The clinical concept of whether constipation is a disease or a disease is rather confusing, and there are multiple views on the issue of whether “constipation” is a disease or a disease in the domestic medical community, and there is a lack of uniform understanding, so that researchers or clinicians are at a loss. This article introduces the respective understanding of constipation disease and disease in international and domestic medical circles and Chinese medicine, and proposes the basic conditions, differences and connections between constipation disease and disease, in order to guide clinical practice.
With the change of diet structure and the disturbance of mental and psychological factors, constipation has become one of the important factors affecting the quality of life of modern people. However, the current clinical concept of constipation as a disease or a disease is rather confusing, and “constipation” is a disease in the International Classification of Diseases. The lack of a unified understanding of constipation has left researchers or clinicians at a loss.
A better understanding of the difference and connection between constipation and the disease is not only beneficial to solve the practical problems in the clinic, but also conducive to academic exchanges. Now on the “constipation” understanding of personal views, in order to throw a brick to draw jade.
First, the international understanding of constipation
International Classification of Diseases (ICD-10) Application Guidance Manual” is the tenth revision of WHO’s “International Statistical Classification of Diseases and Related Health Problems”, which is the WHO and the medical experts of member countries jointly developed the health information classification standards, representing the development process of international standardization of disease classification.
In ICD-10, “constipation” is clearly listed as an independent disease with the statistical code 098. With the increasing research on functional gastrointestinal disorders (FGID), the Rome III Collaborative Committee developed a series of standards for Rome III FGID on the basis of Rome II in 2006. Although the understanding of constipation is not the same in all countries, most of them take RomeⅢ diagnostic criteria as the basis and combine with the clinical reality of each country to develop the diagnosis and treatment process with national characteristics.
RomeIII’s diagnostic criteria for functional constipation (FC) are
1. Symptoms have been present for at least 6 months prior to diagnosis, with symptomatic episodes in the last 3 months, which should include 2 or more of the following symptoms.
(1) Effort to defecate (at least 1 out of every 4 bowel movements);
(2) Lumpy or hard stools (at least 1 in 4 bowel movements);
(3) incomplete bowel movement (at least 1 in 4 bowel movements);
(4) Anorectal obstruction and/or blockage (at least 1 out of every 4 bowel movements);
(5) Requires manual manipulation (e.g., finger-assisted defecation, pelvic floor support for defecation) to facilitate defecation (at least 1 in 4 defecations);
(6) Defecation less than 3 times per week; 2. Almost no loose stools without laxatives.
2. Inadequate conditions for the diagnosis of IBS (irritable bowel syndrome). And the main points of the diagnosis and treatment process of constipation in the United States is based on the history, signs and laboratory tests, the first proposed experimental treatment, for patients with intractable constipation, and then barium defecography and related power function tests, according to the type of constipation, the corresponding treatment. And the diagnosis of constipation is divided into 6 cases, namely 1. IBS constipation type ;
Second, the understanding of constipation in Chinese medicine
The first discussion of constipation in Chinese medicine was found in the Yellow Emperor’s Classic of Internal Medicine. Suwen・To the true to the great treatise said: “Taiyin division of the sky, dampness and obscenity by the Sheng …… stool difficult, Yin Qi do not use.” Suwen・lifting pain theory also said: “heat stay in the small intestine, intestine pain, paralysis heat anxiety and thirst, then firm dry can not come out, so pain and closed can not carry on”, respectively, elaborated the constipation of the site of the disease, the cause, the relevant organs and clinical symptoms, but did not clearly point out that it is a disease.
Later medical doctors have played on the symptoms, diagnosis, identification, treatment and other aspects of constipation, some treat it as an independent disease, some only treat it as a symptom, so far lack of unified understanding. The current textbook of Chinese medicine colleges and universities, “Internal medicine of Chinese medicine”, “constipation is due to abnormal conduction of the large intestine, resulting in constipation, prolonged defecation cycle; or the cycle is not long, but the feces is dry and difficult to discharge; or fecal quality is not hard, although the intention to defecate, but not smooth evidence of the disease.
Constipation is a common clinical symptom that can occur in the course of various acute and chronic illnesses, and this section discusses illnesses with constipation as the main manifestation”. Accordingly, it is inferred that the constipation discussed in this article is mainly in the concept of symptoms. But then the article will be constipation into real constipation (intestinal heat, Qi stagnation, Yin cold stagnation) and deficiency constipation (Qi deficiency, blood deficiency, Yin deficiency, Yang deficiency) two categories of seven types of evidence, a more detailed identification of the type, where the discussion of “constipation” is clearly a disease rather than a “symptom The “constipation” discussed here is obviously a disease rather than a “symptom”.
In the same article, the concept of disease and symptom is still blurred. The National Standard of the People’s Republic of China “Chinese medicine clinical diagnosis and treatment terminology disease part” has a total of 930 disease terms (excluding orthopedic diseases), 49 symptomatic terms, constipation is clearly classified as a symptomatic term, and constipation is considered a symptom. The recently published monographs on Chinese medicine, however, list constipation in an independent chapter on the same status as other anorectal diseases, and discuss it as an independent disease from etiology and pathology, clinical manifestations, laboratory tests, diagnosis and differentiation, treatment and prognosis, etc., which is far beyond the scope of symptoms.
