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 22 February 2018

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News

When to progress along the treatment algorithm for chronic constipation

The latest issue of the Alimentary Pharmacology & Therapeutics provides an international expert consensus definition of failure of a treatment to provide adequate relief for chronic constipation.

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As treatments for constipation become increasingly available, it is important to know when to progress along the treatment algorithm if the patient is not better.

To establish the definition of failure of a treatment to provide adequate relief (F-PAR) to support this management and referral process in patients with chronic constipation.

Dr Emmanuel and colleagues from the United Kingdom conducted an international Delphi Survey among gastroenterologists and general practitioners with a special interest in chronic constipation. 

An initial questionnaire based on recognized rating scales was developed following a focus group. 

Data were collected from 2 subsequent rounds of questionnaires completed by all authors. 

A clear consensus was established on further reduction to 8 symptom statements in the final definition
Alimentary Pharmacology & Therapeutics
Likert scales were used to establish a consensus on a shorter list of more severe symptoms.

The team reported that the initial focus group yielded a first round questionnaire with 84 statements. 

The research team found a good consensus on symptom severity, and a clear severity response curve, allowing 67 of the symptom-severity pairings to be eliminated. 

Subsequently, a clear consensus was established on further reduction to eight symptom statements in the final definition, condensed by the steering committee into 5 diagnostic statements.

Dr Emmanuel's team comments, "We present an international consensus on chronic constipation, of five symptoms and their severities, any of which would be sufficient to provide clinical evidence of treatment failure."

"We also provide data representing an expert calibration of commonly used rating scales, thus allowing results of clinical trials expressed in terms of those scales to be converted into estimates of rates of provision of adequate relief."

Aliment Pharmacol Ther 2017: 45(3): 434–442
12 January 2017

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