title: Comparison of the effectiveness of polyethylene glycol with and without electrolytes in constipation: a systematic review and network meta-analysis.
abstract: BACKGROUND
  Polyethylene glycol is commonly used to manage constipation and is available with or without electrolytes. The addition of electrolytes dates back to its initial development as lavage solutions in preparation for gastrointestinal interventions. The clinical utility of the addition of electrolytes to polyethylene glycol for the management of constipation is not established. The objective of this systematic review and network meta-analysis (NMA) was to assess the relative effectiveness of polyethylene glycol with (PEG + E) or without electrolytes (PEG) in the management of functional constipation in adults.
  
  
  METHODS
  A systematic review was conducted to identify randomised controlled clinical trials that assessed the use of polyethylene glycol in functional constipation. The primary outcome was the mean number of bowel movements per week.
  
  
  RESULTS
  Nineteen studies were included in the NMA (PEG N = 9, PEG + E N = 8, PEG versus PEG + E N = 2; involving 2247 patients). PEG and PEG + E are both effective, increasing the number of bowel movements per week by 1.8 (95 % Crl 1.0, 2.8) and 1.9 (95 % Crl 0.9, 3.0) respectively versus placebo and by 1.8 (95 % Crl 0.0, 3.5) and 1.9 (95 % Crl 0.2, 3.6) respectively versus lactulose. There was no efficacy difference between PEG + E and PEG (0.1, 95 % Crl -1.1, 1.2) and there were no differences in safety or tolerability.
  
  
  CONCLUSIONS
  Polyethylene glycol with and without electrolytes are effective and safe treatments for constipation in adults. The addition of electrolytes to polyethylene glycol does not appear to offer any clinical benefits over polyethylene glycol alone in the management of constipation.
authors.affiliation: Gastroenterology Department, Concord Hospital, The University of Sydney, Hospital Rd, Concord, NSW, Australia. peter.katelaris@sydney.edu.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Katelaris
authors.affiliation: Centre for Education and Research on Ageing and The Ageing and Alzheimers Institute, University of Sydney and Concord Hospital, Hospital Rd, Concord, NSW, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Liu
authors.affiliation: Scius Healthcare Solutions Pty Ltd, PO Box 84, Northbridge, NSW, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Krassas
authors.affiliation: Matraville Medical Centre, 165a Perry St, Matraville, NSW, 2036, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Gullotta
mesh_terms: D003248:Constipation / Q000188:drug therapy*; D004573:Electrolytes / Q000627:therapeutic use*; D006801:Humans; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D013501:Surface-Active Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004573:Electrolytes; D013501:Surface-Active Agents; D011092:Polyethylene Glycols
keywords: Constipation; Macrogol; Meta-analysis; Polyethylene glycol; Systematic review