Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment)

Table 2 Levels of evidence and grades of recommendation of medical treatment in chronic constipation

	Level of evidence	Grade of recommendation
Life style
Physical exercise	V	C
Toilet training	V	C
Increased fluid intake	V	C
Bulking laxatives
Insoluble fibre	III	C
Soluble fibre: Psyllium	II	B
Osmotic laxatives
Lactulose	II	B
Sorbitol	V	C
Magnesium hydroxide/magnesium salts	V	C
Polyethylene glycol	I	A
Stimulant laxatives
Sodium picosulfate, bisacodyl	I	B
Senna, aloe, cascara	V	C
Softening laxatives
Docusate	V	C
Serotoninergic enterokinetics
Tegaserod	I	A1
Prucalopride	I	A
Prosecretory agents
Lubiprostone	I	B2
Linaclotide	I	B3
Gastrointestinal μ-opioid antagonists
Methylnaltrexone	I(no effect)	A (not used)
Alvimopan	I(no effect)	A (not used)2
Probiotics	V	C
Colchicine	III	C
Procedures to empty the rectum-sigma
Peristeen®	V	C

¹Food and Drug Administration prescribing restrictions;

²Not approved in Europe;

³Phase II study. Adapted from: American College of Gastroenterology Chronic Constipation Task Force[184]; and Rao[249].