すぐわかる子どもの便秘 診療ルートガイド

出版社: 中外医学社
著者:
発行日: 2022-12-01
分野: 臨床医学:内科  >  小児科学一般
ISBN: 9784498145849
電子書籍版: 2022-12-01 (1版1刷)
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長年にわたり子どもの便秘の診療に携わってきた著者が,「論文」「経験」の両面から小児プライマリケアでの便秘診療を解説.要所を大胆かつ簡潔にまとめた「ぶっちゃけて言えばこう!」では明日からの診療に使える知識やコツをすぐに学べる.本文では排便の生理と発達から便秘のメカニズム,診断,治療,ホームケアやトレーニングなどを丁寧に説明し,エビデンスと現場での実際のギャップを埋める一冊となっている.

目次

  • 第1章 排便の生理と発達
    (A) 腸と脳の発生
    (B) 腸脳相関の成立
    (C) 正常の排便メカニズム
       1)排便機能の発達
       2)排便の大蠕動と胃結腸反射
       3)実際の排便メカニズム
       【Column】 本当は理にかなっている和式便器

    第2章 便秘のメカニズム
    (A) 子どもの便秘メカニズム
    (B) 成人の便秘メカニズム
       1)DD の病態
       (1)排便協調運動不全
       (2)便意の低下
       2)STC の病態
    (C) 子どもの便秘から大人の便秘へ
       1)子どもの便秘の発症
       2)大人への便秘移行メカニズム

    第3章 便秘の診断
    (A) ROME IV 診断基準
       1)ROME 基準による便秘の定義の変遷
       2)ROME IV 基準による便秘の診断
       3)過敏性腸症とのかかわり
    (B) 診断の留意点
       1)問診のポイント〜基礎疾患の否定
       2)便秘と混同されやすいもの
       (1)無貯留性遺糞
       (2)排便頻度の減少
       (3)乳児排便困難症
       【Column】 綿棒浣腸はやってはいけない
       メモ: 1 歳未満の排便困難児への対応

    第4章 便秘の診察・検査のポイント
    (A) 理学所見
    (B) 血液生化学検査
    (C) 画像検査
       1)腹部X 線単純撮影
       2)腹部超音波断層撮影
       〇腹部超音波検査の便秘診断のポイント
       3)大腸ガストログラフィン造影
    (D)より高度な専門領域の検査
       1)直腸肛門マノメトリー検査(ARM)
       2)バルーン排出試験
       3)結腸通過時間測定
       (1) X 線不透過マーカー法
       (2) RI シンチグラフィー法

    第5章 便秘のホームケア
    (A) 水分摂取
    (B) 食物繊維
    (C) プロ/ プレバイオティクス
    (D)牛乳除去
    (E)便秘のホームケア(まとめ)

    第6章 便秘の治療
    (A) 初診からDisimpaction 〜維持療法まで
       1)治療イメージの説明
       2)治療の実際
       (1)排便日誌
       (2) Disimpaction
    (B) 維持療法
       【Column】 下剤はくせになる? ならない?
       1)浸透圧下剤
       (1) ポリエチレングリコール Polyethylene glycol(PEG: モビコールⓇ)
       【Column】 お薬を飲まない児
       (2)酸化マグネシウム(Magnesium oxide: MgO)
       (3)ラクチュロース
       2)膨張性下剤(バルク形成性下剤)
       3)刺激性下剤
       (1)アントラキノン系誘導体
       (2)ジフェニール系誘導体
       4)新規に開発された緩下剤
       (1)ルビプロストン(アミティーザⓇ)
       (2)リナクロタイド(リンゼスⓇ)
       (3)胆汁酸トランスポーター阻害剤(エロビキシバット: グーフィスⓇ)
       (4)セロトニン5-HT4 受容体刺激薬
    (C) 維持療法から卒業までの遠〜い道すじ

    第7章 排便トレーニング
    (A) 排便トレーニングプログラム
       1)トレーニングの準備
       2)トレーニングの実際
    (B) 排便トレーニングのモチベーションを上げる
       1)行動療法的アプローチ
       2)お手本(プロンプト)を見せる
       3) スモールステップアプローチ「少しずつ,ゆっくりマイペースで」
       4)トークンエコノミー(token-economy)法
    (C) 難治例に関して
       (1)排便協調運動の習熟に時間がかかる児
       (2)便性状に問題がないのに腹痛を訴える児

    第8章 慢性便秘の予後
    (A) 便秘の治療期間成人に移行させないために
    (B) 治 療期間,治癒にかかわる因子治療の重点目標を知る
    (C) 再発と成人への持ち越しに関して

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本参考文献は電子書籍掲載内容を元にしております。

第1章 排便の生理と発達

P.13 掲載の参考文献
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第2章 便秘のメカニズム

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P.33 掲載の参考文献
1) Vriesman MH, Koppen IJN, Camilleri M, et al. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020 ; 17 : 21-39.
2) Park SY, Burton D, Busciglio I, et al. Regional colonic transit pattern does not conclusively identify evacuation disorders in constipated patients with delayed colonic transit. J Neurogastroenterol Motil 2017 ; 23 : 92-100.

