Barbara Giovanni, Barbaro Maria R, Marasco Giovanni, Cremon Cesare
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy -
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy -
Minerva Gastroenterol (Torino). 2023 Jun;69(2):277-290. doi: 10.23736/S2724-5985.22.03335-6. Epub 2023 Feb 2.
Chronic constipation (CC) is one of the most common conditions found in gastrointestinal clinical practice and defined by the presence of fewer than 3 bowel movements per week and/or more than one fourth of bowel movements with Bristol stool form types 1 or 2. CC affects people regardless of race, age, or sex, although it is most common in women and in elderly. It is associated with relevant disease burden, including significant impairment of patients' quality of life. In the absence of alarm features, patients should receive a symptom-based diagnosis. Treatment options include lifestyle and general measures, bulking agents, in particular dietary fiber supplementation. Osmotic laxatives are currently considered the first-line gold-standard pharmacological treatment of CC together with stimulant laxatives which are often used as a rescue therapy. When necessary, prokinetic agents and/or intestinal secretagogues can be used. Biofeedback may be indicated in patients with functional defecation disorders. In this review, we will briefly summarize the current understanding on epidemiology, classification, pathophysiology and clinical evaluation of CC and discuss in depth the pharmacological and not pharmacological management of patients with this disorder.
慢性便秘（CC）是胃肠临床实践中最常见的病症之一，其定义为每周排便少于3次和/或超过四分之一的排便为布里斯托大便分类法1型或2型。CC影响所有种族、年龄或性别的人群，不过在女性和老年人中最为常见。它与相关疾病负担有关，包括对患者生活质量的显著损害。在没有警示特征的情况下，患者应接受基于症状的诊断。治疗选择包括生活方式和一般措施、容积性泻药，特别是膳食纤维补充剂。渗透性泻药目前被认为是CC的一线金标准药物治疗，刺激性泻药则常作为挽救疗法使用。必要时，可使用促动力剂和/或肠道促分泌剂。生物反馈疗法可能适用于功能性排便障碍患者。在本综述中，我们将简要总结目前对CC的流行病学、分类、病理生理学和临床评估的认识，并深入讨论该病症患者的药物和非药物管理。
