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The American Journal of Gastroenterology Jun 2021Constipation is commonly treated with over-the-counter (OTC) products whose efficacy and safety remain unclear. We performed a systematic review of OTC therapies for...
INTRODUCTION
Constipation is commonly treated with over-the-counter (OTC) products whose efficacy and safety remain unclear. We performed a systematic review of OTC therapies for chronic constipation and provide evidence-based recommendations.
METHODS
We searched PubMed and Embase for randomized controlled trials of ≥4-week duration that evaluated OTC preparations between 2004 and 2020. Studies were scored using the US Preventive Services Task Force criteria (0-5 scale) including randomization, blinding, and withdrawals. The strengths of evidence were adjudicated within each therapeutic category, and recommendations were graded (A, B, C, D, and I) based on the level of evidence (level I, good; II, fair; or III, poor).
RESULTS
Of 1,297 studies identified, 41 met the inclusion criteria. There was good evidence (grade A recommendation) for the use of the osmotic laxative polyethylene glycol (PEG) and the stimulant senna; moderate evidence (grade B) for psyllium, SupraFiber, magnesium salts, stimulants (bisacodyl and sodium picosulfate), fruit-based laxatives (kiwi, mango, prunes, and ficus), and yogurt with galacto-oligosaccharide/prunes/linseed oil; and insufficient evidence (grade I) for polydextrose, inulin, and fructo-oligosaccharide. Diarrhea, nausea, bloating, and abdominal pain were common adverse events, but no serious adverse events were reported.
DISCUSSION
The spectrum of OTC products has increased and quality of evidence has improved, but methodological issues including variability in study design, primary outcome measures, trial duration, and small sample sizes remain. We found good evidence to recommend polyethylene glycol or senna as first-line laxatives and moderate evidence supporting fiber supplements, fruits, stimulant laxatives, and magnesium-based products. For others, further validation with more rigorously designed studies is warranted.
Topics: Bisacodyl; Cathartics; Chronic Disease; Citrates; Constipation; Defecation; Fruit; Gastrointestinal Agents; Glucans; Humans; Inulin; Laxatives; Magnesium; Nonprescription Drugs; Oligosaccharides; Organometallic Compounds; Picolines; Polyethylene Glycols; Psyllium; Senna Extract; Yogurt
PubMed: 33767108
DOI: 10.14309/ajg.0000000000001222 -
World Journal of Gastroenterology Mar 2023Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of... (Review)
Review
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
Topics: Humans; Aged; Cathartics; Colonoscopy; Polyethylene Glycols; Colon; Ascorbic Acid
PubMed: 37077514
DOI: 10.3748/wjg.v29.i11.1685 -
Gastrointestinal Endoscopy Mar 2009Few bowel-preparation rating scales have been validated. Most scales were intended for comparing oral purgatives and fail to account for washing and/or suctioning by the...
BACKGROUND
Few bowel-preparation rating scales have been validated. Most scales were intended for comparing oral purgatives and fail to account for washing and/or suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes, such as polyp-detection rates.
OBJECTIVE
To develop a valid and reliable scale for use in colonoscopy outcomes research.
SETTING
Academic medical center.
METHODS
We developed the Boston bowel preparation scale (BBPS), a 10-point scale that assesses bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed interobserver and intraobserver reliability by using video footage of colonoscopies viewed on 2 separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies and compared BBPS scores with clinically meaningful outcomes, including polyp-detection rates and procedure times.
RESULTS
The intraclass correlation coefficient (a measure of interobserver reliability) for BBPS scores was 0.74. The weighted kappa (a measure of intraobserver reliability) for scores was 0.77 (95% CI, 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 +/- 1.6. Higher BBPS scores (> or =5 vs <5) were associated with a higher polyp-detection rate (40% vs 24%, P < .02). BBPS scores were inversely correlated with colonoscope insertion (r = -0.16, P < .003) and withdrawal (r = -0.23, P < .001) times.
LIMITATIONS
Single-center study.
CONCLUSIONS
The BBPS is a valid and reliable measure of bowel preparation. It may be well suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.
