Diagnosis and treatment of chronic constipation – a European perspective

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Abstract

Background

Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.

Purpose

We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.

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Most cited references 94

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Chronic constipation: a survey of the patient perspective.

J Johanson, J Kralstein (2007)

Constipation is a common, often chronic, gastrointestinal motility disorder characterized by such symptoms as straining, hard stool, and infrequent defecation. Published literature is limited regarding symptom prevalence, healthcare-seeking behaviour, and patient satisfaction with traditional therapies for chronic constipation. To assess the prevalence of chronic constipation among a random sample of Americans, to identify the frequency, severity and bothersomeness of their symptoms, and to assess satisfaction levels with traditional treatments. All members (N = 37,004) of the Knowledge Networks Panel, representative of the US population, participated in a web-based survey. Eligibility was established using a six-question screener. Of the 24,090 panellists consenting to participate, 557 met eligibility requirements and took the 45-question survey. The most prevalent symptom was straining (79%). Hard stool and straining were the top two severe symptoms, and bloating, straining and hard stool were the top three bothersome symptoms. Symptoms affected quality of life of more than half (52%) the respondents. Among those who worked or went to school, 12% experienced reduced productivity and a mean of 2.4 days of absence in the month before the survey. Most respondents had used (96%) or were using (72%) constipation relief therapy; however, nearly half (47%) were not completely satisfied, mainly because of efficacy (82%) and safety (16%) concerns. Chronic constipation is common. Individual symptoms are often severe and bothersome, and many patients are dissatisfied with traditional treatment options, primarily because of lack of efficacy.

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Systematic review: impact of constipation on quality of life in adults and children.

M Geraint, D Candy, J Belsey … (2010)

Comparison of quality of life (QoL) across disease areas requires the use of appropriate tools. Although many studies have investigated QoL in constipation, most used disease-specific tools that are inappropriate for cross-comparisons. To identify studies of QoL in constipation and to compare these results with other chronic conditions. A comprehensive literature search identified studies in constipation that used a generic QoL tool. Results were statistically pooled where possible and compared with published results using the same tools in other chronic conditions. A total of 13 qualifying studies were identified, 10 in adults and three in children. Results from eight studies using the SF-36/12 tools were pooled; the remaining five were narratively reported. Mental and physical components of QoL scores were consistently impaired in both adult and child populations, with the greatest impact being seen in secondary care studies. Mental health effects predominated over physical domains. The magnitude of impact was comparable with that seen in patients with allergies, musculoskeletal conditions and inflammatory bowel disease. The impact of constipation on QoL is significant and comparable with other common chronic conditions. Improving management may prove to be an effective way of improving QoL for a substantial number of patients.

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A placebo-controlled trial of prucalopride for severe chronic constipation.

Lieve Vandeplassche, An Rykx, Rene Kerstens … (2008)

In this 12-week trial, we aimed to determine the efficacy of prucalopride, a selective, high-affinity 5-hydroxytryptamine4 receptor agonist, in patients with severe chronic constipation. In our multicenter, randomized, placebo-controlled, parallel-group, phase 3 trial, patients with severe chronic constipation (< or =2 spontaneous, complete bowel movements per week) received placebo or 2 or 4 mg of prucalopride, once daily, for 12 weeks. The primary efficacy end point was the proportion of patients having three or more spontaneous, complete bowel movements per week, averaged over 12 weeks. Secondary efficacy end points were derived from daily diaries and validated questionnaires completed by patients. Adverse events, clinical laboratory values, and cardiovascular effects were monitored. Efficacy was analyzed in 620 patients. The proportion of patients with three or more spontaneous, complete bowel movements per week was 30.9% of those receiving 2 mg of prucalopride and 28.4% of those receiving 4 mg of prucalopride, as compared with 12.0% in the placebo group (P<0.001 for both comparisons). Over 12 weeks, 47.3% of patients receiving 2 mg of prucalopride and 46.6% of those receiving 4 mg of prucalopride had an increase in the number of spontaneous, complete bowel movements of one or more per week, on average, as compared with 25.8% in the placebo group (P<0.001 for both comparisons). All other secondary efficacy end points, including patients' satisfaction with their bowel function and treatment and their perception of the severity of their constipation symptoms, were significantly improved with the use of 2 or 4 mg of prucalopride as compared with placebo, at week 12. The most frequent treatment-related adverse events were headache and abdominal pain. There were no significant cardiovascular effects of treatment. Over 12 weeks, prucalopride significantly improved bowel function and reduced the severity of symptoms in patients with severe chronic constipation. Larger and longer trials are required to further assess the risks and benefits of the use of prucalopride for chronic constipation. (ClinicalTrials.gov number, NCT00483886 [ClinicalTrials.gov].). Copyright 2008 Massachusetts Medical Society.

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Author and article information

Journal

Journal ID (nlm-ta): Neurogastroenterol Motil

Journal ID (publisher-id): nmo

Title: Neurogastroenterology and Motility

Publisher: Blackwell Publishing Ltd

ISSN (Print): 1350-1925

ISSN (Electronic): 1365-2982

Publication date (Print): August 2011

Publication date (Electronic): 16 March 2011

Volume: 23

Issue: 8

Pages: 697-710

Affiliations

[* ]simpleDivision of Gastroenterology, University Hospital Leuven Leuven, Belgium

[† ]simpleDepartment of Internal Medicine Park-Klinik Weissensee, Berlin, Germany

[‡ ]simpleDepartment of Clinical Medicine, University of Bologna Bologna, Italy

[§ ]simpleDepartments of Medicine and Gastroenterology, St Vincent's Hospital Melbourne, Australia and simpleImperial College London, UK

[¶ ]simpleDepartment of Internal Medicine, Sahlgrenska University Hospital Göteborg, Sweden

[** ]simpleDepartment of Liver and Gastroenterology, Institute of Diseases of the Digestive System Nantes CHU Nantes, France

[†† ]simpleDivision of Gastroenterology and Hepatology, University Hospital Zurich Zurich, Switzerland

Author notes

Address for Correspondence Jan Tack, Division of Gastroenterology, University Hospital Leuven, Leuven, Belgium. Tel: +32 16 344225; fax: +32 16 344419; e-mail: jan.tack@ 123456med.kuleuven.ac.be

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Article

DOI: 10.1111/j.1365-2982.2011.01709.x

PMC ID: 3170709

PubMed ID: 21605282

SO-VID: d9054cd5-e38d-4a73-aa9c-abfe8e5d2474

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Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

Diagnosis and treatment of chronic constipation – a European perspective

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Abstract

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Purpose

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Karger: Gastroenterology

Most cited references 94

Chronic constipation: a survey of the patient perspective.

Systematic review: impact of constipation on quality of life in adults and children.

A placebo-controlled trial of prucalopride for severe chronic constipation.

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