Functional constipation is a highly prevalent condition and has a negative impact on the quality of life, not only for adults but children as well. Also, it incurs high treatment costs. Minguez et al undertook a study in which they reviewed published articles on PEG, with or without electrolytes and evaluated its efficacy as treatment for functional constipation and fecal impaction in adults and in children.

MEDLINE, EMBASE and Cochrane initiative databases were searched for articles until May 2016; 58 articles were selected for the review. These included clinical trials, observational studies, prospective studies and systematic reviews or meta-analysis. These studies compared PEG with placebo, lactulose, milk of magnesia, enemas, psyllium, prucalopride, paraffin oil, fiber combinations and Descurainia sophia in adults and children. The authors mentioned the conclusions from these studies in the review.

Studies comparing PEG with placebo in adults showed a significant superiority of PEG regarding number of bowel movements and less straining; fewer patients on PEG needed a rescue laxative and fewer patients on PEG discontinued their treatment. Attar et al demonstrated a superior effect of PEG 3350 with electrolytes compared to lactulose in relation to frequency of stools. PEG was also better tolerated as patients taking lactulose reported more flatus. PEG was found to be more efficacious than tegaserod in improving stool frequency. Tegaserod has, however, now been withdrawn from the market because of adverse cardiac effects. Only one trial compared PEG 3350 + E with prucalopride in females with chronic constipation and found it to show a significantly higher response with improvement in symptoms of constipation. PEG + E also significantly increased mean weakly defecation rate vis-à-vis psyllium. The acceptance rate of PEG was better than that of other laxatives in children with functional constipation. All formulations of PEG (with and without electrolytes) were equally effective and well-tolerated.

Conclusions drawn from the review of published evidence on PEG illustrate that the osmotic laxative PEG is the drug of first choice for treatment of functional constipation, in children and in adults. It is also the first-line drug for management of fecal impaction. PEG was found to be as effective as other laxatives such as milk of magnesia, paraffin oil or sodium phosphate, while it was better than lactulose in alleviating constipation. Moreover, PEG was found to be a safe drug and its acceptance and tolerability was better than the other laxatives analysed in the review.

Source: Mínguez M, et al. Rev Esp Enferm Dig. 2016 Dec;108(12):790-806.