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Efficacy and safety of traditional medical therapies for chronic constipation: systematic review.

Abstract

OBJECTIVES

Constipation is common, and its treatment is unsatisfactory. Although many agents have been tried, there are limited data to support their use. Our aim was to undertake a systematic review of the efficacy and safety of traditional medical therapies for chronic constipation and to make evidence-based recommendations.

METHODS

We searched the English literature for drug trials evaluating treatment of constipation by using MEDLINE and PUBMED databases from 1966 to 2003. Only studies that were randomized, conducted on adult subjects, and published as full manuscripts were included. Studies were assigned a quality score based on published methodology. Standard forms were used to abstract data regarding study design, duration, outcome measures, and adverse events. By using the cumulative evidence of published data for each agent, recommendations were made regarding their use following the United States Preventive Services Task Force guidelines.

RESULTS

Good evidence (Grade A) was found to support the use of polyethylene glycol (PEG) and tegaserod. Moderate evidence (Grade B) was found to support the use of psyllium, and lactulose. There was a paucity of quality data regarding many commonly used agents including milk of magnesia, senna, bisacodyl, and stool softeners.

CONCLUSIONS

There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.

    Source

    MeSH

    Adult
    Aged
    Cathartics
    Chronic Disease
    Constipation
    Evidence-Based Medicine
    Humans
    Middle Aged
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    15784043

    Citation

    Ramkumar, Davendra, and Satish S C. Rao. "Efficacy and Safety of Traditional Medical Therapies for Chronic Constipation: Systematic Review." The American Journal of Gastroenterology, vol. 100, no. 4, 2005, pp. 936-71.
    Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100(4):936-71.
    Ramkumar, D., & Rao, S. S. (2005). Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. The American Journal of Gastroenterology, 100(4), pp. 936-71.
    Ramkumar D, Rao SS. Efficacy and Safety of Traditional Medical Therapies for Chronic Constipation: Systematic Review. Am J Gastroenterol. 2005;100(4):936-71. PubMed PMID: 15784043.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. AU - Ramkumar,Davendra, AU - Rao,Satish S C, PY - 2005/3/24/pubmed PY - 2005/4/30/medline PY - 2005/3/24/entrez SP - 936 EP - 71 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 100 IS - 4 N2 - OBJECTIVES: Constipation is common, and its treatment is unsatisfactory. Although many agents have been tried, there are limited data to support their use. Our aim was to undertake a systematic review of the efficacy and safety of traditional medical therapies for chronic constipation and to make evidence-based recommendations. METHODS: We searched the English literature for drug trials evaluating treatment of constipation by using MEDLINE and PUBMED databases from 1966 to 2003. Only studies that were randomized, conducted on adult subjects, and published as full manuscripts were included. Studies were assigned a quality score based on published methodology. Standard forms were used to abstract data regarding study design, duration, outcome measures, and adverse events. By using the cumulative evidence of published data for each agent, recommendations were made regarding their use following the United States Preventive Services Task Force guidelines. RESULTS: Good evidence (Grade A) was found to support the use of polyethylene glycol (PEG) and tegaserod. Moderate evidence (Grade B) was found to support the use of psyllium, and lactulose. There was a paucity of quality data regarding many commonly used agents including milk of magnesia, senna, bisacodyl, and stool softeners. CONCLUSIONS: There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/15784043/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=15784043 DB - PRIME DP - Unbound Medicine ER -