- 小儿细胞外胆固醇沉着综合征
- 什么是胃乳头状腺瘤?
- 胃切除术与倾倒综合症
- 吻合口溃疡如何治疗?
- 容易与胃癌混淆的疾病哪些?
- 大肠杆菌感染与腹泻的一些问题
- 十二指肠血管压迫综合征
- Oddis括约肌功能障碍的影像...
- 游走脾的介绍
- 结肠憩室不是结肠息肉
- 一位色素沉着--肠息肉综合症(...
- 弥漫性食管痉挛应与胡桃夹食管进...
- 慢性浅表性胃炎与消化不良
- 结肠炎有哪些危害?
- 十二指肠炎有哪些治疗方法?
- 秋季怎样预防腹泻?
- 急性化脓性胃炎
- 急性腐蚀性胃炎
- 肛门部肿物脱出有哪些疾病?
- 消化不良知多少?
- 慢性便秘有哪些危害?
- 急性胆囊炎应该与哪些疾病鉴别?
- 幼年性息肉病的内镜下表现与病理...
- 哪些腹泻不需要用抗生素治疗?
- 胃肠运动功能障碍与功能性消化不...
- 几种常见的肠胃功能紊乱症
- 大肠息肉易复发,定期复查很重要
- 胃癌是如何进行转移的?
- 慢性萎缩性胃炎与贫血
- 胆囊的良性肿瘤有哪些?
- 急性肠炎的饮食调养
- 急性胆道感染的临床表现有哪些?...
- 胆囊胆固醇沉着症与胆结石形成有...
- 什么是功能性呕吐?
- 口咽部粘连引起吞咽困难及引起吞...
- 如何诊断吸收不良综合症引起的腹...
- 食管裂孔疝有几种类型?
- 嗜酸性粒细胞性胃肠炎是怎么回事...
- 精神因素对胃有什么影响?
- 大肠杆菌的基础知识
- 肠易激综合症的诊断与饮食调养
- 什么原因导致了乙型肝炎隐匿感染...
- 十二指肠炎有哪些治疗方法?
- 什么是急性糜烂性胃炎?
- 肠系膜上动脉压迫综合症怎么办?
- 急性肠炎的饮食调养
- 浅谈药物性胃损伤
- 容易与胃癌混淆的疾病哪些?
- 认识贲门黏膜撕裂综合征
- 为什么说肠道菌群与腹泻密切相关...
- Relation betwee...
- Relation betwee...
- Helicobacter py...
- 《中国慢性胃炎共识意见》解读-...
- Helicobacter py...
- Management of p...
- Management of p...
- 中华人民共和国卫生部长新年致词
- 结肠息肉怎么办?
- 两成胃食管反流病患者“走错门”
- 医学生教育的永恒主题:人文关怀
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- EASL临床实践指南:肝硬化腹...
- Safety of the l...
- Peutz-Jeghers s...
- Experience in t...
- Difficult colon...
- Familial adenom...
- Hyperplastic po...
- Accuracy and sa...
- Accuracy and sa...
- Accuracy and sa...
- Accuracy and sa...
- Accuracy and sa...
- Short-term effe...
- Effect of daily...
- Individual-pati...
- How to alleviat...
- What is the tre...
- Colon cancer--h...
- How does hydrog...
- What about curr...
- How does acute ...
- Gallstones
- Barrett
- rectal bleeding...
- gastroenteritis...
- constipation---...
- constipation---...
- 2009EASL乙型肝炎诊治指...
- About Karl Hein...
- How to assess t...
- Helicobacter py...
- Helicobacter py...
- 96. 拉米夫定治疗乙肝为什么...
- 胆囊结石的治疗
- 胃下垂能治愈吗
- Heterotopic gas...
- Heterotopic gas...
- Seniors Have T...
- Seniors Have T...
- Iodized Salt Is...
- Iodized Salt Is...
- Discussions abo...
- Discussions abo...
- Radiation And H...
- Radiation And H...
- 别让时间消磨你
- 别让时间消磨你
- of studies
- of studies
- 平衡与健康
- 平衡与健康
- 疲惫与健康
- 疲惫与健康
- 学会放手,自然轻松
- 学会放手,自然轻松
- 读书与女人
- 读书与女人
- 肠系膜上动脉压迫综合症怎么办?
- 肠系膜上动脉压迫综合症怎么办?
- 胃食管反流病需要维持治疗吗?
- 胃食管反流病有哪些危害?
- 胆汁反流性食管炎如何治疗?
- Barrett食管治疗的一些常...
- 父母钻石婚庆感言
- 父母钻石婚庆感言
- Barrett食管会癌变吗?
- Barrett食管是如何发生的...
- Barrett食管的胃镜表现和...
- Barrett食管的危险因素有...
- Barrett食管有哪些伴发病...
- Barrett食管有哪些伴发病...
- 如何随访Barrett食管?
- 如何随访Barrett食管?
- 怎样治疗Barrett食管?
- 怎样治疗Barrett食管?
- 适量运动有助胃肠健康
- 贲门粘膜撕裂综合症的预后如何?
- 贲门粘膜撕裂综合症的预后如何?
- 贲门粘膜撕裂综合症该如何治疗?
- 贲门粘膜撕裂综合症该如何治疗?
- 贲门粘膜撕裂综合症是如何诊断的...
- 贲门粘膜撕裂综合症是如何诊断的...
- 贲门粘膜撕裂综合症常见临床表现...
- 贲门粘膜撕裂综合症常见临床表现...
- 认识贲门黏膜撕裂综合征
- 认识贲门黏膜撕裂综合征
- 霉菌性食管炎该如何诊治?
- 霉菌性食管炎该如何诊治?
- 霉菌性食管炎的临床表现有哪些?
- 霉菌性食管炎的临床表现有哪些?
- 笑口常开,健康益寿
- 笑口常开,健康益寿
- 弥漫性食管痉挛该如何治疗和预防...
- 弥漫性食管痉挛该如何治疗和预防...
- 弥漫性食管痉挛应与哪些疾病进行...
- 弥漫性食管痉挛应与哪些疾病进行...
- 弥漫性食管痉挛如何诊断?
- 弥漫性食管痉挛如何诊断?
- 弥漫性食管痉挛的临床表现有哪些...
- 弥漫性食管痉挛的临床表现有哪些...
- 弥漫性食管痉挛的病因是什么?
- 弥漫性食管痉挛的病因是什么?
- Common Osteopor...
- Common Osteopor...
- 贲门失弛缓症该如何预防发作?
- 贲门失弛缓症该如何预防发作?
- 贲门失弛缓症有哪些并发症?
- 贲门失弛缓症有哪些并发症?
- Risk for gastri...
- Risk for gastri...
- Defensin patter...
- Defensin patter...
- Alpha-defensins...
- Alpha-defensins...
- Pathophysiologi...
- Pathophysiologi...
- Defensin-mRNA e...
- Defensin-mRNA e...
- Functional role...
- Functional role...
- Potential role ...
- Potential role ...
- Duodenogastric ...
- Duodenogastric ...
- 贲门失弛缓症需要与哪些疾病鉴别...
- 贲门失弛缓症需要与哪些疾病鉴别...
- Risk factors in...
- Risk factors in...
- Helicobacter py...
- Helicobacter py...
- Safety of the l...
