Am J Gastroenterol. 2022 Apr 1;117(4S):S21-S26. doi: 10.14309/ajg.0000000000001709.

Darren M Brenner ¹, Lucinda A Harris ², Christopher H Chang ³, Scott A Waldman ⁴, David M Poppers ^5 6, Amy Kassebaum-Ladewski ⁷, Gregory S Sayuk ^8 9 10

Author information

¹Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

²Mayo Clinic, Scottsdale, Scottsdale, Arizona, USA.

³University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

⁴Departments of Pharmacology and Experimental Therapeutics and Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

⁵Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York, USA.

⁶Center for Advanced Therapeutics and Innovation, NYU Langone Health, New York, New York, USA.

⁷Digestive Health Center, Northwestern Memorial Hospital, Chicago, Illinois, USA.

⁸Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.

⁹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.

¹⁰Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA.

Abstract

Chronic idiopathic constipation and irritable bowel syndrome with constipation are complex, overlapping conditions. Although multiple guidelines have informed healthcare providers on appropriate treatment options for patients with chronic idiopathic constipation and irritable bowel syndrome with constipation, little direction is offered on treatment selection. First-line treatment options usually include fiber and over-the-counter osmotic laxatives; however, these are insufficient for many individuals. When these options fail, prescription secretagogues (plecanatide, linaclotide, lubiprostone, and tenapanor [pending commercial availability]), or serotonergic agents (prucalopride and tegaserod) are generally preferred. Individuals experiencing concurrent abdominal pain and/or bloating may experience greater overall improvements from prescription therapies because these agents have been proven to reduce concurrent abdominal and bowel symptoms. Should initial prescription treatments fail, retrying past treatment options (if not adequately trialed initially), combining agents from alternative classes, or use of adjunctive therapies may be considered. Given the broad spectrum of available agents, therapy should be tailored by mutual decision-making between the patient and practitioner. Overall, patients need to be actively monitored and managed to maximize clinical outcomes.