Sa1383 Efficacy of Multidisciplinary Approach for the Management of Severe Constipation: A 4-Year Experience

Abstract

Background: Chronic constipation is one of the most common gastrointestinal disorders throughout theworld. Many patients with severe constipation are resistant to pharmacological treatments and operations. Objective: To evaluate the efficacy of multidisciplinary approach in patients with severe constipation through a long-term follow-up.Methods: Three hundred and ninety-one patients diagnosed with constipation according to Rome III criteria accepted multidisciplinary treatment or standard medical treatment between March, 2010 and April, 2013. The multidisciplinary constipation clinic in a tertiary care setting with dietary modification, exercise therapy, bowel habit adjustment, abdominal breathing exercise and drug therapy. Constipation symptoms, quality of life (SF-36), anxiety and depression were assessed before enrollment and after therapy. Results: Two hundred and eighty-eight subjects were treated by multidisciplinary treatment and 235 subjects complete the follow-up. The mean age of patients was 50.6 ± 16.0 years. 74.7% of patients were female. The mean duration of follow-up was 2.3 years. The weekly bowel movements was higher in the multidisciplinary group than the medication group(5 (3, 7) vs. 3.0 (2, 4), P<0.001). There was significant improvement on Bristol score (3 (3, 3) vs. 3 (2, 3), P=0.032), straining effort (4 (3, 5) vs. 8 (6.75, 9.0), P<0.001) and straining time(10 (7, 13) vs. 15 (10, 17), P=0.002). Significant improvement was also noted with multidisciplinary treatment on straining at defecations(31.1% vs. 59.8%, P=0.005), Hard stools(24.3% vs. 52.4%, P=0.005) and sensation of anorectal obstruction(8.5% vs. 35.4%, P<0.001). The proportion of patients with laxative/ enema use was lower in multidisciplinary group than the medication group(27.6% vs. 63.4%, P<0.001). Meanwhile, the score of quality of life (N=13) were significant higher compared with baseline. Multidisciplinary treatment also reduced score of anxiety (33.07±6.31 vs. 35.13±4.05, P=0.032)and depression(37.59±9.45 vs. 44.07±6.77, P<0.001)(N=44).Conclusion: This study suggest that multidisciplinary approach improves long-term constipation symptoms. Improvement in quality of life was also seen in patients attending themultidisciplinary constipation clinic.