Background and study aims: There are no definite guidelines regarding colonoscopic evaluation for the indication of constipation, a common gastrointestinal complaint. The aim of our study was to determine the risk of finding significant lesions in patients undergoing colonoscopy for the indication of constipation alone compared with constipation with another indication or average-risk screening.
Patients and methods: A retrospective review of the Clinical Outcomes Research Initiative database was carried out for colonoscopies undertaken between 1 January 2000 and 30 June 2003. A total of 41 775 index colonoscopies performed for the indications of average-risk screening, constipation only or constipation with another indication were identified. Logistic regression analyses were performed for constipation alone versus constipation with another indication, and for constipation alone versus average-risk screening.
Results: Constipation alone did not show any increased risk of significant findings on colonoscopy. Constipation and the presence of another indication, however, had a statistically significant increased risk of a significant finding on colonoscopy. The indication of constipation alone had a lower risk of significant findings on colonoscopy compared with average-risk screening. Variations in the definition of constipation used was a limitation of the study.
Conclusions: Colonoscopy for constipation alone has a lower yield for significant findings compared with average-risk screening and constipation with another indication; hence, colonoscopy should not be done for constipation alone.
References
1
Sonnenberg A, Koch T R.
Epidemiology of constipation in the United States.
Dis Colon Rectum.
1989;
32
1-8
2
American College of Gastroenterology Chronic Constipation Task Force .
An evidence-based approach to the management of chronic constipation in North America.
Am J Gastroenterol.
2005;
100 Suppl 1
S1-4
3
Stewart W F, Liberman J N, Sandler R S. et al .
Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features.
Am J Gastroenterol.
1999;
94
3530-3540
4
Pare P, Ferrazzi S, Thompson W G. et al .
An epidemiological survey of constipation in canada: definitions, rates, demographics, and predictors of health care seeking.
Am J Gastroenterol.
2001;
96
3130-3137
5
Locke 3rd
G R, Pemberton J H, Phillips S F.
American Gastroenterological Association Medical Position Statement: guidelines on constipation.
Gastroenterology.
2000;
119
1761-1766
6
Qureshi W, Adler D G, Davila R E. et al .
ASGE guideline: guideline on the use of endoscopy in the management of constipation.
Gastrointest Endosc.
2005;
62
199-201
8
Dukas L, Willett W C, Colditz G A. et al .
Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women.
Am J Epidemiol.
2000;
151
958-964
9
Pepin C, Ladabaum U.
The yield of lower endoscopy in patients with constipation: survey of a university hospital, a public county hospital, and a Veterans Administration medical center.
Gastrointest Endosc.
2002;
56
325-332
10
Roberts M C, Millikan R C, Galanko J A. et al .
Constipation, laxative use, and colon cancer in a North Carolina population.
Am J Gastroenterol.
2003;
98
857-864
11
Watanabe T, Nakaya N, Kurashima K. et al .
Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study.
Eur J Cancer.
2004;
40
2109-2115
12
Lieberman D A, Weiss D G, Bond J H. et al .
Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380.
New Engl J Med.
2000;
343
162-168
13
Kune G A, Kune S, Field B, Watson L F.
The role of chronic constipation, diarrhea, and laxative use in the etiology of large-bowel cancer. Data from the Melbourne Colorectal Cancer Study.
Dis Colon Rectum.
1988;
31
507-512
15
Harewood G C, Lieberman D A.
Prevalence of advanced neoplasia at screening colonoscopy in men in private practice versus academic and Veterans Affairs medical centers.
Am J Gastroenterol.
2003;
98
2312-2316
