Bali Chronic Constipation Roundtable Report: Chronic Constipation Management in Asia

Abstract

Background/Aims

Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care.

Methods

The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations.

Results

Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing.

Conclusions

The Bali Chronic Constipation Roundtable highlighted Asia’s need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.

Introduction

Chronic constipation (CC) is a complex, multifaceted condition with significant implications for patients' health-related quality of life (HRQoL) and considerable economic burdens on healthcare systems.¹ In Asia, CC affects millions of individuals, but its prevalence varies widely due to differences in diagnostic practices and cultural attitudes toward seeking medical care.^2-5 The cultural stigma surrounding discussions of bowel symptoms further exacerbates delays in diagnosis and treatment.^6,7 Additionally, systemic barriers such as cost constraints and limited diagnostic infrastructure hinder the widespread adoption of effective treatments for CC across the region.

Self-treatment of constipation is common in Asia, with individuals frequently relying on over-the-counter laxatives, herbal remedies, and dietary supplements. In Singapore, up to 80% of female patients with CC attempt to self-treat constipation before consulting a doctor.⁷ A survey in China found that 81.7% of participants with CC preferred lifestyle and dietary management, followed by traditional medicine (51.1%) and laxatives (25.2%).⁸ A multinational study reported that laxative use is more common in the West (40.0% in the United States) than in the East (16.0% in South Korea).⁹ Another study, which included participants from China and Indonesia, also demonstrated that only fewer than one-third of those with CC used laxatives.¹⁰

Lifestyle differences across Asia significantly impact the presentation and management of CC. Dietary fiber intake, a cornerstone of constipation management, varies widely. Rural populations typically consume more fiber due to traditional diets, whereas urbanized areas experience a shift toward low-fiber, high-fat diets.^11,12 The mean daily fiber intake across Asia varies, but is generally higher than in the West – for example, 52.3 g in India, 19.4 g for Chinese males, and 17.6 g for Chinese females, compared to 15.9 g for American adults.^13-15 Higher fiber intake is associated with greater stool weight, shorter colonic transit time, and reduced constipation frequency. Research indicates that the mean intestinal transit time for Northern Indian adults is 39.9 hours, compared to 83.4 hours for Caucasian adults.¹⁶

Despite the availability of international guidelines on CC management,^17-19 these recommendations often do not fully address the unique socioeconomic, cultural, and genetic factors in Asia. Such disparities pose distinct challenges in diagnosing, investigating, and treating CC within the region.

In November 2024, experts from across Asia convened for the Bali Chronic Constipation Roundtable, held both onsite and online following the Asia Pacific Digestive Week 2024 regional meeting. This multidisciplinary workgroup included specialists from Bangladesh (1), Hong Kong (2), India (1), Indonesia (1), Japan (2), China (3), Malaysia (5), Singapore (2), South Korea (1), Taiwan (2), Thailand (2), and Vietnam (1).

The roundtable aimed to explore real-world challenges and opportunities in managing CC across Asia. Through a multinational questionnaire (Supplementary Data) and collaborative discussions, participants examined key barriers and gaps in current CC management. This report consolidates the insights gathered, offering actionable recommendations to address existing limitations and highlighting the need for future research to improve CC outcomes in diverse populations. This report focuses exclusively on primary and idiopathic CC, including functional constipation (FC) and irritable bowel syndrome with constipation predominant subtype (IBS-C). The ultimate goal is to equip clinicians with region-specific knowledge, enabling them to provide more effective and culturally sensitive care for patients with CC.

Key Insights and Consensus Points From the Bali Chronic Constipation Roundtable (Figure 1)

Figure 1.

Key insights and consensus points from the Bali Chronic Constipation Roundtable. ANMA CC, Asian Neurogastroenterology and Motility Association chronic constipation; FC, functional constipation; IBS-C, irritable bowel syndrome with constipation predominant subtype; BSFS, Bristol stool form scale.

The Bali Chronic Constipation Roundtable convened experts from 11 Asian countries to discuss real-world challenges in the management of CC across the region. Several key consensus points emerged. First, participants strongly agreed that the Rome IV diagnostic criteria for irritable bowel syndrome (IBS)—particularly the requirement for abdominal pain—are overly restrictive for Asian populations, where bloating and discomfort are more commonly reported symptoms. Consequently, there was strong support for a pragmatic approach that groups FC and IBS-C under the broader umbrella of “chronic constipation” to simplify diagnosis and guide treatment. The group also underscored the urgent need for culturally adapted diagnostic tools—such as the Asian Neurogastroenterology and Motility Association (ANMA) CC tool—and patient education strategies aligned with local dietary practices and lifestyles.

A recurring concern was the significant disparity in healthcare resources among countries. Experts highlighted limited access to gastrointestinal motility testing and biofeedback therapy, as well as the high cost and inconsistent availability of newer pharmacological agents such as prucalopride and elobixibat. These core insights form the foundation of the region-specific recommendations outlined in this report.

Epidemiology and Impact of Chronic Constipation

The global Rome epidemiology study highlights significant variability in the prevalence of FC across Asia, ranging from 1.8% in India to 16.6% in Japan.³ In contrast, IBS is less common, with prevalence rates ranging from 0.2% in India to 4.7% in South Korea.³ IBS-C subtype was the least common, with a pooled prevalence of 1.1% to 2.3%, as reported in a meta-analysis.²⁰ Interestingly, roundtable participants estimated higher prevalence rates of CC in their respective countries than those reported in the literature (Fig. 2). These discrepancies are more apparent when examining diverse epidemiological studies across Asia and globally,^1,3,20-37 and are likely influenced by variations in study methodology, healthcare access, cultural dietary practices, and individual symptom perception (Table 1).

Figure 2.

Estimated prevalence rates of chronic constipation in their respective countries by the roundtable participants.

Table 1.

