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Correct Answer: E
Rationale
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient.
References
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218.
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Correct Answer: E
Rationale
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient.
References
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218.
[email protected]
Correct Answer: E
Rationale
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient.
References
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218.
[email protected]
A 66-year-old woman presents for an evaluation of a 3-year history of constipation. She reports some mild abdominal pain, which is related to constipation. She denies GI bleeding and any relevant family history of colorectal neoplasia or IBD. A previous trial of fiber and polyethylene glycol was unsuccessful. Physical examination is normal, including the rectal examination. Evaluation including routine blood work and thyroid evaluation is normal. Her last colonoscopy was 1 year ago and was normal. She undergoes anorectal manometry, balloon expulsion testing and defecography, which do not reveal any significant abnormalities. Sitz marker test reveals 14 markers remaining in the colon on day 5. She is started on intestinal secretagogue therapy with no significant improvement in symptoms.
What is the next best step in the evaluation of this patient?