The association between prucalopride efficacy and constipation type

• Published in: Techniques in coloproctology Vol. 17; no. 5; pp. 555 - 559
• Main Authors: Jadav, A. M., Mcmullin, C. M., Smith, J., Chapple, K., Brown, S. R.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.10.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Benzofurans - therapeutic use; Cohort Studies; Colorectal Surgery; Constipation - diagnosis; Constipation - drug therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Gastroenterology; Gastrointestinal Transit - drug effects; Gastrointestinal Transit - physiology; Humans; Intestinal Obstruction - diagnosis; Intestinal Obstruction - drug therapy; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Satisfaction - statistics & numerical data; Proctology; Retrospective Studies; Serotonin Receptor Agonists - therapeutic use; Severity of Illness Index; Surgery; Syndrome; Treatment Outcome; Young Adult; Slow transit constipation; Prucalopride; Obstructed defaecation syndrome; Constipation; Constipation-predominant irritable bowel syndrome
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-013-1017-8

Background Prucalopride is a selective serotonin receptor agonist with prokinetic activity, indicated for women with chronic constipation in whom laxatives have failed to provide adequate relief. Data suggests an improvement in about 50 % of such patients but whether the therapeutic effect is on patients with slow transit constipation (STC) and/or obstructed defaecation syndrome (ODS), or even those with constipation-predominant irritable bowel syndrome (IBS-C) is unknown. We therefore assessed whether there is any association between prucalopride efficacy and constipation type. Methods All patients receiving prucalopride between June 2010 and April 2012 at our institution were identified, and data analysed following a 4-week “test” period. Patients were sub-grouped as those suffering with ODS, STC, mixed (ODS and STC) or IBS-C based on symptomatology and investigations. Subjective assessment of patient satisfaction and continuation of medication were taken as positive outcomes and analysed for each sub-type along with any side effects. Results Sixty-nine patients met our criteria. Data were available for 59 women (median age 46 years, range 17–79 years). Sixty-five per cent of prescriptions came from colorectal surgeons. Overall, 25 out of 59 (42 %) patients improved, according to our criteria, after the 4-week trial period. Seventeen patients (29 %) had ODS, 26 (44 %) had STC, 7 (12 %) had mixed symptoms and 9 (15 %) had IBS-C. At 4 weeks, 10 out of 17 patients (59 %) with ODS had improved compared with 4 out of 9 patients (44 %) with IBS-C, 3 out of 7 patients (43 %) with mixed symptoms and 8 out of 26 (31 %) patients with STC. The underlying disorder did not predict whether or not a patient responded to the 4-week trial period ( p  = 0.32). Nine patients (15 %) experienced side effects that precluded further use. Conclusions Patients with all categories of constipation may respond to prucalopride. A trial regime may be indicated regardless of the aetiology of the constipation.