Prevalence of Chronic Constipation in Different Studies

Author	Year of publication	Country	Sample size	Type of study	Diagnostic criteria	Prevalence
Asia
Vu et al21	2024	Japan	5386	Cross-sectional study – university students	Rome IV	13.7%
Chen et al22	2022	China	124 079	Meta-analysis of population based study	Rome II, Rome III, Rome IV	8.5% (overall pooled prevalence using Rome criteria), 10.6% (Rome II), 6.5% (Rome III), 8.1% (Rome IV)
Chuah et al1	2021	Malaysia	1002	Cross-sectional study – primary care	Rome III, Rome IV	10.5 (Rome III), 11.7% (Rome IV)
Otani et al23	2021	Japan	10 658	Cross-sectional study – primary care	Rome IV	2.1%
Abdul Wahab et al24	2021	Malaysia	400	Cross-sectional study of elderly patients from primary care	Rome III	14.8%
Moezi et al25	2018	Iran	9264	Population based study	Rome IV	8.10%
Gwee et al26	2017	Multicenter (China, South Korea, Malaysia, Philippines, Singapore)	4570	Cross-sectional study – secondary care	ANMA CC tool, Rome III, self-defined (SD), investigator’s judgement	9.1% (ANMA CC tool), 7.5% (Rome III), 14.4% (self-defined), 8.6% (investigator’s judgement)
Ghoshal and Singh27	2017	India	2774	Population based study (rural)	Rome III - diagnostic criteria for functional constipation	2.4%
Tamura et al28	2016	Japan	5155	Population based study	Rome III	28.0%
Lim et al29	2016	Malaysia	1662	Cross-sectional study – university students	Rome III - diagnostic criteria for functional constipation	16.2%
Zhang et al30	2015	China	1942	Population based study (elderly)	Rome III	32.6%
Rajput and Saini31	2014	India	505	Population based study	Rome II	16.8%
Panigrahi et al32	2013	India	1200	Population based study	Stool frequency (≤ 3 stools/week diagnostic criteria)	2.6%
Makharia et al33	2011	India	4767	Population based study	Self-perception	11.6%
Jun et al37	2006	South Korea	1029	Population based study	Rome II	9.2%
Global/outside Asia
Salari et al34	2023	Global	58 405	Meta-analysis of cross-sectional study of elderly population	Rome II, Rome III, Rome IV	18.9% (overall pooled prevalence), 16.2% (Rome II), 19.2% (Rome III), 10.3% (Rome IV)
Sperber et al3	2021	33 countries across 6 continents	73 076	Population based study	Rome IV	11.7% (internet surveys, functional constipation), 6.6% (household surveys, functional constipation)
Oh et al35	2020	United States	4702	Population based study	Rome IV	24.0%
Palsson et al36	2020	United States, Canada, United Kingdom	5931	Population based study	Rome IV	7.9-8.6% (functional constipation)
Oka et al20	2020	42 countries	423 362	Meta-analysis of population based study	Rome III, Rome IV	9.2% (Rome III), 3.8% (Rome IV)

ANMA CC, Asian Neurogastroenterology and Motility Association chronic constipation.

Underreporting remains a challenge in community-based studies, particularly among elderly and female Asian participants due to cultural taboos and stigma, especially in face-to-face household surveys.^6,7 Additionally, limited internet penetration in rural areas restricts the effectiveness of online surveys in capturing broader population experiences.

Certain groups, including the elderly and women, are disproportionately affected by CC. A study in China reported an overall CC prevalence rate of 8.2%, increasing to 18.1% among the elderly population.³⁸ Women are also at higher risk, with studies in Japan and Singapore demonstrating significantly greater prevalence rates among women compared to men.^21,39 These demographic groups are correspondingly also identified by roundtable respondents to be more commonly affected by CC in their countries.

Patients with disorder of gut brain interaction (DGBI) often report dissatisfaction with treatment,⁴⁰ with studies indicating that only one-third of CC patients feel their symptoms are adequately controlled.⁴¹ The global annual cost of evaluating and managing constipation exceeds United States dollar 6.9 billion.⁴² In the United States, the annual direct costs of per patient range from $1900 to $12 000 per patient, while the United Kingdom’s National Health Service spent £162 million on constipation treatment in 2017-2018.⁴³ Additionally, the Japanese National Health and Wellness Survey found that CC patients experience lower HRQoL, reduced work productivity, higher absenteeism and greater indirect costs. The overall health burden of CC surpasses that of conditions such as type 2 diabetes, IBS, and gastroesophageal reflux disease.⁴⁴

Expert insights and recommendations

The true prevalence of CC in Asia remains unknown due to variations in study methodologies and underreporting in certain populations. A comprehensive survey assessing the frequency and impact of CC, specifically tailored to include rural and less developed regions, would provide a more accurate representation of the condition across Asia. Additionally, identifying and focusing on high-risk groups, such as the elderly and women, will help develop targeted management strategies to improve patient outcomes.

Symptom Patterns, Perceptions, and Diagnostic Considerations in Chronic Constipation

Symptom patterns and perceptions of CC vary significantly across Asia. A systematic review of 11 studies found that the majority of Asian CC patients reported straining (82.8%), lumpy or hard stools (74.2%), and incomplete evacuation (68.1%).⁴⁵ However, regional differences persist. Misconceptions about constipation are also prevalent. For example, among Korean patients, there is a lack of recognition of manual maneuvers, anorectal obstruction, infrequent bowel movements, incomplete evacuation, hard stools, and straining as indicators of constipation. The Rome Foundation-Asian Working Team previously identified a unique symptom cluster in which Asian patients commonly report mid-abdominal or right upper quadrant pain, a pattern distinct from Western populations.⁴⁶ Additionally, cultural and regional factors influence symptom interpretation; for example, some Asian patients perceive Bristol stool form scale (BSFS) Type III as constipation.⁴⁷ A Thai study further demonstrated that BSFS Types I-III were associated with delayed colonic transit, whereas in Western studies, only BSFS Types I-II are linked to slow transit.⁴⁸

The Rome IV diagnostic criteria remains the gold standard for diagnosing DGBI. A total of 71.4% of roundtable participants reported the routine use of the Rome IV criteria in their practice for diagnosing CC. However, Rome IV redefined IBS by requiring abdominal pain (excluding discomfort) as a criterion.¹⁷ IBS under Rome IV criteria may indicate that Rome IV-diagnosed IBS cases represent more severe forms of the disorder.⁴⁹ This shift significantly reduced the reported prevalence of IBS—for example, from 4.0% (Rome III) to 0.9% (Rome IV) in Malaysia.¹ Asian bowel disorders tend to present with less abdominal pain compared to Western populations. Furthermore, abdominal pain was reported to be contributed from constipation and passing motion lead to the relieve of the pain or discomfort.⁵⁰ As such, 19.0% of roundtable participants reported the use of their respective local guidelines and criteria in the diagnosis of CC. In addition, using the less restrictive Rome III criteria, FC and IBS-C were reported as not distinct entities with the symptoms overlap and the diagnoses switched over 12 months.⁵¹ Therefore, grouping FC and IBS-C under the broader category of CC may be more practical in the Asian context, as it simplifies education, treatment, and research.

