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American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.

Publication ,  Journal Article
Chang, L; Chey, WD; Imdad, A; Almario, CV; Bharucha, AE; Diem, S; Greer, KB; Hanson, B; Harris, LA; Ko, C; Murad, MH; Patel, A; Shah, ED ...
Published in: Am J Gastroenterol
June 1, 2023

INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS: The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS: The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION: This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.

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Published In

Am J Gastroenterol

DOI

EISSN

1572-0241

Publication Date

June 1, 2023

Volume

118

Issue

6

Start / End Page

936 / 954

Location

United States

Related Subject Headings

  • Sennosides
  • Quality of Life
  • Polyethylene Glycols
  • Magnesium Oxide
  • Lubiprostone
  • Laxatives
  • Lactulose
  • Humans
  • Gastroenterology & Hepatology
  • Gastroenterology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S., … Sultan, S. (2023). American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol, 118(6), 936–954. https://doi.org/10.14309/ajg.0000000000002227
Chang, Lin, William D. Chey, Aamer Imdad, Christopher V. Almario, Adil E. Bharucha, Susan Diem, Katarina B. Greer, et al. “American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.Am J Gastroenterol 118, no. 6 (June 1, 2023): 936–54. https://doi.org/10.14309/ajg.0000000000002227.
Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, et al. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2023 Jun 1;118(6):936–54.
Chang, Lin, et al. “American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.Am J Gastroenterol, vol. 118, no. 6, June 2023, pp. 936–54. Pubmed, doi:10.14309/ajg.0000000000002227.
Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, Greer KB, Hanson B, Harris LA, Ko C, Murad MH, Patel A, Shah ED, Lembo AJ, Sultan S. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2023 Jun 1;118(6):936–954.

Published In

Am J Gastroenterol

DOI

EISSN

1572-0241

Publication Date

June 1, 2023

Volume

118

Issue

6

Start / End Page

936 / 954

Location

United States

Related Subject Headings

  • Sennosides
  • Quality of Life
  • Polyethylene Glycols
  • Magnesium Oxide
  • Lubiprostone
  • Laxatives
  • Lactulose
  • Humans
  • Gastroenterology & Hepatology
  • Gastroenterology