Treating Chronic Constipation: How Should We Interpret the Recommendations?

David A. Johnson

Disclosures

Clin Drug Invest. 2006;26(10):547-557. 

In This Article

Editor's Note

Please note: The following announcement supersedes any information contained in this article. On March 30, 2007, Novartis, in compliance with an FDA request, suspended marketing and sales of its irritable bowel/constipation drug tegaserod maleate (Zelnorm) after an analysis of its clinical database pointed to a higher incidence of myocardial infarction, stroke, and unstable angina among patients taking the drug. For updated information on this issue, see the Medscape Alert Center on tegaserod.

 

Abstract and Introduction

Abstract

Chronic constipation is a multisymptom gastrointestinal motility disorder that negatively impacts the lives of those affected. New recommendations on diagnosing and treating this condition have recently been published. This review aims to assist clinicians in applying these recommendations in clinical practice. Although lifestyle interventions and bulking agents help some patients with constipation, data are lacking to support their efficacy in those with chronic constipation. If empirical treatment of patients with chronic constipation fails, osmotic laxatives (e.g. lactulose and polyethylene glycol), a serotonin (5-HT4) receptor agonist (e.g. tegaserod) or a chloride channel activator (e.g. lubiprostone) can be considered. Osmotic laxatives, though effective at increasing stool frequency, are often associated with adverse effects such as bloating and diarrhoea and typically do not effectively relieve the multiple symptoms of chronic constipation. Use of tegaserod and the recently approved lubiprostone is supported by high-quality evidence, and these agents have acceptable safety profiles in patients with chronic constipation.

Recent advances in the definition of chronic constipation and in its pharmacological management have led to refinements in identifying the appropriate treatment needs of patients with this condition. It is hoped that these advancements will help clinicians select effective medical regimens for patients with chronic constipation.

Abstract and Introduction

Abstract

Chronic constipation is a multisymptom gastrointestinal motility disorder that negatively impacts the lives of those affected. New recommendations on diagnosing and treating this condition have recently been published. This review aims to assist clinicians in applying these recommendations in clinical practice. Although lifestyle interventions and bulking agents help some patients with constipation, data are lacking to support their efficacy in those with chronic constipation. If empirical treatment of patients with chronic constipation fails, osmotic laxatives (e.g. lactulose and polyethylene glycol), a serotonin (5-HT4) receptor agonist (e.g. tegaserod) or a chloride channel activator (e.g. lubiprostone) can be considered. Osmotic laxatives, though effective at increasing stool frequency, are often associated with adverse effects such as bloating and diarrhoea and typically do not effectively relieve the multiple symptoms of chronic constipation. Use of tegaserod and the recently approved lubiprostone is supported by high-quality evidence, and these agents have acceptable safety profiles in patients with chronic constipation.

Recent advances in the definition of chronic constipation and in its pharmacological management have led to refinements in identifying the appropriate treatment needs of patients with this condition. It is hoped that these advancements will help clinicians select effective medical regimens for patients with chronic constipation.

Introduction

Medicine is an ever-changing field that has dramatically evolved over the past several decades, in part because of advances in technology. These advances affect our understanding of the pathophysiology, the diagnostic strategies and the quality and effectiveness of medications. In addition, they directly affect clinical care and the practice of medicine. Formats for disclosure of these advances include clinical guidelines, medical position statements, technical reviews and systematic reviews. When clinicians review these reports, however, their relationship to practice is often unclear.

One of the major challenges in treating patients with chronic constipation is identifying and recognising it as a 'real' medical condition that warrants treatment. Patients who seek care for chronic constipation have clinically significant impairment in daily function and quality of life.[1,2] As such, appropriate therapy of the condition should be based on solid evidence of efficacy.

Recently, the American College of Gastroenterology (ACG) Chronic Constipation Task Force addressed a number of issues related to chronic constipation in its published medical position statement and systematic review, An Evidence-Based Approach to the Management of Chronic Constipation in North America.[3,4] Other groups have also published medical position statements and technical reviews on the treatment of constipation (not specifically chronic constipation).[5,6,7] Although the intention may be to assist clinicians in decision making, many of those same clinicians are often left wondering: What is the difference between a clinical guideline and a position statement? What is the relevance of a technical or a systematic review? How is each of these reports prepared? How do we apply this information in clinical practice?

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....