While stool frequency and consistency are the primary diagnostic criteria, many patients prioritize secondary symptoms, such as bloating or abdominal discomfort, complicating symptom assessment.⁵² Secondary symptoms like bloating, though frequently reported and distressing to patients, remain underrecognized by clinicians as diagnostic markers of CC. Furthermore, overlap syndromes, such as CC with functional dyspepsia or gastroesophageal reflux disease, are often underdiagnosed, despite their higher symptom burden and treatment resistance.⁴⁰

While the Rome criteria remains the global standard, a multi-center Asian study found that the ANMA CC tool is more sensitive than the Rome III criteria (Supplementary Table). The ANMA CC tool achieved a higher level of agreement with self-defined constipation (90.3%) and investigator judgment (93.7%) compared to Rome III. Unlike Rome III, the ANMA CC tool employs a 2-step approach, incorporating bloating and fullness alongside traditional constipation indicators. Additionally, BSFS Type III is recognized as indicative of constipation.²⁶ These findings emphasize the need for standardized methodologies and region-focused investigations to improve the characterization of CC epidemiology in Asia.

Digital rectal examination (DRE) is a crucial yet underutilized tool in CC evaluation. When performed correctly, DRE can help identify rectal masses, assess fecal characteristics, and diagnose dyssynergic defecation (DD), with sensitivity (75%) and specificity (87%), comparable to high-resolution anorectal manometry (HR-ARM).⁵³ Despite its clinical utility, DRE remains overlooked in practice, underscoring the need for greater emphasis on its role in CC assessment.

Expert insights and recommendations

Given the lower frequency of abdominal pain in bowel disorders among Asians,^1,49 CC can be recognized as the initial diagnosis without differentiating between FC and IBS-C in clinical practice. This approach simplifies education, treatment, and research. Utilizing symptom assessment tools like the ANMA CC tool, which incorporates local cultural contexts, may improve diagnostic accuracy. However, validation in specific local populations is necessary to ensure reliability. Additionally, overlap syndromes and secondary symptoms such as bloating and fullness should be actively identified for better management. Nevertheless, if pain associated with defecation is prominent, treat as IBS with antispasmodic should be initiated. The importance of DRE should be emphasized, particularly in cases of refractory CC, as it plays a critical role in detecting DD and structural abnormalities.

Treatment Strategies

Management of Chronic Constipation (Figure 3)

Figure 3.

Management of chronic constipation. IBAT, ileal bile acid transporter inhibitor; DGBI, disorder of gut brain interaction.

Lifestyle modification

Fluid intake

Lifestyle differences across Asia significantly impact the presentation and management of CC. Dietary fiber intake, a cornerstone of constipation management, varies widely across the region. In addition to diet, cultural norms influence fluid intake, which can further affect constipation symptoms.

Adequate hydration is essential for preventing hard stools and supporting gut motility, particularly when increasing dietary fiber intake. While studies have shown that inadequate water intake is associated with CC among the elderly population,^24,54 findings have been inconsistent. For instance, a population-based study in the United States found no significant association between low water consumption and increased constipation risk.⁵⁵ In contrast, a study involving 3835 young Japanese women reported that low water intake was associated with a higher risk of FC, particularly among those with relatively low dietary fiber intake.⁵⁶ Patient education on achieving a daily fluid intake of 1.5-2.0 L is generally recommended to optimize the benefits of fiber.⁵⁷ However, there is currently no robust evidence that increasing water intake alone directly improves constipation.

Physical activity

Urbanization and increasingly sedentary lifestyles have contributed to a rising prevalence of constipation, particularly in populations transitioning away from traditional, physically active routines. A meta-analysis of 9 studies demonstrated that exercise therapy is effective in alleviating constipation symptoms and improving quality of life.⁵⁵ Additionally, a recent study reported that high levels of physical activity combined with a healthy diet exert a synergistic effect in enhancing stool consistency and frequency.⁵⁶ A minimum of 150 minutes of moderate-intensity exercise per week—such as brisk walking or tai chi, which aligns well with local cultural practices—is generally recommended to support bowel regularity.^58-60

Pharmacological interventions

First-line treatment: dietary vs supplemental fiber

The management of CC typically begins with non- pharmacological interventions, emphasizing lifestyle modifications. These include increasing dietary fiber intake to enhance stool consistency, ensuring adequate hydration to prevent hard stools and improve gut motility, and maintaining regular physical activity to reduce intestinal transit time and support overall gut function. These fundamental first-line treatments aim to improve bowel regularity and address modifiable risk factors for constipation.

Dietary fiber remains the cornerstone of first-line treatment for CC due to its ability to enhance stool bulk, retain water, and facilitate softer, easier bowel movements. Regular incorporation of dietary fiber is an evidence-based approach and a critical component of lifestyle modification in constipation management.⁶¹

Traditional Asian diets are naturally high in fiber, featuring an abundance of fruits, vegetables, legumes, and whole grains.⁶² However, the westernization of dietary patterns across Asia has led to a shift toward higher-fat, lower-fiber consumption. This transition is particularly notable in urbanized populations, where convenience foods and protein-rich diets are increasingly prevalent.⁶³ Patients should be encouraged to gradually increase their fiber intake to improve constipation while minimizing potential gastrointestinal side effects, such as bloating and gas.

