臨牀消化器内科 Vol.33 No.4(1)


特集名 慢性便秘―新たな分類と病態・診断・治療
題名 定義・分類・診断基準
発刊年月 2018年 04月
著者 味村 俊樹 三慶会指扇病院排便機能センター
【 要旨 】 「慢性便秘症診療ガイドライン2017」では，「便秘」は，「本来体外に排出すべき糞便を十分量かつ快適に排出できない状態」と定義された．
便秘の分類としては，従来の痙攣性・弛緩性・直腸性を廃止し，症状の観点から排便回数減少型と排便困難型に分類して初期診療を行い，それでも症状が十分に改善しない場合に，病態の観点から，専門的検査を用いて大腸通過正常型，大腸通過遅延型，便排出障害に分類する．
「慢性便秘症」の診断基準は，国際的に使用されているRome基準の「機能性便秘」の診断基準を翻訳改変して作成した．ただし，Rome基準で「機能性便秘」から除外されている過敏性腸症候群は，慢性便秘症の原因の一つと考え，本診断基準では，Rome基準に記載されている「過敏性腸症候群の基準を満たさない」と「下剤を使用しないときに軟便になることはまれである」の条件は除外した．
Theme Chronic Constipation : A New Classification, Pathophysiology, Diagnosis, Treatment
Title Definition, Classification, and Diagnostic Criteria for Constipation -- Japanese 2017 Guideline for the Management of Chronic Constipation
Author Toshiki Mimura Center for Functional Bowel and Anorectal Disorders, Sashiogi Hospital
[ Summary ] In the Japanese guideline for the management of chronic constipation, newly published in 2017, "Constipation" is defined as "A condition, in which a certain amount of stool that ought to be defecated cannot be evacuated sufficiently and comfortably."
In this guideline, constipation is first classified into either the "Infrequent Bowel Motion type" or the "Evacuation Difficulty type", solely based on the patient's symptoms and used for their initial case management. If the initial therapies fail, the patient's condition is further classified into normal transit constipation, slow transit constipation, and defecation disorder, utilizing specialized examinations, such as a colonic transit study, defecography, and other methods.
The diagnostic criteria for "Chronic Constipation" are a modified version of the Rome IV criteria for "Functional Constipation". Although irritable bowel syndrome (IBS) is excluded from "Functional Constipation" in the Rome IV criteria, IBS can be generally regarded as one of the causes of "Chronic Constipation", and therefore the two conditions of "Insufficient criteria for irritable bowel syndrome" and "Loose stools are rarely present without the use of laxatives" in the Rome IV, were excluded from the diagnostic criteria for "Chronic Constipation" in the Japanese guideline for the management of chronic constipation.
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