title: Persistent constipation and abdominal adverse events with newer treatments for constipation.
abstract: BACKGROUND
  Clinical trials of several new treatments for opioid-induced constipation (OIC), chronic idiopathic constipation (CIC) and constipation-predominant irritable bowel syndrome (IBS-C) have focused on differences between subjects relieved of constipation with placebo and active treatment. Patients and clinicians however, are more interested in the probability these treatments provide actual relief of constipation and its associated symptoms.
  
  
  METHODS
  We searched the medical literature using MEDLINE and Cochrane central register of controlled trials. Randomised, placebo-controlled trials that examined the use of methylnaltrexone, naloxegol, lubiprostone, prucalopride or linaclotide in adults with OIC, CIC and IBS-C were eligible for inclusion. The primary efficacy measure was relief of constipation. Adverse event data for abdominal symptoms were also analysed.
  25 publications were included in our analyses. The proportion of constipated individuals with active treatment was significantly lower than the proportion with placebo; however, in 15 of these 20 trials analysed, a majority of patients remained constipated with active treatment. Analyses of adverse event data revealed that the percentage of participants who experienced abdominal pain, diarrhoea and flatulence with active treatment was higher than that with placebo in the majority of trials analysed.
  
  
  CONCLUSIONS
  Newer pharmacological treatments for constipation are superior to placebo in relieving constipation, but many patients receiving active treatment may remain constipated. In addition, all 5 of the treatments studied are accompanied by no change or a possible increase in the prevalence of abdominal symptoms, such as abdominal pain, diarrhoea and flatulence.
authors.affiliation: Stanford University School of Medicine , Palo Alto, California , USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Sonu
authors.affiliation: Stanford University School of Medicine , Palo Alto, California , USA.
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
authors.affiliation: Science for Organizations, Inc. , Mill Valley, California , USA.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Gardner
keywords: ABDOMINAL PAIN; CONSTIPATION; FUNACTIONAL ABDOMINAL PAIN; IRRITABLE BOWEL SYNDROME