In many Asian cultures, there is a strong preference for natural or food-based remedies over pharmaceutical supplements. Partially hydrolyzed guar gum has been extensively studied in Japan, where it has demonstrated efficacy in improving bowel movement frequency and reducing the reliance on laxatives.^64,65 Additionally, other dietary fiber sources, such as kiwi fruit, prunes, and psyllium, have shown significant benefits in increasing the rate and frequency of spontaneous bowel movements (SBMs).^61,66

For patients unable to achieve adequate fiber intake through diet alone, fiber supplements offer a practical alternative. Soluble fibers, such as psyllium, have demonstrated significant efficacy in improving stool consistency, reducing straining, alleviating global symptoms, minimizing pain during defecation, and increasing bowel frequency. However, evidence regarding the effectiveness of insoluble fibers, such as wheat bran, remains inconsistent.^61,67

Nevertheless, excessive fibres intake, particularly the insoluble type may worsen constipation related symptoms, such as abdominal distension and flatulence, especially in patients with slow-transit constipation (STC) or DD.⁶⁸ A total of 90.5% of roundtable participants also report dietary changes as the initial step in CC management, while 66.7% reported the use of supplementary fiber as initial treatment.

a. Osmotic laxatives

Osmotic laxatives are a key component of the pharmacological management of CC. They are commonly used as first-line agents, either alone or in combination with dietary interventions, particularly when dietary fiber alone is insufficient to achieve symptom relief. These agents work by osmotically drawing water into the colonic lumen, softening stools and increasing their volume to facilitate defecation.⁶⁹ Their favorable safety profile makes them appropriate for long-term use when prescribed correctly. Polyethylene glycol (PEG) is a widely preferred osmotic laxative, with strong evidence supporting its efficacy in improving stool frequency, consistency and reducing the need for additional treatment.⁷⁰ PEG is well-tolerated and has a proven long term safety profile, making it a practical and effective first-line option.⁷¹ Amongst the various laxatives preparations, PEG has received a Grade A recommendation with Level 1 evidence.⁷² In patients experiencing bloating and pain, lactulose should be used with caution or avoided due to its potential to worsen bloating, despite its safety profile.⁷⁰

b. Stimulant laxatives

Stimulant laxatives are a valuable option for patients who fail to respond adequately to dietary fiber or osmotic agents. Stimulant laxatives are best used as short term or rescue therapy.⁷³ These medications act by stimulating the enteric nervous system to enhance colonic motility, thereby promoting bowel movements.⁶⁹

Bisacodyl is one of the most commonly used stimulant laxatives, known for its reliability in alleviating constipation. It is frequently included in clinical protocols for short-term symptom relief. A network meta-analysis ranked bisacodyl as the most effective agent for achieving 3 or more complete SBMs per week over a 4-week period, outperforming other laxatives. Common adverse events include abdominal pain and diarrhea. Prolonged use may lead to electrolyte imbalances, particularly in older adults and those with kidney disease, and continued use might decrease its efficacy.^74,75 Although there are no long-term studies on bisacodyl, recent research has not reported electrolyte imbalances or the development of tolerance with its use.^76-78

Senna, a plant-derived stimulant laxative, is another effective option.⁷⁹ Popular senna-containing products include herbal teas, powders, and tablet forms, marketed under various brands.⁸⁰ However, its long-term use requires careful monitoring due to uncertainties regarding the risks associated with extended administration. In addition, sodium picosulfate and senna require bacterial metabolism for their laxative effects. Therefore, alterations in the intestinal microbiota—such as those induced by antibiotic therapy—may reduce their efficacy. In contrast, bisacodyl appears to have a more consistent effect independent of microbial activity.⁷⁸

While first line laxatives are widely accessible and affordable, their unsupervised use raises concerns about dependency, electrolyte imbalances, and improper management of underlying conditions. These risks were primarily reported in elderly individuals and those with eating disorder, such as anorexia or bulimia nervosa.⁸¹ Nevertheless, when taken at the recommended doses, laxatives are generally safe, including for short-term use (up to 1 month) in elderly patients.^75,82 In contrast, long-term safety data on laxatives remained limited, except for PEG.⁷⁵ Therefore, laxatives should be used cautiously and under medical supervision, particularly for the long-term management of constipation.

c. A regional overview of laxative prescribing practices in Asian countries

Laxative use across Asia is shaped by a confluence of cultural practices, healthcare infrastructure, and drug availability. In Japan, magnesium oxide remains the predominant first-line agent, owing to its long-standing use, cost-effectiveness, and prescriber familiarity.⁸³ Osmotic agents such as PEG are also utilized, with more recent incorporation of secretagogues such as elobixibat, lubiprostone, and linaclotide into second-line options.

China exhibits a distinct pattern characterized by the widespread reliance on traditional medicine.⁸⁴ Despite the availability of agents like lactulose and senna-based preparations, the overall use of pharmacologic laxatives remains low, with only approximately a quarter of patients utilising them. Linaclotide is available but access remains limited.

In South Korea, magnesium hydroxide is the most commonly used agent because it is reimbursed and the least expensive. Although PEG is recommended in the guidelines for its long-term safety, it is not reimbursed and is relatively costly, resulting in limited use.^57,85 Lubiprostone is no longer available, leaving prucalopride as the only remaining second-line therapeutic option. Before visiting the hospital, 91.4% of patients self-medicate with over-the-counter laxatives from pharmacies, of which 89.2% use stimulant laxatives. Additionally, 18.5% of patients use traditional medicine, and 81.5% try folk remedies.⁸⁶

Thailand's landscape is marked by the prevalent use of stimulant laxatives such as bisacodyl and lactulose, often without medical supervision. While newer agents like elobixibat and prucalopride are available, their uptake remains limited in primary care settings.

India demonstrates a unique profile dominated by self-medication, particularly with psyllium-based bulking agents and traditional Ayurvedic remedies.⁸⁷ Although elobixibat has received regulatory approval, structured guidance on its use appears lacking, particularly outside tertiary institutions.

Singapore reflects a more structured approach, with PEG, lactulose, and bisacodyl commonly prescribed. PEG is the preferred agent in hospital settings, while a notable proportion of patients—especially women—engage in self-treatment.⁷ Second-line therapies including prucalopride, linaclotide, lubiprostone, and elobixibat are accessible.

In Malaysia, the prescribing pattern differs between levels of care. In tertiary centres, PEG is widely used and aligns with international recommendations. Conversely, in primary care, lactulose and bisacodyl remain the mainstay, likely due to ease of access and clinician familiarity. Prucalopride is available but predominantly utilised in specialist care.

This regional overview highlights the heterogeneity in laxative utilisation across Asia and underscores the need for culturally tailored, evidence-informed strategies to improve constipation management. These country-specific prescribing patterns are summarized in Table 2.

Table 2.

