Emerging treatments for chronic constipation

Introduction: Chronic constipation (CC) is a common problem worldwide and, for some sufferers, a cause of considerable morbidity. Recent definitions of CC have moved from the former emphasis on stool frequency alone to a broader concept that strives to encompass the various symptoms that may bother afflicted individuals. Accordingly, new therapies attempt to not only increase frequency of defecation but also to address such symptoms as satisfaction with bowel action, straining, bloating, and distension. Areas covered: To provide context the relative merits and problems related to conventional laxative-based approaches to constipation are first reviewed and then more recent novel pharmacological approaches to the management of constipation assessed. The focus is on two classes of compounds, selective prokinetics and prosecretory agents, and studies on their efficacy and safety in chronic idiopathic constipation were retrieved and evaluated. Expert opinion: While undoubtedly effective, high-quality evidence to support laxatives, the traditional remedies for constipation, is remarkably scarce due, in large part, to the absence, until very recently, of high-quality randomized controlled clinical trials. The selective prokinetic agent prucalopride and the prosecretory agents lubiprostone and linaclotide have shown efficacy and been associated with a good safety record in large well-conducted clinical studies. Other novel approaches, such as the inhibition of ileal bile salt absorption, offer particular promise.