Chronic constipation is a common digestive disease that affects people's quality of life, with complex causes and difficult treatment. Nearly half of the patients with chronic constipation do not achieve satisfactory treatment results, which is referred to as refractory constipation.Current clinical strategies for addressing refractory constipation have predominantly focused on the mitigation of intestinal symptoms. However, emerging evidence suggests that the pathogenesis and progression of refractory constipation are multifactorial and highly intricate, and that strategies targeted solely at symptom relief may be insufficient to yield optimal therapeutic outcomes. Based on the concept of disorders of brain gut interaction disorder (DBGI) proposed by Rome IV, we found that DBGI may play a key role in patients with refractory constipation. From the perspective of DBGI, this review synthesized the contemporary insights into the pathological mechanisms underlying refractory constipation, as well as diagnostic and therapeutic strategies focusing on four aspects: the central nervous system, the peripheral nervous system, the endocrine system, and the intestinal environment.
慢性便秘是影响人们生活质量的常见消化系统疾病，其病因复杂，治疗难度大。近一半的慢性便秘患者治疗效果并不理想，称为顽固性便秘。目前，临床对顽固性便秘的诊治主要集中在肠道局部治疗。然而近期研究发现，顽固性便秘的发生和发展是一个多因素参与的复杂过程，单一针对肠道症状治疗并不能取得理想的效果。基于罗马Ⅳ提出的脑肠互动障碍理念，我们发现在顽固性便秘患者中，脑肠互动障碍可能起到了关键作用。本文将从脑肠互动障碍的角度，围绕中枢神经系统，外周神经系统，内分泌系统及肠道4个方面，对顽固性便秘的病理机制、诊治思路进行综述。.