- Safety of the l...
- Adverse effects...
- Adverse effects...
- Helicobacter py...
- Helicobacter py...
- OLGA Gastritis ...
- OLGA Gastritis ...
- Age-related dif...
- Age-related dif...
- 贲门失弛缓症为什么要进行X线检...
- 贲门失弛缓症为什么要进行X线检...
- 贲门失弛缓症的临床表现有哪些?
- 贲门失弛缓症的临床表现有哪些?
- 贲门失弛缓发病原因有哪些?
- 贲门失弛缓发病原因有哪些?
- 什么是贲门失弛缓症?
- 什么是贲门失弛缓症?
- 癌症将成为人类的头号杀手
- 癌症将成为人类的头号杀手
- 烧心时需要进行哪些检查项目?
- 烧心时需要进行哪些检查项目?
- 哪些情况下容易引起烧心?
- 哪些情况下容易引起烧心?
- 烧心时如何就医?
- 烧心时如何就医?
- 什么是烧心?
- 什么是烧心?
- 哪些吞咽困难可以进行内镜下治疗...
- 哪些吞咽困难可以进行内镜下治疗...
- 吞咽困难该如何治疗?
- 吞咽困难该如何治疗?
- 哪些检查方法可以了解食管运动功...
- 哪些检查方法可以了解食管运动功...
- 吞咽困难为什么要进行胃镜检查?
- 吞咽困难为什么要进行胃镜检查?
- 吞咽困难为什么要进行食管吞钡检...
- 吞咽困难为什么要进行食管吞钡检...
- 吞咽困难患者需要做哪些检查?
- 吞咽困难患者需要做哪些检查?
- 吞咽困难常有哪些伴随症状?
- 吞咽困难常有哪些伴随症状?
- 引起吞咽困难的常见疾病有哪些?
- 引起吞咽困难的常见疾病有哪些?
- 哪些疾病可以引起吞咽困难?
- 哪些疾病可以引起吞咽困难?
- 什么是吞咽困难?
- 什么是吞咽困难?
- 反流性食管炎该怎么办?
- 反流性食管炎该怎么办?
- 胃镜可以确诊胆汁反流性胃炎吗?
- Oddis括约肌功能障碍如何进...
- Oddis括约肌功能障碍如何进...
- Oddis括约肌功能障碍可以用...
- Oddis括约肌功能障碍可以用...
- 萎缩性胃炎伴肠化怎么办?
- 萎缩性胃炎伴肠化怎么办?
- 如何诊断Oddis括约肌功能障...
- 如何诊断Oddis括约肌功能障...
- Oddis括约肌功能障碍如何分...
- Oddis括约肌功能障碍如何分...
- 如何进行Oddis括约肌动力学...
- 如何进行Oddis括约肌动力学...
- Oddis括约肌功能障碍的影像...
- Oddis括约肌功能障碍的影像...
- Oddis括约肌功能障碍的实验...
- Oddis括约肌功能障碍的实验...
- Oddis括约肌功能障碍有哪些...
- Oddis括约肌功能障碍有哪些...
- 认识“Oddi括约肌功能障碍”
- 认识“Oddi括约肌功能障碍”
- 胆管癌的诊断与治疗
- 胆管癌的诊断与治疗
- 胆管癌的病因及临床表现
- 胆管癌的病因及临床表现
- 胆管有哪些良性肿瘤?
- 胆管有哪些良性肿瘤?
- 胆囊癌的治疗方法有哪些?
- 胆囊癌的治疗方法有哪些?
- 哪些检查可以诊断胆囊癌?
- 哪些检查可以诊断胆囊癌?
- 胆囊癌知多少?
- 胆囊癌知多少?
- 胆囊息肉的治疗原则是什么?
- 胆囊息肉的治疗原则是什么?
- 胆囊息肉是如何诊断的?
- 胆囊息肉是如何诊断的?
- 胆囊的良性肿瘤有哪些?
- 胆囊的良性肿瘤有哪些?
- 真情是医患沟通的基础
- 真情是医患沟通的基础
- 急性胆囊炎应该与哪些疾病鉴别?
- 急性胆囊炎应该与哪些疾病鉴别?
- 急性胆囊炎时有哪些体征?
- 急性胆囊炎时有哪些体征?
- 急性胆囊炎的上腹痛有何特点?
- 急性胆囊炎的上腹痛有何特点?
- 急性胆囊炎的发病因素有哪些?
- 急性胆囊炎的发病因素有哪些?
- 影响胆囊运动的因素有哪些?
- 影响胆囊运动的因素有哪些?
- 胆囊有功能吗?
- 急性梗阻性胆管炎该如何治疗?
- 急性梗阻性胆管炎该如何治疗?
- 急性重症胆管炎有哪些临床表现?
- 急性重症胆管炎有哪些临床表现?
- 胆石症的严重并发症是什么?
- 胆石症的严重并发症是什么?
- 胆总管结石该怎么办?
- 胆总管结石该怎么办?
- 胆囊结石的非手术治疗方式有哪些...
- 胆囊结石的非手术治疗方式有哪些...
- 胆囊结石手术治疗的适应症有哪些...
- 胆囊结石手术治疗的适应症有哪些...
- 话说健康意识
- 话说健康意识
- 以胆绞痛为主要表现的胆石症应与...
- 以胆绞痛为主要表现的胆石症应与...
- 以黄疸为主要表现的胆石症还应与...
- 以黄疸为主要表现的胆石症还应与...
- 寻找幸福的人 -转载
- 寻找幸福的人 -转载
- 不惜代价治疗肿瘤对吗? ---...
- 不惜代价治疗肿瘤对吗? ---...
- Potential role ...
- Potential role ...
- Defensin-mRNA E...
- Defensin-mRNA E...
- Expression of h...
- Expression of h...
- Human beta-defe...
- Human beta-defe...
- 哪些检查可用于检查胆结石?
- 哪些检查可用于检查胆结石?
- 善良与快乐
- 善良与快乐
- 胆结石的饮食调养
- 胆结石的饮食调养
- 无题
- 无题
- “夏科氏三联征”是怎么回事?
- “夏科氏三联征”是怎么回事?
- 胆结石一定有症状吗?
- 胆结石一定有症状吗?
- 累了,就把心事放下
- 累了,就把心事放下
- 中国慢性乙型肝炎防治指南
- 中国慢性乙型肝炎防治指南
- 如何认识胆总管结石的临床表现特...
- 如何认识胆总管结石的临床表现特...
- 什么是胆绞痛?
- 什么是胆绞痛?
- 急性胆道感染的临床表现有哪些?
- 急性胆道感染的临床表现有哪些?
- 胆结石的临床表现与胆结石的位置...
- 胆结石的临床表现与胆结石的位置...
- 胆道感染与胆石症关系如何?
- 胆道感染与胆石症关系如何?
- 科学选择,癌症≠死亡
- 科学选择,癌症≠死亡
- 40岁查胃镜 50岁查肠镜
- 40岁查胃镜 50岁查肠镜
- 健康管理胃炎,积极预防胃癌
- 健康管理胃炎,积极预防胃癌
- 陈竺:医患双方是利益共同体(转...
- 陈竺:医患双方是利益共同体(转...
- Endoscopical an...
- Endoscopical an...
- Post-cholecyste...
- Post-cholecyste...
