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Diagnosis and treatment of chronic constipation – a European perspective

  1. J. Tack1,
  2. S. Müller-Lissner2,
  3. V. Stanghellini3,
  4. G. Boeckxstaens1,
  5. M. A. Kamm4,
  6. M. Simren5,
  7. J.-P. Galmiche6,
  8. M. Fried7

Article first published online: 24 MAY 2011

DOI: 10.1111/j.1365-2982.2011.01709.x

Issue

Neurogastroenterology & Motility

Neurogastroenterology & Motility

Volume 23, Issue 8, pages 697–710, August 2011

Additional Information

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

Author Information

  1. 1

    Division of Gastroenterology, University Hospital Leuven, Leuven, Belgium

  2. 2

    Department of Internal Medicine, Park-Klinik Weissensee, Berlin, Germany

  3. 3

    Department of Clinical Medicine, University of Bologna, Bologna, Italy

  4. 4

    Departments of Medicine and Gastroenterology, St Vincent’s Hospital, Melbourne, Australia, and Imperial College, London, UK

  5. 5

    Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden

  6. 6

    Department of Liver and Gastroenterology, Institute of Diseases of the Digestive System Nantes, CHU Nantes, France

  7. 7

    Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland

*Address for Correspondence Jan Tack, Division of Gastroenterology, University Hospital Leuven, Leuven, Belgium. Tel: +32 16 344225; fax: +32 16 344419; e-mail: jan.tack@med.kuleuven.ac.be

  1. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

Publication History

  1. Issue published online: 15 JUL 2011
  2. Article first published online: 24 MAY 2011
  3. Received: 27 September 2010 Accepted for publication: 16 March 2011

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Keywords:

  • algorithm;
  • constipation;
  • dissatisfaction;
  • prokinetic;
  • prucalopride

Abstract

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.

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