Open AccessChronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options
Author(s) -
Gabrio Bassotti,
Paolo Usai-Satta,
Massimo Bellini
Publication year - 2021
Publication title -
clinical and experimental gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.113
H-Index - 30
ISSN - 1178-7023
DOI - 10.2147/ceg.s256364
Subject(s) - medicine , constipation , chronic constipation , intensive care medicine , regimen , defecation , quality of life (healthcare) , dyssynergia , pelvic floor dysfunction , pelvic floor , physical therapy , surgery , urinary system , nursing
Chronic idiopathic constipation (CIC) is a common functional bowel disorder characterized by difficult, infrequent, and/or incomplete defecation. It has a great impact on the quality of life and on health care system and represents a heavy economic burden. The diagnosis is based on symptoms, classified by the Rome IV criteria. The aim of this review was to evaluate the current therapeutic guidelines for adult CIC and highlight new emerging treatments. In detail, European, French, Spanish and Korean guidelines have been identified and compared. Osmotic laxatives, and in particular polyethylene glycol, represent the first-line therapeutic approach. Stimulant laxatives are recommended as a second-line therapy. Pelvic floor rehabilitation is recommended in patients with ano-rectal dyssynergia. In patients who fail to improve with pharmacological therapies sacral nerve stimulation is considered as last chance before surgery. Surgical approach has however limited indications in selected cases. Inertia coli refractory to any approach and obstructed defecation are two subtypes which can benefit from surgery. Among emerging agents, prucalopride, a prokinetic agent, is recommended as a second-line treatment in refractory CIC patients. In addition, the secretagogues linaclotide and plecanatide and the bile acid transported inhibitor elobixibat can be effective in patients not responsive to a second-line therapeutic regimen, although they are not worldwide commercially available.