- Rabeprazole com...
- Rabeprazole com...
- 最近总是腹胀,应该怎么办?
- 最近总是腹胀,应该怎么办?
- 胆结石是如何分类的?
- 胆结石是如何分类的?
- 胆结石形成的相关因素有哪些?
- 胆结石形成的相关因素有哪些?
- 心态平和是一种优良的品性和养生...
- 心态平和是一种优良的品性和养生...
- 与癌共存-转载
- 与癌共存-转载
- 医生就像印度的湿婆大神-转载
- 医生就像印度的湿婆大神-转载
- 关注消化健康 延长健康寿命 (...
- 关注消化健康 延长健康寿命 (...
- 医学为什么是一种特殊的专业?
- 医学为什么是一种特殊的专业?
- 健康小秘密 ?转载
- 健康小秘密 ?转载
- 胃癌的分子靶向治疗研究怎样?
- 胃癌患者该如何进行精神调理?
- 胃癌患者该如何进行精神调理?
- 胃癌可以自我诊断吗?
- 胃癌可以自我诊断吗?
- 胃癌的预后如何?
- 胃癌的预后如何?
- 胃癌的化疗方法有哪些?
- 胃癌的化疗方法有哪些?
- 胃癌的放射治疗如何评价?
- 胃癌的放射治疗如何评价?
- 胃癌的治疗方法有哪些?
- 胃癌的治疗方法有哪些?
- 4年未曾治好的顽固病-打嗝
- 4年未曾治好的顽固病-打嗝
- 胃癌术后该如何进行饮食调理?
- 胃癌术后该如何进行饮食调理?
- 未来20年癌症患者翻番
- 未来20年癌症患者翻番
- 健康新概念
- 健康新概念
- 肠易激综合症
- 肠易激综合症
- 《人民日报》:医生子女为何不学...
- 《人民日报》:医生子女为何不学...
- 胃癌是如何进行转移的?
- 胃癌是如何进行转移的?
- 胃癌病人常有的临床症状有哪些?...
- 胃癌病人常有的临床症状有哪些?...
- 容易与胃癌混淆的疾病哪些?
- 容易与胃癌混淆的疾病哪些?
- 胃癌的形态分型如何?
- 胃癌的形态分型如何?
- 什么是胃癌的癌前期变化?
- 肝炎与肝癌
- 肝炎与肝癌
- 根除幽门螺杆菌能否降低胃癌的发...
- 根除幽门螺杆菌能否降低胃癌的发...
- 幽门螺杆菌感染在胃癌致病过程中...
- 幽门螺杆菌感染在胃癌致病过程中...
- 我国胃癌的治疗现状如何?
- 我国胃癌的治疗现状如何?
- 幽门螺杆菌与胃癌的关系如何?
- 幽门螺杆菌与胃癌的关系如何?
- 调整不良生活习惯 预防胃病发生
- 调整不良生活习惯 预防胃病发生
- 哪些不良生活习惯与胃肠道疾病有...
- 胃癌的发病原因有哪些?
- 胃癌的发病原因有哪些?
- 牢记神圣使命,做一名合格的好医...
- 牢记神圣使命,做一名合格的好医...
- 十二指肠炎有哪些治疗方法?
- 十二指肠炎有哪些治疗方法?
- 十二指肠炎的内镜是如何分型、分...
- 十二指肠炎的内镜是如何分型、分...
- 十二指肠炎有哪些检查方法?
- 十二指肠炎有哪些检查方法?
- 十二指肠炎的病理改变如何分型以...
- 十二指肠炎的病理改变如何分型以...
- 何谓十二指肠粘膜胃上皮化生?
- 何谓十二指肠粘膜胃上皮化生?
- 十二指肠炎是如何分类的?
- 十二指肠炎是如何分类的?
- 慢性十二指肠炎的发病原因有哪些...
- 慢性十二指肠炎的发病原因有哪些...
- 何谓十二指肠炎?
- 何谓十二指肠炎?
- 何谓Peutz-Jeghers...
- 何谓Cronkhite-Can...
- 什么是家族性息肉病?
- 胃息肉有哪些临床表现以及如何治...
- 检查胃息肉的方法有哪些?
- 幼年性息肉病的内镜下表现与病理...
- 异位性息肉的内镜下表现于病理表...
- 什么是胃的错构瘤样息肉?
- 什么是胃乳头状腺瘤?
- 什么是胃腺瘤?
- 什么是再生性胃息肉?
- 胃息肉是如何分类的?
- Gastric Bypass ...
- Gastric Bypass ...
- Flexible Sigmoi...
- Flexible Sigmoi...
- Celiac Sprue
- Celiac Sprue
- Rectal Bleeding
- Rectal Bleeding
- 用心做医生
- 用心做医生
- Ostomy, Colosto...
- Ostomy, Colosto...
- Prevention of C...
- Prevention of C...
- 我国消化不良的诊断流程有哪些?
- 我国消化不良的诊断流程有哪些?
- 国外消化不良患者的诊断流程有哪...
- 国外消化不良患者的诊断流程有哪...
- 胆囊胰腺因素与功能性消化不良有...
- 胆囊胰腺因素与功能性消化不良有...
- 幽门螺杆菌感染与功能性消化不良...
- 幽门螺杆菌感染与功能性消化不良...
- 胃酸与功能性消化不良有何关系?
- 胃酸与功能性消化不良有何关系?
- Autoimmune Hepa...
- Autoimmune Hepa...
- Cirrhosis
- Cirrhosis
- 关于胃结石的问题
- 关于胃结石的问题
- 神经精神心理因素如何导致功能性...
- 神经精神心理因素如何导致功能性...
- Pancreas Diseas...
- Pancreas Diseas...
- 胃肠激素如何引起功能性消化不良...
- 胃肠激素如何引起功能性消化不良...
- 话说知足常乐与健康
- 话说知足常乐与健康
- Anti-Dumping Po...
- Anti-Dumping Po...
- Gastroesophagea...
- Gastroesophagea...
- 春节莫忘胃肠疾病侵袭
- 春节莫忘胃肠疾病侵袭
- 如何让您的胃肠“不生气”?
- 如何让您的胃肠“不生气”?
- 修身养性-2
- 修身养性-2
- 内脏敏感性增强与功能性消化不良
- 内脏敏感性增强与功能性消化不良
- 什么是内脏感觉?
- 什么是内脏感觉?
- 胃肠运动功能障碍与功能性消化不...
- 胃肠运动功能障碍与功能性消化不...
- 功能性消化不良的病因有哪些?
- 功能性消化不良的病因有哪些?
- Diverticulosis
- Diverticulosis
- 什么是功能性消化不良?
- 什么是功能性消化不良?
- 什么是胃黏膜上皮内瘤变?
- 什么是胃黏膜上皮内瘤变?
- Dietary treatme...
- Dietary treatme...
- Dietary treatme...
- 肠上皮化生与胃癌之间有何关系?
- 肠上皮化生与胃癌之间有何关系?
- 哪些物质可降低胃癌发生的危险性...
- 哪些物质可降低胃癌发生的危险性...
- 慢性胃炎的治疗目的是什么?
- 慢性胃炎的治疗目的是什么?
- 生命的列车
- 生命的列车
- Colon Gas & Fla...
- Colon Gas & Fla...