Topics: Cathartics; Colonoscopy; Humans; Observer Variation; Preoperative Care; Prospective Studies; Reproducibility of Results
PubMed: 19136102
DOI: 10.1016/j.gie.2008.05.057 -
World Journal of Gastroenterology Mar 2016Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related... (Review)
Review
Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol (PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents (e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents (e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents (e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.
Topics: Administration, Oral; Cathartics; Colonoscopy; Defecation; Drug Therapy, Combination; Gastrointestinal Motility; Humans; Medication Adherence; Polyethylene Glycols; Therapeutic Irrigation; Treatment Outcome
PubMed: 26973388
DOI: 10.3748/wjg.v22.i10.2915 -
Kidney International Nov 2009Acute phosphate nephropathy (APhN) is a clinical pathological entity characterized by acute and subsequent chronic renal failure following exposure to oral sodium... (Review)
Review
Acute phosphate nephropathy (APhN) is a clinical pathological entity characterized by acute and subsequent chronic renal failure following exposure to oral sodium phosphate (OSP) bowel purgatives. Renal biopsy findings include acute and chronic tubular injury with prominent tubular and interstitial calcium phosphate deposits. Risk factors for APhN include older age, female gender, hypertension, chronic kidney disease (CKD), and treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. The pathomechanism of APhN involves hypovolemia-induced avid proximal salt and water reabsorption, delivery of a large phosphate load to the distal nephron, and precipitation of calcium phosphate in the distal tubule and collecting duct. To date, 37 cases of biopsy-proven APhN have been reported, and epidemiologic studies have produced inconsistent results regarding the incidence of acute kidney injury (AKI) following the use of OSP purgatives. OSP solution was withdrawn from the market in December of 2008, but OSP tablets, offered by prescription only, remain available. Prevention of APhN is best achieved by avoiding OSP in high-risk patients, aggressive hydration before, during, and after OSP administration, minimizing the dose of OSP, and maintaining a minimum of a 12 h interval between OSP administrations.
Topics: Acute Disease; Acute Kidney Injury; Administration, Oral; Biopsy; Calcium Phosphates; Cathartics; Cohort Studies; Female; Humans; Incidence; Kidney Failure, Chronic; Middle Aged; Phosphates; Risk Factors
PubMed: 19675530
DOI: 10.1038/ki.2009.308 -
Journal of Natural Medicines Oct 2017Resin glycosides are well known as purgative ingredients, which are characteristic of certain crude drugs such as Mexican Scammony Radix, Orizabae Tuber, and Jalapae... (Review)
Review
Resin glycosides are well known as purgative ingredients, which are characteristic of certain crude drugs such as Mexican Scammony Radix, Orizabae Tuber, and Jalapae Tuber, all of which originate from Convolvulaceae plants. Depending on their solubility in ether, these are roughly classified into two groups-jalapin (soluble) and convolvulin (insoluble). Almost all jalapins hitherto isolated and characterized had common intramolecular macrocyclic ester structures. These are composed of 1 mol of oligoglycoside of hydroxyl fatty acid (glycosidic acid) partially acylated by some organic acids at the sugar moiety, some examples of which are ester-type dimers. On the other hand, convolvulin is regarded as an oligomer of a variety of acylated glycosidic acids. This review describes the isolation and structural elucidation of resin glycosides from some Convolvulaceae plants, including Ipomoea operculata, Pharbitis nil, Quamoclit pennata, Calystegia soldanella, and I. muricata.
Topics: Cathartics; Convolvulaceae; Glycosides; Humans; Molecular Structure; Plant Extracts; Plant Roots; Plant Tubers; Resins, Plant; Seeds
PubMed: 28748432
DOI: 10.1007/s11418-017-1114-5 -
Report on Carcinogens : Carcinogen... 2011
Topics: Animals; Anthraquinones; Carcinogens; Cathartics; Humans; Neoplasms
PubMed: 21850139
DOI: No ID Found -
American Family Physician Sep 1998Constipation affects as many as 26 percent of elderly men and 34 percent of elderly women and is a problem that has been related to diminished perception of quality of... (Review)
Review
Constipation affects as many as 26 percent of elderly men and 34 percent of elderly women and is a problem that has been related to diminished perception of quality of life. Constipation may be the sign of a serious problem such as a mass lesion, the manifestation of a systemic disorder such as hypothyroidism or a side effect of medications such as narcotic analgesics. The patient with constipation should be questioned about fluid and food intake, medications, supplements and homeopathic remedies. The physical examination may reveal local masses or thrombosed hemorrhoids, which may be contributing to the constipation. Visual inspection of the colon is useful when no obvious cause of constipation can be determined. Treatment should address the underlying abnormality. The chronic use of certain treatments, such as laxatives, should be avoided. First-line therapy should include bowel retraining, increased dietary fiber and fluid intake, and exercise when possible. Laxatives, stool softeners and nonabsorbable solutions may be needed in some patients with chronic constipation.
