Medical Therapy of Constipation: Current Standards and Beyond

Andresen, Viola; Layer, Peter

doi:10.1159/000488695

Cited by 20 publications

(19 citation statements)

References 39 publications

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“…A stepwise approach is recommended in the treatment of chronic constipation [32]. The diagnostic and therapeutic approach to patients with constipation begins with a detailed history and physical examination.…”

Section: Discussionmentioning

confidence: 99%

Chronic Constipation: Gastroenterohepatologist’s Approach

Milosavljević

Popović

Mijač

et al. 2021

Dig Dis

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Background: Constipation is a common problem in gastroenterological practice. The prevalence of constipation is about 16%. Constipation can be primary or secondary. Summary: The diagnostic and therapeutic approach to patients with constipation begins with a detailed history and physical examination. In selected cases, the use of additional diagnostic procedures is very important. This includes the use of laboratory, endoscopic, and radiological examinations, as well as advanced physiological testing (anorectal manometry, balloon expulsion test, colonic transit studies, and defecography). Constipation therapy can be both nonoperative and operative. Nonoperative therapy includes the application of a lifestyle measures, pharmacotherapy and biofeedback therapy. Key Messages: Two key things when taking a medical history and physical examination are to rule out the existence of alarm symptoms/signs and to rule out secondary constipation (primarily drug-induced). Therapy begins with lifestyle modification, and in case of failure, bulk or osmotic laxatives are used. In case of failure, the use of lubiprostone is indicated, as well as linaclotide. Surgical treatment of constipation is reserved for cases of refractory constipation, with delayed intestinal transit.

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Section: Discussionmentioning

confidence: 99%

Chronic Constipation: Gastroenterohepatologist’s Approach

Milosavljević

Popović

Mijač

et al. 2021

Dig Dis

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“…A wide range of pharmacological treatments is currently available, including commonly used laxative compounds (e.g., bulk-forming and osmotic laxatives, stimulants, stool softeners, and lubricants) and relatively new agents (e.g., chloride channel activators, guanylate cyclase C receptor agonists, selective serotonin 5-HT 4 receptor agonists, and ileal bile acid transporter inhibitors). 125,126 This heterogeneous group of drugs differs substantially in their pharmacological characteristics and mechanisms of action (Table 4). Recent recommendations from the American College of Gastroenterology Evidence-Based Monograph and a practice guideline from the American Gastroenterological Association suggest the use of bulk-forming and osmotic agents (e.g., psyllium and polyethylene glycol) first, supplemented by stimulant laxatives as needed (as "rescue" agents), before considering the use of newer agents with more physiological mechanisms of action.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Constipation in CKD

Sumida

Yamagata

Kövesdy

2020

Kidney International Reports

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Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for constipation, some of which showing unique renoprotective properties, the adequate management of constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.

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“…Linaclotide is a peptide agonist of the guanylate cyclase-C receptor involved in the intracellular conversion of guanosine 5-triphosphate to cyclic guanosine monophosphate [54]. Linaclotide has been shown to be an effective and well-tolerated agent for the treatment of chronic constipation [55][56][57][58]. Lubiprostone is a specific activator of the type 2 chloride channels at the intestinal epithelium whose activity increases the liquidity of contents [59].…”

Section: Additional Agents and Mechanisms To Oic Controlmentioning

confidence: 99%

Opioid-Induced Constipation in Oncological Patients: New Strategies of Management

Mesı́a

Echaburu

Gómez

et al. 2019

Curr. Treat. Options in Oncol.

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Opinion statementCancer-associated pain has traditionally been treated with opioid analgesics, often in escalating doses. Opioid-induced constipation (OIC) is a common problem associated with chronic use of opioid analgesics. Typical treatment strategies to alleviate constipation are based on dietary changes, exercise, and laxatives. However, laxatives have a nonspecific action and do not target underlying mechanisms of OIC. This article will review prevalent, clinical presentation and recommendations for the treatment of OIC. An independent literature search was carried out by the authors. We reviewed the literature for randomized controlled trials that studied the efficacy of laxatives, naloxone, and naloxegol in treating OIC. Newer strategies addressing the causal pathophysiology of OIC are needed for a more effective assessment and management of OIC. Finally, traditional recommended therapies are appraised and compared with the latest pharmacological developments. Future research should address whether naloxegol is more efficacious by its comparison directly with first-line treatments, including laxatives.

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Medical Therapy of Constipation: Current Standards and Beyond

Cited by 20 publications

References 39 publications

Chronic Constipation: Gastroenterohepatologist’s Approach

Chronic Constipation: Gastroenterohepatologist’s Approach

Constipation in CKD

Opioid-Induced Constipation in Oncological Patients: New Strategies of Management

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