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Medical Therapy of Constipation: Current Standards and Beyond
1Israelitic Hospital, University of Hamburg, Hamburg, Germany.
Visceral Medicine
|June 12, 2018
Summary
Chronic constipation management involves lifestyle changes, laxatives, and advanced therapies for refractory cases. Opioid-induced constipation benefits from peripherally acting µ-opioid antagonists, improving quality of life and survival.
Area of Science:
- Gastroenterology
- Pharmacology
- Internal Medicine
Background:
- Chronic constipation significantly impacts patient quality of life.
- Constipation is a complex disorder involving multiple defecation issues.
- Current guidelines advocate a structured, stepwise treatment approach.
Purpose of the Study:
- To outline current management strategies for chronic constipation.
- To discuss advanced pharmacological options for refractory constipation.
- To highlight treatments for opioid-induced constipation (OIC).
Main Methods:
- Review of current guidelines and medical literature.
- Stepwise treatment algorithm including lifestyle, laxatives, and advanced therapies.
- Focus on peripherally acting µ-opioid antagonists for OIC.
Main Results:
- Initial management includes lifestyle adjustments and bulking agents.
- Conventional laxatives are the next therapeutic step.
- Prucalopride, linaclotide, lubiprostone, and peripherally acting µ-opioid antagonists (naloxone, naloxegol, naldemedine, methylnaltrexone) show efficacy in refractory and OIC.
- OIC treatments improve symptoms and may increase survival in terminally ill patients.
Conclusions:
- Effective management of chronic constipation requires identifying evacuation disorders.
- Modern pharmacotherapies offer significant benefits for difficult-to-treat constipation.
- A simple tool to identify treatment failure could enhance patient care.
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