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Neurogastroenterol Motil. 2019 Nov 22:e13762. doi: 10.1111/nmo.13762. [Epub ahead of print]

European society of neurogastroenterology and motility guidelines on functional constipation in adults.

Author information

1
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.
2
Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, Badalona, Spain.
3
Department of Medicine, Autonomous University of Barcelona, Badalona, Spain.
4
Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
5
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
6
Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
7
Division of Gastroenterology B, AOUI Verona, Verona, Italy.
8
UNC Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA.
9
Department of Gastroenterology, UMR INSERM 1073, Rouen University Hospital, Rouen, France.
10
Department of Physiology, UMR INSERM 1073 & CIC INSERM 1404, Rouen University Hospital, Rouen, France.
11
General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.
12
Department of Medicine, Israelitic Hospital, Hamburg, Germany.
13
Sant Adrià de Besòs (Barcelona) Catalan Institut of Health (ICS), La Mina Primary Health Care Centre, Badalona, Spain.
14
Department of Surgery, Division of General Surgery, Medical University of Graz, Graz, Austria.
15
Neurogastroenterology Group, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts, UK.
16
The London School of Medicine & Dentistry, Queen Mary University London, London, UK.
17
Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
18
Division of Diabetes, Endocrinology & Gastroenterology, Neurogastroenterology Unit, Wythenshawe Hospital, University of Manchester, Manchester, UK.

Abstract

INTRODUCTION:

Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation.

DESIGN:

After a thorough review of the literature by experts in relevant fields, including gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal motility testing from various European countries, a Delphi consensus process was used to produce statements and practical algorithms for the management of chronic constipation.

KEY RESULTS:

Seventy-three final statements were agreed upon after the Delphi process. The level of evidence for most statements was low or very low. A high level of evidence was agreed only for anorectal manometry as a comprehensive evaluation of anorectal function and for treatment with osmotic laxatives, especially polyethylene glycol, the prokinetic drug prucalopride, secretagogues, such as linaclotide and lubiprostone and PAMORAs for the treatment of opioid-induced constipation. However, the level of agreement between the authors was good for most statements (80% or more of the authors). The greatest disagreement was related to the surgical management of constipation.

CONCLUSIONS AND INFERENCES:

European guidelines on chronic constipation, with recommendations and algorithms, were developed by experts. Despite the high level of agreement between the different experts, the level of scientific evidence for most recommendations was low, highlighting the need for future research to increase the evidence and improve treatment outcomes in these patients.

KEYWORDS:

Delphi process; chronic constipation; guidelines; management of constipation

PMID:
31756783
DOI:
10.1111/nmo.13762

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