Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management
Slow transit constipation (STC) has an estimated prevalence of 2–4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and...
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| Format: | Article |
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MDPI AG
2024-01-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/1/108 |
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| author | Luke J. Vlismas William Wu Vincent Ho |
| author_facet | Luke J. Vlismas William Wu Vincent Ho |
| author_sort | Luke J. Vlismas |
| collection | DOAJ |
| description | Slow transit constipation (STC) has an estimated prevalence of 2–4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others. |
| first_indexed | 2024-03-08T10:41:16Z |
| format | Article |
| id | doaj.art-60ee25b4066740fba51a9408b82b47d4 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-08T10:41:16Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-60ee25b4066740fba51a9408b82b47d42024-01-26T17:35:24ZengMDPI AGMedicina1010-660X1648-91442024-01-0160110810.3390/medicina60010108Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and ManagementLuke J. Vlismas0William Wu1Vincent Ho2Deptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, AustraliaDeptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, AustraliaDeptartment of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, AustraliaSlow transit constipation (STC) has an estimated prevalence of 2–4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others.https://www.mdpi.com/1648-9144/60/1/108slow transit constipationconstipationcolondysmotilityenteric nervous systemmanometry |
| spellingShingle | Luke J. Vlismas William Wu Vincent Ho Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management Medicina slow transit constipation constipation colon dysmotility enteric nervous system manometry |
| title | Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management |
| title_full | Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management |
| title_fullStr | Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management |
| title_full_unstemmed | Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management |
| title_short | Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management |
| title_sort | idiopathic slow transit constipation pathophysiology diagnosis and management |
| topic | slow transit constipation constipation colon dysmotility enteric nervous system manometry |
| url | https://www.mdpi.com/1648-9144/60/1/108 |
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