Management of Chronic Constipation: A Comprehensive Review.

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Chronic constipation treatment traditionally relied on lifestyle changes and laxatives.
• Recent advancements have introduced novel pharmacological agents with new mechanisms of action.
• The availability of treatments like polyethylene glycol and lactulose under insurance in Japan has expanded therapeutic options.

Purpose of the Study:

• To review the evolving landscape of chronic constipation treatment.
• To highlight the expanded therapeutic arsenal for managing chronic constipation.
• To discuss the diagnostic and therapeutic strategies based on patient presentation and physiological subgroups.

Main Methods:

• Review of recent pharmacological developments in constipation treatment.
• Classification of treatment approaches based on diagnostic subgroups (functional tests or symptom-based typing).
• Categorization of available medical therapies, including laxatives, secretagogues, and Kampo medicines.

Main Results:

• The number of treatment options for chronic constipation has significantly increased.
• A tiered approach to treatment is recommended, starting with lifestyle modifications and progressing to pharmacological interventions.
• Various medical therapies are available, including osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines.

Conclusions:

• Chronic constipation management has evolved with new drug classes and expanded treatment accessibility.
• Personalized treatment strategies, considering patient symptoms and physiological subtypes, are crucial.
• Further research is needed to determine the utility of interventions like biofeedback in chronic constipation management.