This month's quiz asks readers to determine the most appropriate management for a 36-year-old woman with a 12-year history of refractory constipation that began after a difficult childbirth.
The oral medication is taken once per day and works in the upper GI tract to stimulate secretion of intestinal fluid, supporting regular bowel function.
Opioid-induced constipation differs mechanistically from other forms of the disorder, and its medical management deserves dedicated attention, the American Gastroenterological Association (AGA) said.
Mu-opioid receptor antagonists appear safe, effective for opioid-induced constipation, review finds | ACP Gastroenterology Monthly
Researchers looked at randomized controlled trials of peripheral mu-opioid receptor antagonists (methylnaltrexone, naloxone, naloxegol, alvimopan, axelopran, or naldemedine) and the prescription-strength laxatives lubiprostone or prucalopride.
Four FDA-approved drugs for opioid-induced constipation form the backbone of treatment, with more options in the research pipeline.
Naloxone, naldemedine appear best for opioid-induced constipation after laxatives | ACP Gastroenterology Monthly
A meta-analysis found naloxone to have the highest efficacy and safety of pharmacological therapies for opioid-induced constipation, and previous research has shown it to be cost-effective, study authors said.
In IBS with constipation, plecanatide reduced abdominal pain and increased bowel movements at 12 wk | ACP Gastroenterology Monthly
Clinical judgment will be needed to determine whether the relatively modest improvement in outcomes will be important to patients for whom the drug is considered, according to an accompanying ACP Journal Club commentary.
In chronic severe functional constipation, electroacupuncture increased complete spontaneous bowel movements | ACP Gastroenterology Monthly
Patients undergoing electroacupuncture experienced a change from baseline in mean complete spontaneous bowel movements per week during the treatment period, and treatment effects were even greater after patients stopped attending the sessions.
Compared to placebo, the drug significantly reduced symptoms in a randomized controlled trial of 264 adults with travelers' diarrhea in Guatemala and Mexico.
ACP Gastroenterology Monthly delivers a monthly summary of news in gastroenterology and hepatology, including the latest research, clinical guidelines, and FDA drug actions.