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 Vol. 20 No. 4, October 2008
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AAP Grand Rounds 20:41-42 (2008)
© 2008 American Academy of Pediatrics

GASTROENTEROLOGY/NUTRITION

Treatment of Constipation – the Search Continues

Sources: (1) Thomas J, Karver S, Cooney GA, et al. Methylnaltrex-one for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358(22):2332–2343; doi:10.1056/NEJMoa0707377.[Abstract/Free Full Text] (2) Camilleri M, Kerstens R, Rykx A, et al. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358(22):2344–2354; doi:10.1056/NEJMoa0800670[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.


PICO

Question: In adults with severe constipation, does methylnaltrexone for opioid-induced constipation or prucalopride for idiopathic severe constipation result in improved stool habits?

Question type: Therapy

Study design: Randomized controlled trial

 

Two new pharmacologic therapies for constipation, one for opioid-induced and the other for severe chronic constipation, are reviewed.

In the first study, investigators from 27 US and Canadian nursing homes, hospice sites, and palliative care centers studied the efficacy of subcutaneous methylnaltrexone, a µ-opioid-receptor antagonist with restricted ability to cross the blood-brain barrier, in treating opioid-induced constipation in adults with advanced illness.

Patients who had received opioids for two or more weeks and who had been treated with laxatives for three or more days without relief of opioid-induced constipation were randomly assigned to receive subcutaneous methylnaltrexone or placebo every other day for two weeks. Exclusion criteria included constipation that was not primarily caused by opioids, mechanical gastrointestinal obstruction, fecal impaction, acute surgical abdomen, and fecal ostomy. Patients were assessed daily for laxation, including consistency and difficulty, and adverse events. Patients who completed the initial two-week phase were eligible to enter a three-month, open-label extension trial.

A total of 133 adult patients (median age, 71 years) were enrolled. In the methylnaltrexone group, 48% of patients defecated within four hours after the first . . . [Full Text of this Article]

Ayesha Fatima, MD and Neal S. LeLeiko, MD, PhD, FAAP
Pediatrics, Brown School of Medicine, and Pediatric Gastroenterology, Nutrition and Liver Disease, Hasbro Children’s Hospital, Providence,RI