The potential treatment possibilities for chronic constipation (CC) include non-pharmaceutical approaches like lifestyle modification, and pharmaceutical therapy with dietary fiber, osmotic laxatives such as polyethylene glycol, secretory laxatives, and prokinetic medications.

The goal of a new study published in Annals of Gastroenterology was to address issues relating treatment strategies, definitions of drug efficacy, parameters for drug selection, and conceived limitations of the available treatments for chronic constipation by comparing treatment strategies among gastroenterology specialists (GIs) and general practitioners (GPs).

This study entailed a nationwide internet-based survey including gastroenterology specialists (GIs) and general practitioners (GPs); 40 GIs and 132 GPs responded. The findings revealed that treatment strategies varied considerably between GPs and GIs. The major parameters for drug selection were related to drug safety among GIs and clinical outcomes among GPs. The conceived limitations of drug therapy were lack of experience and unwanted side effects. It was also noted that all GIs and 70% of the GPs recommended osmotic laxatives as the first drug choice for CC. Polyethylene glycol (PEG) was the most common drug of choice, selected by 73% of the GIs, which was followed by lactulose (13%). The second-line treatment options included secretory laxatives, added fiber, a different osmotic laxative, and prucalopride. The third-line of treatment preferred by GIs were prucalopride, bisacodyl, paraffin oil, fleet enemas, and PEG-3350 with electrolytes.

On the other hand, GPs chose PEG as the first-line of treatment option in 41% of cases, lactulose in 29%, bisacodyl in 13% and fiber in 10%. The second-line of treatment options included secretory laxatives, osmotic laxatives, and fiber supplementations. While drug choices for the third-line of treatment comprised secretory laxatives, osmotic laxatives in, glycerin suppositories, fleet enema, paraffin oil, and prucalopride.

Hence, it was inferred that awareness of the possible treatment options and the recommended order of prescription differs among GIs and GPs. It was stated that it is essential to optimize treatment strategies for chronic constipation.