Recent advances in the management of difficult constipation

Comparison of the effects of colonic electrical stimulation and prucalopride on gastrointestinal transit and defecation in a canine model of constipation

OBJECTIVE

The aim of this study was to compare the effects of colonic electrical stimulation (CES) and prucalopride on gastrointestinal transit and defecation and to verify the safety of CES in a canine model of constipation.

METHODS

Eight beagles received CES implantation and induction drugs for slow transit constipation (STC). In the STC model, the gastrointestinal transit time (GITT), colonic transit time (CTT), stool frequency and stool consistency were assessed to compare the effects of CES and prucalopride on gastrointestinal transit and defecation. The histocompatibility of the implantable device was evaluated.

RESULTS

The individualized parameters for CES varied greatly among the animals, and the GITTs were not significantly shortened by CES or prucalopride; however, both the CES and prucalopride treatment significantly accelerated CTT and improved stool consistency compared with sham stimulation. CES treatment also resulted in significantly higher stool frequency than prucalopride treatment, which did not significantly change the stool frequency. No severe inflammation response was detected in the gross and microscopic appearance around the implants.

CONCLUSION

CES and prucalopride treatment may yield similar short-term effects for improving gastrointestinal transit and stool consistency, and CES outperformed prucalopride treatment in terms of defecation inducement in the short term. There were ideal levels of endurance and histocompatibility for the animals that underwent CES.

Randomised clinical trial: transabdominal interferential electrical stimulation vs sham stimulation in women with functional constipation

BACKGROUND

Managing chronic constipation is challenging as patients frequently remain dissatisfied with laxative treatments. Novel studies using transabdominal electrical interferential therapy in children have shown benefit but there are inadequate adult studies.

AIM

To examine the effects of transabdominal interferential stimulation on bowel symptoms and quality of life in women with refractory constipation.

METHODS

In a single-blind, randomised, sham-controlled pilot study, women aged ≥18 years with refractory constipation were randomised to receive interferential stimulation (with crossing of electric currents) or a novel sham stimulation (with no crossing of currents) for 1 hour a day for 6 weeks. Primary outcome was the number of patients with ≥3 spontaneous bowel movements/week. Secondary endpoints included change in PAC-SYM (Patient Assessment of Constipation-SYMptoms), PAC-QOL (Patient Assessment of Constipation-Quality of Life) and an overall symptom severity score (measured at baseline, mid time point of stimulation, end of treatment and 3 months after cessation of treatment).

RESULTS

Interferential therapy (n = 17) met the primary outcome in 9(53%) compared with 2(12%) with sham therapy (n = 16) (P = 0.02). Interferential therapy resulted in reductions in PAC-SYM (P = 0.03) and overall symptom scores (P = 0.05). Laxative use more than halved in 66% with interferential therapy compared with 14% with sham therapy (P = 0.01). Significant improvements in symptom outcomes were maintained at 3 months. There were no treatment-related adverse effects.

CONCLUSION

Transabdominal interferential electrical stimulation is effective in reducing constipation in adult women. Three months after therapy, response is maintained and quality of life improved. Not allowing currents to cross intra-abdominally was an effective placebo. (Australianclinicaltrials.gov.au ACTRN12614000736640).

Understanding constipation treatment: do we need to strain to obtain better results?

Chronic constipation is a commonly encountered symptom in everyday clinical practice, and numerous drugs are available for its medical treatment. However, there are several misconceptions that still often limit an effective approach, as well as the fact that it is older but effective treatments are sometimes neglected in favor of more recent, but not necessarily more effective, treatments. The actual knowledge on the efficacy and safety of currently available laxative treatment for chronic constipation, as shown by the review on which this editorial comments, clearly demonstrates that constipation may be effectively treated in most cases. Those caring for constipated patients, however, must be confident with use (and misuse) of medical treatment, to avoid lack of efficacy and onset of side effects leading to drug withdrawal. As for many other pathological issues, understanding the pathophysiological grounds of the condition to face greatly simplifies and accurately individuates the problem, to target the problem and help in reaching the therapeutic goal.