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The scientific review indicates that some cases of chronic constipation, especially slow transit and treatment-resistant types, may be linked to disruptions in the interaction between gut microbes, the intestinal barrier, the immune system, and the enteric nervous system, known as the "second brain." The evidence remains inconclusive regarding the initial cause of this imbalance or how to correct it. However, the proposed model suggests that microbiome changes, weakening of the intestinal barrier, disturbances in immune and nerve communication, and deterioration of interstitial cells of Cajal may contribute to the development of the condition. Conventional treatment with dietary guidance and medications may not be effective in resistant cases, and developing targeted therapies based on a deeper understanding of these relationships requires further research.
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