Laxative Treatment Practices in Selected Asian Countries

Country	Most commonly used first-line laxatives	Second-line therapy availability (examples)	Notes
Japan	Magnesium oxide, PEG	Elobixibat, lubiprostone, linaclotide	Magnesium oxide is widely preferred due to cost and familiarity78
China	Lactulose, senna-based traditional remedies	Linaclotide (limited)	High use of traditional medicine; only 25.2% of patients use laxatives79
South Korea	Fiber, magnesium hydroxide, lactulose, PEG	Prucalopride	Magnesium hydroxide is is most commonly used. PEG is less used due to high cost. Stimulant laxatives are the most frequently sold over-the-counter agents85
Thailand	Bisacodyl, lactulose	Elobixibat, prucalopride	Stimulant laxatives are often used unsupervised as first-line agents
India	Isabgol (psyllium), lactulose	Elobixibat (approved)	High rate of self-medication with fiber and traditional Ayurvedic remedies82
Singapore	PEG, lactulose, bisacodyl	Prucalopride, linaclotide, lubiprostone, elobixibat	PEG is preferred in hospitals; high rate of self-treatment (80% of women)7
Malaysia	Lactulose, bisacodyl, PEG	Prucalopride	PEG is common in tertiary care, while lactulose and bisacodyl are frequent in primary care

PEG, polyethylene glycol.

Based on manuscript data, roundtable discussions, and expert communications.

Availability is subject to local regulatory approval, pricing, and healthcare policies.

d. Expert insights and recommendations

Given the diverse dietary and lifestyle habits across Asia, region-specific public health strategies are essential to raise awareness of modifiable lifestyle factors for effective CC management. A thorough assessment of dietary intake is crucial, with an emphasis on encouraging traditional high-fiber Asian diets. When dietary fiber intake is insufficient, supplementation with soluble fiber may be recommended.

Asia’s vast geographic and economic diversity leads to disparities in healthcare access, which may limit the availability of certain laxative options in some regions. Depending on local availability and patient tolerability, either osmotic or stimulant laxatives can be considered as first-line treatment options.

When monotherapy fails to provide adequate relief or is poorly tolerated, combination therapy may be a viable alternative for treating constipation.⁸⁸ This approach typically involves pairing an osmotic laxative with a stimulant laxative, with or without a fiber supplement, to create a synergistic effect that targets multiple physiological mechanisms of constipation. Although clinical evidence on combination therapy is limited, such regimens may enhance treatment efficacy, particularly for patients with persistent symptoms or those who have not responded adequately to single-agent therapy, while careful monitoring is necessary to minimize potential adverse effects, such as dependence, withdrawal, and colonic dysfunction associated with long-term stimulant laxative use.¹⁷

Second-line therapies and emerging treatments

In cases where first-line interventions fail to provide adequate symptom relief for CC, second-line therapies and emerging treatments offer additional options to address the symptoms (Table 3).

Table 3.

Meta-analysis of Second Line Therapies With Number Needed to Treat and Number Needed to Harm

	Mechanism of action	Number of studies	Number needed to treat	Number needed to harm
Lubiprostone	Secretagogues: selectively activates type 2 chloride channels in epithelial cells	Efficacy: 2 Safety: 5	SBM frequency of ≥ 4 per week at week 1: 3 SBM frequency of ≥ 3 per week at week 1: 5	Diarrhea: 14 Nausea: 5 Abdominal pain: 47
Linaclotide	Secretagogues: guanylate cyclase-C agonist	Efficacy: 3 Safety: 6	SBM frequency of ≥ 3 per week and an increase of at least 1 SBM: 5	Diarrhea: 12 Nausea: 46 Abdominal pain: 47
Prucalopride97	Prokinetics: highly selective serotonin 5-HT4 receptor agonist	Efficacy: 6	SBM frequency of ≥ 3 per week over week 12: 8.8
Elobixibat	Ileal bile acid transporter inhibitor	Efficacy: 3 Safety: 3	SBM frequency of ≥ 3 per week and an increase of at least 1 SBM: 3	Diarrhea: 11-> 12 Nausea: 53 -> 96 Abdominal pain: 5 -> 6

SBM, spontaneous bowel movement; 5-HT₄, 5-hydroxytryptamine receptor 4.

Lubiprostone is approved for CC in Japan and IBS-C in Singapore, for CC and IBS-C in Bangladesh, but was previously available in South Korea and is no longer approved. Linaclotide is available in Japan for CC and Singapore for IBS-C, and in Bangladesh for CC and IBS-C but remains limited elsewhere. Prucalopride is approved in Hong Kong, Malaysia, Singapore, Bangladesh, and Thailand for CC, while it is not widely available in other regions. Elobixibat is approved in Thailand, Indonesia, the Philippines, Singapore, Myanmar, India, Bangladesh, and Japan for CC. These differences in availability may be influenced by regulatory approvals, pricing, and healthcare policies in each country. In general, roundtable participants reported cost (76.2% of respondents) and availability (38.1%) as the major factors which influence regional preferences for specific drug classes.

a. Lubiprostone

Lubiprostone selectively activates type 2 chloride channels in epithelial cells, promoting an influx of chloride into the intestinal lumen, which accelerates intestinal transit. The response rate of achieving 4 or more SBMs per week was significantly higher in the lubiprostone group (75.4%) compared to the placebo group (29.0%). Common adverse effects include nausea, vomiting, and diarrhea, with reported incidence rates ranging from 2.4% to 75%.^89,90

b. Linaclotide

Linaclotide is a guanylate cyclase-C agonist with a dual mechanism of action: it accelerates gastrointestinal transit by increasing fluid secretion and reduces visceral hypersensitivity. Linaclotide has been shown to significantly improve stool form, abdominal pain, bloating, and global symptom severity in patients with IBS-C and CC.⁹¹ Compared to placebo, the relative risk for response to treatment was 1.95 for IBS-C and 4.26 for CC. The most common adverse event was diarrhea, with a relative risk of 4.72 compared to placebo.⁹²

Both Linaclotide and Lubiprostone are FDA-approved for IBS-C and FC, providing reliable efficacy across multiple symptoms (eg, stool consistency, abdominal pain, and bloating). Their approval status for IBS-C may facilitate insurance claims in some regions, making them important options for patients with coverage.

