title: Efficacy and safety of traditional medical therapies for chronic constipation: systematic review.
abstract: OBJECTIVE
  Constipation is common, and its treatment is unsatisfactory. Although many agents have been tried, there are limited data to support their use. Our aim was to undertake a systematic review of the efficacy and safety of traditional medical therapies for chronic constipation and to make evidence-based recommendations.
  
  
  METHODS
  We searched the English literature for drug trials evaluating treatment of constipation by using MEDLINE and PUBMED databases from 1966 to 2003. Only studies that were randomized, conducted on adult subjects, and published as full manuscripts were included. Studies were assigned a quality score based on published methodology. Standard forms were used to abstract data regarding study design, duration, outcome measures, and adverse events. By using the cumulative evidence of published data for each agent, recommendations were made regarding their use following the United States Preventive Services Task Force guidelines.
  
  
  RESULTS
  Good evidence (Grade A) was found to support the use of polyethylene glycol (PEG) and tegaserod. Moderate evidence (Grade B) was found to support the use of psyllium, and lactulose. There was a paucity of quality data regarding many commonly used agents including milk of magnesia, senna, bisacodyl, and stool softeners.
  
  
  CONCLUSIONS
  There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated.
authors.affiliation: Division of Gastroenterology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
authors.forename: Davendra
authors.initials: D
authors.lastname: Ramkumar
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D002400:Cathartics