Korean J Gastroenterol.  2014 Sep;64(3):148-153. 10.4166/kjg.2014.64.3.148.

Current Issues on the Treatment of Chronic Constipation

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 5Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
  • 6Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 7Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine and Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea.
  • 9Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea. medcsc@wmc.wonkwang.ac.kr

Abstract

Chronic constipation is a very common clinical problem with its prevalence of up to 14% in the general population. It is not a life-threatening disease, but since patient's satisfaction to the treatment is known to be as low as 50%, chronic constipation still remains a clinically challenging problem. Fortunately, many new treatments have been introduced or are to be introduced in the near future. This article will review the basic concepts and the results of recent studies on the new treatments for chronic constipation.

Keyword

Constipation; Prucalopride; Lubiprostone; Linaclotide

MeSH Terms

Chloride Channel Agonists/therapeutic use
Chronic Disease
Constipation/*drug therapy/epidemiology
Humans
Laxatives/*therapeutic use
Polyethylene Glycols/therapeutic use
Prevalence
Probiotics/therapeutic use
Serotonin 5-HT4 Receptor Agonists/therapeutic use
Chloride Channel Agonists
Laxatives
Serotonin 5-HT4 Receptor Agonists
Polyethylene Glycols

Reference

References

1. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011; 106:1582–1591.
Article
2. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007; 25:599–608.
Article
3. Chapman H, Pasternack M. The action of the novel gastrointestinal prokinetic prucalopride on the HERG K+ channel and the common T897 polymorph. Eur J Pharmacol. 2007; 554:98–105.
Article
4. Tack J, van Outryve M, Beyens G, Kerstens R, Vandeplassche L. Prucalopride (Resolor) in the treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut. 2009; 58:357–365.
Article
5. Quigley EM, Vandeplassche L, Kerstens R, Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation–a 12-week, randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2009; 29:315–328.
6. Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008; 358:2344–2354.
Article
7. Jadav AM, McMullin CM, Smith J, Chapple K, Brown SR. The association between prucalopride efficacy and constipation type. Tech Coloproctol. 2013; 17:555–559.
Article
8. Tack J, Stanghellini V, Dubois D, Joseph A, Vandeplassche L, Kerstens R. Effect of prucalopride on symptoms of chronic constipation. Neurogastroenterol Motil. 2014; 26:21–27.
Article
9. Shin A, Camilleri M, Kolar G, Erwin P, West CP, Murad MH. Systematic review with meta-analysis: highly selective 5-HT4 ag-onists (prucalopride, velusetrag or naronapride) in chronic constipation. Aliment Pharmacol Ther. 2014; 39:239–253.
Article
10. Camilleri M, Bharucha AE, Ueno R, et al. Effect of a selective chloride channel activator, lubiprostone, on gastrointestinal transit, gastric sensory, and motor functions in healthy volunteers. Am J Physiol Gastrointest Liver Physiol. 2006; 290:G942–G947.
Article
11. Cuppoletti J, Malinowska DH, Tewari KP, et al. SPI-0211 activates T84 cell chloride transport and recombinant human ClC-2 chloride currents. Am J Physiol Cell Physiol. 2004; 287:C1173–C1183.
Article
12. Johanson JF, Drossman DA, Panas R, Wahle A, Ueno R. Clinical trial: phase 2 study of lubiprostone for irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2008; 27:685–696.
Article
13. Lembo AJ, Johanson JF, Parkman HP, Rao SS, Miner PB Jr, Ueno R. Long-term safety and effectiveness of lubiprostone, a chloride channel (ClC-2) activator, in patients with chronic idiopathic constipation. Dig Dis Sci. 2011; 56:2639–2645.
Article
14. Drossman DA, Chey WD, Johanson JF, et al. Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome–results of two randomized, placebo-controlled studies. Aliment Pharmacol Ther. 2009; 29:329–341.
15. Chey WD, Drossman DA, Johanson JF, Scott C, Panas RM, Ueno R. Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2012; 35:587–599.
16. Vaandrager AB. Structure and function of the heat-stable enter-otoxin receptor/guanylyl cyclase C. Mol Cell Biochem. 2002; 230:73–83.
Article
17. Castro J, Harrington AM, Hughes PA, et al. Linaclotide inhibits colonic nociceptors and relieves abdominal pain via guanylate cy-clase-C and extracellular cyclic guanosine 3',5'-monophosphate. Gastroenterology. 2013; 145:1334–1346.e11.
Article
18. Andresen V, Camilleri M, Busciglio IA, et al. Effect of 5 days linaclotide on transit and bowel function in females with constipation-predominant irritable bowel syndrome. Gastroenterology. 2007; 133:761–768.
Article
19. Rao S, Lembo AJ, Shiff SJ, et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol. 2012; 107:1714–1724.
20. Chey WD, Lembo AJ, Lavins BJ, et al. Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, dou-ble-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol. 2012; 107:1702–1712.
Article
21. Quigley EM, Tack J, Chey WD, et al. Randomised clinical trials: linaclotide phase 3 studies in IBS-C - a prespecified further analysis based on European Medicines Agency-specified endpoints. Aliment Pharmacol Ther. 2013; 37:49–61.
