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Chronic Constipation.

Adil E Bharucha1, Arnold Wald2

  • 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

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Summary
This summary is machine-generated.

Constipation management involves various treatments, including laxatives and newer medications for opioid-induced cases. Refractory constipation requires further evaluation for disorders and potential surgical intervention.

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Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Constipation is a prevalent symptom, often self-managed, but 22% seek medical care, incurring significant healthcare costs.
  • Primary (functional) constipation or constipation secondary to disorders/medications necessitates effective management strategies.

Purpose of the Study:

  • To review current evidence on constipation management.
  • To discuss diagnostic approaches for refractory constipation.
  • To guide treatment choices based on efficacy and cost.

Main Methods:

  • Literature review of evidence-based treatments for constipation.
  • Discussion of diagnostic studies for defecatory disorders and slow-transit constipation.
  • Analysis of treatment options including laxatives, secretagogues, and opiate antagonists.

Main Results:

  • Stimulant laxatives, osmotic laxatives, intestinal secretagogues, and peripherally restricted μ-opiate antagonists are effective and safe.
  • Peripherally restricted μ-opiate antagonists represent a significant advancement for opioid-induced constipation.
  • Defecatory disorders may respond to biofeedback; slow-transit constipation might need surgery.

Conclusions:

  • Treatment selection for functional and opioid-induced constipation should balance efficacy and cost.
  • Further comparative studies are needed for inexpensive laxatives versus newer mechanisms.
  • Comprehensive evaluation is crucial for refractory constipation cases.