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To evaluate the efficacy of these treatments, it is imperative to have a consistent definition of pharmacologically refractory constipation. A systematic review of studies on refractory, difficult\u2010to\u2010treat or surgically treated constipation was carried out to determine the criteria that various authors used to define this group of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was performed for literature published from June 2005 to June 2015 using PubMed, Cochrane, and Scopus databases, as well as manual searches. Studies on patients with refractory or intractable constipation were extracted. Criteria used for defining refractory constipation, as well as pharmacological agents tried including dosage, frequency, and duration, were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010one studies were included in this review. Forty\u2010eight involved surgical treatment of constipation, while 13 examined non\u2010surgical therapies for refractory constipation. There is no generally accepted definition of refractory constipation. Authors consider constipation to be refractory when response to management is suboptimal, but there is no consensus on the choice of drug, order of usage, and dosage or treatment duration. Prior medical therapy was not mentioned at all in five studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is need for a detailed definition of pharmacologically refractory constipation before submitting patients to invasive treatments and to evaluate new pharmacological agents.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.13998","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T15:38:27Z","timestamp":1506613107000},"page":"564-575","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Searching for a definition for pharmacologically refractory constipation: A systematic review"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1981-1941","authenticated-orcid":false,"given":"Alex Yu Sen","family":"Soh","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology National University 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