- Peptic Ulcer Di...
- Peptic Ulcer Di...
- 慢性胃炎内镜检查的分型分级
- 慢性胃炎内镜检查的分型分级
- 胃镜下如何诊断慢性萎缩性胃炎?
- Diarrhea
- Diarrhea
- 多发性胃溃疡怎么治?
- 多发性胃溃疡怎么治?
- 诊断慢性胃炎需要做哪些检查?
- 诊断慢性胃炎需要做哪些检查?
- Peptic Ulcer Di...
- Peptic Ulcer Di...
- Gastritis (2)
- Gastritis (2)
- 饭后半小时饱胀,晚饭后加重,左...
- 饭后半小时饱胀,晚饭后加重,左...
- About Gastritis...
- About Gastritis...
- About gastritis
- About gastritis
- Gastritis
- Gastritis
- Increased lysoz...
- Increased lysoz...
- Helicobacter py...
- Helicobacter py...
- Practical appro...
- Practical appro...
- The effect of H...
- The effect of H...
- Exploring the l...
- Exploring the l...
- Gastric atrophy...
- Gastric atrophy...
- Iron deficiency...
- Iron deficiency...
- Increased lysoz...
- Increased lysoz...
- Definition of B...
- Gastric-and-int...
- Gastric-and-int...
- Role of transfo...
- Role of transfo...
- Helicobacter py...
- Helicobacter py...
- 您知道胃底腺有几种分泌细胞吗?
- 您知道胃底腺有几种分泌细胞吗?
- 您知道胃有几种消化腺吗?
- 您知道胃有几种消化腺吗?
- Practical appro...
- Practical appro...
- Association of ...
- Association of ...
- 胃肠道是人体的“第二大脑”
- 胃肠道是人体的“第二大脑”
- 再谈“慢性胃炎”的发病原因
- 再谈“慢性胃炎”的发病原因
- 做胃镜时为何需要做活检
- 引起胃运动功能障碍的疾病有哪些...
- 引起胃运动功能障碍的疾病有哪些...
- 什么是急性化脓性胃炎?
- 什么是急性化脓性胃炎?
- 什么是急性腐蚀性胃炎?
- 什么是急性腐蚀性胃炎?
- 什么是急性糜烂性胃炎?
- 什么是急性糜烂性胃炎?
- 什么是胃炎?急性胃炎有哪些?
- 什么是胃炎?急性胃炎有哪些?
- 幽门螺杆菌感染与慢性胃炎有什么...
- 幽门螺杆菌感染与慢性胃炎有什么...
- 饮酒对胃有什么影响?
- 饮酒对胃有什么影响?
- 慢性胃炎的常见病因有什么?
- 慢性胃炎的常见病因有什么?
- 什么是慢性胃炎 ?胃炎分几种?
- 什么是慢性胃炎 ?胃炎分几种?
- 常见的胃病有哪些?
- 常见的胃病有哪些?
- Hanover Square(...
- Hanover Square(...
- 检查胃病的常用方法有哪些?
- 检查胃病的常用方法有哪些?
- 胃有哪些运动功能?
- 胃有哪些运动功能?
- 您了解胃有哪些功能吗?
- 您了解胃有哪些功能吗?
- 脂肪肝有哪些危险因素?
- 脂肪肝有哪些危险因素?
- 急性肠炎的饮食调养
- 急性肠炎的饮食调养
- IDEAL 理想
- IDEAL 理想
- Health care(转载)
- Health care(转载)
- 关于甲型H1N1流感
- 关于甲型H1N1流感
- 呼吸系统疾病与消化系统疾病有哪...
- 呼吸系统疾病与消化系统疾病有哪...
- 慢性肾功能衰竭与消化系统有哪些...
- 慢性肾功能衰竭与消化系统有哪些...
- 肠道疾病的警示症状有哪些?
- 肠道疾病的警示症状有哪些?
- 呃逆的饮食调养
- 呃逆的饮食调养
- 便秘的外科手术指征有哪些?
- 便秘的外科手术指征有哪些?
- 老人消化不良是怎么回事?
- 贲门失弛缓症如何治疗?
- 贲门失弛缓症如何治疗?
- 这样的结石应采用什么方法最好?
- 这样的结石应采用什么方法最好?
- 怎么知道是不是乙肝病毒携带者
- 怎么知道是不是乙肝病毒携带者
- 慢性腹泻怎么办?
- 慢性腹泻怎么办?
- 重度萎缩性胃炎癌变怎么治疗?
- 重度萎缩性胃炎癌变怎么治疗?
- 2009版肝癌诊治指南
- 2009版肝癌诊治指南
- 胆囊息肉0.7*0.6CM是否...
- 胆囊息肉0.7*0.6CM是否...
- 修身养性
- 修身养性
- 几种常见的肠胃功能紊乱症
- 几种常见的肠胃功能紊乱症
- 腹泻时吃大蒜和蔬菜合适吗?
- 腹泻时吃大蒜和蔬菜合适吗?
- 胆汁反流性胃炎的内镜诊断
- 胆汁反流与胃溃疡
- 胆汁反流与胃溃疡
- 胃食管反流病、Barrett食...
- 胃食管反流病、Barrett食...
- 十首唐宋词
- 十首唐宋词
- 胆汁反流性胃炎与胃癌
- 30 如何判断幽门螺杆感染的治...
- 30 如何判断幽门螺杆感染的治...
- 29 消化性溃疡为什么要进行幽...
- 29 消化性溃疡为什么要进行幽...
- 27 如何理解幽门螺杆菌感染的...
- 26 Hp根除治疗方案中常用药...
- 25 哪些幽门螺杆菌感染患者需...
- 反流性食管炎该怎么治疗?
- 怎样判断我的消化道出血的部位
- 怎样判断我的消化道出血的部位
- 治疗脾血管瘤能否不切除脾?
- 治疗脾血管瘤能否不切除脾?
- 内镜检查为什么要进行活检病理检...
- 溃疡病会癌变吗?
- 溃疡病会癌变吗?
- 治疗胃食管反流病手术治疗不能取...
- 治疗胃食管反流病手术治疗不能取...
- 是不是食管反流
- 是不是食管反流
- 如何诊断糖尿病性腹泻?
- 如何诊断糖尿病性腹泻?
- 慢性咳嗽与胃食管反流性疾病
- 胃食管反流病常见的临床症状有哪...
- 胃食管反流病常见的临床症状有哪...
- 小孩也会得胃炎吗?
- 慢性胃炎的治疗原则是什么?
- 精神因素对胃有什么影响?
- 精神因素对胃有什么影响?
- 花儿在不同的季节开放(俞洪敏)
- 花儿在不同的季节开放(俞洪敏)
- 非酒精性脂肪性肝病诊疗指南治疗...
- 非酒精性脂肪性肝病诊疗指南治疗...
- 陈竺:打破中西医的壁垒(转载)
- 陈竺:打破中西医的壁垒(转载)
- 胃溃疡患者如何养胃?
- 胃溃疡患者如何养胃?
- 肠结核与Crohn病的鉴别诊断
- 肠结核与Crohn病的鉴别诊断
- 对肠易激综合征患者如何进行心理...
- 如何治疗肠道菌群失调?
- 如何治疗甲状腺机能亢进及其腹泻...
- 如何治疗甲状腺机能亢进及其腹泻...
