AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• A subset of patients experiences refractory constipation (RC) despite medical therapy, presenting diagnostic and therapeutic challenges.
• RC is relatively rare, necessitating a systematic approach to diagnosis and management.

Purpose of the Study:

• To provide expert guidance on the diagnosis and management of refractory constipation.
• To outline best practices for evaluating patients prior to considering surgical interventions for chronic constipation.

Main Methods:

• Expert review commissioned and approved by the American Gastroenterological Association (AGA).
• Statements derived from a review of published literature and expert opinion.
• Internal and external peer review process.

Main Results:

• Systematic exclusion of correctable secondary causes (medications, neurologic disorders, defecatory disorders [DDs]) is crucial.
• Confirmation of slow colonic transit and adequate trials of medical/nonpharmacologic therapies are essential before considering surgery.
• Surgical treatment (e.g., colectomy) requires careful patient selection, excluding concurrent DDs, evaluating for upper-gut dysmotility, and considering psychological comorbidities.

Conclusions:

• Surgical treatment for RC carries risks and potential for unsatisfactory outcomes, demanding thorough preoperative evaluation.
• Psychological evaluation is advisable to assess suitability for surgery and predict outcomes.
• Colectomy with ileorectal anastomosis should be reserved for patients without ongoing defecatory disorders.