慢性特发性便秘(CIC)是与生活质量显着损害相关的常见疾病。这个临床实践指南,由美国胃肠病学会和美国胃肠病学会联合开发,旨在通过为成人CIC的药物治疗提供循证实践建议来告知临床医生和患者。
美国胃肠病学协会和美国胃肠病学学会组成了一个多学科指南小组,对以下药物进行了系统评价:纤维,渗透性泻药(聚乙二醇,氧化镁,乳果糖),兴奋剂泻药(比沙可啶,吡科硫酸钠,senna),分泌素(鲁比前列酮,利那洛肽,plecanatide),和5-羟色胺4型激动剂(普鲁卡必利)。小组对临床问题和结果进行了优先排序,并使用了建议分级评估,发展,和评估框架,以评估每个干预措施的证据确定性。决策证据框架用于根据理想和不良效果之间的平衡制定临床建议,患者价值观,成本,和健康公平考虑。
专家组就成人CIC的药理学管理提出了10项建议。根据现有证据,小组对聚乙二醇的使用提出了强有力的建议,吡科硫酸钠,利那洛肽,plecanatide,和普鲁卡必利在成人中用于CIC。对纤维的使用提出了有条件的建议,乳果糖,Senna,氧化镁,和鲁比前列酮。
本文件提供了可用于治疗CIC的各种非处方药和处方药物的全面概述。该指南旨在为CIC的管理提供一个框架;临床提供者应根据患者的偏好以及药物成本和可用性进行共同决策。强调了证据的局限性和差距,以帮助指导未来的研究机会并加强对慢性便秘患者的护理。
Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults.
The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (
prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations.
The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and
prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone.
This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.