S Mark Scott1, Magnus Simrén2,3, Adam D Farmer1,4, Philip G Dinning5, Emma V Carrington1,6, Marc A Benninga7, Rebecca E Burgell8, Eirini Dimidi9, Asma Fikree1,10, Alexander C Ford11, Mark Fox12,13, Caroline L Hoad14,15, Charles H Knowles1, Klaus Krogh16, Karen Nugent17, Jose Maria Remes-Troche18, Kevin Whelan9, Maura Corsetti15,19. 1. Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK. 2. Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 3. Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 4. Institute of Applied Clinical Science, University of Keele, Keele, UK. 5. College of Medicine and Public Health, Flinders Medical Centre, Flinders University & Discipline of Gastroenterology, Adelaide, SA, Australia. 6. Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland. 7. Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 8. Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Vic., Australia. 9. Department of Nutritional Sciences, King's College London, London, UK. 10. Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London, UK. 11. Leeds Institute of Medical Research at St. James's, Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK. 12. Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. 13. Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland. 14. Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK. 15. NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham University, Nottingham, UK. 16. Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. 17. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK. 18. Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, Mexico. 19. Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
Abstract
BACKGROUND: Chronic constipation is a prevalent disorder that affects patients' quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published (2009; 21 (Suppl.2)). This included seven articles, disseminating all themes covered during a preceding 2-day meeting held in London, entitled "Current perspectives in chronic constipation: a scientific and clinical symposium." In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held, again over 2 days. All faculty members were invited to author two new review articles, which represent a collective synthesis of talks presented and discussions held during this meeting. PURPOSE: This article represents the first of these reviews, addressing epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. Clearly, not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular "hot topics" and themes that are of contemporary interest. The second review addresses management of chronic constipation, covering behavioral, conservative, medical, and surgical therapies.
BACKGROUND: Chronic constipation is a prevalent disorder that affects patients' quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published (2009; 21 (Suppl.2)). This included seven articles, disseminating all themes covered during a preceding 2-day meeting held in London, entitled "Current perspectives in chronic constipation: a scientific and clinical symposium." In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held, again over 2 days. All faculty members were invited to author two new review articles, which represent a collective synthesis of talks presented and discussions held during this meeting. PURPOSE: This article represents the first of these reviews, addressing epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. Clearly, not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular "hot topics" and themes that are of contemporary interest. The second review addresses management of chronic constipation, covering behavioral, conservative, medical, and surgical therapies.