Tanisa Patcharatrakul, Kewin T H Siah, Ari Fahrial Syam, Atsushi Nakajima, Hidekazu Suzuki, Yeong Yeh Lee, Mariko Hojo, Pakkapon Rattanachaisit, Panyavee Pitisuttithum, Sabrina Quek, Tao Bai, Yi Ping Ren, Akihito Nagahara, Andrew Ming-Liang Ong, Chien-Lin Chen, Ching-Liang Lu, Duc Trong Quach, Govind K Makharia, Justin C Y Wu, Kee Wook Jung, Kee Huat Chuah, Linda Zhong, M Masudur Rahman, Tae Hee Lee, Uday C Ghoshal, Xiaohua Hou, Xiucai Fang, Ying-Lian Xiao, Sutep Gonlachanvit
This Asian Neurogastroenterology and Motility Association/Asia-Pacific Association of Gastroenterology consensus provides a practical, algorithm-based framework to improve management of chronic constipation across diverse Asian healthcare settings.
BACKGROUND/AIMS: : Chronic constipation is a common gastrointestinal (GI) disorder in Asia, characterized by heterogeneous symptom presentation, frequent overlap with other GI symptoms, and limited access to specialized diagnostic tests in many settings. These factors contribute to under-recognition and suboptimal management. The and the APAGE developed a regional consensus to provide practical, evidence-based guidance tailored to the Asian context.
METHODS: : A multidisciplinary task force comprising 24 voting members and 5 non-voting facilitators from across Asia was convened. Experts were divided into 4 working groups addressing clinical evaluation, non-pharmacological management, pharmacological management, and specialized investigations and treatments. Targeted literature reviews were performed, and statements were developed using a structured Delphi process with iterative anonymous voting. The certainty of the evidence and the strength of the recommendations were graded using the GRADE framework.
RESULTS: : Thirty-nine consensus statements were developed, covering clinical assessment and stepwise management. Recommendations emphasize comprehensive symptom assessment, early evaluation of disease severity and psychosocial impact, and prioritizing constipation treatment in patients with overlapping GI symptoms and those with pelvic floor damage. Initial management includes lifestyle modification and conventional laxatives, with treatment response assessed within 4 weeks. For inadequate response, treatment optimization, combination or switching of laxatives, and newer agents are recommended. The algorithm also highlights appropriate use of anorectal physiologic testing and biofeedback therapy for functional defecatory disorders. Surgical interventions are reserved for highly selected patients after comprehensive evaluation.
CONCLUSION: This Asian Neurogastroenterology and Motility Association/Asia-Pacific Association of Gastroenterology consensus provides a practical, algorithm-based framework to improve management of chronic constipation across diverse Asian healthcare settings.