Letter: chronic constipation – a warning sign for oxidative stress?

Current Rome III criteria distinguish functional constipation and constipation predominant irritable bowel syndrome. The interesting paper by Koloski et al.,1 strengthens, however, recent views that both conditions are similar in terms of symptomatology and pathophysiology. The majority of patients with chronic constipation therefore form a large, homogeneous group. Consequently, associations with other diseases, including colorectal cancer and benign colorectal neoplasms, as recently reported by Guérin et al.,2 significantly gain impact. Severe constipation has also been associated with growth retardation in children,3 with gastroesophageal reflux disease,4and with cardiovascular risk in post-menopausal women.5 Guérin et al.2 proposed an increased contact time of carcinogens in the lumen as a possible mechanism for the association between constipation and colorectal cancer. We propose another mechanism for the association: oxidative stress. This mechanism could also explain the association with the other diseases. Oxidative stress is found in constipated children,6 in oesophageal tissue, even after successful anti-reflux surgery7 and it is associated with risk for both cardiovascular disease8 and for colorectal cancer.9 The vital question is: will adequate management of constipation reduce both oxidative stress and the risk for associated conditions? In an animal model, provoking constipation led to oxidative stress.10 Prebiotics attenuated both constipation and oxidative stress. Effective management of constipation in children appeared beneficial to their growth status.3 It is thus plausible that adequate management of constipation may help reducing oxidative stress and the risk for constipation-associated diseases. The consequences would be far-reaching. The disease burden from the associated diseases is considerably higher than that from chronic constipation. Chronic constipation-related symptoms might be a warning sign for oxidative stress. This could be translated into a very powerful public health promotion message that may have a significant impact on the prevention of a number of major health problems, many of which are becoming more prevalent in our ageing societies. Declaration of personal and funding interests: None.