AGA Technical Review on Constipation

The symptom of constipation is very common.1,2 The aisles of any drugstore confirm the impact of this problem. The goal of this technical review is to identify a rational, efficacious, and ideally cost-effective approach to the patient presenting with constipation. The perspective will be that of the practicing gastroenterologist. Constipation in children will not be specifically addressed, nor will special populations such as patients with spinal cord injury. The background for this technical review, especially the subthemes comprising the clinical syndromes, their epidemiology, diagnosis, treatment, and their socioeconomic impacts have been subjects of recent reviews and monographs.1,3,4 These were supplemented by selected and focused literature searches. Our discussion of the epidemiology of constipation is based on peer-reviewed, published surveys. Estimates of the economic impact to society have been published; however, formal cost-effectiveness analyses for specific diagnostic and therapeutic algorithms have not been performed. Comparisons of diagnostic approaches, with precise estimates of specificity and sensitivities, also have not been published. Indeed, in many instances, individual diagnostic techniques have not been even standardized. Moreover, most reports of treatment have not separated clearly patients with slow-transit constipation (STC) from those with disorders of the pelvic floor. There are few well-designed clinical trials of therapy, and only one meta-analysis of comparable studies has been published. Most evidence must, therefore, be based on clinical experience, descriptive studies, and reports of expert committees. Where possible, we indicate those studies that have tested for transit defects and pelvic floor dysfunctions.