Recent advances in understanding and managing chronic constipation.

Area of Science:

• Gastroenterology
• Colorectal Physiology
• Pharmacology

Background:

• Constipation is a prevalent condition in Western societies, negatively impacting physical, mental, and social well-being.
• Current empiric therapies for constipation often result in low patient satisfaction due to limited efficacy, side effects, or failure to address underlying pathophysiology.
• Defecatory disorders, treatable with pelvic floor biofeedback, are often overlooked in pharmacological trials for constipation.

Purpose of the Study:

• To review recent advances in the understanding of colonic and defecatory function physiology and pathophysiology.
• To highlight novel diagnostic tools, including high-resolution manometry, for assessing anorectal function.
• To discuss emerging therapeutic agents for constipation and their potential advantages over traditional laxatives.

Main Methods:

• Review of recent literature on colonic and anorectal physiology.
• Discussion of advancements in diagnostic techniques like high-resolution anorectal manometry.
• Analysis of new therapeutic agents, including secretagogues, pro-kinetics, and transport inhibitors.

Main Results:

• High-resolution manometry offers refined assessment of anorectal pressures and structural abnormalities.
• New therapeutic agents targeting colonic molecular physiology have been developed.
• The comparative efficacy of newer agents against traditional laxatives remains largely unestablished due to placebo-controlled trial designs.

Conclusions:

• Advances in physiology and diagnostics are improving the understanding and assessment of constipation.
• Novel therapeutic agents show promise but require further investigation regarding their comparative effectiveness.
• Future research should focus on trials comparing new constipation therapies directly with established treatments.