Treatment Algorithm for Chronic Idiopathic Constipation and Constipation-Predominant Irritable Bowel Syndrome Derived from a Canadian National Survey and Needs Assessment on Choices of Therapeutic Agents

Abstract

Background. Chronic idiopathic constipation (CIC) and constipation-predominant irritable bowel syndrome (IBS-C) are common functional lower gastrointestinal disorders that impair patients' quality of life. In a national survey, we aimed to evaluate (1) Canadian physician practice patterns in the utilization of therapeutic agents listed in the new ACG and AGA guidelines; (2) physicians satisfaction with these agents for their CIC and IBS-C patients; and (3) the usefulness of these new guidelines in their clinical practice. Methods. A 9-item questionnaire was sent to 350 Canadian specialists to evaluate their clinical practice for the management of CIC and IBS-C. Results. The response rate to the survey was 16% (n = 55). Almost all (96%) respondents followed a standard, stepwise approach for management while they believed that only 24% of referring physicians followed the same approach. Respondents found guanylyl cyclase C (GCC) agonist most satisfying when treating their patients. Among the 69% of respondents who were aware of published guidelines, only 50% found them helpful in prioritizing treatment choices and 69% of respondents indicated that a treatment algorithm, applicable to Canadian practice, would be valuable. Conclusion. Based on this needs assessment, a treatment algorithm was developed to provide clinical guidance in the management of IBS-C and CIC in Canada.

Cystic Fibrosis & disorders of the large intestine: DIOS, constipation, and colorectal cancer

“…For constipation, gradual step-up therapy (typically using non-stimulant stool softeners, fiber, or polyethylene glycol (PEG)-based solutions first) have been used safely and effectively for short-and long-term use in patients with CF. [20] To a certain extent, a similar approach to diagnostic evaluation (when necessary) and gradual therapeutic escalation used in non-CF patients may be utilized by the clinician based on anecdotal experience [21,22]; consideration for specialty consultation with a gastroenterologist familiar with CF may be indicated when response to initial conservative treatment has not yielded timely resolution of symptoms.…”

Polyphenol‐rich Mango (Mangifera indica L.) Ameliorate Functional Constipation Symptoms in Humans beyond Equivalent Amount of Fiber

“…Recent studies show that fiber supplements are among the first‐line of choice in treating chronic idiopathic constipation (CIC) and constipation‐predominant irritable bowel syndrome (IBS‐C), where most subjects reported considering fiber supplements as a satisfying treatment for their symptoms. Dietary guidelines from the Office of Disease Prevention and Health Promotion recommend 22–37 g of fiber per day.…”

Consensus statements on diagnosis and management of chronic idiopathic constipation in adults in Hong Kong

“…Patients with alarming features, such as anaemia, recent onset of symptoms after 50 years of their absence, rectal bleeding, significant weight loss, abnormal physical examination, and family history of colon cancer should also be referred for further assessment. [4][5][6] Psychiatric comorbidities are not uncommon in patients with chronic constipation, and any feature of significant psychiatric co-morbidities should prompt referral to a psychiatrist. 7…”

“…19 In general, PEG is also better tolerated (less likely to cause bloating and gas) than lactulose, which may result in better compliance by patients. 6 Given the favourable efficacy and safety profile, long-term use of PEG is acceptable as a first-line treatment for CIC. 8 The use of phosphate solution is strongly discouraged because of the high potential for serious complications, including phosphate nephropathy and electrolyte imbalances, especially in elderly people.…”

“…Treatment failure can be considered after 2 months (alongside non-pharmacological measures) before proceeding to second-line therapy. 6 This period is also dependent on patient preference.…”