Journal Scan

Role of the gut microbiota: Recent investigations have highlighted the possible role of intestinal microbiota in constipation.Methane-producing microorganisms have attracted particular attention because methane appears to slow intestinal motility.Individuals with higher methane levels often demonstrate delayed colonic transit and more severe constipation symptoms.Diagnosis of STC requires confirmation of delayed colonic transit and exclusion of other causes of constipation.Initial clinical assessment includes detailed history, medication review, and physical examination, particularly digital rectal examination to assess pelvic floor function.Objective measurement of transit time is typically performed using radiopaque marker studies.Patients ingest small markers that can later be visualized on abdominal radiographs.Persistence of markers within the colon several days after ingestion indicates delayed transit.Additional investigations may include anorectal manometry and balloon expulsion testing to exclude defecatory disorders.In selected cases, imaging techniques such as defecography may be used to assess pelvic floor anatomy.Management generally follows a stepwise approach.Initial therapy involves lifestyle and dietary modifications, including increased fiber intake, adequate hydration, and regular physical activity.However, these interventions often provide limited benefit in severe STC.Pharmacological treatment includes osmotic laxatives such as polyethylene glycol, which increase stool water content, and stimulant laxatives that enhance intestinal contractions.Newer agents such as chloride channel activators and guanylate cyclase-C agonists promote intestinal fluid secretion and facilitate stool passage.Prucalopride, a selective serotonin receptor agonist, improves colonic motility and has shown effectiveness in patients with chronic constipation unresponsive to conventional therapy.Emerging treatments include fecal microbiota transplantation and neuromodulation therapies, although current evidence remains limited.In patients with severe, refractory disease, surgical intervention such as subtotal colectomy with ileorectal anastomosis may be considered.