Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
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02631788
Submitted on:
May 20, 2026, 06:54
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Reader Comments:
his review article provides an insightful and clinically important discussion on the functional disorders associated with chronic constipation. The authors successfully combine evidence from the literature with their extensive personal experience, making the manuscript both academically informative and practically relevant.The concept of the “iceberg model” is particularly noteworthy, as it clearly illustrates how underlying functional abnormalities may remain undetected in patients presenting with apparent structural pathology. The emphasis on comprehensive functional evaluation prior to surgical intervention is highly valuable and reflects current multidisciplinary approaches in colorectal practice.The manuscript also effectively highlights the role of anorectal physiology, pelvic floor dysfunction, and psychological factors in the pathogenesis of chronic constipation. The review will be useful for gastroenterologists, colorectal surgeons, pelvic floor specialists, and trainees involved in managing complex constipation disorders.
Overall, this is a well-written and educational review that contributes meaningfully to the understanding of chronic constipation and its functional components.
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03769692
Submitted on:
May 19, 2026, 15:35
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Reader Comments:
This review focuses on functional factors that are often overlooked in chronic constipation, particularly issues underlying OD, such as anxiety and depression, pelvic floor dyssynergia, rectal hyposensitivity, slow-transit constipation, and pudendal neuropathy. It therefore has considerable clinical practical value. The article emphasizes that, before deciding on surgery, organic causes should be thoroughly excluded and hidden functional disorders should be identified through functional assessment. This is important for reducing unnecessary surgery and avoiding postoperative symptom worsening or treatment failure. The model proposed by the authors vividly illustrates the relationship between superficial lesions and deeper functional disorders in patients with OD, helping readers understand why some patients have poor outcomes after surgery.
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02896773
Submitted on:
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Reader Comments:
The review by Pescatori et al provides a valuable and practical overview of functional disorders associated with chronic constipation and obstructed defecation. The “iceberg” concept is particularly interesting in highlighting the frequently overlooked functional and psychological components that may contribute to poor surgical outcomes. The emphasis on careful patient selection and multidisciplinary management is highly relevant in current practice.
An interesting aspect of this review is the inclusion of the authors’ personal clinical experience, which adds practical insight to the discussion. However, in sections where specific therapeutic approaches and institutional experiences are mentioned, it would be worthwhile to directly cite the authors’ previously published studies more consistently, allowing interested readers to further explore the original data and clinical outcomes in greater detail.
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05400979
Submitted on:
May 18, 2026, 11:01
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Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
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11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
Language Quality:
Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
The mini-review by Mario Pescatori and colleagues offers a clinically relevant, experience-based overview of functional disorders associated with chronic constipation and obstructed defecation. The “iceberg model” presented by the authors is particularly valuable because it highlights the often-overlooked functional and psychological contributors to obstructed defecation. The article also effectively emphasizes the risks of inappropriate surgical intervention in patients with predominantly functional pathology and reinforces the importance of multidisciplinary management.
The discussion of anxiety-depression, anismus, rectal hyposensitivity, and pudendal neuropathy is concise yet clinically meaningful. Including institutional experience alongside the literature review strengthens the article’s practical relevance. The proposed treatment strategies, particularly psycho-echo-biofeedback and selective puborectalis myotomy, provide useful insight into individualized management approaches.
A few additional points could further strengthen the manuscript. Incorporating recent guideline-based recommendations from international colorectal and gastroenterology societies would reinforce the evidence-based framework of the review. A brief discussion of standardized diagnostic algorithms for pelvic floor dyssynergia, including the role of high-resolution anorectal manometry, may also improve completeness. In addition, a summary table outlining functional disorders, diagnostic modalities, and preferred management strategies would enhance readability for practicing clinicians and trainees.
Overall, this article makes an important contribution to the understanding of functional constipation and obstructed defecation. It appropriately cautions against excessive reliance on surgery and underscores the need for careful functional evaluation before operative intervention.