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Diagnosis and treatment of chronic constipation – a European perspective
Version of Record online: 24 MAY 2011
© 2011 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 23, Issue 8, pages 697–710, August 2011
How to Cite
Tack, J., Müller-Lissner, S., Stanghellini, V., Boeckxstaens, G., Kamm, M. A., Simren, M., Galmiche, J.-P. and Fried, M. (2011), Diagnosis and treatment of chronic constipation – a European perspective. Neurogastroenterology & Motility, 23: 697–710. doi: 10.1111/j.1365-2982.2011.01709.x
- Issue online: 15 JUL 2011
- Version of Record online: 24 MAY 2011
- Received: 27 September 2010 Accepted for publication: 16 March 2011
Background Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.
Purpose We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.