Third, the domestic medical community’s understanding of constipation
The editorial committee of Chinese medical journal has organized experts twice in 1990 and 1999 to formulate “provisional standards for the diagnosis and treatment of constipation”, and clearly pointed out that “constipation is not a disease, but a symptom of many diseases”. Some medical publications also believe that “constipation is not an independent disease, but a complex symptom caused by the pathological process of multiple diseases”.
Obviously, this not only contradicts the WHO’s revision of the International Classification of Diseases, but also contradicts the Ministry of Health of China, which is scheduled to officially promote the use of ICD-10 in hospitals and death investigation sites at county level and above in 2002, as the new national statistical classification of diseases and deaths. However, some types of constipation, such as “outlet obstructive constipation”, have been clearly classified as a disease in newly published medical monographs.
It is also defined as follows: “Constipation is not only a disease, but also the most common clinical symptom of the digestive tract”. This will be constipation both as a disease, but also as a symptom of the views of the clinical reality, we tend to this, but the authoritative academic organizations are still not listed in the disease constipation, this issue deserves serious consideration by colleagues, subject to further discussion.
Fourth, the difference and connection between constipation disease and constipation disease
Constipation is a difficult and complex clinical problem, with the rapid development of modern science and technology in recent years, as well as the continuous combination with modern medicine, the medical profession has made great progress in the understanding of constipation, especially the introduction of radiological imaging technology into the study of constipation, resulting in a qualitative leap, the establishment of constipation and constipation with their own basic conditions, as follows: the basic conditions for the establishment of constipation.
1, with a clear location, the location of the disease in the large intestine;
2, with a clear pathogenesis, the basic pathology of the slow transmission and exit obstruction of the colon;
3, with a set of unique symptoms, signs and laboratory test results, such as: reduced stool, dry feces, lack of bowel movement; barium X-ray imaging typical features “goose head sign”, “shelf sign”, “rectal mucosal overlap “other features;
4.There are clear diagnostic criteria and differentiation methods;
5, can propose typing, classification, staging, grading, etc.
The basic conditions for establishing constipation are.
1, some functional constipation without organic abnormalities, the patient lacks common sense of defecation physiology, thus disrupting the normal physiological conditioned reflexes of defecation, such as: irregular defecation, long-term suppression of bowel movement;
2, there is a clear primary disease associated with constipation.
(1) mental disorders caused by constipation, such as depression, psychosis, anorexia nervosa;
(2) medical constipation, such as codeine, morphine, antidepressants, anticholinergic agents, iron, braking, etc.
3, non-organic lesions caused by constipation, constipation within a year “disease duration” less than 3 months. These are symptomatic constipation, easy to distinguish from constipation disease.
In summary, constipation can be diagnosed as a constipation disease if the symptoms of constipation are present and organic abnormalities of the relevant intestinal channels or adjacent organs can be detected by imaging and laboratory diagnosis, and if regular medication is ineffective for more than 3 months or is not effective, or if long-term medication, manipulation, or apparatus is needed to help defecation. If the primary disease is clear, often secondary to other diseases outside the intestinal channel, or caused by drugs and devices used to treat other diseases, and there is no relevant organic abnormality through imaging and laboratory diagnosis, and constipation can be relieved or eliminated after curing the primary disease or removing the above factors, constipation can be diagnosed as constipation.
In other words, patients with constipation disease must have constipation symptoms, but not all constipation can be diagnosed as constipation disease. Constipation develops once it causes organic abnormalities in the associated intestinal channels or adjacent organs. Of course, after effective treatment of constipation, the constipation is only a symptom when there is no further organic abnormality in the relevant intestinal channels or adjacent organs on review, and constipation still exists. Therefore, constipation disease and constipation have both a difference and an inherent connection.
Fifth, the practical significance of distinguishing constipation and constipation disease
In clinical practice, if constipation as a symptom and only take the corresponding symptomatic treatment, it is impossible to carry out in-depth exploration from the etiology, can not develop the corresponding treatment plan, not only can not achieve the therapeutic effect, and sometimes even mislead the patient’s condition; on the contrary, if all constipation as a disease to diagnose and treat, may also be mistreatment of many originally only need to cure the primary disease or remove certain factors will Symptomatic constipation that can be relieved or eliminated.
This requires clinicians not only to master the physiological and anatomical basis of the digestive system and the physiological mechanism of defecation, but also to thoroughly study the causes, diagnosis, differentiation and treatment of constipation. The identification of constipation or constipation can guide the clinic to adopt the most optimal individual treatment plan, reduce unnecessary pain and medical expenses of patients, and facilitate academic exchange, better carry out large-scale, multicenter randomized controlled studies, and better evaluate systematically the research results or clinical efficacy, with a view to formulating corresponding and clear treatment norms, which is of great significance.