Introduction Chronic constipation is a common problem within the general population and can have a negative impact on quality of life. Patients referred to secondary care with this symptom often undergo a colonoscopy, which is often normal. There are American Gastroenterological Association (AGA) and NICE guidelines on the investigation and management of constipation. We hypothesised that there is variability in how patients with constipation are assessed and managed, and that patients with chronic constipation are often discharged following a normal colonoscopy without a clear diagnosis or plan. Our aim was to observe current practice in the management of patients with symptoms of constipation and a normal colonoscopy.
Method This was a single centre, retrospective study of patients with constipation who had a normal colonoscopy within a large London District General Hospital. Data was collected from patients with constipation and a normal colonoscopy using the ‘Unisoft GI reporting tool’ and electronic patient records. Data was collected on 50 patients and scrutinised for subgroup analysis to include demographic data, investigations performed, type of clinic, diagnosis in clinic and further management.
Results Mean age 51. Female 74%. In terms of further investigations 28% had imaging, 32% had a thyroid function test, 20% had a calcium blood test, 16% had a colon transit study and 6% had anorectal manometry. 10% of patients had biofeedback therapy.
58% of patients were discharged or never followed up following a normal colonoscopy. Of those that were followed up, 38% had other diagnosis or gastrointestinal co-morbidities unrelated to the constipation.
70% of patients had no clear diagnosis documented in relation to their constipation. 44% of patients had no clear documented management plan for their constipation.
64% of patients were under the care of surgical specialties.
Conclusion There is clear variability in how patients with chronic constipation are assessed and managed in secondary care. The majority of patients are discharged following a normal colonoscopy back to the GP without further investigations of potentially reversible causes of their symptoms (only a third had TFTs checked, only 20% had calcium assessment) and no clear diagnosis or long-term management plan. In this study only a small number of patients in secondary care have investigations to categorise the subgroup of constipation disorders (only 16% had colon transit study) into normal transit, slow transit and defecation disorder by way of colon transit study. We conclude that more awareness and implementation of guidelines such as those from AGA in assessment and management of constipation is required. We also conclude that the assessment and management of constipation in secondary care is substandard.
Disclosure of Interest None Declared
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