+AA
Fr
McMasterLogo_New-2017-300x165
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Some medications improve chronic constipation

Nelson AD, Camilleri M, Chirapongsathorn S, et al. Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis. Gut. 2016 Jun 10. [Epub ahead of print}

Review question

Do medications work for treating chronic (long-term) constipation?

Background

Chronic constipation is infrequent bowel movements (often 2 or fewer movements/week) or difficult bowel movements, for several weeks or longer. Symptoms may include straining, hard and/or lumpy stools, inability to empty the bowel without manual maneuvers, and feelings of not completely emptying the bowel.

How the review was done

The review included 19 studies (randomized controlled trials) that were published up to May 2015.

The studies included 9,189 people with chronic constipation. People were, on average, 42 to 76 years of age.

People in the studies had chronic constipation with no known cause.

The studies compared prucalopride, linaclotide, tegaserod, lubiprostone, velusetrag, elobixibat, bisacodyl, or sodium picosulphate with placebo or other treatments.

The 2 most important outcomes were having at least 3 complete spontaneous bowel movements per week and having 1 more complete spontaneous bowel movement per week than before treatment. The  outcomes were assessed after 1 to 6 months of medication use.

Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.

What the researchers found

Compared with placebo:

  • velusetrag, bisacodyl, sodium picosulphate, prucalopride, or elobixibat improved at least one of the outcomes; and
  • neither of the outcomes was improved by linaclotide or tegaserod.

Velusetrag increased the likelihood of having at least 1 more complete bowel movement per week than before treatment compared with prucalopride and tegaserod.

None of the other medications was better than another at improving either outcome.

Conclusion

In people with chronic constipation, velusetrag, bisacodyl, sodium picosulphate, and prucalopride improve constipation more than placebo.

Medications for the treatment of chronic constipation

Comparisons

Effect of medication

Velusetrag vs placebo

More people had at least 3 bowel movements per week than with placebo (relative benefit increase of 386%; could be as low as 58% or as high as 1400%)

Velusetrag increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo (relative benefit increase of 210%; could be as low as 61% or as high as 495%)

Bisacodyl vs placebo

 

More people had at least 3 bowel movements per week than with placebo (relative benefit increase of 146%; could be as low as 14% or as high as 431%)

Bisacodyl increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo (relative benefit increase of 104%; could be as low as 30% or as high as 219%)

Sodium picosulphate vs placebo

More people had at least 3 bowel movements per week than with placebo (relative benefit increase of 183%; could be as low as 27% or as high as 531%)

Sodium picosulphate increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo (relative benefit increase of 103%; could be as low as 27% or as high as 223%)

Prucalopride vs placebo

More people had at least 3 bowel movements per week than with placebo (relative benefit increase of 84%; could be as low as 40% or as high as 143%)

Prucalopride increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo (relative benefit increase of 54%; could be as low as 30% or as high as 83%)

Linaclotide vs placebo

Linaclotide did not affect the likelihood of having at least 3 bowel movements per week compared with placebo

Elobixibat vs placebo

The effect of elobixibat on the likelihood of having at least 3 bowel movements per week was not assessed

Elobixibat increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo (relative benefit increase of 97%; could be as low as 9% or as high as 255%)

Tegaserod vs placebo

Tegaserod did not affect the likelihood of having at least 3 bowel movements per week compared with placebo.

Tegaserod did not affect the likelihood of having at least 1 more bowel movement per week than before treatment compared with placebo.

Velusetrag vs prucalopride

Velusetrag did not affect the likelihood of having at least 3 bowel movements per week compared with prucalopride.

Velusetrag increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with prucalopride (relative benefit increase of 101%; could be as low as 2% or as high as 293%).

Velusetrag vs tegaserod

Velusetrag did not affect the likelihood of having at least 3 bowel movements per week compared with prucalopride.

Velusetrag increased the likelihood of having at least 1 more bowel movement per week than before treatment compared with prucalopride (relative benefit increase of 133%; could be as low as 13% or as high as 380%).

*Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.



Related Topics


Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.

Related Web Resources

  • Heartburn and GERD

    Informed Health Online
    Regular acid reflux may mean you have gastro-esophageal reflux disease, also known as GERD. Treatment for GERD includes lifestyle changes, medication or surgery.
  • Ulcerative colitis: Should I have surgery?

    OHRI
    This patient decision aid helps people who have ulcerative colitis and are considering surgery to remove the colon to decide on whether to have surgery or to keep taking medicine by comparing the benefits, risks and side effects of both options.
  • Treatment options for GERD

    Informed Health Online
    Symptoms of GERD are heartburn and regurgitation. To treat symptoms, try changing your diet and avoid eating in the evening. Medications and surgery can help, but increase the risk of side effects or serious complications.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use