CLINICAL-RESPONSE TO DIETARY FIBER TREATMENT OF CHRONIC CONSTIPATION

Objectives: To determine the clinical outcome of dietary fiber therapy in patients with chronic constipation. Methods: One hundred, forty-ni ne patients with chronic constipation (age 53 yr, range 18-81 yr, 84% women) at two gastroenterology departments in Munich, Germany, were tr eated with Plantago ovata seeds, 15-30 g/day, for a period of at least 6 wk. Repeated symptom evaluation, oroanal transit time measurement ( radiopaque markers), and functional rectoanal evaluation (proctoscopy, manometry, defecography) were performed. Patients were classified on the basis of the result of dietary fiber treatment: no effect, n = 84; improved, n = 33; and symptom free, n = 32, Results: Eighty percent o f patients with slow transit and 63% of patients with a disorder of de fecation did not respond to dietary fiber treatment, whereas 85% of pa tients without a pathological finding improved or became symptom free. Conclusion: Slow GI transit and/or a disorder of defecation may expla in a poor outcome of dietary fiber therapy in patients with chronic co nstipation. A dietary fiber trial should be conducted before technical investigations, which are indicated only if the dietary fiber trial f ails.