c. Prucalopride

Prucalopride is a highly selective serotonin 5-hydroxytryptamine receptor 4 agonist that effectively stimulates colonic transit, making it a valuable treatment for CC. A meta-analysis demonstrated that prucalopride significantly increases the frequency of SBMs per week across various doses—1 mg, 2 mg, and 4 mg—with standardized mean differences of 0.42, 0.33, and 0.33, respectively.⁹³ Common adverse events associated with prucalopride include headache, abdominal cramps, excessive flatulence, dizziness, diarrhea, and rash. Prucalopride not only improves colonic transit but also accelerates gastric and esophageal transit. Prucalopride will be most suitable for CC patients with co-existing gastroparesis due to its benefits in improving gastric emptying and gastroparesis symptoms.⁹⁴

d. Elobixibat

Elobixibat is an ileal bile acid transporter inhibitor (IBAT) that improves CC by triple mode of action that increases colonic bile acids, stimulate colonic motility and promote secretion. It also enhances rectal sensation, thereby increasing the desire to defecate.⁹⁵ The Japanese Constipation Guidelines strongly recommend elobixibat for CC (Strength A, 100% agreement), citing its proven efficacy and safety. By blocking IBAT, elobixibat improved stool frequency and form, significantly enhancing quality of life.⁹⁶ Phase III trials showed a rapid median time to the first bowel movement of 5.1 hours (vs 25.5 hours with placebo).⁹⁷ Its effectiveness and consistent safety profile have also been demonstrated in older adults, patients with cancer, chronic kidney disorders, heart failure, hemodialysis, and Parkinson disease, cementing its role as a valuable treatment option.^96,98-103

A network meta-analysis of randomized controlled trials in Japan reported that Elobixibat, ranked first among laxatives in terms of increasing SBMs and complete SBMs within the first week of treatment, as well as reducing the time to the first SBM.⁸³ Compared to placebo, elobixibat demonstrated superior efficacy, with an odds ratio of 5.69, compared to 1.95 for linaclotide and 2.41 for lubiprostone. The number needed to treat for elobixibat to achieve a significant response at week 1 was reported to be only 3, highlighting its remarkable effectiveness.⁹⁰

The most common adverse events associated with elobixibat include mild abdominal pain (24.0%) and diarrhea (15.0%), which were generally well-tolerated. Post-hoc analyses suggest its safety and efficacy even in IBS-C patients.¹⁰⁴

Elobixibat represents a promising and highly effective option for the treatment of CC, particularly for patients who have not responded to first-line therapies.

e. Probiotics

A total of 57.1% of roundtable respondents report prescribing probiotics for the management of CC. Probiotics play a potential role in managing CC by increasing SBMs, improving stool consistency, and shortening colonic transit time. Clinical trials and meta-analyses have demonstrated the efficacy of specific strains, such as Lactobacillus casei Shirota, Bifidobacterium lactis, and Lactobacillus reuteri, in alleviating symptoms of constipation.¹⁰⁵ Japanese guidelines emphasize these findings, reporting improved bowel movement frequency and abdominal symptoms,⁹⁶ while Korean guidelines recognize probiotics as a supplementary treatment due to variability in strain efficacy, dosage, and study design.⁸⁵ Meta-analyses also highlight probiotics' ability to reduce incomplete evacuation and gut transit time, with minimal adverse effects compared to placebo. However, caution is advised when administering probiotics to immunocompromised patients, those in intensive care, or individuals with central lines, as rare cases of sepsis have been reported. Although probiotics are a safe adjunct to other treatments, their effects are strain-specific, necessitating further research to identify the optimal strains, dosages, and long-term benefits for consistent and reliable outcomes in CCmanagement.¹⁰⁶

f. Biofeedback therapy

Biofeedback therapy is a non-invasive, highly effective treatment designed to retrain the pelvic floor muscles and improve coordination during defecation. As the first-line treatment for DD, it targets the underlying dysfunction rather than simply managing symptoms.¹⁰⁷ The therapy typically begins with an assessment using anorectal manometry or electromyography to evaluate pelvic floor muscle activity during simulated defecation. During training sessions, patients receive real-time visual or auditory feedback on their pelvic floor muscle activity and are guided to relax the anal sphincter and pelvic floor muscles while gently increasing intra-abdominal pressure. These techniques are reinforced through regular home exercises to ensure consistency and lasting results.

The primary mechanism of action is enhancing the patient’s awareness and voluntary control over pelvic floor muscle function. By facilitating the proper relaxation of the anal sphincter and pelvic floor muscles during defecation, biofeedback therapy promotes effective stool expulsion. Clinical studies report success rates of 70.0-80.0% in improving both constipation symptoms and objective defecatory function. Moreover, the benefits of biofeedback therapy are often sustained long after treatment, offering long-term relief for many patients. In some cases, satisfactory defecation can be achieved following successful therapy without the need for laxatives, highlighting its role as a durable and symptom-resolving intervention.¹⁰⁸ However, availability remains an issue where only 38.1% of respondents reported biofeedback as a commonly available therapeutic option in their region.

g. Expert insights and recommendations

Second-line therapy options for CC in Asia are limited, especially in resource-constrained regions.¹⁰⁹ High costs and availability issues influence the choice of treatment, making an individualized approach critical. Accessibility and cost of medications remain significant barriers in many regions. By tailoring therapy choices to patient needs, local drug availability, and healthcare infrastructure, effective management of CC can be achieved, even in resource-constrained settings.

Gastrointestinal motility tests in refractory chronic constipation

Refractory constipation, though not clearly defined, is often recognized as CC that has shown suboptimal response to lifestyle modifications and pharmacological treatments.¹¹⁰ In these cases, further categorizing patients into DD, STC, and normal transit constipation through various motility studies allows for more personalized treatment approaches. Diagnostic strategies for CC vary significantly between Western and resource-limited regions. In Western countries, advanced diagnostic tools such as HR-ARM and colonic transit studies are incorporated early in the diagnostic pathway, particularly when first-line treatments fail.⁶⁹ These technologies, typically available in specialized centers, ensure precise and timely diagnoses. However, in many regions across Asia, significant barriers to comprehensive diagnostic evaluations exist, particularly in rural and under-resourced areas. A survey of gastroenterologists across multiple centers in Asia revealed that 66.7% of their facilities do not provide colonic transit time tests.¹¹¹ This disparity in access to diagnostic technologies delays effective treatment, leading to prolonged patient suffering and increased healthcare costs over time. The availability of key diagnostic motility tests in selected Asian countries are summarized in Table 4.

