Letters To The Editor Open Access
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World J Gastroenterol. Sep 7, 2008; 14(33): 5226-5227
Published online Sep 7, 2008. doi: 10.3748/wjg.14.5226
Management of constipation in the elderly: Emerging therapeutic strategies
Shailendra Kapoor
Shailendra Kapoor, Department of Family Medicine, University of Illinois at Chicago, Chicago, IL 60612, United States
Author contributions: Kapoor S contributed all to this paper.
Correspondence to: Shailendra Kapoor, MD, Department of Family Medicine, University of Illinois at Chicago, Chicago IL-60612, United States. shailendrakapoor@yahoo.com
Telephone: +1-312-3441704 Fax: +1-312-1441464
Received: June 9, 2008
Revised: August 14, 2008
Accepted: August 21, 2008
Published online: September 7, 2008

Abstract

A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly efficacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containing components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opiods for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the efficacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confirm the findings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.

Key Words: Constipation, Prucalopride, Lubiprostone, Neostigmine, Methylnaltrexone



TO THE EDITOR

The recent article by McCrea et al about the pathophysi-ology of constipation was highly enlightening[1]. Interestingly, a number of new, novel strategies for managing constipation in the elderly have emerged over the past few years.

Prucalopride is one such new agent that is highly efficacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg[2]. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Lubiprostone is most efficacious when administered in a daily dose of 16 mg[3]. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine administered in cancer patients[4]. Symbiotic yogurt containing components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation[5].

Elderly patients especially those in hospices and nursing homes are often on opioids for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid related constipation and was recently approved by the FDA[6,7]. Sacral nerve stimulation is another emerging strategy[8]. A recent analysis by Mowatt et al supports the efficacy of this technique[9]. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be effective in elderly constipation[10].

Further larger studies are needed to confirm the findings noted in these studies. Constipation is clearly a major issue in the elderly, and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.

Footnotes

Peer reviewer: Wallace F Berman, MD, Professor, Box 3009 DUMC, Durham NC 27710, United States

S- Editor Li DL L- Editor Ma JY E- Editor Lin YP

References
1.  McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. Pathophysiology of constipation in the older adult. World J Gastroenterol. 2008;14:2631-2638.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358:2344-2354.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Johanson JF, Drossman DA, Panas R, Wahle A, Ueno R. Clinical trial: phase 2 study of lubiprostone for irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2008;27:685-696.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Rubiales AS, Hernansanz S, Gutierrez C, Del Valle ML, Flores LA. Neostigmine for refractory constipation in advanced cancer patients. J Pain Symptom Manage. 2006;32:204-205.  [PubMed]  [DOI]  [Cited in This Article: ]
5.  De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam. 2008;38:16-25.  [PubMed]  [DOI]  [Cited in This Article: ]
6.  Portenoy RK, Thomas J, Moehl Boatwright ML, Tran D, Galasso FL, Stambler N, Von Gunten CF, Israel RJ. Subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness: a double-blind, randomized, parallel group, dose-ranging study. J Pain Symptom Manage. 2008;35:458-468.  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Traynor K. Relistor approved for opioid-related constipation. Am J Health Syst Pharm. 2008;65:996.  [PubMed]  [DOI]  [Cited in This Article: ]
8.  Lee KJ, Kim JH, Cho SW. Short-term effects of magnetic sacral dermatome stimulation for idiopathic slow transit constipation: sham-controlled, cross-over pilot study. J Gastroenterol Hepatol. 2006;21:47-53.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodyn. 2008;27:155-161.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Irani K, Rodriguez L, Doody DP, Goldstein AM. Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction. Pediatr Surg Int. 2008;24:779-783.  [PubMed]  [DOI]  [Cited in This Article: ]