Searching for a Definition for Pharmacologically Refractory Constipation: A Systematic Review. Alex Yu Sen Soh,Jin-Yong Kang,Kewin Tien Ho Siah,Carmelo Scarpignato,Kok-Ann Gwee.Journal of Gastroenterology and Hepatology Accepted manuscript online: 27 September 2017
Background and Aim.Surgery and other non-pharmacological treatments such as sacral nerve stimulation are used for the treatment of difficult to treat chronic constipation. Novel pharmacological therapeutic agents are also being introduced.
To evaluate the efficacy of these treatments, it is imperative to have a consistent definition of pharmacologically refractory constipation. We carried out a systematic review of studies on refractory, difficult-to-treat or surgically treated constipation to determine the criteria various authors used to define this group of patients.Method.A systematic review was performed for literature published from June 2005 to June 2015 using Pubmed, Cochrane and Scopus databases, as well as manual searches. Studies on patients with refractory or intractable constipation were extracted. Criteria used for defining refractory constipation, as well as pharmacological agents tried including dosage, frequency and duration, were reviewed.Results.61 studies were included in this review. 48 involved surgical treatment of constipation, while 13 examined non-surgical therapies for refractory constipation. There is no generally accepted definition of refractory constipation. Authors consider constipation to be refractory when response to management is sub-optimal but there is no consensus on choice of drug, the order of usage, dosage or treatment duration. Prior medical therapy was not mentioned at all in five studies.Conclusions.There is need for a detailed definition of pharmacologically refractory constipation before submitting patients to invasive treatments, and to evaluate new pharmacological agents.