiological tests. Patients with normal transit constipation, slow transit constipation, and dyssynergic defecation were 21%, 27%, and 29% of the all patients, respectively. Rectal hyposensitivity was found in 16.9% of patients and 25% of them revealed anatomic abnormalities on defecography. CONCLUSIONS: Korean patients with constipation have a tendency to delay an accurate diagnosis and treatment and to use folk remedies. As physiological tests for patients with constipation who visited a tertiary hospital showed a relatively high rate of abnormal results, such as dyssynergic defecation and anatomic problems, active physiological evaluations should be considered for such patients.

A Case of Isolated Ileal Ganglioneuroma

Ganglioneuromas of the gastrointestinal tract are rare, but have an established association with genetic disorders, such as the multiple endocrine neoplasia (MEN) syndrome (type 2b) and neurofibromatosis (type 1). However, solitary ganglioneuromas are not associated with an increased risk for MEN 2b, neurofibromatosis type 1, or any other systemic conditions. Ganglioneuromas of the gastrointestinal tract have been reported to predominantly involve the colon and rectum, and are thereby occasionally detected during colonoscopy or surgery. Although there are no characteristic symptoms of solitary ganglioneuromas, symptoms can be induced by solitary ganglioneuromas, such as abdominal pain, bleeding, or obstruction, depending on the location and size. Herein we report a case of a solitary ganglioneuroma of the ileum. A 34-year-old man sought evaluation at our hospital for anemia. The medical and family histories were benign and there was no history of genetic disorders. The evaluation for anemia revealed iron-deficiency anemia and CT enterography revealed a single mass in the ileum. Laparoscopic resection of the lesion was performed and the pathologic examination confirmed an ileal ganglioneuroma.

A Case of Isolated Ileal Ganglioneuroma

Ganglioneuromas of the gastrointestinal tract are rare, but have an established association with genetic disorders, such as the multiple endocrine neoplasia (MEN) syndrome (type 2b) and neurofibromatosis (type 1). However, solitary ganglioneuromas are not associated with an increased risk for MEN 2b, neurofibromatosis type 1, or any other systemic conditions. Ganglioneuromas of the gastrointestinal tract have been reported to predominantly involve the colon and rectum, and are thereby occasionally detected during colonoscopy or surgery. Although there are no characteristic symptoms of solitary ganglioneuromas, symptoms can be induced by solitary ganglioneuromas, such as abdominal pain, bleeding, or obstruction, depending on the location and size. Herein we report a case of a solitary ganglioneuroma of the ileum. A 34-year-old man sought evaluation at our hospital for anemia. The medical and family histories were benign and there was no history of genetic disorders. The evaluation for anemia revealed iron-deficiency anemia and CT enterography revealed a single mass in the ileum. Laparoscopic resection of the lesion was performed and the pathologic examination confirmed an ileal ganglioneuroma.

Clinical Characteristics of Constipation with Hypothyroidism

BACKGROUND/AIMS: Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. METHODS: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. RESULTS: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). CONCLUSIONS: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function.

Clinical Characteristics of Constipation with Hypothyroidism

BACKGROUND/AIMS: Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. METHODS: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. RESULTS: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). CONCLUSIONS: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function.

The Efficacy of Bedside Colonoscopy for Critically Ill Patients with Acute Lower Gastrointestinal Hemorrhage

BACKGROUND/AIMS: Most studies on acute gastrointestinal (GI) hemorrhage of intensive care unit (ICU) patients have focused on upper GI hemorrhage (UGIH), but reports on acute lower GI hemorrhage (LGIH) with the role of bedside colonoscopy are still lacking. Therefore, we determined the clinical characteristics of acute LGIH in ICU patients and the efficacy of bedside colonoscopy in ICU setting. METHODS: We reviewed the medical records of 76 ICU patients who underwent bedside colonoscopy for acute LGIH between January 2005 and December 2007. The clinical characteristics of the patients, the outcomes of colonoscopy, and the clinical course after colonoscopy were investigated. RESULTS: Of 76 patients, 43 patients (56.6%) were males and the median age was 67 years. End-stage renal diseases were the most common underlying diseases, followed by cardiovascular diseases. Cecal intubation was possible in 18 patients (23.7%) and bleeding foci were identified in 41 patients (53.9%). The two main causes of bleeding were rectal ulcers (48.8%) and ischemic colitis (22.0%). Endoscopic treatments were successful in 12 patients (15.8%), and there was only 1 case of rebleeding after 7 days. There were no severe complications associated with bedside colonoscopy; 3 patients (3.9%) died of uncontrolled LGIH during hospital period. CONCLUSIONS: Bedside colonoscopy is effective and safe for the diagnosis of acute LGIH in ICU patients. In addition, endoscopic treatment can be successfully performed in select patients. Therefore, in acute LGIH of ICU patients, bedside colonoscopy can be performed as a first-line procedure.

The Efficacy of Bedside Colonoscopy for Critically Ill Patients with Acute Lower Gastrointestinal Hemorrhage

BACKGROUND/AIMS: Most studies on acute gastrointestinal (GI) hemorrhage of intensive care unit (ICU) patients have focused on upper GI hemorrhage (UGIH), but reports on acute lower GI hemorrhage (LGIH) with the role of bedside colonoscopy are still lacking. Therefore, we determined the clinical characteristics of acute LGIH in ICU patients and the efficacy of bedside colonoscopy in ICU setting. METHODS: We reviewed the medical records of 76 ICU patients who underwent bedside colonoscopy for acute LGIH between January 2005 and December 2007. The clinical characteristics of the patients, the outcomes of colonoscopy, and the clinical course after colonoscopy were investigated. RESULTS: Of 76 patients, 43 patients (56.6%) were males and the median age was 67 years. End-stage renal diseases were the most common underlying diseases, followed by cardiovascular diseases. Cecal intubation was possible in 18 patients (23.7%) and bleeding foci were identified in 41 patients (53.9%). The two main causes of bleeding were rectal ulcers (48.8%) and ischemic colitis (22.0%). Endoscopic treatments were successful in 12 patients (15.8%), and there was only 1 case of rebleeding after 7 days. There were no severe complications associated with bedside colonoscopy; 3 patients (3.9%) died of uncontrolled LGIH during hospital period. CONCLUSIONS: Bedside colonoscopy is effective and safe for the diagnosis of acute LGIH in ICU patients. In addition, endoscopic treatment can be successfully performed in select patients. Therefore, in acute LGIH of ICU patients, bedside colonoscopy can be performed as a first-line procedure.