Current Overview on Clinical Management of Chronic Constipation

Constipation is one of the major gastrointestinal disorders diagnosed in clinical practice in Western countries. Almost 20% of population suffer from this disorder, which means constipation is a substantial utilization of healthcare. Pathophysiology of constipation is complex and multifactorial, where aspects like disturbance in colonic transit, genetic predisposition, lifestyle habits, psychological distress, and many others need to be taken into consideration. Diagnosis of constipation is troublesome and requires thorough accurate examination. A nonpharmacological approach, education of the patient about the importance of lifestyle changes like diet and sport activity state, are the first line of therapy. In case of ineffective treatment, pharmacological treatments such as laxatives, secretagogues, serotonergic agonists, and many other medications should be induced. If pharmacologic treatment fails, the definitive solution for constipation might be surgical approach. Commonness of this disorder, costs of medical care and decrease in quality life cause constipation is a serious issue for many specialists. The aim of this review is to present current knowledge of chronic constipation and management of this disorder.

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Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽

10.3390/medicina57070643 ◽

2021 ◽

Vol 57 (7) ◽

pp. 643

Author(s):

Angela Saviano ◽

Mattia Brigida ◽

Alessio Migneco ◽

Gayani Gunawardena ◽

Christian Zanza ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Abdominal Pain ◽

Human Health ◽

Bowel Disease ◽

Chronic Constipation ◽

Lactobacillus Reuteri ◽

Current Knowledge ◽

Gastrointestinal Symptoms ◽

Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

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Colonic Transit Study Using Radiopaque Markers in Japanese Patients with Chronic Constipation: A Single-center, Observational Study

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.73.237 ◽

2020 ◽

Vol 73 (6) ◽

pp. 237-243

Author(s):

Tatsuya Abe ◽

Yoshikazu Hachiro ◽

Kei Ohara ◽

Mitsuhiro Inagaki ◽

Houhei Hishiyama ◽

...

Keyword(s):

Observational Study ◽

Chronic Constipation ◽

Japanese Patients ◽

Colonic Transit ◽

Single Center ◽

Radiopaque Markers ◽

Transit Study ◽

Single Center Observational Study

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The north–south and east–west gradient in colorectal cancer risk: a look at the distribution of modifiable risk factors and incidence across Canada

Current Oncology ◽

10.3747/co.25.4071 ◽

2018 ◽

Vol 25 (3) ◽

pp. 231 ◽

Cited By ~ 2

Author(s):

J. Tung ◽

C.E. Politis ◽

J. Chadder ◽

J. Han ◽

J. Niu ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Vegetable Consumption ◽

Current Knowledge ◽

Incidence Rates ◽

Lifestyle Changes ◽

Modifiable Risk Factors ◽

Excessive Alcohol Consumption ◽

Positive Effects ◽

East West

Colorectal cancer (crc) is the 2nd most common cancer in Canada and the 2nd leading cause of cancer death. That heavy burden can be mitigated given the preventability of crc through lifestyle changes and screening. Here, we describe the extent of the variation in crc incidence rates across Canada and the disparities, by jurisdiction, in the prevalence of modifiable risk factors known to contribute to the crc burden.Findings suggest that there is a north–south and east–west gradient in crc modifiable risk factors, including excess weight, physical inactivity, excessive alcohol consumption, and low fruit and vegetable consumption, with the highest prevalence of risk factors typically found in the territories and Atlantic provinces. In general, that pattern reflects the crc incidence rates seen across Canada. Given the substantial interjurisdictional variation, more work is needed to increase prevention efforts, including promoting a healthier diet and lifestyle, especially in jurisdictions facing disproportionately higher burdens of crc.Based on current knowledge, the most effective approaches to reduce the burden of crc include adopting public policies that create healthier environments in which people live, work, learn, and play; making healthy choices easier; and continuing to emphasize screening and early detection. Strategic approaches to modifiable risk factors and mechanisms for early cancer detection have the potential to translate into positive effects for population health and fewer Canadians developing and dying from cancer.

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Expanding criteria for slow colonic transit in patients being evaluated for chronic constipation by scintigraphy

Neurogastroenterology & Motility ◽

10.1111/nmo.13878 ◽

2020 ◽

Vol 32 (9) ◽

Author(s):

Katayoun Khoshbin ◽

Irene Busciglio ◽

Duane Burton ◽

Margaret K. Breen‐Lyles ◽

Michael Camilleri

Keyword(s):

Chronic Constipation ◽

Colonic Transit

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S1304 Wireless pH-Motility Capsule for Colonic Transit: Prospective Comparison With Radiopaque Markers in Chronic Constipation

Gastroenterology ◽

10.1016/s0016-5085(10)61020-7 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-224-S-225 ◽

Cited By ~ 1

Author(s):

Michael Camilleri ◽

Nyree K. Thorne ◽

Yehuda Ringel ◽

William L. Hasler ◽

Braden Kuo ◽

...

Keyword(s):

Chronic Constipation ◽

Colonic Transit ◽

Prospective Comparison ◽

Radiopaque Markers

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Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2011.02.049 ◽

2011 ◽

Vol 46 (7) ◽

pp. 1406-1411 ◽

Cited By ~ 22

Author(s):

Yee Ian Yik ◽

Timothy M. Cain ◽

Coral F. Tudball ◽

David J. Cook ◽

Bridget R. Southwell ◽

...

Keyword(s):

Chronic Constipation ◽

Colonic Transit

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Recommendations on Chronic Constipation (Including Constipation Associated with Irritable Bowel Syndrome) Treatment

Canadian Journal of Gastroenterology ◽

10.1155/2007/848706 ◽

2007 ◽

Vol 21 (suppl b) ◽

pp. 3B-22B ◽

Cited By ~ 35

Author(s):

Pierre Paré ◽

Ronald Bridges ◽

Malcolm C Champion ◽

Subhas C Ganguli ◽

James R Gray ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Health Care Professionals ◽

Chronic Constipation ◽

Clinical Care ◽

Treatment Algorithm ◽

Treatment Recommendations ◽

Lifestyle Changes ◽

Bulking Agents ◽

Consensus Group ◽

Irritable Bowel

While chronic constipation (CC) has a high prevalence in primary care, there are no existing treatment recommendations to guide health care professionals. To address this, a consensus group of 10 gastroenterologists was formed to develop treatment recommendations. Although constipation may occur as a result of organic disease, the present paper addresses only the management of primary CC or constipation associated with irritable bowel syndrome. The final consensus group was assembled and the recommendations were created following the exact process outlined by the Canadian Association of Gastroenterology for the following areas: epidemiology, quality of life and threshold for treatment; definitions and diagnostic criteria; lifestyle changes; bulking agents and stool softeners; osmotic agents; prokinetics; stimulant laxatives; suppositories; enemas; other drugs; biofeedback and behavioural approaches; surgery; and probiotics. A treatment algorithm was developed by the group for CC and constipation associated with irritable bowel syndrome. Where possible, an evidence-based approach and expert opinions were used to develop the statements in areas with insufficient evidence. The nature of the underlying pathophysiology for constipation is often unclear, and it can be tricky for physicians to decide on an appropriate treatment strategy for the individual patient. The myriad of treatment options available to Canadian physicians can be confusing; thus, the main aim of the recommendations and treatment algorithm is to optimize the approach in clinical care based on available evidence.

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