第3章 便秘の診断

P.40 掲載の参考文献
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4) Vandenplas Y, Alarcon P, Alliet P, et al. Algorithms for managing infant constipation, colic, regurgitation and cow's milk allergy in formula-fed infants. Acta Paediatr 2015 ; 104 : 449-57.

第4章 便秘の診察・検査のポイント

P.65 掲載の参考文献
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第5章 便秘のホームケア

P.76 掲載の参考文献
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第6章 便秘の治療

P.98 掲載の参考文献
1) 日本小児栄養消化器肝臓学会, 日本小児消化管機能研究会, 編. 小児慢性機能性便秘症診療ガイドライン. 東京 : 診断と治療社 ; 2013.
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P.121 掲載の参考文献
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P.123 掲載の参考文献
1) Barish CF, Drossman D, Johanson JF, et al. Efficacy and safety of lubiprostone in patients with chronic constipation. Dig Dis Sci 2010 ; 55 : 1090-7.
2) Hyman PE, Di Lorenzo C, Prestridge LL, et al. Lubiprostone for the treatment of functional constipation in children. JPGN 2014 ; 58 : 283-91.
3) Benninga MA, Hussain SZ, Sood MR, et al. Lubiprostone for pediatric functional constipation : randomized, controlled, double-blind study with long-term extension. Clin Gastroenterol Hepatol 2021 ; S1542-3565 (21) 00393-1.
P.124 掲載の参考文献
1) Baaleman DF, Gupta S, Benninga MA, et al. The use of linaclotide in children with functional constipation or irritable bowel syndrome : A retrospective chart review. Paediatr Drugs 2021 ; 23 : 307-14.
P.127 掲載の参考文献
1) Cinca R, Chera D, Gruss H-J, et al. Randomised clinical trial : macrogol/PEG 3350+electrolytes versus prucalopride in the treatment of chronic constipation--a comparison in a controlled environment. Aliment Pharmacol Ther 2013 ; 37 : 876-86.
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1) Wegh CAM, Baaleman DF, Tabbers MM, et al. Nonpharmacologic treatment for children with functional constipation : A systematic review and meta-analysis. J Pediatr 2022 ; 240 : 136-49.
2) van Dijk M, Bongers MEJ, De Vries GJ, et al. Behavioral therapy for childhood constipation : a randomized, controlled trial. Pediatrics 2008 ; 121 : e1334-41.

第7章 排便トレーニング

P.136 掲載の参考文献
1) van Dijk M, Benninga MA, Grootenhuis MA, et al. Chronic childhood constipation : a review of the literature and the introduction of a protocolized behavioral intervention program. Patient Educ Couns 2007 ; 67 : 63-77.
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1) 三田村仰. はじめてまなぶ行動療法. 東京 : 金綱出版 ; 2017.
2) 実森正子, 中島定彦. 学習の心理-行動のメカニズムを探る (コンパクト新心理学ライブラリ), 東京 : サイエンス社 ; 2018.

第8章 慢性便秘の予後

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1) van den Berg MM, van Rossum CH, de Lorijn F, et al. Functional constipation in infants : a follow-up study. J Pediatr 2005 ; 147 : 700-4.
2) van Ginkel R, Reitsma JB, Buller HA, et al. Childhood constipation : longitudinal follow-up beyond puberty. Gastroenterology 2003 ; 125 : 357-63.
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1) Bongers ME, van Wijk MP, Reitsma JB, et al. Long-term prognosis for childhood constipation : clinical outcomes in adulthood. Pediatrics 2010 ; 126 : e156-62.
2) Pijpers MA, Bongers ME, Benninga MA, et al. Functional constipation in children : a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr 2010 ; 50 : 256-68.
P.156 掲載の参考文献
1) Bongers MEJ, van Wijk MP, Reitsma JB, et al. Long-term prognosis for childhood constipation : clinical outcomes in adulthood. Pediatrics 2010 ; 126 : 156-62.
2) van Ginkel R, Reitsma JB, Buller HA, et al. Childhood constipation : longitudinal follow-up beyond puberty. Gastroenterology 2003 ; 125 : 357-63.

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