Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis
Open accessAbstract
Background: There has been no definitive systematic review and meta-analysis to date examining the effect of laxatives and pharmacological therapies in chronic idiopathic constipation (CIC). Objective: To assess efficacy of these therapies systematically in CIC. Design: Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (up to September 2010). Eligibility criteria for selecting studies: Placebo-controlled trials of laxatives or pharmacological therapies in adult CIC patients were eligible. Minimum duration of therapy was 1 week. Trials had to report either a dichotomous assessment of overall response to therapy at last point of follow-up in the trial, or mean number of stools per week during therapy. Study appraisal and synthesis methods: Symptom data were pooled using a random effects model. Effect of laxatives or pharmacological therapies compared to placebo was reported as RR of failure to respond to therapy, or a weighted mean difference (WMD) in mean number of stools per week, with 95% CIs. Results: Twenty-one eligible RCTs were identified. Laxatives (seven RCTs, 1411 patients, RR=0.52; 95% CI 0.46 to 0.60), prucalopride (seven trials, 2639 patients, RR=0.82; 95% CI 0.76 to 0.88), lubiprostone (three RCTs, 610 patients, RR=0.67; 95% CI 0.56 to 0.80), and linaclotide (three trials, 1582 patients, RR=0.84; 95% CI 0.80 to 0.87) were all superior to placebo in terms of a reduction in risk of failure with therapy. Treatment effect remained similar when only RCTs at low risk of bias were included in the analysis. Diarrhoea was significantly more common with all therapies. Limitations: Only two RCTs were conducted in primary care, and total adverse events data for laxatives and linaclotide were sparse. Conclusions: Laxatives, prucalopride, lubiprostone and linaclotide are all more effective than placebo for the treatment of CIC.
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Prucalopride is efficacious in the treatment of chronic idiopathic constipation, but to date there have been no RCTs in IBS-C.
“Although prucalopride, which is a highly selective 5-HT 4 agonist with no known cardiovascular or cerebrovascular safety concerns, is efficacious in the treatment of chronic idiopathic constipation, 220 to date there have been no RCTs in IBS-C.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [220]
The Response to therapy with prucalopride section reports better outcomes than placebo in chronic idiopathic constipation, supporting efficacy. The paper reviews trials in that condition but does not establish the separate claim that no prucalopride RCTs had been conducted in IBS-C; a search for IBS-C trials found no passage addressing it. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAlthough both stimulant and osmotic laxatives are efficacious in the treatment of chronic idiopathic constipation, only the latter have been evaluated in 2 RCTs of polyethylene glycol, recruiting 181 patients with IBS-C.
“Although both stimulant and osmotic laxatives are efficacious in the treatment of chronic idiopathic constipation, 220 only the latter have been evaluated in 2 RCTs of polyethylene glycol, recruiting 181 patients with IBS-C.221 222”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [220]
Prucalopride was superior to placebo in chronic constipation.
“Prucalopride, another 5-HT4 agonist, was superior to placebo in chronic constipation”
From Irritable bowel syndrome (2020) · cites this paper as [106]
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- Authors
- Ford, A. C., & Suares, N. C.
- Affiliations
- Leeds General Infirmary (GB)
- ORCID
- Ford, Alexander C
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2011-01-04
- Volume
- 60
- Issue
- 2
- Pages
- 209-218
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W2111430126
- Cited by
- 378
- References
- 50
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 17 · 2023: 24 · 2022: 18 · 2021: 20 · 2020: 42 · 2019: 28 · 2018: 30 · 2017: 20 · 2016: 30 · 2015: 13 · 2014: 34 · 2013: 33 · 2012: 20
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- chronic idiopathic constipation, laxatives, prucalopride, lubiprostone, linaclotide, pharmacotherapy, treatment efficacy, adverse events, diarrhea
- MeSH terms
- Lubiprostone, Alprostadil, Benzofurans, Chronic Disease, Constipation, Diarrhea, Humans, Peptides, Randomized Controlled Trials as Topic, Treatment Outcome, Laxatives
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