- 如何治疗肠易激综合症及其腹泻?
- 如何治疗胃部手术后引起的腹泻?
- 如何治疗胃部手术后引起的腹泻?
- 如何治疗胃肠运动过速性腹泻?
- 如何治疗胃肠运动过速性腹泻?
- 一定要幸福(转载)
- 一定要幸福(转载)
- 能否应用益生菌制剂治疗感染性腹...
- 能否应用益生菌制剂治疗感染性腹...
- 腹泻一定要用抗生素治疗吗?
- 春节来临谨防胰腺炎“偷袭”
- 嗜酸性粒细胞性胃肠炎是怎么回事...
- 嗜酸性粒细胞性胃肠炎是怎么回事...
- 如何诊断慢性肠原性腹泻?
- 如何诊断慢性肠原性腹泻?
- 如何诊断胃原性腹泻?
- 如何诊断吸收不良综合症引起的腹...
- 如何诊断吸收不良综合症引起的腹...
- 腹泻患者就诊时应该向医生提供哪...
- 为什么说肠道菌群与腹泻密切相关...
- 为什么说肠道菌群与腹泻密切相关...
- 老年人为什么容易发生腹泻?
- 老年人消化器官改变有何特点?
- 老年人消化器官改变有何特点?
- 便血时该怎么办?
- 便血时该怎么办?
- 引起慢性腹泻的疾病有哪些?
- 引起慢性腹泻的疾病有哪些?
- 抗生素能引起腹泻吗?为什么?
- 抗生素能引起腹泻吗?为什么?
- 腹部手术后出现肠麻痹是怎么回事...
- 腹部手术后出现肠麻痹是怎么回事...
- 胃手术或腹部手术后会引起胃排空...
- 胃手术或腹部手术后会引起胃排空...
- 你知道肠道也有年龄吗?
- 你知道肠道也有年龄吗?
- 排气-肠道的守卫兵
- 排气-肠道的守卫兵
- 肠道内毒素是癌症的根源
- 肠道内毒素是癌症的根源
- 警惕肠道疾病,预防至关重要
- 警惕肠道疾病,预防至关重要
- 如何诊断胃黏膜相关淋巴瘤?
- 如何诊断胃黏膜相关淋巴瘤?
- 胃粘膜相关淋巴瘤有癌前病变吗?
- 胃粘膜相关淋巴瘤有癌前病变吗?
- 胃内也会长淋巴瘤吗?
- 胃内也会长淋巴瘤吗?
- 溃疡性结肠炎怎样治疗
- 溃疡性结肠炎怎样治疗
- 我这种情况是不是胃泌素瘤?
- 我这种情况是不是胃泌素瘤?
- 吃了辛辣的食物就肚子痛是什么病...
- 吃了辛辣的食物就肚子痛是什么病...
- 慢性胰腺炎的影像学特点?
- 慢性胰腺炎的影像学特点?
- 什么是小残胃综合症?
- 什么是小残胃综合症?
- 如何诊断和治疗倾倒综合症?
- 如何诊断和治疗倾倒综合症?
- 我是消化系统问题,是肠肠道易激...
- 我是消化系统问题,是肠肠道易激...
- 胃切除术后为什么会发生倾倒综合...
- 胃切除术后为什么会发生倾倒综合...
- 胃切除术与倾倒综合症
- 胃切除术与倾倒综合症
- 结肠镜检查有哪些禁忌症?
- 结肠镜检查有哪些禁忌症?
- 外科手术会导致哪些胃肠功能障碍...
- 外科手术会导致哪些胃肠功能障碍...
- 外科手术与可导致胃肠动力障碍吗...
- 外科手术与可导致胃肠动力障碍吗...
- 哪些临床表现能提示胃溃疡癌变?...
- 哪些临床表现能提示胃溃疡癌变?...
- 腹胀是如何产生的?
- 腹胀是如何产生的?
- 消化道以外脏器疾病可以引起腹泻...
- 消化道以外脏器疾病可以引起腹泻...
- 胰腺疾病能引起腹泻吗?
- 胰腺疾病能引起腹泻吗?
- 胆道系统疾病能引起腹泻吗?
- 胆道系统疾病能引起腹泻吗?
- 胆汁反流性胃炎如何治疗?
- 胆汁反流性胃炎如何治疗?
- 大肠疾病可以引起腹泻吗?
- 大肠疾病可以引起腹泻吗?
- 小肠疾病可以引起腹泻吗?
- 小肠疾病可以引起腹泻吗?
- 十二指肠疾病可以引起腹泻吗?
- 十二指肠疾病可以引起腹泻吗?
- 胃病可以引起腹泻吗?
- 胃病可以引起腹泻吗?
- 21世纪的新观点--对于肿瘤和...
- 21世纪的新观点--对于肿瘤和...
- 打嗝如何饮食调理?
- 打嗝如何饮食调理?
- 颈部淋巴结结核如何诊治?
- 颈部淋巴结结核如何诊治?
- 胃食管反流病如何治疗?
- 胃食管反流病如何治疗?
- 重视肠道健康
- 重视肠道健康
- 当一位患者在咨询就医中反复提出...
- 当一位患者在咨询就医中反复提出...
- 慢性胃炎诊断治疗的尴尬 -转载
- 慢性胃炎诊断治疗的尴尬 -转载
- 呃气怎么办?
- 呃气怎么办?
- 萎缩性胃炎治疗和饮食需要注意什...
- 萎缩性胃炎治疗和饮食需要注意什...
- 肝腹水的治疗
- 肝腹水的治疗
- 40岁以上应做肠镜检查
- 40岁以上应做肠镜检查
- 胃息肉是否手术切除?
- 肝癌的危险因素有哪些?
- 肝癌的危险因素有哪些?
- 请问自免疫性肝炎如何治疗?
- 请问自免疫性肝炎如何治疗?
- 十二指肠多发息肉、胃炎、十二指...
- 十二指肠多发息肉、胃炎、十二指...
- 是冠心病吗?
- 是冠心病吗?
- 老年人消化不良有何意义?
- 为什么饮酒会造成肝脏的损害呢?
- 为什么饮酒会造成肝脏的损害呢?
- 生命就在你的手中--于丹(转载...
- 生命就在你的手中--于丹(转载...
- 胃癌的风险因素有哪些?
- 胃癌的风险因素有哪些?
- 反复性消化到出血是不是小肠糜
- 反复性消化到出血是不是小肠糜
- 胃粘膜下肿瘤(平滑肌瘤可能)该...
- 胃粘膜下肿瘤(平滑肌瘤可能)该...
- 返流性食道炎及慢性浅表性胃炎伴...
- 返流性食道炎及慢性浅表性胃炎伴...
- 24.治疗幽门螺杆菌感染中存在...
- 浅表性胃炎怎么治疗?
- 浅表性胃炎怎么治疗?
- 22.为什么说幽门螺杆菌是胃癌...
- 23.为什么说幽门螺杆菌是消化...
- 21.为什么说幽门螺杆菌在十二...
- 20.Hp感染是如何导致胃癌发...
- 19.为什么说幽门螺杆菌感染与...
- 18.什么是Hp相关性胃炎?H...
- 17.幽门螺杆菌感染就一定会发...
- 16.为什么说幽门螺杆菌是胃癌...