Table 4.

Availability of Key Diagnostic Motility Tests in Selected Asian Countries^a

Country	High-resolution anorectal manometry	Balloon expulsion test	Colonic transit study
Japan
South Korea
Singapore
Hong Kong
Thailand	□		□
Malaysia	□	□	□
India
Indonesia	✖	□	✖
Vietnam	□	□	✖

^aBased on roundtable expert survey.

, available in most tertiary centers; □, limited availability (major cities/select centers); ✖, rarely available.

a. Balloon expulsion test

The balloon expulsion test (BET) is a simple, cost-effective physiological assessment used to evaluate rectoanal function during defecation. As a widely available and easy-to-perform screening tool, it helps identify potential defecatory disorders, such as DD or other forms of outlet obstruction.¹¹² The procedure involves inserting a soft latex balloon, attached to a thin catheter, into the rectum, inflating it with a standardized volume of water (typically 50 mL), and instructing the patient to sit on a commode and attempt to expel the balloon within 1-3 minutes. Failure to expel the balloon within this timeframe suggests defecatory dysfunction, such as dyssynergia.¹¹³ However, it is important to note that a normal BET result does not definitively exclude such disorders, as it serves as a screening rather than a diagnostic test.¹¹⁴ A meta-analysis of 2090 individuals reported BET's sensitivity at 70% and specificity at 77%, with an area under the curve of 0.80, underscoring its utility as an initial diagnostic tool.¹¹⁵

In many Asian clinical settings, where access to advanced diagnostic modalities like anorectal manometry is limited, the BET plays a vital role in identifying patients who require further specialized evaluation. Additionally, cultural and behavioral factors unique to Asian populations may influence patient performance during the test, highlighting the need for cultural sensitivity and patient-specific instructions to ensure accurate and effective results.⁸⁵

b. Colonic transit studies

Colonic transit studies are a vital diagnostic tool for evaluating the movement of contents through the colon over time, playing a critical role in diagnosing STC. These studies provide valuable insights into colonic motility, helping clinicians differentiate between normal and pathological transit patterns.¹¹⁶ The most widely used method is the radiopaque marker (ROM) study, where patients ingest capsules containing ROMs, and serial abdominal X-rays are taken over several days (typically 3-7 days) to track the markers’ progression through the colon. Protocols may vary in the number of markers administered and the timing of imaging.¹¹⁷

In addition to ROM studies, the wireless motility capsule, or SmartPill, offers a more advanced approach. It measures pH, pressure, and temperature as the capsule moves through the gastrointestinal tract, providing comprehensive data on gastric emptying, small bowel transit, and colonic motility.¹¹⁸ Scintigraphy, although considered the gold standard for colonic transit assessment due to its detailed and precise measurements, is less frequently used because of its higher complexity and cost. This technique utilizes a radioactive tracer to track the movement of colonic contents.

Clinically, colonic transit studies are indispensable for confirming STC and tailoring treatment plans.¹¹⁹ In contrast, a significant proportion of patients with DD also exhibit delayed colonic transit, which may be reversed following biofeedback therapy.¹²⁰ Additionally, retention of radiopaque markers predominantly in the rectosigmoid region may suggest DD.¹²¹ Findings from colonic transit studies can guide the use of prokinetic agents or, in severe and refractory cases, inform surgical decisions. However, delayed transit time associated with DD or STC that may also occur in conditions such as chronic intestinal pseudo-obstruction, in which colectomy may not provide clinical benefit.¹²²

A total of 38.1% of roundtable respondents reported the routine use of tests assessing colonic transit time, in which radioopaque markers were the most commonly used modality. For Asian populations, potential variations in normal colonic transit times due to differences in race, ethnicity, and dietary habits must be considered.⁴⁸ Adjusting diagnostic thresholds to align with these variations ensures accurate diagnosis and effective management for patients in diverse ethnic groups.

c. High-resolution anorectal manometry

HR-ARM is an essential diagnostic tool for assessing recto-anal coordination, anal sphincter integrity, and sensation. By measuring circumferential luminal pressure from the distal rectum through the entire anal canal, HR-ARM generates a detailed color-plot topography that visualizes anorectal function. During normal defecation, an individual exhibits a synchronized increase in rectal pressure and relaxation of the external anal sphincter to facilitate stool evacuation. In cases of DD, this coordinated movement is impaired, leading to defecatory dysfunction.^123,124

HR-ARM identifies key abnormalities associated with DD. Poor propulsion, characterized by a reduced change in rectal pressure, and positive anal pressure changes (indicating anal contraction during the simulated “push“ maneuver), are manometric markers of recto-anal discoordination. The rectoanal gradient during defecation is the most commonly utilized HR-ARM variable for diagnosing DD.¹¹² When combined with supportive findings of impaired evacuation from the BET or defecography, the diagnosis of DD is confirmed, allowing for targeted therapeutic interventions.¹²⁵

d. Defecography

Defecography is a dynamic imaging technique that offers real-time visualization of the defecation process, providing critical insights into both structural and functional aspects of anorectal and pelvic floor dynamics. This modality plays a key role in evaluating the anorectal angle, pelvic floor movement, and rectal emptying, helping to identify abnormalities that contribute to defecatory dysfunction. Traditional fluoroscopic defecography involves introducing a thick contrast paste, such as barium, into the rectum, with the patient seated on a radiolucent commode.¹²⁶ Fluoroscopic images are then captured during different phases of defecation, including rest, voluntary squeezing, and straining. While fluoroscopy has been the standard for decades, magnetic resonance defecography is increasingly favored due to its superior soft tissue contrast, which provides detailed visualization of pelvic floor muscles and adjacent organs.^127,128

Defecography can reveal a wide range of abnormalities associated with defecatory dysfunction, including DD, excessive pelvic floor descent, paradoxical contraction of pelvic floor muscles, rectocele (an outpouching of the rectal wall into the vaginal canal), intussusception (telescoping of the rectum into itself), and rectal prolapse (protrusion of the rectal mucosa through the anus). These findings are essential for understanding the underlying causes of outlet obstruction or incomplete evacuation.¹²⁹

