Systematic review supports use of polyethylene glycol, senna for constipation
Evidence from a systematic review published in American Journal of Gastroenterology showed polyethylene glycol and senna were effective for the treatment of constipation.
“The spectrum of [over-the-counter (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,” Satish S.C. Rao, MD, PhD, from division of gastroenterology/hepatology, Medical College of Georgia, Augusta University, Augusta, and colleagues wrote. “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.”
Rao and colleagues searched PubMed and Embase for randomized controlled trials evaluating OTC preparations between 2004 and 2020 that had a duration of 4 weeks or longer. Of the 1,297 studies they identified, 41 met the inclusion criteria. The investigators used the U.S. Preventive Services Task Force criteria to score the studies by randomization, blinding and withdrawals. Recommendations were graded based on level of evidence, according to researchers.
“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 galactooligosaccharide/prunes/linseed oil; and insufficient evidence (grade I) for polydextrose, inulin, and fructo-oligosaccharide,” Rao and colleagues wrote.
According to researchers, common adverse events included diarrhea, nausea, bloating and abdominal pain. However, no serious adverse events were reported.
“For these and other alternative products, there is a clear need for more rigorous, high-quality studies using standardized endpoints. Docusate lacks well-controlled trials demonstrating its efficacy and has poor evidence to support its use in clinical practice,” the researchers wrote.