Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisSome 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%). |
Related Topics
Glossary
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
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