CHRONIC CONSTIPATION IN ADULTS: CONTEMPORARY PERSPECTIVES AND CLINICAL CHALLENGES. 1: EPIDEMIOLOGY, DIAGNOSIS, CLINICAL ASSOCIATIONS, PATHOPHYSIOLOGY AND INVESTIGATION

BACKGROUND

Chronic constipation is a prevalent disorder that affects patients’ quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published (2009;21(Suppl.2)). This included seven articles, disseminating all themes covered during a preceding two-day meeting held in London, entitled ‘Current perspectives in chronic constipation: a scientific and clinical symposium’. In October 2018, the 3^rd London Masterclass, entitled ‘Contemporary management of constipation’ was held, again over two days. All faculty members were invited to author two new review articles representing a collective synthesis of talks presented and discussions held during this meeting.

PURPOSE

This article represents the first of these reviews, addressing epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Clearly not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular ‘hot topics’ and themes that are of contemporary interest. The second review addresses management of chronic constipation, covering behavioural, conservative, medical and surgical therapies.

 

 

AUTHORS’ CONTRIBUTIONS:

SMS conceived the idea of these review articles. All authors performed the literature search and wrote the manuscript according to the section they were assigned: Introduction: SMS, MC, CK; Epidemiology and diagnosis: MS, JR-T, ED, AF. Clinical associations: ADF, SMS, AF, KN. Pathophysiology: PD, SMS, RB, CK, KW. Investigation: EC, MF, RB, PD, CH, KK. Section Leads were: SMS, MS, ADF, PD and EC. Initially, SMS collated and revised all sections of the manuscript. Section Leads and finally all authors critically revised subsequent versions of the manuscript and approved the final version.

 

 

AUTHORS’ CONFLICTS OF INTEREST:

SMS and EC have received honoraria for teaching for Laborie.

MS has received unrestricted research grants from Danone Nutricia Research, Glycom and Ferring Pharmaceuticals; acted as Consultant/Advisory Board member for Danone Nutricia Research, Nestlé, Menarini, Biocodex, Genetic Analysis AS, Glycom, Arena and Shire; and has been part of the speakers’ bureau of Tillotts, Menarini, Kyowa Kirin, Takeda, Shire, Biocodex, Alimentary Health, AlfaSigma, and Falk Foundation.

MB is Consultant for Shire, Norgine, Coloplast, Allergan, FrieslandCampina, HIPP, Danone and Sensus.

RB is a paid speaker for Bayer, NPS medicinewise and Advisory board member for Allergan, Anatara Life Sciences and Atmo Biosciences

ED has received an education grant from Alpro, research funding from the British Dietetic Association, Almond Board of California, International Nut and Dried Fruit Council and Nestec Ltd and has served as a consultant for Puratos.

MF has acted as a paid Consultant and has been paid for speaking and reimbursed for attending symposiums by Medtronic, Reckitt Benckiser and Shire Pharmaceuticals; he has received funding of research and support of staff by Medtronic, Mui Scientific, Reckitt Benckiser and Nestle International, and has organized educational activities that have been supported by Medtronic, Sandhill Scientific Instruments and Medical Measurement Systems.

CK is a paid Consultant and speaker for Medtronic Inc. He has consulted in the last 3 years for Coloplast, Enetromed and Alimentary Health. He has received funding for research activities from Saluda Medical, Cook Medical, Exero Medical and Takeda. He is a member of committees that benefit from industry sponsorship including the Rome Foundation and The International Anorectal Physiology Working Group.

KN has consulted in the last year for Coloplast.

JMR-T is a Consultant / Advisory Board member for Takeda, Asofarma, Chinoin, Medtronic and Biocodex; he has received research funding from CONACYT, Mexico

KW has received research funding from government bodies including National Institute of Health Research and Medical Research Council, charities including Crohn’s and Colitis UK, ForCrohns, The Leona M. and Harry B. Helmsley Charitable Trust, Kenneth Rainin Foundation, as well as from industrial sources including Almond Board of California, Clasado Biosciences, Danone and the International Dried Fruit and Nut Council. KW is the co-inventor of a mobile application to support people following dietary restrictions (FoodMaestro).

MC has acted as consultant for Allergan, Kyowa Kirin, and Sanofi.

The remaining Authors have not conflict of interest.

 

FUNDING: none.