Constipación crónica. Conceptos actuales desde la fisiopatología hasta el tratamiento

Chronic constipation is one of the most frequent gastrointestinal pathologies worldwide, and it negatively impacts the quality of life of patients. The objective of this narrative review is to present the most innovative and relevant information in relation to chronic constipation, from its pathophysiology to treatment. It is recognized that there are at least three subtypes of primary chronic constipation that are functional, that associated with irritable bowel and that related to evacuation disorders. It is considered that there are multiple causes of secondary chronic constipation, especially drugs and the entity called opioid-induced constipation is specifically detailed. The pathophysiological mechanisms of functional chronic constipation are multiple (they include motor and sensory alterations, dysbiosis, and structural and functional alterations of the pelvic floor) and frequently overlap. No test provides a complete description of defecation; therefore in general, a combination of these is generally used to assess motor and sensory structure and function. Advanced diagnostic studies of the function of the colon, rectum, and anus are recommended in patients with chronic constipation in whom the first-line treatment have failed. Regarding treatment, the usefulness of hygienic-dietary measures, exercise, fiber, the laxatives, the new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, probiotics, and other therapies fecal microbiota transplantation and surgery.