In addition to its diagnostic value, defecography guides targeted therapeutic interventions. For instance, structural abnormalities such as rectocele or rectal prolapse may require surgical correction, whereas functional issues like DD can benefit from biofeedback therapy. This dual role in diagnosis and treatment planning makes defecography a valuable tool in managing defecatory dysfunction.^129,130 Among roundtable participants, 71.4% reported the routine assessment of pelvic floor dysfunction, with 86.7%, 66.7%, and 53.3% performing ARM, BET, or defecography respectively as part of their evaluation.

e. Expert insights and recommendations

The utility of gastrointestinal motility tests and biofeedback therapy has been well demonstrated in numerous studies for the management of refractory CC. These tests play a crucial role in identifying the underlying pathophysiology, enabling targeted interventions. Ideally, gastrointestinal motility tests should be performed in refractory CC cases, preferably before or after second-line therapy, to guide personalized treatment strategies. However, in many Asian countries, access to these diagnostic tests and trained biofeedback therapists remains a significant challenge. This highlights the pressing need for expanded resources, infrastructure, and training programs to improve the availability of these essential tools and therapies in the region.

Challenges and Future Directions

A key takeaway from the roundtable was the urgent need to standardize diagnostic and management practices for CC. Uniform diagnostic criteria and protocols tailored to regional contexts can improve early detection and enable timely intervention. Standardization not only reduces variability in care but also promotes consistency in treatment approaches and facilitates cross-regional research collaborations.

Healthcare disparities, financial constraints, and policy gaps remain significant barriers to effective CC management in Asia, particularly in low- and middle-income countries.^131,132 Roundtable participants reported the lack of specialized centre (76.2% of respondents), cost of newer treatments (61.9%) and access to diagnostic tools (57.1%) as major challenges faced in managing CC. All respondents indicated a gap in either availability of diagnostic tools or treatment options in their countries. Limited access to gastrointestinal motility studies and advanced therapies disproportionately affects rural and resource-poor regions, delaying diagnosis and restricting access to personalized treatment options.¹³³ This perpetuates unmet medical needs, further highlighting the need for equitable healthcare infrastructure.

Improving access to emerging therapies was another critical focus. While innovative treatments such as prucalopride, linaclotide, lubiprostone, and elobixibat offer significant benefits, their high costs and limited availability pose challenges in resource-constrained settings. Advocacy for subsidized treatments, public-private partnerships, and streamlined regulatory processes are essential to expand the reach of these therapies.

The roundtable also emphasized the importance of culturally sensitive care. Given the diverse cultural and socioeconomic backgrounds across Asia, incorporating culturally appropriate interventions, dietary recommendations, and tailored communication strategies can improve patient engagement and adherence to treatment plans. This personalized approach fosters trust and aligns care with the unique needs of the region's populations.

Addressing unmet needs in CC management will require sustained collaboration among researchers, clinicians, policymakers, and pharmaceutical companies. Researchers should continue exploring innovative solutions such as stratified treatments and combination therapies. Policymakers must focus on creating enabling environments for equitable healthcare delivery, while clinicians should integrate evidence-based practices into daily care while remaining attuned to cultural and individual nuances.

The study “Knowledge, Attitudes, and Practices of Doctors on Constipation Management in Singapore“ reveals gaps in training and misconceptions among physicians.¹³⁴ Only 34% were familiar with Rome IV criteria, and many non-specialists incorrectly viewed lactulose as more effective than PEG. Gastroenterologists showed better knowledge and confidence, while non-specialists had reservations about long-term laxative safety. Improved education and adherence to guidelines are essential to enhance constipation management and patient outcomes.¹³⁴

Increased awareness and education among healthcare providers and patients about treatment options and the importance of early intervention can further alleviate the burden of CC. Developing regional treatment guidelines tailored to the healthcare resources and epidemiological patterns of specific areas can optimize outcomes. By tackling these challenges collectively, the healthcare community can make significant strides in delivering effective, equitable, and evidence-based care for individuals with CC in Asia and beyond, ultimately setting a precedent for addressing other functional gastrointestinal disorders in the region.

In addition, several knowledge gaps in the management of CC were identified, emphasizing the need for further research and innovation:

1. Economic and healthcare disparities: Understanding the impact of economic and healthcare disparities on patients with CC in Asia is critical. This includes assessing how limited access to diagnostic tools and advanced therapies influences patient outcomes in low- and middle-income regions.

2. Cost-effectiveness of treatment strategies: The comparative cost-effectiveness of step-up versus top-down treatment strategies needs to be evaluated. This involves analyzing whether starting with potent novel laxatives upfront is more beneficial and cost-effective for severe CC compared to the traditional approach of initiating therapy with first-line medications.

3. Combination therapies: More research is needed to determine the synergistic effects, efficacy, and safety of combination therapies, particularly those involving second-line laxatives for managing refractory CC.

4. Early motility studies: Investigating the role of early motility studies in stratifying CC into subtypes—slow transit, normal transit, or defecatory disorders—is essential for developing personalized treatment strategies and improving patient outcomes.

5. Novel therapeutic targets: Exploring novel therapeutic targets, such as gut microbiota modulation through probiotics, prebiotics, or microbiota transplantation, holds promise for advancing CC management.

6. Innovative pharmacological agents: Further research into innovative pharmacological agents that target neural pathways and gut-brain interactions could provide groundbreaking treatment options for CC, particularly for patients unresponsive to existing therapies.

Addressing these gaps through robust research, collaborative efforts, and investment in innovation will contribute to a deeper understanding of CC and enable the development of more effective, personalized, and accessible management strategies. Key challenges in the management of CC in Asia setting is summarized in Figure 1.

Conclusion

While CC pose a significant health burden worldwide, the application of standardized international guidelines may not be suitable for Asia due to the region's unique socioeconomic, cultural, and genetic diversity. This roundtable meeting has highlighted the challenges, gaps, and specific needs in the diagnosis, investigation, and management of CC in Asia. By addressing these issues, the report aims to provide clinicians with tailored guidance, ensuring that treatment strategies are better aligned with the regional context and ultimately improving patient care across the continent.

Supplementary Materials

Note: To access the supplementary data and table mentioned in this article, visit the online version of Journal of Neurogastroenterology and Motility at http://www.jnmjournal.org/, and at http://doi.org/10.5056/jnm25076.