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Apr 29, 2023

New treatment guidelines for chronic constipation in adults published

New guidelines have been published for managing chronic idiopathic constipation

New guidelines have been published for managing chronic idiopathic constipation (CIC), a common disorder that affects ​​8% to 12% of adults in the United States.

The guidance, authored by experts with the American Gastroenterological Association and the American College of Gastroenterology, includes evidence-based practice recommendations for the pharmacological treatment of CIC.

A panel performed systematic reviews, leading to "strong recommendation" for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide and prucalopride in adults. The authors also conditionally recommend that clinicians consider the use of fiber, lactulose, senna, magnesium oxide and lubiprostone.

Alongside potential pharmacological management, the first steps of treatment for CIC typically involve nonpharmacological therapies, the authors noted. These may include dietary recommendations, with clinicians suggesting that patients increase their fluid intake and boost dietary fiber.

Patients also are often counseled on making behavioral changes such as exercise and may try over-the-counter or prescription medications, such as polyethylene glycol (PEG), secretagogues or prokinetic agents, the authors wrote.

The guidelines are meant to provide a framework for managing the disorder, they said.

"Clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability," they concluded.

The guidelines, "American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation" were published May 19 in the American Journal of Gastroenterology.

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