Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Gastroenterology & Hepatology, Michigan Medicine, Ann Arbor, Michigan.
Gastroenterology. 2023 Jun;164(7):1086-1106. doi: 10.1053/j.gastro.2023.03.214.
Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults.
The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations.
The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone.
This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.
慢性特发性便秘（CIC）是一种常见的疾病，会显著降低生活质量。本临床实践指南由美国胃肠病学会和美国胃肠病学院共同制定，旨在为成人 CIC 的药物治疗提供循证实践建议，为临床医生和患者提供信息。
美国胃肠病学会和美国胃肠病学院成立了一个多学科指南小组，对以下药物进行了系统评价：纤维、渗透性泻药（聚乙二醇、氧化镁、乳果糖）、刺激性泻药（比沙可啶、匹可硫酸钠、番泻叶）、促分泌剂（鲁比前列酮、利那洛肽、普卡必利）和 5-羟色胺 4 型激动剂（普芦卡必利）。小组确定了临床问题和结局的优先级，并使用推荐评估、制定和评估（Grading of Recommendations Assessment, Development, and Evaluation）框架来评估每种干预措施的证据确定性。根据期望效果和不良反应、患者价值观、成本和健康公平因素之间的平衡，使用决策框架制定临床建议。
小组就成人慢性特发性便秘的药物治疗达成了 10 项建议。基于现有证据，小组强烈推荐在成人 CIC 中使用聚乙二醇、匹可硫酸钠、利那洛肽、普卡必利和鲁比前列酮。纤维、乳果糖、番泻叶、氧化镁和鲁比前列酮则有条件推荐。
本文档提供了治疗 CIC 的各种非处方药和处方药的全面概述。指南旨在为 CIC 的管理提供一个框架；临床医生应根据患者的偏好、药物成本和可获得性，进行共同决策。本指南还强调了证据中的局限性和差距，以帮助指导未来的研究机会，并改善慢性便秘患者的护理。