Article
22. Shailubhai K, Comiskey S, Foss JA, et al. Plecanatide, an oral guanylate cyclase C agonist acting locally in the gastrointestinal tract, is safe and well-tolerated in single doses. Dig Dis Sci. 2013; 58:2580–2586.
Article
23. Simrén M, Barbara G, Flint HJ, et al. Rome Foundation Committee. Intestinal microbiota in functional bowel disorders: a Rome foundation report. Gut. 2013; 62:159–176.
Article
24. Chmielewska A, Szajewska H. Systematic review of randomised controlled trials: probiotics for functional constipation. World J Gastroenterol. 2010; 16:69–75.
25. Chen CC, Su MY, Tung SY, Chang FY, Wong JM, Geraint M. Evaluation of polyethylene glycol plus electrolytes in the treatment of severe constipation and faecal impaction in adults. Curr Med Res Opin. 2005; 21:1595–1602.
Article
26. Culbert P, Gillett H, Ferguson A. Highly effective new oral therapy for faecal impaction. Br J Gen Pract. 1998; 48:1599–1600.
27. Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. 2011; 60:209–218.
Article
28. Migeon-Duballet I, Chabin M, Gautier A, et al. Long-term efficacy and cost-effectiveness of polyethylene glycol 3350 plus electrolytes in chronic constipation: a retrospective study in a disabled population. Curr Med Res Opin. 2006; 22:1227–1235.
Article
29. Cinca R, Chera D, Gruss HJ, Halphen M. Randomised clinical trial: macrogol/PEG 3350+electrolytes versus prucalopride in the treatment of chronic constipation–a comparison in a controlled environment. Aliment Pharmacol Ther. 2013; 37:876–886.
30. Hofmann AF. The continuing importance of bile acids in liver and intestinal disease. Arch Intern Med. 1999; 159:2647–2658.
Article
31. Chadwick VS, Gaginella TS, Carlson GL, Debongnie JC, Phillips SF, Hofmann AF. Effect of molecular structure on bile acid-induced al-terations in absorptive function, permeability, and morphology in the perfused rabbit colon. J Lab Clin Med. 1979; 94:661–674.
32. Conley DR, Coyne MJ, Bonorris GG, Chung A, Schoenfield LJ. Bile acid stimulation of colonic adenylate cyclase and secretion in the rabbit. Am J Dig Dis. 1976; 21:453–458.
Article
33. Wong BS, Camilleri M, McKinzie S, Burton D, Graffner H, Zinsmeister AR. Effects of A3309, an ileal bile acid transporter inhibitor, on colonic transit and symptoms in females with functional constipation. Am J Gastroenterol. 2011; 106:2154–2164.
Article
34. Chey WD, Camilleri M, Chang L, Rikner L, Graffner H. A randomized placebo-controlled phase IIb trial of a3309, a bile acid transporter inhibitor, for chronic idiopathic constipation. Am J Gastroenterol. 2011; 106:1803–1812.
Article
35. Triantafyllou K, Chang C, Pimentel M. Methanogens, methane and gastrointestinal motility. J Neurogastroenterol Motil. 2014; 20:31–40.
Article
36. Attaluri A, Jackson M, Valestin J, Rao SS. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol. 2010; 105:1407–1411.
Article
37. Lee KM, Paik CN, Chung WC, Yang JM, Choi MG. Breath methane positivity is more common and higher in patients with objectively proven delayed transit constipation. Eur J Gastroenterol Hepatol. 2013; 25:726–732.
Article
38. Ghoshal UC, Srivastava D, Verma A, Misra A. Slow transit constipation associated with excess methane production and its improvement following rifaximin therapy: a case report. J Neurogastroenterol Motil. 2011; 17:185–188.
Article
39. Tooth D, Garsed K, Singh G, et al. Characterisation of faecal pro-tease activity in irritable bowel syndrome with diarrhoea: origin and effect of gut transit. Gut. 2014; 63:753–760.
Article
40. Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin North Am. 2008; 37:569–586. viii.
Article
41. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol. 2010; 105:890–896.
Article
42. Jodorkovsky D, Dunbar KB, Gearhart SL, Stein EM, Clarke JO. Biofeedback therapy for defecatory dysfunction: “real life” experience. J Clin Gastroenterol. 2013; 47:252–255.
Article
43. Paulson DM, Kennedy DT, Donovick RA, et al. Alvimopan: an oral, peripherally acting, mu-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction–a 21-day treatment-randomized clinical trial. J Pain. 2005; 6:184–192.
44. Büchler MW, Seiler CM, Monson JR, et al. Clinical trial: alvimopan for the management of post-operative ileus after abdominal surgery: results of an international randomized, double-blind, multi-centre, placebo-controlled clinical study. Aliment Pharmacol Ther. 2008; 28:312–325.
45. Viscusi ER, Goldstein S, Witkowski T, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc. 2006; 20:64–70.
46. Delaney CP, Weese JL, Hyman NH, et al. Alvimopan Postoperative Ileus Study Group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum. 2005; 48:1114–1125. discussion 1125–1126; author reply 1127–1129.
Article
47. Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008; 358:2332–2343.
Article
48. Cryer B, Katz S, Vallejo R, Popescu A, Ueno R. A randomized study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain. Pain Med. 2014. doi: 10.1111/pme. 12437. [Epub ahead of print].
Article
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