Constipation: Advances in Diagnosis and Treatment

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Chronic constipation affects millions, leading to significant healthcare costs.
• Opioid-induced constipation (OIC) is a common challenge.
• Existing treatments for chronic idiopathic constipation (CIC) include laxatives and therapies for defecation disorders.

Purpose of the Study:

• To review current evidence for chronic constipation treatments.
• To provide guidance on managing CIC refractory to initial therapies.
• To highlight the need for comparative studies on laxative efficacy and cost.

Main Methods:

• Review of established and emerging treatments for chronic constipation.
• Discussion of treatment algorithms for refractory CIC.
• Emphasis on peripherally restricted μ-opiate receptor antagonists for OIC.

Main Results:

• Stimulant and osmotic laxatives, secretogogues, and μ-opiate receptor antagonists show strong efficacy.
• Biofeedback and addressing defecation disorders are crucial for refractory CIC.
• Long-term use of stimulant laxatives like senna and bisacodyl is safe and effective.
• There is a lack of comparative studies between inexpensive and newer constipation agents.

Conclusions:

• Treatment decisions for CIC and OIC must balance cost and efficacy.
• Patients with refractory constipation require specialized evaluation at centers with expertise in defecation and colonic transit studies.