- 请问,我经常大便前部分全部是两...
- 请问,我经常大便前部分全部是两...
- 胆囊炎饮食治疗原则是什么?
- 胆囊炎饮食治疗原则是什么?
- 慢性胆囊炎平时饮食该注意怎么,...
- 慢性胆囊炎平时饮食该注意怎么,...
- 15.幽门螺杆菌是怎样导致胃黏...
- 14.为什么幽门螺杆菌可以导致...
- 肝不好的人应该吃些什么
- 肝不好的人应该吃些什么
- 13.幽门螺杆菌感染可导致口腔...
- 12.怎样才能“捉住”幽门螺杆...
- 11.幽门螺杆菌与慢性萎缩性胃...
- 10.为什么说HP是胃病传染的...
- 9.为什么说幽门螺杆菌(Hp)...
- 8.幽门螺杆菌与胃肠外疾病有关...
- 7.幽门螺杆菌与哪些上胃肠道疾...
- 我是一个大三阳的女性,如果结婚...
- 我是一个大三阳的女性,如果结婚...
- 胃溃疡如何治疗
- 胃溃疡如何治疗
- 小三阳能传染吗
- 小三阳能传染吗
- 反流性食管炎咋治疗?
- 反流性食管炎咋治疗?
- 做结肠镜检查的病人要作哪些准备...
- 做结肠镜检查的病人要作哪些准备...
- 哪些人需要做电子结肠镜检查?
- 哪些人需要做电子结肠镜检查?
- 6. 幽门螺杆菌的传播途径是什...
- 5. 幽门螺杆菌容易感染哪些人...
- 小腹胀气,经常放屁
- 小腹胀气,经常放屁
- 3年肚胀,大便细软,前天大便有...
- 3年肚胀,大便细软,前天大便有...
- 4. 幽门螺杆菌在我国的研究历...
- 3.幽门螺旋杆菌是如何命名的?
- 150. 目前抗病毒药物治疗慢...
- 150. 目前抗病毒药物治疗慢...
- 中科院院士汪忠镐 --逃出鬼?...
- 中科院院士汪忠镐 --逃出鬼?...
- 149.乙型肝炎患者妊娠后继续...
- 149.乙型肝炎患者妊娠后继续...
- 148.乙型肝炎患者为何容易失...
- 148.乙型肝炎患者为何容易失...
- 147.如何了解自己的免疫功能...
- 147.如何了解自己的免疫功能...
- 146.慢性肝炎患者可以长途旅...
- 146.慢性肝炎患者可以长途旅...
- 145.慢性肝炎如何运动?
- 145.慢性肝炎如何运动?
- 144.急性肝炎如何运动?
- 144.急性肝炎如何运动?
- 143.乙肝患者能否参加体力劳...
- 143.乙肝患者能否参加体力劳...
- 142.肝炎后脂肪肝如何治疗?
- 142.肝炎后脂肪肝如何治疗?
- 141.肝炎后脂肪肝的预后如何...
- 141.肝炎后脂肪肝的预后如何...
- 哪些人需要做胃镜检查?
- 哪些人需要做胃镜检查?
- 胃镜检查很重要
- 胃镜检查很重要
- 140.HBsAg健康携带者健...
- 140.HBsAg健康携带者健...
- 139.乙肝病毒携带者预后如何...
- 139.乙肝病毒携带者预后如何...
- 138.乙肝能否治愈,愈后会复...
- 138.乙肝能否治愈,愈后会复...
- 137.什么是人工肝?
- 137.什么是人工肝?
- 136.肝病患者用药禁忌有哪些...
- 136.肝病患者用药禁忌有哪些...
- 135.为什么有的“小三阳”患...
- 135.为什么有的“小三阳”患...
- 134.各型病毒性肝炎治疗有何...
- 134.各型病毒性肝炎治疗有何...
- 133.使用拉米夫定过程中病情...
- 133.使用拉米夫定过程中病情...
- 132.拉米夫定出现耐药性后怎...
- 131.干扰素治疗效果如何?
- 132.拉米夫定出现耐药性后怎...
- 131.干扰素治疗效果如何?
- 130.干扰素、拉米夫定可以用...
- 130.干扰素、拉米夫定可以用...
- 129.拉米夫定有何优缺点?
- 129.拉米夫定有何优缺点?
- 128.使用干扰素过程中出现不...
- 128.使用干扰素过程中出现不...
- 127.什么情况下使用干扰素?
- 127.什么情况下使用干扰素?
- 126.干扰素治疗效果如何?
- 126.干扰素治疗效果如何?
- 慢性腹痛,元凶竟是肠息肉!
- 慢性腹痛,元凶竟是肠息肉!
- 急性上消化道出血的治疗措施有哪...
- 急性上消化道出血的治疗措施有哪...
- 酒精性肝硬化如何治疗?
- 酒精性肝硬化如何治疗?
- 125.干扰素有何优缺点?
- 125.干扰素有何优缺点?
- 124.乙肝病毒为什么会变异,...
- 124.乙肝病毒为什么会变异,...
- 123.是“大三阳”好还是“小...
- 123.是“大三阳”好还是“小...
- 122.何谓“肝病三步曲“?
- 122.何谓“肝病三步曲“?
- 121.乙肝治愈的标准是什么?
- 121.乙肝治愈的标准是什么?
- 120.乙肝病毒携带者是否可以...
- 120.乙肝病毒携带者是否可以...
- 119.携带乙肝病毒的母亲能母...
- 119.携带乙肝病毒的母亲能母...
- 118.接种乙肝疫苗后会导致乙...
- 118.接种乙肝疫苗后会导致乙...
- 117.什么情况下不宜注射乙肝...
- 117.什么情况下不宜注射乙肝...
- 116.新生儿注射乙肝疫苗需要...
- 116.新生儿注射乙肝疫苗需要...
- 115、乙肝母婴传播是怎么传播...
- 115、乙肝母婴传播是怎么传播...
- 114.携带乙肝病毒的妇女能生...
- 114.携带乙肝病毒的妇女能生...
- 113.一方是乙肝病毒感染者可...
- conspitation---available treatments
- 作者:常玉英|发布时间:2011-10-23|浏览量:925次
What treatments are available for constipation?
There are many treatments for constipation, and the best approach relies on a clear understanding of the underlying cause.
Dietary fiber (bulk-forming laxatives)
The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fiber supplements can be useful.四川省第四人民医院消化内科常玉英
Fiber is defined as material made by plants that is not digested by the human gastrointestinal tract. Fiber is one of the mainstays in the treatment of constipation. Many types of fiber within the intestine bind to water and keep the water within the intestine. The fiber adds bulk (volume) to the stool and the water softens the stool.
There are different sources of fiber and the type of fiber varies from source to source. Types of fiber can be categorized in several ways, for example, by their source.
The most common sources of fiber include:
fruits and vegetables,
wheat or oat bran,
psyllium seed (for example, Metamucil, Konsyl),
synthetic methyl cellulose (for example, Citrucel), and
polycarbophil (for example, Equilactin, Konsyl Fiber).
Polycarbophil often is combined with calcium (for example, Fibercon). However, in some studies, the calcium-containing polycarbophil was not as effective as the polycarbophil without calcium.
A lesser known source of fiber is an extract of malt (for example, Maltsupex); however, this extract may soften stools in ways other than increasing fiber.
