Predicting Treatment Outcomes in Refractory Constipation Through Brain Connectivity Evaluation

Inclusion Criteria:

• 18≤ age ≤ 45 years old

• Right-handed

• Patients diagnosed as functional constipation according to the Rome IV criteria

• Informed consent of patients

Exclusion Criteria:

• Complicated with gastrointestinal organic disease or significant functionalabnormalities (tuberculosis, polyps, Crohn's disease, tumors, congenital megacolon,pelvic floor muscle relaxation, abnormal colonic transit test, etc.)

• Long-term intense exercise (continuous exercise for more than 8 hours per week, suchas marathon runners or triathletes)

• No history of chronic pain, no recent major trauma

• Drug abuse or tobacco dependence (half a pack or more per day)

• Combined hypothyroidism and Parkinson's disease

• Patients with confirmed mental illness or neurological disorders who takepsychotropic drugs, analgesics or hormones

• History of abdominal surgery (appendectomy, hysterectomy, or cholecystectomy)

• Contraindications to functional magnetic resonance imaging (claustrophobia, metalimplants)

• Pregnant or lactating women with constipation after delivery

• Patients with other benign and malignant tumors and autoimmune diseases

• Infectious diseases such as hepatitis B, hepatitis C, AIDS, etc.

• Heart disease, organ failure and other chronic diseases that require long-termmedication or affect the quality of life