The End of the Road: Managing Refractory Constipation

Society: AGA

In this session timed to reflect the findings of an upcoming clinical practice update from the AGA, we will investigate the constipated patient who has seemingly failed all options. Although the majority of patients with constipation are unlikely to seek care for their symptoms, many of those who do remain constipated despite an increasing armamentarium of pharmacologic agents. More severe or refractory symptoms are associated with a disproportionate impact on quality of life and likely disproportionate share of direct and indirect medical expenditures. Thus, there is an imperative to a more effective approach to this long-suffering and resource-intensive patient population. Important questions to be answered by this session include: 1. What is the definition of refractory chronic constipation? 2. What physiologic testing should be performed in patients with refractory chronic constipation? 3. What lifestyle treatments might be effective in this population? 4. What pharmacotherapy should be offered to patients with refractory chronic constipation? 5. When is surgical therapy appropriate for refractory chronic constipation and what surgical options are available? In which patients should surgery be avoided? 6. Are there procedural alternatives to colectomy for patients with refractory chronic constipation?