Increased gas (flatulence) is a common side effect of high-fiber diets. The gas occurs because the bacteria normally present within the colon are capable of digesting fiber to a small extent. The bacteria produce gas as a byproduct of their digestion of fiber. All fibers, no matter what their source, can cause flatulence. However, since bacteria vary in their ability to digest the various types of fiber, the different sources of fiber may produce different amounts of gas. To complicate the situation, the ability of bacteria to digest one type of fiber can vary from individual to individual. This variability makes the selection of the best type of fiber for each person (for example, a fiber that improves the quality of the stool without causing flatulence) more difficult. Thus, finding the proper fiber for an individual becomes a matter of trial and error.
The different sources of fiber should be tried one by one. The fiber should be started at a low dose and increased every one to two weeks until either the desired effect on the stool is achieved or troublesome flatulence interferes. (Fiber does not work overnight.) If flatulence occurs, the dose of fiber can be reduced for a few weeks and the higher dose can then be tried again. (It generally is said that the amount of gas that is produced by fiber decreases when the fiber is ingested for a prolonged period of time; however, this has never been studied.) If flatulence remains a problem and prevents the dose of fiber from being raised to a level that affects the stool satisfactorily, it is time to move on to a different source of fiber.
When increasing amounts of fiber are used, it is recommended that greater amounts of water be consumed (for example, a full glass with each dose). In theory, the water prevents "hardening" of the fiber and blockage (obstruction) of the intestine. This seems like simple and reasonable advice. However, ingesting larger amounts of water has never been shown to have a beneficial effect on constipation, with or without the addition of fiber. (There is already a lot of water in the intestine and extra water that is digested is absorbed and excreted in the urine.) It is reasonable to drink enough fluids to prevent dehydration because with dehydration there may be reduced intestinal water.
Because of concern about obstruction, persons with narrowings (strictures) or adhesions (scar tissue from previous surgery) of their intestines should not use fiber unless it has been discussed with their physician. Some fiber laxatives contain sugar, and patients with diabetes may need to select sugar-free products.
Lubricant laxatives
Lubricant laxatives contain mineral oil as either the plain oil or an emulsion (combination with water) of the oil. The oil stays within the intestine, coats the particles of stool, and presumably prevents the removal of water from the stool. This retention of water in the stool results in softer stool. Mineral oil generally is used only for the short-term treatment of constipation since its long-term use has several potential disadvantages.
The oil can absorb fat-soluble vitamins from the intestine and, if used for prolonged periods, may lead to deficiencies of these vitamins. This is of particular concern in pregnancy during which an adequate supply of vitamins is important for the fetus. In the very young or very elderly in whom the swallowing mechanism is not strong or is impaired by strokes, small amounts of the swallowed oil may enter the lungs and cause a type of pneumonia called lipid pneumonia. Mineral oil also may decrease the absorption of some drugs such as warfarin (Coumadin) and oral contraceptives, thereby decreasing their effectiveness. Despite these potential disadvantages, mineral oil can be effective when short-term treatment is necessary.
Emollient laxatives (stool softeners)
Emollient laxatives are generally known as stool softeners. They contain a compound called docusate (for example, Colace). Docusate is a wetting agent that improves the ability of water within the colon to penetrate and mix with stool. This increased water within the stool softens the stool. Although studies have not shown docusate to be consistently effective in relieving constipation. Stool softeners often are used in the long-term treatment of constipation. It may take a week or more for docusate to be effective. The dose should be increased after one to two weeks if no effect is seen.
Although docusate generally is safe, it may increase the absorption of mineral oil and some medications from the intestine. Absorbed mineral oil collects in tissues of the body, for example, the lymph nodes and the liver, where it causes inflammation. It is not clear if this inflammation has any important consequences, but it generally is felt that prolonged absorption of mineral oil should not be allowed. The use of emollient laxatives is not recommended together with mineral oil or with certain prescription medications. Emollient laxatives are commonly used when there is a need to soften the stool temporarily and make defecation easier (for example, after surgery, childbirth, or heart attacks). They are also used for individuals with hemorrhoids or anal fissures.
Hyperosmolar laxatives
Hyperosmolar laxatives are undigestible, unabsorbable compounds that remain within the colon and retain the water that already is in the colon. The result is softening of the stool. The most common hyperosmolar laxatives are lactulose (for example, Kristalose), sorbitol, and polyethylene glycol (for example, MiraLax). and are available by prescription only. These laxatives are safe for long-term use and are associated with few side effects.
Hyperosmolar laxatives may be digested by colonic bacteria and turned into gas, which may result in unwanted abdominal bloating and flatulence. This effect is dose-related and less with polyethylene glycol. Therefore, gas can be reduced by reducing the dose of the laxative. In some cases, the gas will decrease over time.
Saline laxatives
Saline laxatives contain non-absorbable ions such as magnesium, sulfate, phosphate, and citrate [for example, magnesium citrate (Citroma), magnesium hydroxide, sodium phosphate). These ions remain in the colon and cause water to be drawn into the colon. Again, the effect is softening of the stool.
Magnesium also may have mild stimulatory effects on the colonic muscles. The magnesium in magnesium-containing laxatives is partially absorbed from the intestine and into the body. Magnesium is eliminated from the body by the kidneys. Therefore, individuals with impaired kidney function may develop toxic levels of magnesium from chronic (long duration) use of magnesium-containing laxatives.
Saline laxatives act within a few hours. In general, potent saline laxatives should not be used on a regular basis. If major diarrhea develops with the use of saline laxatives and the lost fluid is not replaced by the consumption of liquids, dehydration may result. For constipation, the most frequently-used and mildest of the saline laxatives is milk of magnesia. Epsom Salt is a more potent saline laxative that contains magnesium sulfate.
Stimulant laxatives
Stimulant laxatives cause the muscles of the small intestine and colon to propel their contents more rapidly. They also increase the amount of water in the stool, either by reducing the absorption of the water in the colon or by causing active secretion of water in the small intestine.
The most commonly-used stimulant laxatives contain cascara (castor oil), senna (for example, Ex-Lax, Senokot), and aloe. Stimulant laxatives are very effective, but they can cause severe diarrhea with resulting dehydration and loss of electrolytes (especially potassium). They also are more likely than other types of laxatives to cause intestinal cramping. There is concern that chronic use of stimulant laxatives may damage the colon and worsen constipation, as previously discussed. Bisacodyl (for example, Dulcolax, Correctol) is a stimulant laxative that affects the nerves of the colon which, in turn, stimulate the muscles of the colon to propel its contents. Prunes also contain a mild colonic stimulant.
Tegaserod (Zelnorm)
Tegaserod (Zelnorm) was approved in 2002 by the FDA specifically for the treatment of abdominal pain and constipation in women with irritable bowel syndrome. In March of 2007, the FDA asked Novartis, the company manufacturing tegaserod, to suspend sales of tegaserod in the U.S. because a retrospective analysis of data by Novartis from more than 18,000 patients showed a slight difference in the incidence of cardiovascular events (heart attacks, strokes and angina) among patients taking tegaserod compared to placebo. The data showed that cardiovascular events occurred in 13 out of 11,614 patients treated with tegaserod (.11%), compared to one cardiovascular event in 7,031 (.01%) placebo-treated patients. However, it is unclear whether tegaserod actually causes heart attacks and strokes. Doctors and scientists will be scrutinizing the data to determine the long-term safety of tegaserod.
