Chronic constipation in Rome IV era: The Indian perspective.

Area of Science:

• Gastroenterology
• Internal Medicine
• Public Health

Background:

• Chronic constipation (CC) is a global health issue with distinct characteristics in India.
• The Rome IV guidelines have spurred interest in the Indian perspective on CC.
• Differences exist in bowel habits, epidemiology, pathophysiology, and management compared to Western countries.

Purpose of the Study:

• To review chronic constipation in India, highlighting unique aspects.
• To discuss the differences in CC definition, epidemiology, and pathophysiology in India.
• To explore current management strategies and unmet needs for CC in India.

Main Methods:

• Literature review focusing on chronic constipation in the Indian context.
• Analysis of differences in CC presentation and pathophysiology between India and the West.
• Examination of current diagnostic and management approaches, including pharmacological and non-pharmacological options.

Main Results:

• Functional constipation (FC) is more common than constipation-predominant irritable bowel syndrome (IBS-C) in India, partly due to less frequent abdominal pain.
• Pathophysiological mechanisms include slow colon transit and fecal evacuation disorder (FED), but lifestyle factors are significant in primary care.
• Non-pharmacological management for FED, like biofeedback, has limited availability in India.

Conclusions:

• Chronic constipation in India requires a tailored approach considering unique epidemiological and pathophysiological factors.
• There is a need for improved access to diagnostic tools and non-pharmacological treatments for CC, particularly FED.
• Addressing lifestyle and dietary factors is crucial for managing CC in the Indian primary care setting.