Manejo práctico del estreñimiento crónico del adulto. Segundo escalón terapéutico.

Abstract

Chronic functional constipation is a very frequent functional gastrointestinal disorder, with a prevalence of around 16% in the adult population. We review the second-line treatment which includes the use of probiotics, prokinetics such as Prucalopride, and new secretagogue drugs such as Lubiprostone and Linaclotide. We analyze its mechanism of action, indications and potential side effects. Special consideration is constipation associated with opioid treatment, one of its most frequent side effects. For this, the new drugs called PAMORA, antagonists of the peripheral μ opioid receptors: naltrexone, alvimopan, naloxegol, nalmedine and the combination of oxycodone-naloxone. In patients with dyssynergic defecation, the treatment of choice is anorectal rehabilitation with biofeedback techniques guided by Manometry. Finally, treatments restricted to highly selected patients such as sacral neurostimulation, the Malone procedure and the subtotal colectomy.