Chronic constipation and treatment options (Review)

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Chronic constipation (CC) is a prevalent disorder impacting patient quality of life and incurring significant healthcare costs.
• While most CC cases are manageable with diet and laxatives, a subset of patients with functional CC (slow-transit and non-slow transit) show poor response to these treatments.
• These refractory cases cause substantial psychological and social distress, consuming disproportionate medical resources.

Purpose of the Study:

• To review the therapeutic options for functional chronic constipation.
• To explore the mechanisms of action for novel treatments targeting specific pathways involved in CC.

Main Methods:

• Review of existing literature on the pathophysiology and treatment of chronic constipation.
• Analysis of pharmacological mechanisms for prucalopride and linaclotide.
• Evaluation of non-pharmacological interventions such as biofeedback and sacral nerve stimulation.

Main Results:

• Functional CC may involve dysregulation of the serotonin transmission system.
• Prucalopride, a serotonin receptor agonist, demonstrates prokinetic effects and may correct underlying disturbances.
• Linaclotide increases intestinal fluid secretion and has shown efficacy in functional CC.
• Biofeedback and sacral nerve stimulation are effective for CC related to pelvic floor disorders.

Conclusions:

• Novel pharmacological agents like prucalopride and linaclotide offer effective treatment options for functional chronic constipation.
• Interventions targeting specific pathophysiological mechanisms, including serotonin pathways and fluid secretion, are crucial.
• For CC with pelvic floor dysfunction, biofeedback and sacral nerve stimulation provide valuable therapeutic avenues.