The effect of parathyroidectomy on chronic constipation in patients affected by primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is usually associated with chronic constipation; however, its prevalence is not defined by standardized criteria. The aim of the study was to evaluate both the prevalence of chronic constipation, defined by the standardized Rome diagnostic criteria III (Rome III) in PHPT, and the effect of parathyroidectomy (PTx). Fifty postmenopausal PHPT patients and 50 sex- and age-matched controls were studied. Each patient underwent mineral metabolism biochemical evaluation and completed a questionnaire and a 2-week diary card about bowel habits. PHPT patients were reevaluated after 6months. According to Rome III, 40% of PHPT patients had chronic constipation compared with 12% of controls (p=0.0002). The only difference between constipated PHPT patients (group A, n=20) and those without constipation (group B, n=30) was higher mean PTH values (79.9±18.7ng/l vs. 65.4±26.0ng/l; p=0.03), which predicted the presence of constipation (p=0.004, OR 1.059, CI 1.011-1.059). Forty percent of PHPT patients had undergone PTx. In group A, constipation was resolved in 80% of patients after PTx compared to none of the same group who had not undergone PTx (p=0.0007). In group B, 17.6% of patients who had not undergone PTx became, after 6months, constipated. According to Rome III, a higher prevalence of chronic constipation in PHPT patients was observed compared with controls. PTH levels predicted constipation. A significant reduction of chronic constipation was reported following successful surgery.