The DOI matches its Crossref record; 170 of the 170 references it cites were found in a registry or an index.
Mechanisms, Evaluation, and Management of Chronic Constipation
Open accessAbstract
With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.
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“For prucalopride, a selective agonist of serotonin 5-HT 4 receptors, the recommended dose is 2 mg once daily in adults and 1 mg daily in individuals with severe renal impairment (ie, creatinine clearance <30 mL/min). 80”
From American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation (2023) · cites this paper as [80]
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Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.031 · Cited by 2,866
Self-citationPeery, A. F., Crockett, S. D., Murphy, C. C., Lund, J. L., Dellon, E. S., Williams, J. L., Jensen, E. T., Shaheen, N. J., Barritt, A. S., Lieber, S. R., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2018.08.063 · Cited by 1,619
Epidemiology of constipation in children and adults: A systematic review
Mugie, S. M., Benninga, M. A., & Lorenzo, C. D. (2011) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2010.12.010 · Cited by 945
Simplified assessment of segmental colonic transit
Metcalf, A. M., Phillips, S. F., Zinsmeister, A. R., MacCarty, R. L., Beart, R. W., & Wolff, B. G. (1987) · Gastroenterology · doi:10.1016/0016-5085(87)90837-7 · Cited by 928
American Gastroenterological Association Technical Review on Constipation
Bharucha, A. E., Pembérton, J. H., & Locke, G. R. (2012) · Gastroenterology · doi:10.1053/j.gastro.2012.10.028 · Cited by 924
Self-citationFunctional anorectal disorders.
Bharucha, A., Wald, A., Enck, P., & Rao, S. S. C. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.064 · Cited by 770
Self-citationDefecography in normal volunteers: results and implications.
Shorvon, P. J., McHugh, S., Diamant, N. E., Somers, S., & Stevenson, G. W. (1989) · Gut · doi:10.1136/gut.30.12.1737 · Cited by 756
Ford, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.202 · Cited by 747
Self-citationMyths and Misconceptions About Chronic Constipation
Müller-Lissner, S. A., Kamm, M. A., Scarpignato, C., & Wald, A. M. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.40885.x · Cited by 616
Sphincter denervation in anorectal incontinence and rectal prolapse.
Parks, A. G., Swash, M., & Urich, H. (1977) · Gut · doi:10.1136/gut.18.8.656 · Cited by 552
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Research works printed but not linked: 1
- Diamant, 1999, American Gastroenterological Association medical position statement on anorectal testing techniques, Gastroenterology, 116, 732, 10.1016/S0016-5085(99)70194-0 · DOI
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Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S., Greer, K. B., Hanson, B., Harris, L. A., Ko, C., et al. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.03.214 · Cited by 185
Self-citationACG Clinical Guidelines: Management of Benign Anorectal Disorders
Wald, A. M., Bharucha, A. E., Limketkai, B. N., Malcolm, A., Remes-Troche, J. M., Whitehead, W. E., & Zutshi, M. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001507 · Cited by 166
Self-citationThe enteric nervous system in gastrointestinal disease etiology
Holland, A. M., Bon‐Frauches, A. C., Keszthelyi, D., Melotte, V., & Boesmans, W. (2021) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-021-03812-y · Cited by 172
“This is also the case for slow transit constipation, defined by reduced and infrequent intestinal transit, sensation of anorectal obstruction and solid fecal content [94].”
BackgroundPan, R., Wang, L., Xu, X., Chen, Y., Wang, H., Wang, G., Zhao, J., & Chen, W. (2022) · Nutrients · doi:10.3390/nu14183704 · Cited by 149
“However, the aetiology and pathophysiology of CC are largely unknown [2].”
BackgroundUnderstanding the physiology of human defaecation and disorders of continence and evacuation
Heitmann, P. T., Vollebregt, P. F., Knowles, C. H., Lunniss, P. J., Dinning, P. G., & Scott, S. M. (2021) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-021-00487-5 · Cited by 156
Metadata
- Authors
- Bharucha, A. E., & Lacy, B. E.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Bharucha, Adil E.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 158
- Issue
- 5
- Pages
- 1232-1249.e3
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC7573977
- OpenAlex
- W3000300599
- Cited by
- 655
- References
- 170
- Citations by year
- 2026: 108 · 2025: 157 · 2024: 115 · 2023: 99 · 2022: 112 · 2021: 46 · 2020: 17
- FWCI
- 11.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- chronic constipation, defecation disorders, slow transit constipation, colonic transit, colonic motility, pelvic floor dysfunction, dietary fiber supplementation, laxatives, prokinetic agents, opioid-induced constipation, biofeedback, anorectal manometry, barostat, colectomy, constipation treatment
- MeSH terms
- Secretagogues, Chronic Disease, Colon, Constipation, Defecation, Dietary Fiber, Electromyography, Gastrointestinal Motility, Humans, Intestinal Mucosa, Magnetic Resonance Imaging, Manometry, Rectum, Prevalence, Receptors, Opioid, mu, Pelvic Floor, Dietary Supplements, Defecography, Digital Rectal Examination, Laxatives
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