Topics: Aged; Cathartics; Constipation; Dietary Fiber; Female; Humans; Male
PubMed: 9767726
DOI: No ID Found -
Health Expectations : An International... Apr 2024Experiential knowledge can aid in designing research by highlighting what an idea looks like from a patient and carer perspective. Experiential knowledge can be... (Review)
Review
BACKGROUND
Experiential knowledge can aid in designing research by highlighting what an idea looks like from a patient and carer perspective. Experiential knowledge can be emotional, and this can create challenges at formal research meetings.
OBJECTIVE
The aim of this study was to consider the role of emotions in public involvement.
METHODS
This is a conceptual review informed by relevant literature and reflection within the author team. A structured Scopus search was conducted in November 2021 and December 2022, identifying 18 articles that presented findings from patient and public involvement (PPI) research related to 'emotion'. We complemented the search with theory-generating articles related to the role of emotion and emotional labour in human life.
FINDINGS
Study findings from the structured search were tabulated to identify recurring themes; these were as follows: emotional connections to the research topic can cause stressful as well as cathartic experiences of PPI, 'emotional work' is part of PPI when people are contributing with their experiential knowledge and the emotional aspect of 'lived experience' needs to be recognised in how PPI is planned and facilitated. These points were considered in relation to theoretical works and experiences within the author team.
DISCUSSION
'Emotion work' is often required of public collaborators when they contribute to research. They are asked to contribute to research alongside researchers, with knowledge that often contains emotions or feelings. This can be both upsetting and cathartic, and the environment of the research study can make the experience worse or better.
CONCLUSIONS
The emotional component of experiential knowledge can be challenging to those invited to share this knowledge. It is imperative that researchers, research institutions and health and care professionals adjust research meeting spaces to show an awareness of the emotional labour that is involved in PPI.
PATIENT OR PUBLIC CONTRIBUTION
This review was initiated after a meeting between carers and family members of residents in care homes and researchers. The review is co-written by a group of three researchers and three carers and family members. Regular online meetings were held during the draft stages to incorporate people's views and ideas. Data extracted from the review were presented to the group of public collaborators in a variety of formats (e.g., posters, slideshows, text and verbally) to facilitate shared sense-making and synthesis of the literature.
Topics: Humans; Cathartics; Emotions; Family; Knowledge; Patient Participation
PubMed: 38504467
DOI: 10.1111/hex.14020 -
Clinical Cornerstone 2002Irritable bowel syndrome (IBS) is one of the most common diagnoses made in the primary care setting and is responsible for up to 40% of referrals to gastroenterologists.... (Review)
Review
Irritable bowel syndrome (IBS) is one of the most common diagnoses made in the primary care setting and is responsible for up to 40% of referrals to gastroenterologists. Approximately 70% of persons who meet the diagnostic criteria for IBS do not seek health care, and the remaining account for 12% of visits to primary care providers. IBS is a functional bowel disordered comprising abdominal pain associated with defecation or a change in bowel habit with features of disordered defecation and distension in the absence of any demonstrable abnormality. The diagnosis is based on clinical findings and the exclusion of other disorders. New pharmaceutical agents are available to treat the underlying disorder; however, the treatment of IBS still involves a comprehensive, multicomponent approach that includes medical management of dominant symptoms, dietary modifications, and, possibly, psychotherapy.
Topics: Antidepressive Agents; Antidiarrheals; Cathartics; Cholinergic Antagonists; Colonic Diseases, Functional; Humans; Parasympatholytics; Patient Care Team
PubMed: 12739324
DOI: 10.1016/s1098-3597(02)90003-7