GuidelinesfortheTreatmentofChronicConstipation.doc

Guidelines for the Treatment of Chronic Constipation: What Is the Evidence? Philip S. Schoenfeld, MD, MSEd, MSc Posted: 07/12/2005 Editors Note Please note:?The following announcement supersedes any information contained in this article. On March 30, 2007, Novartis, in compliance with an FDA request, suspended marketing and sales of its irritable bowel/constipation drug tegaserod maleate (Zelnorm) after an analysis of its clinical database pointed to a higher incidence of myocardial infarction, stroke, and unstable angina among patients taking the drug. For updated information on this issue, see the?Medscape Alert Center on tegaserod. Introduction and Context In July 2005, the American College of Gastroenterology Functional Gastrointestinal Disorders Task Force produced an evidence-based monograph on the management of chronic constipation in North America.[1]?This monograph follows the evidence-based format used in a previous review on the treatment of irritable bowel syndrome (IBS),[2]?and provides graded recommendations regarding the appropriate diagnosis and treatment of chronic constipation. This brief report outlines the recommendations of the Task Force and discusses the evidence that supports these recommendations. Epidemiology of Chronic Constipation in North America The prevalence of chronic constipation in North America is approximately 15%, although only a minority of sufferers seek medical care.[3]?On the basis of data from population-based studies, chronic constipation is more common in women, the elderly, nonwhites, and individuals from lower socioeconomic groups.[3]?When these individuals complain about chronic constipation, they are referring to symptoms related to difficult stool passage: straining, hard/lumpy stools, prolonged time to stool, sense of incomplete evacuation, or need for manual maneuvers to pass stool. Only one third of chronic constipation sufferers complain of passing fewer than 3 bowel movements/week. Therefore, the Task Force defi