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Pharmacological Management of Chronic Idiopathic Constipation, critical appraisal of a clinical practice guideline
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Majid Sorouri *   , Siavosh Nasseri-Moghaddam |
| Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences |
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Abstract: (31 Views) |
In this article, we conduct a critical appraisal of the clinical guideline titled “American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.” Our analysis is approached from the perspective of a clinician rather than that of a guideline author or researcher. We employed the AGREE-II (Appraisal of Guidelines for Research and Evaluation II) checklist as a framework for our evaluation. The guideline systematically reviews ten pharmacological treatments compared to placebo in adults aged 18 years and older with idiopathic chronic constipation. Importantly, the recommendations do not encompass patients with opioid-induced constipation, those with constipation resulting from other medical conditions, or individuals with irritable bowel syndrome with constipation, as well as pregnant women.
The guideline emphasizes patient-oriented outcomes. While the recommendations are articulated with clarity, they are primarily based on evidence of limited quality, despite the use of sound methodological approaches. No significant conflicts of interest appear to compromise the integrity of the recommendations. The guideline lacked explicit treatment steps or instructions for applying its recommendations, focusing solely on the efficacy of the ten reviewed drugs. Although Readers may infer those over-the-counter options such as fiber, magnesium oxide, and senna (and possibly lactulose) may serve as initial therapeutic measures. Furthermore, polyethylene glycol and bisacodyl or picosulfate (for short-term or rescue therapy) are identified as effective and low-cost treatment options. In contrast, linaclotide, plecanatide, and prucalopride are recognized as effective but associated with higher costs.
Overall, the guideline serves as a framework for managing chronic idiopathic constipation, emphasizing patient-oriented outcomes and evidence-based recommendations. However, the absence of explicit treatment steps and the limited empirical evidence supporting most treatments will restrict its practical application and effectiveness. |
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| Keywords: Constipation, guideline, fiber, magnesium oxide, senna, lactulose, polyethylene glycol, bisacodyl, picosulfate, lubiprostone, linaclotide, plecanatide, prucalopride, appraise, AGREE |
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Full-Text [PDF 966 kb]
(13 Downloads)
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Type of Study: Research |
Subject:
General
Received: 2025/03/11 | Accepted: 2024/07/31 | Published: 2024/07/31
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