Systematic Review on the Management of Chronic Constipation in North America

Abstract

Chronic constipation (CC) is characterized by unsatisfactory defecation that results from infrequent stools, difficult stool passage, or both. The pathophysiology of CC is multifactorial and may include dysfunction of intestinal motility, visceral sensitivity, ano-rectal musculature and the enteric nervous system. Because CC is common, this monograph has been developed to educate physicians about its epidemiology, diagnostic approach, and treatment. In order to assess published data about the management of CC, systematic reviews were performed. Standard criteria for systematic reviews were met, including comprehensive literature searching, use of pre-specified study selection criteria, and use of a standardized and transparent process to extract and analyze data from studies (Section 2.1). A North American perspective was chosen: only epidemiologic studies from North American populations were used and only treatments available in the United States were examined. After analysis of the systematic reviews, Task Force members produced evidence-based recommendations (Section 2.2). Recommendations were graded using a formalized system (Table 1.1) that quantifies the strength of evidence. Recommendations in this monograph may be cross-referenced with the supporting evidence in the following article: "Systematic Review on the Management of Chronic Constipation in North America." The format of this evidence-based position monograph and systematic review has been adapted from the previous evidence-based monograph produced by the American College of Gastroenterology's Functional GI Disorders Task Force (1). S1 S2

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

“…If constipation is not adequately managed, then the other laxatives like osmotic/stimulant can be added. 8,34 In our study, laxative was the most common concomitant medication used in both constipation subtypes (FC: 36.6%; IBS-C: 50.9%). Of these laxatives, osmotic and bulk laxatives were the most common laxatives used by patients of both constipation subtypes.…”

A Comparison of Standard Anorectal Manometry and High Resolution Manometry Patterns in Dyssynergic Patients

“…The prevalence of Dyssynergic defecation (DD) in patients with chronic constipation approaches 50% [1][2][3] . Thus far, most referral centers had been using the Konigsberg standard solid-state anorectal manometry (SARM) catheter for anorectal motility testing.…”

Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation

“…Recent systematic reviews have concluded that there is good evidence to support the use of psyllium but not other OTC laxatives or fibre supplements. 8,9 Compared with placebo, psyllium appears to increase stool frequency in some but not all of the studies. 8,9 A large study that compared psyllium with placebo showed significant improvement in both stool frequency and stool consistency; and both the investigator and patients noted significant improvement in constipation.…”

“…8,9 Compared with placebo, psyllium appears to increase stool frequency in some but not all of the studies. 8,9 A large study that compared psyllium with placebo showed significant improvement in both stool frequency and stool consistency; and both the investigator and patients noted significant improvement in constipation. 10 However, patients often find fibre supplements inconvenient, particularly during travel, and many dislike liquid preparations.…”