J Neurogastroenterol Motil.
2021 Oct;27(4):495-512. 10.5056/jnm20210.
Medical Management of Constipation in Elderly Patients: Systematic Review
- Affiliations
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- 1Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- 2Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
- 3Institute for Digestive Research, Soonchunhyang University, Seoul, Korea
- 4Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- 5Department of Internal Medicine and Digestive Diseases Research Institute, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea
- 6Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
- 7Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- 9Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea
- KMID: 2521149
- DOI: http://doi.org/10.5056/jnm20210
Abstract
- Background/Aims
Constipation is a common gastrointestinal problem in the elderly. Because of the limitations of life style modifications and the comorbidity, laxative use is also very common. Therefore, this study reviews the latest literature on the effect and safety of laxative in the elderly.
Methods
A systematic review of randomized controlled trials investigating the effectiveness and safety of laxatives for constipation in elderly patients over 65 years old were performed using the following databases: PubMed, EMBASE, and the Cochrane Library.
Results
Twenty-three randomized controlled trials were included in this review. Among the selected studies, 9 studies compared laxative with placebo and 5 studies compared laxatives of the same type. Four studies compared different types of laxatives or compared combination agents. Five studies compared novel medications such as prucalopride, lubiprostone, and elobixibat with placebo. Psyllium, calcium polycarbophil, lactulose syrup, lactitol, polyethylene glycol, magnesium hydroxide, stimulant laxative with or without fiber, and other medications were more effective than placebo in elderly constipation patients in short-term. Generally, the frequency and severity of adverse effects of laxative were similar between the arms of studies.
Conclusions
Bulk laxative, osmotic laxative, stimulant laxative with or without fiber, and other medications can be used in elderly patients in short-term within 3 months with reasonable safety. However, the quality of included studies was not high and most of studies was conducted in a small number of patients. Among these laxatives, polyethylene glycol seems to be safe and effective in long-term use of about 6 months in elderly patients.
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