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Asian Neurogastroenterology and Motility Association and Asia-Pacific Association of Gastroenterology Chronic Constipation Consensus 2026

Patcharatrakul T 1 , Siah KTH 2 , Syam AF 3 , Nakajima A 4 , Suzuki H 5 , Lee YY 6 Show all authors , Hojo M 7 , Rattanachaisit P 8 , Pitisuttithum P 1 , Quek S 9 , Bai T 10 , Ren YP 9 , Nagahara A 7 , Ong AM 11 , Chen CL 12 , Lu CL 13 , Quach DT 14 , Makharia GK 15 , Wu JCY 16 , Jung KW 17 , Chuah KH 18 , Zhong L 19 , Rahman MM 20 , Lee TH 21 , Ghoshal UC 22 , Hou X 10 , Fang X 23 , Xiao YL 24 , Gonlachanvit S 1

Affiliations 

  • 1 Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 3 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 4 Department of Gastroenterology and Hepatology, International University of Health and Welfare and Atami Hospital, Shizuoka, Japan
  • 5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • 6 School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
  • 7 Department of Gastroenterology, Juntendo University Faculty of Medicine, Tokyo, Japan
  • 8 Center of Excellence in Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 9 Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
  • 10 Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 11 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
  • 12 Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
  • 13 Endoscopy Center in Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei City, Taiwan
  • 14 Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
  • 15 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
  • 16 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
  • 17 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 18 Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
  • 19 School of Biological Sciences, Nanyang Technological University, Singapore
  • 20 Department of Gastroenterology, Manikganj Medical College, Manikganj, Bangladesh
  • 21 Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Korea
  • 22 Institute of Gastrosciences & Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India
  • 23 Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 24 Department of Gastroenterology and Hepatology, Sun Yat-sen University, China
J Neurogastroenterol Motil, 2026 Oct 30;32(4):501-533.
PMID: 42663077 DOI: 10.5056/jnm26076

Abstract

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 Asian Neurogastroenterology and Motility Association (ANMA) and the Asia-Pacific Association of Gastroenterology (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 four 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.

CONCLUSIONS: : This ANMA/APAGE consensus provides a practical, algorithm-based framework to improve management of chronic constipation across diverse Asian healthcare settings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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