Guidelines developed for treating chronic idiopathic constipation

In a clinical practice guideline issued by the American Gastroenterological Association and the American College of Gastroenterology, and published online May 19 in the American Journal of Gastroenterology and Gastroenterology, recommendations are presented for the pharmacologic treatment of chronic idiopathic constipation (CIC) in adults.

Lin Chang, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues conducted systematic reviews relating to use of fiber, osmotic laxatives, stimulant laxatives, secretagogues, and serotonin type 4 agonists to provide evidence-based practice recommendations for treatment of CIC in adults.

The multidisciplinary guideline panel agreed on 10 recommendations for pharmacological management of CIC. These included strong recommendations for use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride, based on moderate certainty of evidence. Conditional recommendations, based on low or very low certainty of evidence, were made for fiber supplementation, lactulose, senna, magnesium oxide, and lubiprostone.

"The guidelines are meant to provide a framework for approaching the management of CIC," the authors write. "Clinical providers should engage in shared decision-making based on patient preferences as well as medication cost and availability."

Several authors disclosed ties to the pharmaceutical, medical device, and other industries. Several authors hold patents, including for a rectal expulsion device.

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