Clinical and anamnestic characteristics of patients with different subtypes of chronic slow transit constipation

Abstract

In recent years, chronic slow transit constipation (СSTC) continued to be an actual  clinical challenge due to its high prevalence, multifactorial pathogenesis, and the limited efficacy of current therapeutic strategies. The literature still lacks clear evidence regarding the correlation between the clinical manifestations of CSTC and specific histological alterations within the intestinal wall.

Objective – to identify the clinical course in peculiarities in patients with CSTC depending on the histological subtype of the colonic wall.

Materials and methods. The study included 107 patients diagnosed with chronic slow‑transit constipation (STC group) who underwent evaluation and surgical treatment at the clinical departments of Bogomolets National Medical University between 2011 and 2023. The diagnosis of STC was established according to the Rome IV criteria.

Results. The Cajal subtype was associated with the youngest age of disease onset (8.67±5.08 years), the longest duration of symptoms (25.24±11.18 years), and the highest prevalence of family history (90.5%). This subtype had the lowest average body mass index 20.4±2.3 kg/m². The neuropathic subtype was observed in the oldest patients (52.45±13.61 years) and had a later onset of symptoms compared to other variants. It was characterized by a significantly shorter interval between defecations (8.1±2.5 days). The inflammatory myopathic subtype was accompanied by the most pronounced pain syndrome (4.8±1.4 points on the scale) compared to other subtypes, thereby confirming the role of inflammation in the development of abdominal pain. The dystrophic myopathic subtype was associated with the highest body mass index 25.7±4.3 kg/m² and the longest interval between defecations (12.4±5.5 days), indicating slow transit and muscle layer degeneration. Patients with late onset of symptoms and no need for manual assistance during defecation were more likely to have a histologically intact subtype.

Conclusions. The clinical course in surgically treated patients with CSTC, resistant to conservative therapy, is heterogeneous and significantly varies depending on the histological subtype of the bowel wall, indicating different pathophysiological mechanisms of constipation in different patients. The cajal, neuropathic, myopathic dystrophic, and inflammatory subtypes have clinical differences in the age of disease onset, symptom duration, interval between defecations, pain intensity, and body mass index. Morphological stratification of CSTC based on histological subtypes may provide valuable prognostic and therapeutic information, helping to individualize treatment strategies for patients with severe forms of constipation.