title: Management of constipation in the elderly: emerging therapeutic strategies.
abstract: A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly efficacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containing components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opioids for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the efficacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confirm the findings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Kapoor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000031:analogs & derivatives / Q000627:therapeutic use; D001572:Benzofurans / Q000627:therapeutic use; D003248:Constipation / Q000188:drug therapy*; D006801:Humans; D000068238:Lubiprostone; D009388:Neostigmine / Q000627:therapeutic use
chemical_list: D001572:Benzofurans; C406662:prucalopride; D009388:Neostigmine; D000068238:Lubiprostone; D000527:Alprostadil
references.citation: Acta Gastroenterol Latinoam. 2008 Mar;38(1):16-25
references.pmid: 18533353
references.citation: Pediatr Surg Int. 2008 Jul;24(7):779-83
references.pmid: 18443801
references.citation: J Pain Symptom Manage. 2006 Sep;32(3):204-5
references.pmid: 16939843
references.citation: N Engl J Med. 2008 May 29;358(22):2344-54
references.pmid: 18509121
references.citation: J Gastroenterol Hepatol. 2006 Jan;21(1 Pt 1):47-53
references.pmid: 16706811
references.citation: Neurourol Urodyn. 2008;27(3):155-61
references.pmid: 18314865
references.citation: J Pain Symptom Manage. 2008 May;35(5):458-68
references.pmid: 18440447
references.citation: Am J Health Syst Pharm. 2008 Jun 1;65(11):996
references.pmid: 18499867
references.citation: Aliment Pharmacol Ther. 2008 Apr;27(8):685-96
references.pmid: 18248656
references.citation: World J Gastroenterol. 2008 May 7;14(17):2631-8
references.pmid: 18461648