Constipación crónica. Conceptos actuales desde la fisiopatología hasta el tratamiento

Abstract

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.

Functional gastrointestinal disorders. How to manage them without medication

“…1 In the pathophysiology of functional constipation, 2 major aspects are involved, which are in turn interrelated. 1,6,[29][30][31] • Pain mechanism: It is associated with most FGIDs, in which neurodevelopmental nociception and other determining factors have an impact on the magnitude of this experience. Pain is related to some previous experience passing large stools with a bigger consistency, and/or having a rectal injury.…”

“…6,11,20,21 As in all FGIDs, complete case taking and physical examination are the cornerstones for an adequate diagnosis. 2,6,11,20,29,31 The Bristol stool scale is helpful in identifying stool characteristics 32 (Tables 4 and 5).…”

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar

“…Este trastorno es autolimitado y no requiere tratamiento médico ni estudios diagnósticos. 1 En la fisiopatología del estreñimiento f u n c i o n a l , s e e n c u e n t r a n i n v o l u c r a d o s dos grandes aspectos, que a su vez están interrelacionados: 1,6, [29][30][31] • Mecanismo del dolor: asociado a la mayoría de los TFGI, en el que el neurodesarrollo de la nocicepción y otros factores determinantes impactan en la magnitud de esta experiencia. El dolor se relaciona con alguna experiencia previa con eliminación de heces grandes y aumentadas de consistencia, y/o a una lesión anal.…”

“…6,11,20,21 Para realizar un diagnóstico correcto, como en todo TFGI, la anamnesis y el examen físico completo son los pilares. 2,6,11,20,29,31 La escala de Bristol resulta de ayuda para identificar las características de las deposiciones 32 (Tablas 4 y 5).…”

Disinergia defecatoria

“…También se puede hacer uso de cuestionarios de síntomas intestinales, diario intestinal y a escala de Bristol para la evaluación del tránsito colónico en relación a los síntomas. (12) Los estudios endoscópicos también pueden ser utilizados en pacientes con indicación clínica o algún signo de alarma. (8) 1.…”