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[Constipation - pathophysiology, diagnostics, treatment].

Stefan Müller-Lissner

    Deutsche Medizinische Wochenschrift (1946)
    |August 16, 2019
    PubMed
    Summary

    Chronic constipation is linked to neurological disorders, immobility, and opioids. While current laxatives are generally safe and effective, new treatments are needed for patients unsatisfied with existing options.

    Area of Science:

    • Gastroenterology
    • Pharmacology

    Background:

    • Chronic constipation affects many individuals, often linked to neurological conditions, immobility, and medications like opioids.
    • Standard assessment includes a proctologic exam and ruling out serious conditions.

    Purpose of the Study:

    • To review the risk factors, assessment, and management of chronic constipation.
    • To evaluate the efficacy and safety of current and emerging laxative therapies.

    Main Methods:

    • Literature review of risk factors, diagnostic approaches, and pharmacological treatments for chronic constipation.
    • Analysis of the safety and efficacy profiles of various laxative classes, including older and newer agents.

    Main Results:

    • Neurologic disorders (e.g., Parkinson's disease), immobility, and opioid use are key risk factors.

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  • Established laxatives like Macrogol, Bisacodyl, and sodium picosulfate are first-line treatments and safe for long-term use at recommended doses.
  • Newer agents show comparable efficacy to older ones, but novel mechanisms are desirable for treatment-resistant cases.
  • Peripherally acting µ-opioid antagonists (PAMORAs) can manage opioid-induced constipation.

    • Conclusions:

    • Current laxatives are effective and safe for managing chronic constipation.
    • Despite existing options, research into novel therapeutic targets is warranted for patient satisfaction.
    • Opioid-induced constipation requires specific management strategies, including PAMORAs.