DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20222994
Published: 2022-11-28

The study to understand management of constipation and prescription pattern of laxative therapy

Kajal Shilpi, Amit B. Jain, Dixit Patel

Abstract


Background: The objective of this study was to evaluate demographic profile and prescription pattern of laxative therapy in chronic constipation (CC) patients.

Methods: This real-world, retrospective, SMART-2 study was conducted at various centres in India between April 2021 and March 2022.

Results: Data of a total 12,080 patients diagnosed with CC were analysed. The mean age of patients was 53.84 years and majority (63.62%) were males. Most reported influencing lifestyle parameters included ‘not very active’ or ‘lightly active’ lifestyle (78%) and non-vegetarian diet (67%). Squatting (56.89%) was the common mode of defecation. As per the Bristol stool criteria, the most common stool consistency observed was type 2 (sausage-shaped but lumpy) (25.49%) followed by type 1 [separate hard lumps, like nuts (hard to pass)] (22.92%). As per the Rome IV diagnostic criteria, straining (44.62%) was the most common symptom. Faecal evacuation disorder was present in 52% of the patients. Common associated conditions were diabetes (35%) and hypothyroidism (12.9%). Antihypertensive drugs (23.7%), iron supplements (13.5%) and opiates (10.7%) were the most commonly prescribed drugs in patient’s medication history. Lactulose solution (65%) was the most prescribed drug for CC. Quality of life was adversely impacted in every one out of five patients.

Conclusions: Chronic constipation is more common among males and is influenced by lifestyle parameters. It is associated with comorbidities like diabetes and hypothyroidism. Antihypertensives, iron supplements and opiates are commonly noted in medication history for CC patients. Lactulose solution is the most common prescribed pharmacotherapy for the relief from constipation. Chronic constipation increases distress level among the patients.


Keywords


Chronic constipation, Lactulose, Comorbidities, Distress

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References


Scott SM, Simrén M, Farmer AD, Dinning PG, Carrington EV, Benninga MA, et al. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterol Motil. 2021;33(6):e14050.

Bassotti G, Usai SP, Bellini M. Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options. Clin Exp Gastroenterol. 2021 Oct 22;14:413-28.

Bosshard W, Dreher R, Schnegg JF, Büla CJ. The treatment of chronic constipation in elderly people: an update. Drugs Aging. 2004;21(14):911-30.

Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, et al. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol. 2018;37(6):526-44.

American Gastroenterological Association, Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211-7.

West C, Keim SM, Rosen P. Management of Patients Presenting with Constipation. J Urgent Med Care. 2022.

Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-42.

Werth BL, Christopher SA. Potential risk factors for constipation in the community. World J Gastroenterol. 2021;27(21):2795-817.

Black CJ, Ford AC. Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management. Med J Aust. 2018;209(2):86-91.

Annells M, Koch T. Constipation and the preached trio: diet, fluid intake, exercise. Int J Nurs Stud. 2003;40(8):843-52.

Devrajani BR, Shah SZ, Devrajani T, Kumar D. Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad. J Pak Med Assoc. 2009;59(10):683-6.

Włodarczyk J, Waśniewska A, Fichna J, Dziki A, Dziki Ł, Włodarczyk M. Current Overview on Clinical Management of Chronic Constipation. J Clin Med. 2021;10(8):1738.

Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, et al. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment). World J Gastroenterol. 2012;18(36):4994-5013.

Nooshkam M, Babazadeh A, Jooyandeh H. Lactulose: Properties, techno-functional food applications, and food grade delivery system. Trends Food Sci Technol. 2018;80:23-34.

WHO‎. The selection and use of essential medicines: report of the WHO Expert Committee, 2013 (‎including the 18th WHO model list of essential medicines and the 4th WHO model list of essential medicines for children), 2014. Available at: https://apps.who.int/iris/handle/10665/. Accessed on 11 October 2022.

Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-4.

Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46.

Ghoshal UC. Chronic constipation in Rome IV era: The Indian perspective. Indian J Gastroenterol. 2017;36(3):163-73.

Ghoshal UC. Review of pathogenesis and management of constipation. Trop Gastroenterol. 2007;28(3):91-5.

Shafik A. Constipation. Pathogenesis and management. Drugs. 1993;45(4):528-40.

Rooprai R, Bhat N, Sainani R, Mayabhate MM. Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation. Int J Basic Clin Pharmacol 2017;6:275-85.

Panigrahi MK, Kar SK, Singh SP, Ghoshal UC. Defecation frequency and stool form in a coastal eastern Indian population. J Neurogastroenterol Motil. 2013;19(3):374-80.

Rajput M, Saini SK. Prevalence of constipation among the general population: a community-based survey from India. Gastroenterol Nurs. 2014;37(6):425-9.

Tagart RE. The anal canal and rectum: their varying relationship and its effect on anal continence. Dis Colon Rectum. 1966;9(6):449-52.

Sikirov BA. Primary constipation: an underlying mechanism. Med Hypotheses. 1989;28(2):71-3.

Sikirov D. Comparison of straining during defecation in three positions: results and implications for human health. Dig Dis Sci. 2003;48(7):1201-5.

Sakakibara R, Tsunoyama K, Hosoi H, Takahashi O, Sugiyama M, Kishi M, et al. Influence of Body Position on Defecation in Humans. Low Urin Tract Symptoms. 2010;2(1):16-21.

Srinivas M, Srinivasan V, Jain M, Rani SCS, Mohan V, Jayanthi V. A cross-sectional study of stool form (using Bristol stool chart) in an urban South Indian population. JGH Open. 2019;3(6):464-7.

Khayat A, Algethami G, Baik S, Alhajori M, Banjar D. The Effect of Using Rome IV Criteria on the Prevalence of Functional Abdominal Pain Disorders and Functional Constipation among Children of the Western Region of Saudi Arabia. Glob Pediatr Health. 2021;8:2333794X211022265.

Lillo AR, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol. 2000;95(4):901-5.

Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, et al. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol. 2018;37(6):526-44.

Ray G. Evaluation of the Symptom of Constipation in Indian Patients. J Clin Diagn Res. 2016;10(4):OC01-3.

Talley NJ. Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol. 2003;98(4):750-8.

Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. 2010;31(9):938-49.