Luo Jingyuan, Xu Qianqian, Xu Shujun, Zhai Lixiang, Yuan Chun-Su, Bian Zhaoxiang
Vincent V.C. Woo Chinese Medicine Clinical Research Institute, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong, SAR, China.
Center for Chinese Herbal Medicine Drug Development and School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, SAR, China.
Curr Gastroenterol Rep. 2025 Mar 17;27(1):22. doi: 10.1007/s11894-025-00967-7.
Abdominal pain in constipation-predominant irritable bowel syndrome (IBS-C) and functional constipation (FC) remains a difficult clinical challenge due to unclear pathophysiological mechanisms and limited pain-targeted treatments. This review critically evaluates the evidence on the underlying pain mechanisms in IBS-C and/or FC and explores management strategies, their limitations, and future directions.
Most research on constipation-related pain is based on IBS-C patients or animal models, with limited studies focusing on FC. Visceral hypersensitivity, serotonin dysregulation, gut-brain axis dysfunction, and central/peripheral nervous system alterations are implicated in IBS-C pain, while FC pain is less studied and may be primarily linked to colonic distension and motility dysfunction. Management strategies include 5-HT4 agonists, GC-C agonists, chloride channel activators, psychological therapies, probiotics and complementary medicine. Despite available treatment options, managing abdominal pain in IBS-C and FC remains challenging due to heterogeneous pathophysiology and limited targeted therapies. While some interventions provide symptomatic relief, there is no universally effective treatment for abdominal pain across all patients. Future research should focus on identifying pain-specific biomarkers, refining diagnostic criteria, and integrating multi-omics data and neuroimaging techniques to better distinguish pain mechanisms in IBS-C versus FC and develop more precise, patient-centered interventions.
由于病理生理机制尚不明确且针对疼痛的治疗方法有限，便秘型肠易激综合征（IBS-C）和功能性便秘（FC）中的腹痛仍然是一项艰巨的临床挑战。本综述批判性地评估了IBS-C和/或FC潜在疼痛机制的证据，并探讨了管理策略、其局限性及未来方向。
大多数关于便秘相关疼痛的研究基于IBS-C患者或动物模型，针对FC的研究有限。内脏超敏反应、血清素失调、肠-脑轴功能障碍以及中枢/外周神经系统改变与IBS-C疼痛有关，而FC疼痛的研究较少，可能主要与结肠扩张和动力功能障碍有关。管理策略包括5-HT4激动剂、GC-C激动剂、氯离子通道激活剂、心理治疗、益生菌和补充医学。尽管有可用的治疗选择，但由于病理生理的异质性和靶向治疗有限，IBS-C和FC中腹痛的管理仍然具有挑战性。虽然一些干预措施可提供症状缓解，但并没有对所有患者都普遍有效的腹痛治疗方法。未来的研究应专注于识别疼痛特异性生物标志物、完善诊断标准，并整合多组学数据和神经成像技术，以更好地区分IBS-C与FC中的疼痛机制，并开发更精确、以患者为中心的干预措施。
