Real-World Treatment Strategies to Improve Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation

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.


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.

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