The mechanism whereby tegaserod relieves constipation (and abdominal bloating and pain) is interesting and is related to its effects on the intestinal serotonin, a chemical that controls contractions of intestinal muscles. The contractions of the intestinal muscles control transit of digesting food through the intestine. More contractions speed transit, fewer contractions slow transit. In constipated patients, contractions are fewer.
Serotonin is a chemical manufactured by nerves in the intestine that is released and then binds to muscle cells. Depending on which receptor it binds to on the muscle, serotonin can either promote or prevent contractions. The serotonin 5-HT4 receptor is a receptor that prevents contractions when serotonin binds to it. Tegaserod blocks the 5-HT4 receptor, prevents serotonin from binding to it, and thereby increases contractions of the intestinal muscles. The increased contractions speed the transit of digesting food and reduces constipation. In addition, tegaserod reduces the sensitivity of the intestinal pain-sensing nerves and can thereby reduce abdominal pain.
In large placebo controlled trials involving men and women with chronic constipation, tegaserod was more effective than placebo in increasing the number of spontaneous bowel movements and reducing straining, abdominal bloating, abdominal pain, and abdominal discomfort. The most common side effect of tegaserod was diarrhea, which was usually mild or moderate and generally resolved within a few days while continuing treatment.
Lubiprostone (Amitiza)
Lubiprostone (Amitiza) is a selective chloride channel activator that increases secretion of chloride ions from the cells of the intestinal lining into the intestinal lumen. Sodium ions and water then follow the chloride ions into the lumen, and the water softens the stool. The FDA approved lubiprostone for the treatment of chronic constipation in both men and women in February 2006. At a dose of 24 micrograms twice a day, lubiprostone significantly and promptly increased bowel movements, improved stool consistency, and decreased straining. The most common side effect of initial clinical studies was mild to moderate nausea in 32% of patients treated with lubiprostone, compared to 3% of the controls. More long term studies of efficacy and side effects are needed to determine the place of lubiprostone in the treatment of constipation.
Enemas
There are many different types of enemas. By distending the rectum, all enemas (even the simplest type, the tap water enema) stimulate the colon to contract and eliminate stool. Other types of enemas have additional mechanisms of action. For example, saline enemas cause water to be drawn into the colon. Phosphate enemas (for example, Fleet phosphosoda) stimulate the muscles of the colon. Mineral oil enemas lubricate and soften hard stool. Emollient enemas (for example, Colace Microenema) contain agents that soften the stool.
Enemas are particularly useful when there is impaction, which is hardening of stool in the rectum. In order to be effective, the instructions that come with the enema must be followed. This requires full application of the enema, appropriate positioning after the enema is instilled, and retention of the enema until cramps are felt. Defecation usually occurs between a few minutes and one hour after the enema is inserted.
Enemas are meant for occasional rather than regular use. The frequent use of enemas can cause disturbances of the fluids and electrolytes in the body. This is especially true of tap water enemas. Soapsuds enemas are not recommended because they can seriously damage the rectum.
Suppositories
As is the case with enemas, different types of suppositories have different mechanisms of action. There are stimulant suppositories containing bisacodyl (for example, Dulcolax). Glycerin suppositories are believed to have their effect by irritating the rectum. The insertion of the finger into the rectum when the suppository is placed may itself stimulate a bowel movement.
Combination products
There are many products that combine different laxatives. For example, there are oral products that combine senna and psyllium (Perdiem), senna and docusate (Senokot-S), and senna and glycerin (Fletcher"s Castoria). One product even combines three laxatives, senna-like casanthranol, docusate, and glycerin (Sof-lax Overnight). These products may be convenient and effective, but they also contain stimulant laxatives. Therefore, there is concern about permanent colonic damage with the use of these products, and they probably should not be used for long-term treatment unless non-stimulant treatment fails.
Miscellaneous drugs
Several prescribed drugs that are used to treat medical diseases consistently cause (as a side effect) loose stools, even diarrhea. There actually are several small studies that have examined these drugs for the treatment of constipation.
Colchicine
Colchicine is a drug that has been used for decades to treat gout. Most patients who take colchicine note a loosening of their stools. Colchicine has also been demonstrated to relieve constipation effectively in patients without gout.
Misoprostol (Cytotec)
Misoprostol (Cytotec) is a drug used primarily for preventing stomach ulcers caused by nonsteroidal antiinflammatory drugs such as ibuprofen. Diarrhea is one of its consistent side-effects. Several studies have shown that misoprostol is effective in the short term treatment of constipation. Misoprostol is expensive, and it is not clear if it will remain effective and safe with long-term use. Therefore, its role in the treatment of constipation remains to be determined.
Orlistat (Xenical)
Orlistat (Xenical) is a drug that is used primarily for reducing weight. It works by blocking the enzymes within the intestine that digest fat. The undigested fat is not absorbed, which accounts for the weight loss. Undigested fat is digested by bacteria within the intestine and the products of this bacterial digestion promote the secretion of water. The products of digestion also may affect the intestine in other ways, for example, by stimulating the intestinal muscles. In fact, in studies, orlistat has been shown to be effective in treating constipation. Orlistat has few important side effects, which is consistent with the fact that only very small amounts of the drug are absorbed from the intestine.
It is unclear if these prescribed drugs should be used for the treatment of constipation. Although it is difficult to recommend them specifically just for the treatment of constipation, they might be considered for constipated individuals who are overweight, have gout, or need protection from nonsteroidal antiinflammatory drugs.
Exercise
People who lead sedentary lives are more frequently constipated than people who are active. Nevertheless, limited studies of exercise on bowel habit have shown that exercise has minimal or no effect on the frequency of bowel movements. Thus, exercise can be recommended for its many other health benefits, but not for its effect on constipation.
Biofeedback
Most of the muscles of the pelvis surrounding the anus and rectum are under some degree of voluntary control. Thus, biofeedback training can teach patients with pelvic floor dysfunction how to make their muscles work more normally and improve their ability to defecate. During ano-rectal biofeedback training, a pressure-sensing catheter is placed through the anus and into the rectum. Each time a patient contracts the muscles, the muscles generate a pressure that is sensed by the catheter and recorded on a screen. By watching the pressures on the screen and attempting to modify them, patients learn how to relax and contract the muscles more normally.
Surgery
For individuals with problematic constipation that is due to diseases of the colon or laxative abuse, surgery is the ultimate treatment. During surgery, most of the colon, except for the rectum (or the rectum and part of the sigmoid colon), is removed. The cut end of the small intestine is attached to the remaining rectum or sigmoid colon. In patients with colonic inertia, surgery is reserved for those who do not respond to all other therapies. If the surgery is to be done, there must be no disease of the small intestinal muscles. Normal small intestinal muscles are evidenced by normal motility studies of the small intestine itself.
Electrical pacing
Electrical pacing is still in its experimental phases. Electrical pacing may be done using electrodes implanted into the muscular wall of the colon. The electrodes exit the colon and are attached to an electrical stimulator. Alternatively, stimulation of the sacral skin can be used to stimulate nerves going to the colon. These techniques are promising, but much more work lies ahead before their role in treating constipation, if any, has been defined.
TA的其他文章: